OBJECTIVIZATION OF THE EFFECT OF A COMPLEX OF PHYSICAL FACTORS IN PATIENTS WITH CARPAL TUNNEL SYNDROME BY ELECTROMYOGRAM TEST

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.Electromyography is considered the most accurate diagnostic procedure, although it cannot be fully accepted as a gold standard due to the possibility of false positives (about 15%) and false negatives (about 18%) [1]However, because of its low cost, in comparison to other diagnostic methods, its high diagnostic reliability, and the few contraindications to its application, it remains a method of choice for diagnosis and follow-up of the reinnervation of the median nerve in CTS patients.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 electromyography.Materials and methods. 57 patients with mild to moderate degree of carpal tunnel syndrome clinically proven by electroneurographic study were еexamined. 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, ie 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.In our study, we examined the sensory and motor fibres of the n. medianus. Changes in distal latency, amplitude, and conduction velocity were observed.Results and discussion. The electroneurographic examination we performed showed a statistically significant change (p <0.001) in the normalization of distal latency, conduction velocity and M amplitude in both the sensory and motor fibres of the affected nerve. These results were reported between the first and fourth months after physiotherapy. There is also a tendency for their retention within the next 4-8 months.Correlation analysis shows that there is a very strong, statistically significant (p <0.001) relationship between the ENG parameters for n. medianus sensory and motor fibres conductivity (distant latency, SNAP and conduction velocity) and the treatment performed, which is established even at the first check-up (1-4 months) after end of the treatment, and the results achieved are maintained over time.The statistically significant changes in the values of ENG parametric fibers of n. medianus, we refer to the complex physiotherapy treatment, aimed at improving the trophic and nerve conduction, accelerating the regenerative processes of the nerve structures, improving the trophic and vascularizing the structures located in the carpal tunnel.Last but not least, the fibrolytic action of ultrasound therapy leading to the spreading of fibrous seals, which is quite common in CTS, is also important. Although different in their mechanism of action, the physiotherapeutic procedures included in our program have a synergistic effect aimed at overcoming the functional deficiency and reversing the symptoms of CTS.Conclusions. Our study on the effectiveness of a complex of physical factors in the conservative treatment of the CTS showed that early diagnosis and timely initiation of physiotherapeutic treatment are a prerequisite for achieving very good results in terms of functional recovery of the affected hand and the reverse development of clinical symptoms in patients with proven mild to moderate CTS.The segmental demyelination of the sensory and motor fibers of n. medianus in the initial stages, as a result of its compression in the area of the carpal canal, is a reversible process. An integrated approach to the treatment of CTS, including early diagnosis, prevention and treatment, is the key for success in mild and moderate forms of the syndrome, and competent and timely medical advice is often crucial.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.Electromyography is considered the most accurate diagnostic procedure, although it cannot be fully accepted as a gold standard due to the possibility of false positives (about 15%) and false negatives (about 18%) [1]However, because of its low cost, in comparison to other diagnostic methods, its high diagnostic reliability, and the few contraindications to its application, it remains a method of choice for diagnosis and follow-up of the reinnervation of the median nerve in CTS patients.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 electromyography.Materials and methods. 57 patients with mild to moderate degree of carpal tunnel syndrome clinically proven by electroneurographic study were еexamined. 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, ie 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.In our study, we examined the sensory and motor fibres of the n. medianus. Changes in distal latency, amplitude, and conduction velocity were observed.Results and discussion. The electroneurographic examination we performed showed a statistically significant change (p <0.001) in the normalization of distal latency, conduction velocity and M amplitude in both the sensory and motor fibres of the affected nerve. These results were reported between the first and fourth months after physiotherapy. There is also a tendency for their retention within the next 4-8 months.Correlation analysis shows that there is a very strong, statistically significant (p <0.001) relationship between the ENG parameters for n. medianus sensory and motor fibres conductivity (distant latency, SNAP and conduction velocity) and the treatment performed, which is established even at the first check-up (1-4 months) after end of the treatment, and the results achieved are maintained over time.The statistically significant changes in the values of ENG parametric fibers of n. medianus, we refer to the complex physiotherapy treatment, aimed at improving the trophic and nerve conduction, accelerating the regenerative processes of the nerve structures, improving the trophic and vascularizing the structures located in the carpal tunnel.Last but not least, the fibrolytic action of ultrasound therapy leading to the spreading of fibrous seals, which is quite common in CTS, is also important. Although different in their mechanism of action, the physiotherapeutic procedures included in our program have a synergistic effect aimed at overcoming the functional deficiency and reversing the symptoms of CTS.Conclusions. Our study on the effectiveness of a complex of physical factors in the conservative treatment of the CTS showed that early diagnosis and timely initiation of physiotherapeutic treatment are a prerequisite for achieving very good results in terms of functional recovery of the affected hand and the reverse development of clinical symptoms in patients with proven mild to moderate CTS.The segmental demyelination of the sensory and motor fibers of n. medianus in the initial stages, as a result of its compression in the area of the carpal canal, is a reversible process. An integrated approach to the treatment of CTS, including early diagnosis, prevention and treatment, is the key for success in mild and moderate forms of the syndrome, and competent and timely medical advice is often crucial

Halotherapy - an alternative method for the treatment of respiratory diseases

Halotherapy is an alternative method of treating respiratory diseases. This kind of treatment has become more and more popular in last decades. Sodium chloride has a proven an­tibacterial, antimycotic and anti-inflammatory effect and is of great importance for the normal function of the bronchial ciliated epithelium. This article reveals the benefits of salt in regard to the respiratory system, indications and contrain­dications for this kind of treatment and the possibilities for combining it with some other physical therapy methods

Estuarine mud: a natural protection of joint cartilage

Osteoarthritis, a joint disease characterized by cartilage degeneration, osteophyte formation, and changes in the joint capsule, affects multiple structures surrounding the joint, including muscles, tendons, and ligaments. With a growing interest in non-drug and non-surgical approaches for osteoarthritis prevention and treatment, physical and rehabilitation medicine, along with mud therapy, have gained attention. Mud, a natural product resulting from various chemical, biological, and microbiological processes involving soil particles and organic and inorganic compounds, possesses remarkable anti-inflammatory, analgesic, and immune-stimulant properties. Furthermore, it enhances blood circulation, metabolic activity, and strengthens the bone system. The high mineral concentration in mud from sea estuaries is believed to give it unique healing properties. The specific effects of estuarine mud stem from its composition: sulphur and humic acids inhibit hyaluronidase and stimulate the formation of cytokines, which determine its chondroprotective and anti-inflammatory effects. Alongside traditional osteoarthritis treatment options like medication, physiotherapy, balneotherapy, lifestyle changes, and surgery, mud therapy stands out as a promising alternative. Studies have demonstrated that Liman mud significantly reduces inflammation, eases pain, and boosts the immune system. Additionally, it enhances blood circulation and metabolic processes, leading to improved tissue nourishment and faster regeneration. The healing properties of mud are attributed to a complex interaction of thermal, chemical, mechanical, electrodynamic, biological, and other factors. In particular, thermal and chemical elements play a crucial role in determining the outcomes of the healing process

The healing power of algae

Thalassotherapy is the therapeutic use of seawater or marine products to improve human health. Algae are the basis of modern thalassotherapy. The therapeutic or prophylactic use of seaweed, externally in the form of baths or internally as an extract of its plasma, is called algotherapy. Algotherapy is a special branch of phytotherapy in which marine plants (or bioactive compounds derived from them) are used for therapeutic purposes to treat or prevent the development of a number of diseases and their symptoms. Algae have been shown to be an effective alternative form of treatment for diseases that affect the skin and lymphatic tissue, as well as diseases that affect the internal organs, metabolism, and endocrine glands. This is due to the high content of vitamins, amino acids, trace elements, and other bioactive components that algae possess.Once algae extracts have been produced industrially by certified chemical, pharmaceutical, or other health industries, they are given the status of herbal medicines. Herbal medicines are defined as drugs produced from bioactive plant raw materials (without the inclusion of synthetic additives), the efficacy and safety of which have been confirmed by pharmacological studies, technical and scientific documentation, or clinical evidence. Algae extracts have been shown to be effective in treating a variety of conditions, including cardiovascular disease, cancer, and diabetes

Carpal tunnel syndrome and pregnancy

За първи път, описан от Paget през 1854 г., синдромът на карпалния канал (КТС) е най-честата компресионна невропатия. Независимо от причината за появата на синдрома по време на бременността това е особено състояние, при което по-голяма част възможните методи за лечение не могат да бъдат прилагани. Статията представя възможните алтернативи за диагностика лечение на синдрома на карпалния канал по време на бременност.Carpal tunnel syndrome (CTS) is the most frequent nerve compression described first by Paget in 1954. Though the reasons for its appearance during pregnancy are not very clear, this is a specific condition and the most common methods used for the treatment of CTS could not be applied. The article reveals the possible alternative ways for diagnosis and treatment of CTS during pregnancy

Contemporary Trends Of Spa And Wellness Tourism In Bulgaria

Здравният туризъм като понятие обединява всички варианти на туризъм с профилактичен, възстановителен и лечебен ефект. СПА и уелнес туризмът са нови форми на здравния туризъм, които се превръщат в глобален феномен през последните години в резултат на бързите си темпове на развитие. Статията анализира тенденциите в развитието на СПА и уелнес туризма в България и представя видовете центрове, определени според предоставяните в тях услуги, основните принципи на СПА и някои препоръки за развитието на СПА и уелнес туризма в България.Health tourism combines all the aspects of tourism for prevention, recreation and treatment. SPA and wellness tourism are the new forms of health tourism and have become a global phenomenon during the last years as a result of their quick development. The article analyzes trends in development of SPA and wellness and presents all types of SPA centers in Bulgaria, the main principles of SPA and some recommendations about development of these branches in our country

SPAs and wellness - a new philosophy for harmony in life

The article reveals the development of spa therapy through the years and centuries and its revival by receiving renewed attention from many medical specialties and health tourists. According to their character spas nowadays reflect the progress of science and culture of mankind. The accent is on the contemporary understanding of spa which is based on health promotion and prevention of illnesses. The idea for health prophylaxis has reached a higher level which serves as a base for thefoundations of wellness conception. The idea of this conception is aspiration for achieving complete prosperity of the human personality by synergy of all aspects of health - physical, mental, intellectual, emotional and social

Approaches and techniques of physical therapy and rehabilitation for brain tumours

Brain tumors represent a life-threatening illness that often requires a multifaceted approach to treatment. Rehabilitation, in all its facets, is crucial in helping patients adjust to the alterations in their lives following the diagnosis and treatment of a tumour. This article analyses the key components of rehabilitation in this serious medical condition and the contribution of the rehabilitation team in the recuperation of patients with brain tumours

Physiotherapeutic behavioral pattern of carpal tunnel syndrome induced by occupational activities

Introduction: Carpal tunnel syndrome (CTS) is the most common compression neuropathy that can lead to functional disability at working age. Since 2003, it has been registered in the list of occupational diseases of the European Union. In 2001, the disease was the sixth most frequent among all occupational diseases recognized in the European Union. Often underestimated, CTS can cause serious changes in the quality of life of the patients—their professional and usual daily activities, social and household contacts are violated.Aim: The aim of this article is to analyze the results of physiotherapy treatment in patients with mild and moderate form of CTS induced by excessive upper limb load in terms of their working ability, daily activities and their social activity based on anamnestic data, a survey and a Boston questionnaire for carpal tunnel syndrome.Material and Methods: A total of 57 patients with mild to moderate degree of manifestation of the syndrome were investigated—22 (38.60%)—with right hand affected, 9 patients (15.80%) with affected left hand, and 26 patients (45.60%) with bilateral involvement. In the last group, both hands were examined, i.e. 57 patients and 82 hands were examined.Conclusion: The combination of kinesitherapy with physical physiotherapy methods has a favorable effect on both subjective complaints and clinical symptoms as well as the extent of restoration of affected hand functions at the end of the physiotherapy course, this tendency being maintained for 4 to 8 months after physiotherapeutical treatment .The Boston Questionnaire is a reliable tool for diagnosing, processing, analyzing and evaluating the results of one or another type of CTS treatment.The segmental demyelination of the sensory and motor fibers of n. medianus in the initial stages resulting from its compression in the carpal canal is a reversible process. A comprehensive approach to CTS treatment, including early diagnosis and prevention, is a pledge to achieve success in mild and moderate forms of the syndrome, and competent and timely medical counseling is often of great importance for shortening recovery time, improving the function of the hand, quality of life of the patient and resulting in significant socioeconomic effects