Prevalence and Causes of Ulnar Neuropathy in the Electrodiagnosis Clinic of Shohada-e-Tajrish Medical Center

Background: The prevalence of ulnar nerve mono neuropathy has increased in recent years. Upper limb involvement by ulnar neuropathy results in motor and sensory disability and this disability imposes significant physical, psychological and financial burdens on patients. We aimed to assess the prevalence and causes of ulnar neuropathy in the Electrodiagnosis clinic of Shohada-e-Tajrish medical center. Materials and Methods: In this cross-sectional study we extracted the electronic files of all patients referred to the clinic during 2009-2013. Patients with ulnar neuropathies were selected and required data were obtained. 62 patients with ulnar nerve lesions were included and their data (include age, sex, involved side, cause of lesion, severity and location of involvement) were analyzed. Results: Of the 62 patients enrolled, 42(67.7\%) were men and 20 (32.3\%) were women with a mean age of 41.63 years (range: 17-79 years). There was a significant relationship between age and disease prevalence. The highest prevalence rate of the disease was observed in the 20–39year-old age group and the lowest in the below 20-year-old age group. Trauma was a more frequent cause than entrapment. Elbow was the most frequent location of injury. Conclusion:Ulnar neuropathy was more prevalent in young and middle-aged individuals than those above 60 years. Considering the potential disability caused by this nerve damage, more attention is needed to evaluate patients and initiate proper treatment and rehabilitation in those ulnar nerve lesion

Rehabilitation Medicine Management of Spasticity

Spasticity is a poorly recognized but common symptom, present in a wide range of neurological conditions. It can have a major impact on those affected, much of which is potentially preventable. This chapter provides an excellent paradigm to incorporate many of the key elements fundamental to the management of chronic conditions and it is of relevance to those who work in spasticity rehabilitation

Evaluation of the Effect of Age on Median Nerve Cross-sectional Area: A Cross-sectional Study

Objective This cross-sectional study was designed considering disagreements on the normal range of Median Nerve Cross-Sectional Area (MNCSA) and its association with age. Methods In this cross-sectional descriptive study, the upper limbs of 98 healthy subjects (46 men and 52 women) were assessed bilaterally by sonography, and MNCSA was measured at the distal wrist crease.Results Mean MNCSA values for subjects older and younger than 40 were 11.25 mm2 and 10.21 mm2, respectively. The results showed that the MNCSA significantly increased after 40 years of age. Conclusion According to the present study's findings, advances in age can increase the MNCSA and affect the diagnostic accuracy of MNCSA measurement in CTS diagnosis

Application of magnetic motor stimulation for measuring conduction time across the lower part of the brachial plexus

<p>Abstract</p> <p>Objective</p> <p>The objective of this study was to calculate central motor conduction time (CMCT) of median and ulnar nerves in normal volunteers. Conduction time across the lower part of the brachial plexus was measured by using magnetic stimulation over the motor cortex and brachial plexus and recording the evoked response in hand muscles.</p> <p>Design</p> <p>This descriptive study was done on 112 upper limbs of healthy volunteers. Forty-six limbs belonging to men and sixty-six belonging to women were studied by magnetic stimulation of both motor cortex and brachial plexus and recording the evoked response in thenar and hypothenar muscles. Stimulation of the motor cortex gives rise to absolute latency of each nerve whereas stimulation of the brachial plexus results in peripheral conduction time. The difference between these two values was considered the central motor conduction time (CMCT).</p> <p>Results</p> <p>In summary the result are as follows; Cortex-thenar latency = 21.4 ms (SD = 1.7), CMCT-thenar = 9.6 ms (SD = 1.9), Cortex-hypothenar latency = 21.3 ms (SD = 1.8), CMCT-hypothenar = 9.4 ms (SD = 1.8).</p> <p>Conclusion</p> <p>These findings showed that there is no meaningful difference between two genders. CMCT calculated by this method is a little longer than that obtained by electrical stimulation that is due to the more distally placed second stimulation. We recommend magnetic stimulation as the method of choice to calculate CMCT and its use for lower brachial plexus conduction time. This method could serve as a diagnostic tool for diagnosis of lower plexus entrapment and injuries especially in early stages.</p

Principles of Rehabilitation Strategies in Spinal Cord Injury

Spinal cord injury (SCI) is a debilitating condition that affects millions of people worldwide and results in a remarkable health economic burden imposed on patients and the healthcare system annually. The most common causes of SCI are the trauma caused by falls, traffic accidents, or violence. The course of SCI is associated with several complications that severely impair the patient’s quality of life, including sensory and motor dysfunction, pain, neurogenic bladder and bowel, autonomic dysreflexia, cardiovascular and pulmonary dysfunction, spasticity, urinary tract infection, and sexual dysfunction. Despite great strides that have been made in the field of regenerative medicine and neural repair, the treatment of SCI still mostly revolves around rehabilitative strategies to improve patients’ quality of life and function. Rehabilitation following the SCI is a multidisciplinary process that requires the involvement of multiple disciplines. Moreover, recent advances in the field of neurorehabilitation following SCI, are changing the face of this field. Therefore, we decided to review various aspects of rehabilitation following the SCI, including the goals and different modalities whereby we could achieve them

Effectiveness of Low-Level Laser Therapy compared to Ultrasound in Patients With Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis

Introduction: Carpal tunnel syndrome (CTS) is the most common type of peripheral entrapment neuropathy that occurs in the wrist area in a space called the carpal tunnel. Low-level laser therapy (LLLT) and ultrasound are among the most common methods of physical modalities for treating CTS; the effectiveness of these two methods and superiority of one over the other is not agreed among experts.Methods: In present systematic review and meta-analysis study, the most important databases including PubMed, Cochrane Library, Scopus, Centre for Reviews and Dissemination, Science Direct, Trip Medical Database, and Google Scholar were searched using appropriate keywords and specific strategies without time limitation to collect data. The collected data was analyzed using meta-analytic method and random effects model. The heterogeneity among studies was examined using I2. The data was analyzed using Review Manager Software.Results: From among 108 related studies, 49 cases were entered in the first stage. After the final examination, 6 studies were selected for meta-analysis. The total number of patients in these six studies was 403; 204 subjects were in the LLLT group and 199 subjects were in the ultrasound group. The results of meta-analyses showed that there was no significant difference between these two therapeutic methods in terms of pain relief, symptom severity scale (SSS), functional status scale (FSS), motor latency, sensory latency, handgrip strength, and motor amplitude.Conclusion: Based on meta-analyses, there was no significant difference between two LLLT and ultrasound methods; in other words, they had similar effectiveness in improving the condition of patients with CTS. However, the authors believed that arriving at conclusions in this area requires high-quality and large size studies.

Efficacy of High-Power Laser in Alleviating Pain and Improving Function of Patients With Patellofemoral Pain Syndrome: A Single-Blind Randomized Controlled Trial

Introduction: In this study, a single-blind and randomized controlled trial (RCT) for assessing the effectiveness of high-power (up to 12 W) laser therapy (HPLT) on patients with patellofemoral pain syndrome (PFPS) was carried out.Methods: Forty-four patients were randomly assigned to two treatment groups by generating random numbers with MATLAB 2014b software, where odd and even numbers were attributed to sham laser group (group A) and actual laser group (group B), respectively. Group B patients underwent HPLT with total dose of 300 J/session for 5 consecutive sessions separated by a 2-day interval. On the other hand, sham laser was applied to group A patients. Both groups had the same exercise therapy programs during the study period (3 months). The exercise therapy program included isometric knee exercise for 3 sets per day and 10 times in each set, with duration of 10 seconds per time and straight leg raise for 15 seconds 10 times a day. The group codes of patients were not revealed to subjects and data analyzer until completion of the study. Kujala, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) questionnaires were chosen as outcome measures. These questionnaires were completed at three points during the study; at the beginning of the study to obtain the pre-therapy conditions and one month and three months after the start of the study to evaluate post-therapy conditions.Results: Two main analyses were conducted: within-group and between-group analyses. Within-group analyses indicated significant improvements in respect to all measurements where pre-therapy and post-therapy comparisons were conducted in both groups (P &lt; 0.05). On the other hand, between-group comparisons did not reveal any statistically significant functional difference between group A and group B regarding the evaluative criteria (P &gt; 0.05) except for pain VAS (P &lt; 0.05).Conclusion: This study indicated that short-term HPLT accompanied by appropriate exercise regimen significantly decreased pain in patients with PFPS. But it was not recommended as an efficient modality in functional improvement. Also, it was observed that, in the short-term period of study, HPLT was a safe modality

The Effect of Polarized Polychromatic Noncoherent Light (Bioptron) Therapy on Patients with Carpal Tunnel Syndrome

Introduction: To study the effects of Polarized Polychromatic Noncoherent Light (Bioptron) therapy on patients with carpal tunnel syndrome (CTS).Methods: This study was designed as a randomized clinical trial. Forty four patients with mild or moderate CTS (confirmed by clinical and electrodiagnostic studies) were assigned randomly into two groups (intervention and control goups). At the beginning of the study, both groups received wrist splinting for 8 weeks. Bioptron light was applied for the intervention group (eight sessions, for 3/weeks). Bioptron was applied perpendicularly to the wrist from a 10 centimeters distance. Pain severity and electrodiagnostic measurements were compared from before to 8 weeks after initiating each treatment.Results: Eight weeks after starting the treatments, the mean of pain severity based on Visual Analogue Scale (VAS) scores decreased significantly in both groups. Median Sensory Nerve Action Potential (SNAP) latency decreased significantly in both groups. However, other electrophysiological findings (median Compound Motor Action Potential (CMAP) latency and amplitude, also SNAP amplitude) did not change after the therapy in both groups. There was no meaningful difference between two groups regarding the changes in the pain severity.Conclusion: Bioptron with the above mentioned parameters led to therapeutic effects equal to splinting alone in patients with carpal tunnel syndrome. However, applying Bioptron with different therapeutic protocols and light parameters other than used in this study, perhaps longer duration of therapy and long term assessment may reveal different results favoring Bioptron therapy