디스크 논문.. 치료적 맞춤운동 연구소 2학기 개강

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Acquired degenerative changes of the intervertebral segment.pdf

구체적인 질환으로 들어가야겠다.

panic bird...

논문

carpal tunnel syndrome and diabetic neuropathy.pdf

carpal tunnel syndrome review.pdf

cubital tunnel syndroem and double crush syndrome.pdf

reviewsDegenerative Lumbar Stenosis.pdf

1: Neurosurg Rev. 2009 Aug 15. [Epub ahead of print] Links

Cubital tunnel surgery in patients with cervical radiculopathy: double crush syndrome?

Galarza M, Gazzeri R, Gazzeri G, Zuccarello M, Taha J.

Department of Neurosurgery, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain, galarza.marcelo@gmail.com.

To determine differences in clinical outcomes in patients harboring both cubital tunnel syndrome (CuTS) and cervical radiculopathy and the influence of the so-called double crush syndrome. Both procedures were performed in 24 patients, mean age 55 years; first group of 14 patients underwent CuTS surgery as a first procedure. Second group of 10 patients underwent anterior cervical discectomy and fusion (ACDF) then ulnar nerve release (UNR). Two patients underwent bilateral nerve surgery and six multiple cervical discectomies. Surgeries consisted in 26 nerve releases with associated external neurolysis in five, and 34 ACDF procedures, with plating in six. Clinical complaints (mean time 12 months) were sensory in 20 arms, with associated motor weakness and hypothenar atrophy involvement in another six. Electromyography changes were mild (two arms), moderate (16 arms), and severe (eight arms). Mean time of follow-up was 3 years (range 18 months-14 years). Clinical improvement was evidenced in 14 patients. Sensory nerve symptoms improved in 13 limbs in both groups and motor improvement was evident in three patients with UNR as first surgery. A comparative cohort of 20 patients with UNR but without cervical radiculopathy was studied to disclose outcome differences. Of these, 13 patients had clinical improvement. No differences were found among groups. In patients with double crush syndrome, factors that seemed to influence a poor CuTS outcome were evolution of symptoms longer than a year, history of multiple neuropathies or radiculopathies, and ACDF performed before UNR.

1: Arq Neuropsiquiatr. 2009 Jun;67(2B):553-8. Links

Degenerative lumbar stenosis: update.

Joaquim AF, Sansur CA, Hamilton DK, Shaffrey CI.

Department of Neurology, University of Campinas, Campinas, SP, Brazil. andjoaquim@yahoo.com

We present a literature review of the diagnosis and treatment of acquired lumbar spinal stenosis (LS), with a brief description of new surgical techniques. LS is the most common cause of spinal surgery in individuals older than 65 years of age. Neurogenic claudication and radiculopathy result from compression of the cauda equina and lumbosacral nerve roots by degenerated spinal elements. Surgical decompression is a well established treatment for patients with refractory, or moderate to severe clinical symptoms. However, the variety of surgical options is vast. New techniques have been developed with the goal of increasing long term functional outcomes. In this article we review lumbar decompression and fusion as treatment options for LS but also present other recent developments. Prospective long term studies are necessary to know which procedures would result in optimal patient outcome.

1: J Hand Surg Am. 2009 Jun 23. [Epub ahead of print] Links

Clinical Outcomes of Surgical Release Among Diabetic Patients With Carpal Tunnel Syndrome: Prospective Follow-Up With Matched Controls.

Thomsen NO, Cederlund R, Rosén I, Björk J, Dahlin LB.

Department of Hand Surgery, Malmö University Hospital, Malmö; the Department of Health Sciences, Lund University, the Vårdal Institute, Lund; the Department of Clinical Neurophysiology, Lund University Hospital, Lund; and the Competence Centre for Clinical Research, Lund University Hospital, Lund, Sweden.

PURPOSE: To compare the clinical outcome after carpal tunnel release in diabetic and nondiabetic patients. METHODS: We eval‎uated a prospective, consecutive series of 35 diabetic patients (median age, 54 years; 15 with type 1 and 20 with type 2 diabetes) with carpal tunnel syndrome, who were age- and gender-matched with 31 nondiabetic patients (median age, 51 years) having idiopathic carpal tunnel syndrome. Exclusion criteria were other focal nerve entrapments, cervical radiculopathy, inflammatory joint disease, renal failure, thyroid disorders, previous wrist fracture, and long-term exposure to vibrating tools. Participants were examined independently at baseline (preoperatively) and 6, 12, and 52 weeks after surgery, including eval‎uating sensory function (Semmes-Weinstein), motor function (abductor pollicis brevis muscle strength and grip strength), pillar pain, cold intolerance, and patient satisfaction. RESULTS: The number of patients with normal sensory function (pulp of index finger) increased notably in both patient groups from baseline (diabetic patients, 7 of 35; nondiabetic patients, 10 of 31) compared with the 52-week follow-up (diabetic patients, 25 of 35; nondiabetic patients, 24 of 31). Grip strength decreased temporarily at 6 weeks but recovered completely after 12 weeks. At the 52-week follow-up, mean grip strength (95% confidence interval) had improved significantly in both patient groups (diabetic patients: 3.0 kg [-0.3 to 6.2], nondiabetic patients: 3.4 kg [0.2 to 6.6]). Pillar pain correlated significantly with grip strength at the 6-week follow-up (r(s) = -0.41 to -0.54 [p < .05]). The number of patients reporting cold intolerance decreased over time (diabetic patients, 22 of 35 to 19 of 35; nondiabetic patients, 18 of 31 to 8 of 31), but decreased markedly less for the diabetic patients. Level of patient satisfaction was equal between groups. Comparing type 1 and type 2 diabetic patients, no important difference was noted on any test variables. CONCLUSIONS: Patients with diabetes have the same beneficial outcome after carpal tunnel release as nondiabetic patients. Only cold intolerance demonstrated a lesser extent of relief for diabetic patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic I.

1: Cochrane Database Syst Rev. 2003;(1):CD003219. Links

Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome.

O'Connor D, Marshall S, Massy-Westropp N.

School of Occupational Therapy, University of South Australia, City East Campus, North Terrace, Adelaide, South Australia, Australia. Denise.OConnor@unisa.edu.au

BACKGROUND: Non-surgical treatment for carpal tunnel syndrome is frequently offered to those with mild to moderate symptoms. The effectiveness and duration of benefit from non-surgical treatment for carpal tunnel syndrome remain unknown. OBJECTIVES: To eval‎uate the effectiveness of non-surgical treatment (other than steroid injection) for carpal tunnel syndrome versus a placebo or other non-surgical, control interventions in improving clinical outcome. SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group specialised register (searched March 2002), MEDLINE (searched January 1966 to February 7 2001), EMBASE (searched January 1980 to March 2002), CINAHL (searched January 1983 to December 2001), AMED (searched 1984 to January 2002), Current Contents (January 1993 to March 2002), PEDro and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised studies in any language of participants with the diagnosis of carpal tunnel syndrome who had not previously undergone surgical release. We considered all non-surgical treatments apart from local steroid injection. The primary outcome measure was improvement in clinical symptoms after at least three months following the end of treatment. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected the trials to be included. Two reviewers independently extracted data. Studies were rated for their overall quality. Relative risks and weighted mean differences with 95% confidence intervals were calculated for the primary and secondary outcomes in each trial. Results of clinically and statistically homogeneous trials were pooled to provide estimates of the efficacy of non-surgical treatments. MAIN RESULTS: Twenty-one trials involving 884 people were included. A hand brace significantly improved symptoms after four weeks (weighted mean difference (WMD) -1.07; 95% confidence interval (CI) -1.29 to -0.85) and function (WMD -0.55; 95% CI -0.82 to -0.28). In an analysis of pooled data from two trials (63 participants) ultrasound treatment for two weeks was not significantly beneficial. However one trial showed significant symptom improvement after seven weeks of ultrasound (WMD -0.99; 95% CI -1.77 to - 0.21) which was maintained at six months (WMD -1.86; 95% CI -2.67 to -1.05). Four trials involving 193 people examined various oral medications (steroids, diuretics, nonsteroidal anti-inflammatory drugs) versus placebo. Compared to placebo, pooled data for two-week oral steroid treatment demonstrated a significant improvement in symptoms (WMD -7.23; 95% CI -10.31 to -4.14). One trial also showed improvement after four weeks (WMD -10.8; 95% CI -15.26 to -6.34). Compared to placebo, diuretics or nonsteroidal anti-inflammatory drugs did not demonstrate significant benefit. In two trials involving 50 people, vitamin B6 did not significantly improve overall symptoms. In one trial involving 51 people yoga significantly reduced pain after eight weeks (WMD -1.40; 95% CI -2.73 to -0.07) compared with wrist splinting. In one trial involving 21 people carpal bone mobilisation significantly improved symptoms after three weeks (WMD -1.43; 95% CI -2.19 to -0.67) compared to no treatment. In one trial involving 50 people with diabetes, steroid and insulin injections significantly improved symptoms over eight weeks compared with steroid and placebo injections. Two trials involving 105 people compared ergonomic keyboards versus control and demonstrated equivocal results for pain and function. Trials of magnet therapy, laser acupuncture, exercise or chiropractic care did not demonstrate symptom benefit when compared to placebo or control. REVIEWER'S CONCLUSIONS: Current evidence shows significant short-term benefit from oral steroids, splinting, ultrasound, yoga and carpal bone mobilisation. Other non-surgical treatments do not produce significant benefit. More trials are needed to compare treatments and ascertain the duration of benefit.

 1: Skeletal Radiol. 2008 Jul;37(7):619-26. Epub 2008 May 16. Links

Changes on magnetic resonance tomography in the knee joints of marathon runners: a 10-year longitudinal study.

Krampla WW, Newrkla SP, Kroener AH, Hruby WF.

Radiology Department, Danube Hospital, Langobardenstrasse 122, 1220 Vienna, Austria. wolfgang.krampla@wienkav.at

OBJECTIVE: The aim of the study was to eval‎uate long-term damage in the internal structures of the knee joints of recreational long-distance runners. MATERIALS AND METHODS: Ten years after their participation in a baseline study concerning their knee joints, seven long-distance runners and one who had given up long-distance running were invited to participate in a repeat magnetic resonance imaging (MRI) investigation. The same eval‎uation criteria and the same technical equipment were used, and the results of the two investigations were compared. RESULT: No adverse long-term consequences were observed in six of the seven active runners, regardless of pre-existing damage at the baseline investigation. In one case the arthrotic changes were progressive in nature. The person who had given up running presented with severe deterioration of the internal structures of the knee joint. CONCLUSION: Non-physiological maximal loads secondary to the marathon race do not cause any permanent damage in the internal structures of the knee joint in individuals without significant pre-existing damage. A disposition for premature arthrosis was not registered in the population investigated. A protective value of long distance running on the internal structures of the knee joint is discussed.