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Archives of Rehabilitation Research and... Dec 2021To investigate which tests of hand sensibility correlate with functional outcomes in patients with upper limb traumatic nerve injuries and to assess if composite scales... (Review)
Review
OBJECTIVE
To investigate which tests of hand sensibility correlate with functional outcomes in patients with upper limb traumatic nerve injuries and to assess if composite scales of sensibility correlate with functions.
DATA SOURCES
MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched in May 2020, with a supplementary search in July 2020. Reference lists of the included publications were hand searched.
STUDY SELECTION
Database search found 2437 records. Eligible studies reported on inferential association between sensibility tests and functions pertaining to adults after upper limb nerve repair. Two reviewers independently assessed eligibility. Fifteen publications were included.
DATA EXTRACTION
Extracted data contain patient characteristics, surgical procedure, follow-up duration, sensibility tests, and functional assessments. Two reviewers independently assessed data quality.
DATA SYNTHESIS
Fifteen publications involving 849 patients were reviewed. All publications reported on median and/or ulnar nerve injuries. Monofilament tests correlated with Short-Form Health Survey (=0.548, <.05), pick-up test (=0.45, <.05), and function domain of Patient-Rated Wrist and Hand Evaluation Questionnaire (PRWHE) (=0.58, <.05). The 8 studies of static and moving 2-point discrimination provided conflicting correlations with activities of daily living (ADL) and/or the pick-up test. Data for area localization and object/shape identification were equivocal as well. No data were found for Ten test and vibration tests. Rosén score sensory domain correlated with ADL (=0.59; 95% confidence interval [CI], 0.41-0.72) and PRWHE function domain (=-0.56, <.05). Medical Research Council sensory scale was related to pick-up test; return to work status; and Disabilities of the Arm, Shoulder, and Hand questionnaire.
CONCLUSIONS
Monofilament tests allow practitioners to gather sensibility data meaningful to patients' overall recovery of functions after upper limb nerve trauma. For 2-point discrimination and other sensibility tests, practitioners should be aware that improvement in test performance does not necessarily translate to improved hand function. Findings from the composite scales indicate that hand sensibility, in general, is related to functions. Future research on other common sensibility tests is recommended to explore how the test relates to patients' functions.
PubMed: 34977541
DOI: 10.1016/j.arrct.2021.100159 -
JPMA. the Journal of the Pakistan... Feb 2024To identify and critically appraise literature on true brachial artery aneurysm, exploring its demographic characteristics, aetiologies, clinical manifestations and...
OBJECTIVE
To identify and critically appraise literature on true brachial artery aneurysm, exploring its demographic characteristics, aetiologies, clinical manifestations and different methods of repair along with complication rates to determine future treatment strategies.
METHODS
The systematic review was conducted at Liaquat National Hospital, Karachi, from September 30, 2021, to November 30, 2022, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Literature was searched on MEDLINE, EMBASE and Cochrane databases for relevant studies in English language or with English translation published till May 31, 2022. The key words used for the search were "brachial artery aneurysm". Data was noted on a proforma and was subjected to descriptive analysis.
RESULTS
Of 113 articles, 6 (5.3%) were retrospective studies, 7 (6.1%) were case series and 100 (88.4%) were case reports. The total number of patients involved was 157 with mean age 43.1±23.4 years (range: 2 months to 84 years). The gender was mentioned for 152(96.8%) patients; 111(73%) males and 41(27%) females. The mean diameter of true brachial artery aneurysm was 36.2 ±17.5mm and 106(67.5%) patients presented with localised swelling, 65(41.4%) with pain, 41(26.1%) with distal ischaemic symptoms, and 28(17.8%) with median nerve compression. True brachial artery aneurysms were more common in renal failure patients having a history of arteriovenous fistula creation in the affected limb and were on immunosuppressant drugs due to renal transplant 81(51.5%). Less common causes included primary/idiopathic 27(17.1%), trauma 13(8.2%), connective tissue disorders 8(5%) and vasculitis 7(4.5%). The treatment of choice was aneurysmectomy in 142(90.4%) cases, with revascularisation of limb primarily with reversed great saphenous vein graft 79(50.3 %), followed by end-to-end anastomosis of brachial artery 17(10.8%) and synthetic grafting 17(10.8%). Endovascular intervention was performed in 6(3.8%) cases to exclude true brachial artery aneurysm, and to re-establish adequate blood flow to the associated limb.
CONCLUSION
True brachial artery aneurysm, although a rarity, may lead to significant neurological and vascular problems if ignored. Arteriovenous fistula and immunosuppression are identified as two significant risk factors in the development of true brachial artery aneurysm. Therefore, an effective long-term follow up in renal failure patients is recommended to prevent its complications. Open surgical repair has been the most preferred mode of treatment, but further significant studies are needed to explore and compare different modes of surgical intervention, like open versus endovascular, to plan future treatment strategies.
Topics: Male; Female; Humans; Young Adult; Adult; Middle Aged; Aged; Brachial Artery; Retrospective Studies; Treatment Outcome; Aneurysm; Arteriovenous Fistula; Renal Insufficiency
PubMed: 38419237
DOI: 10.47391/JPMA.9042 -
The Journal of International Medical... Nov 2022To identify whether median nerve stimulation (MNS) may be a potential candidate for the treatment of consciousness disorders via a systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To identify whether median nerve stimulation (MNS) may be a potential candidate for the treatment of consciousness disorders via a systematic review and meta-analysis.
METHODS
PubMed, Cochrane Library, China National Knowledge Infrastructure, Chinese VIP Information, Wanfang, and SinoMed databases were searched. Risk of bias was assessed using the Cochrane Collaboration's tool. The Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), electroencephalogram (EEG), days in the Intensive Care Unit (ICU), and cerebral blood flow measures were compared between the median nerve stimulation and control groups. The meta-analysis was conducted using Review Manager software.
RESULTS
We identified 2244 studies, of which 23 (with data from 1856 patients) qualified for the analysis. MNS improved GCS scores (mean difference [MD] = 2.15), EEG scores (MD = 1.61), cerebral mean blood flow velocity (MD = 4.23), and cerebral systolic blood flow velocity (MD = 10.51). Furthermore, it decreased DRS scores (MD = -1.77) and days in the ICU (MD = -2.02). The effects of MNS on GCS scores increased with longer treatments (1 week, MD = 1.03; 1 month, MD = 2.35) and were better with right MNS (right, MD = 2.36; bilateral, MD = 1.72).
CONCLUSIONS
MNS may promote recovery from consciousness disorders.
Topics: Humans; Consciousness Disorders; Median Nerve; Electric Stimulation; Electroencephalography; Asian People
PubMed: 36448965
DOI: 10.1177/03000605221134467 -
International Journal of Environmental... Feb 2023Carpal tunnel syndrome is a neuropathy that affects the median nerve. The aim of this review is to synthesize the evidence and perform a meta-analysis on the effects of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Carpal tunnel syndrome is a neuropathy that affects the median nerve. The aim of this review is to synthesize the evidence and perform a meta-analysis on the effects of iontophoresis in people with carpal tunnel syndrome.
METHODS
The search was carried out using PubMed, Web of Science, Scopus, CINHAL Complete, Physiotherapy Evidence Database, and SciELO. The methodological quality was evaluated using PEDro. A standardized or mean difference meta-analysis (Hedge's g) using a random-effects model was calculated.
RESULTS
Seven randomized clinical trials using iontophoresis for electrophysiological, pain, and functional outcomes were included. The mean of PEDro was 7/10. No statistical differences were obtained for the median sensory nerve conduction velocity (SMD = -0.89; = 0.27) or latency (SMD = -0.04; = 0.81), motor nerve conduction velocity (SMD = -0.04; = 0.88) or latency (SMD = -0.01; = 0.78), pain intensity (MD = 0.34; = 0.59), handgrip strength (MD = -0.97; = 0.09), or pinch strength (SMD = -2.05; = 0.06). Iontophoresis only seemed to be superior in sensory amplitude (SMD = 0.53; = 0.01).
CONCLUSIONS
Iontophoresis did not obtain an enhanced improvement compared to other interventions, but no clear recommendations could be made due to the limited number of included studies and the heterogeneity found in the assessment and intervention protocols. Further research is needed to draw sound conclusions.
Topics: Humans; Carpal Tunnel Syndrome; Iontophoresis; Hand Strength; Adrenal Cortex Hormones; Pain Measurement
PubMed: 36901312
DOI: 10.3390/ijerph20054287 -
Life (Basel, Switzerland) Apr 2022Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. This meta-analysis compared local steroid injections (LSIs) versus carpal tunnel... (Review)
Review
Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. This meta-analysis compared local steroid injections (LSIs) versus carpal tunnel release (CTR) for the management of CTS. Neurophysiological parameters, patient-reported outcome measures (PROMs), and the complication rate were investigated. We hypothesized that LSIs may represent an effective and safe alternative to surgical management. Methods: This systematic review was conducted according to the 2020 PRISMA statement. All the clinical investigations comparing LSIs versus CTR for carpal tunnel syndrome were accessed. In March 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, and Embase. No time constrains were used for the search. The risk of bias and statistical analyses were conducted using the Review Manager Software 5.3 (The Nordic Cochrane Collaboration, Copenhagen). Results: Data from 1096 procedures were retrieved. The mean follow-up was 12.3 (1 to 58) months. The mean age of the patients was 51.1 ± 4.6. Nocturnal paraesthesia (p < 0.0001) and visual analogue scale (p < 0.0001) were greater in the LSIs cohort. No difference was found in the functional (p = 0.2) and symptom (p = 0.4) subscales of the Boston Carpal Tunnel Questionnaire (BCTQ), median nerve distal motor latency (p = 0.9), median nerve motor amplitude (p = 0.7), median nerve sensory conduction velocity (p = 0.4), or median nerve sensory amplitude (p = 0.3). No difference was found in terms of minor complications (p = 0.9). No major complications were observed within the duration of follow-up. Conclusion: Both CTR and LSIs were effective and feasible in reducing symptoms of carpal tunnel syndrome. Though LSIs led to greater pain relief, this superiority was not permanent. Irrespective of the severity of the symptoms, current evidence suggests that a cycle of LSIs may be considered in patients with CTS. However, patients must be aware that LSIs may not be the definitive therapy, and CTR should be recommended.
PubMed: 35455023
DOI: 10.3390/life12040533 -
Journal of Clinical Medicine Nov 2023Carpal tunnel syndrome (CTS) is the most common entrapment syndrome, primarily affecting women between the ages of 40 and 70, and conservative treatments are the first... (Review)
Review
BACKGROUND
Carpal tunnel syndrome (CTS) is the most common entrapment syndrome, primarily affecting women between the ages of 40 and 70, and conservative treatments are the first option for mild-to-moderate CTS. However, the comparisons between extracorporeal shock wave therapy (ESWT) and other non-surgical methods in the treatment of mild-to-moderate CTS remain controversial, and an updated systematic review is needed.
METHODS
An electronic search was performed, and all available articles until August 2023 were included in the analysis. The overall quality of evidence was assessed by the GRADE approach. Meta-analyses were conducted using Manager V.5.3.3. Pooled effect sizes were expressed as the weighted mean difference (WMD) with 95% confidence intervals (CIs).
RESULTS
A total of 19 RCTs were included. Low-level quality evidence showed that ESWT outperformed the control intervention in terms of functional improvements, pain relief, electrodiagnostic parameters, and cross-sectional area of the median nerve at any time point of follow-up. Compared to local corticosteroid injection (LCI), there were statistically better improvements in functional improvements, pain relief, and electrodiagnostic parameters at 3 and 6 months of follow-up.
CONCLUSIONS
There is low-level quality evidence to show that both fESWT and rESWT are more clinically effective than controls in symptom relief, functional enhancement, and electrophysiologic parameters' improvement for patients with mild-to-moderate CTS at any time point of follow-up. Compared with LCI, ESWT yielded similar short-term (<1 month) but better medium- (1-6 months) and long-term (>6 months) improvements in pain relief and functional recovery with fewer potential complications.
PubMed: 38068415
DOI: 10.3390/jcm12237363 -
Hand (New York, N.Y.) Jan 2023Magnetic resonance diffusion tensor imaging (DTI) can detect microstructural changes in peripheral nerves. Studies have reported that the median nerve apparent diffusion... (Meta-Analysis)
Meta-Analysis Review
Magnetic resonance diffusion tensor imaging (DTI) can detect microstructural changes in peripheral nerves. Studies have reported that the median nerve apparent diffusion coefficient (ADC), a quantification of water molecule diffusion direction, is sensitive in diagnosing carpal tunnel syndrome (CTS). Five databases were searched for studies using ADC to investigate CTS. Apparent diffusion coefficient (measured in mm/s) were pooled in random-effects meta-analyses. Twenty-two studies met criteria yielding 592 patients with CTS and 414 controls. Median nerve ADC were measured at the level of the distal radioulnar joint (CTS ADC: 1.11, 95% CI: 1.07-1.15, I = 54%; control ADC: 1.04, 95% CI: 1.01-1.07, I = 57%), pisiform (CTS ADC: 1.39, 95% CI: 1.37-1.42, I = 0%; control ADC: 1.27, 95% CI: 1.23-1.31, I = 59%), hamate (CTS ADC: 1.40, 95% CI: 1.36-1.43, I = 58%; control ADC: 1.27, 95% CI: 1.25-1.28, I = 47%), and as an combination of several measurements (CTS ADC: 1.40, 95% CI: 1.37-1.47, I = 100%; control ADC: 1.39, 95% CI: 1.24-1.53, I = 100%). Median nerve ADC is decreased in individuals with CTS compared to controls at the levels of the hamate and pisiform. ADC cut-offs to diagnose CTS should be established according to these anatomic levels and can be improved through additional studies that include use of a wrist coil.
Topics: Humans; Carpal Tunnel Syndrome; Diffusion Tensor Imaging; Median Nerve; Magnetic Resonance Imaging; Wrist Joint
PubMed: 35695339
DOI: 10.1177/15589447221096706 -
Frontiers in Pharmacology 2022Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse reaction of chemotherapy. Many studies have confirmed that traditional Chinese medicine (TCM) has... (Review)
Review
Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse reaction of chemotherapy. Many studies have confirmed that traditional Chinese medicine (TCM) has unique advantages for treating CIPN. However, there is no standard TCM prescription in clinical practice or objective outcome index, and similar efficacy varies. Therefore, in this study, a systematic review of randomized controlled trials (RCTs) was performed to evaluate the clinical efficacy of external treatment with Chinese herbal medicine (CHM) for CIPN. This analysis provides evidence-based medical support for the use of CHM for external treatment of CIPN. Relevant RCTs assessing CHM external treatment of CIPN were searched in nine electronic databases, including the China National Knowledge Infrastructure Database, China Biology Medicine Disc, China Science and Technology Journal Database, Wanfang Database, PubMed, Cochrane Library, MEDLINE, Web of Science, and OVID, from inception to July 2021. A meta-analysis was performed on these studies using RevMan5.3 software. Based on the inclusion and exclusion criteria, 33 clinical studies were included, while 1,354 studies were screened out. There were 2,356 patients in total, including 1,208 in the treatment group and 1,148 in the control group. In the treatment group, peripheral neurotoxicity rate, total effect rate, KPS score, TCM syndrome score and efficacy, pain NRS score, and pain relief rate were significantly improved compared with those of the control group ( < 0.01). Furthermore, the peroneal and median nerve conduction velocities were also improved compared with those in the control group ( < 0.05). By creating a funnel plot for the incidence of peripheral neurotoxicity and the total effect rate, we showed that the left and right sides were symmetrical, and that the publication bias was low. CHM external treatment was found to be an effective method for treating CIPN as it significantly improved clinical symptoms and quality of life in patients with CIPN. identifier ChiCTR1900024617.
PubMed: 35250555
DOI: 10.3389/fphar.2022.764473 -
The Cochrane Database of Systematic... Jul 2021Chordoma is a rare primary bone tumour with a high propensity for local recurrence. Surgical resection is the mainstay of treatment, but complete resection is often... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chordoma is a rare primary bone tumour with a high propensity for local recurrence. Surgical resection is the mainstay of treatment, but complete resection is often morbid due to tumour location. Similarly, the dose of radiotherapy (RT) that surrounding healthy organs can tolerate is frequently below that required to provide effective tumour control. Therefore, clinicians have investigated different radiation delivery techniques, often in combination with surgery, aimed to improve the therapeutic ratio.
OBJECTIVES
To assess the effects and toxicity of proton and photon adjuvant radiotherapy (RT) in people with biopsy-confirmed chordoma.
SEARCH METHODS
We searched CENTRAL (2021, Issue 4); MEDLINE Ovid (1946 to April 2021); Embase Ovid (1980 to April 2021) and online registers of clinical trials, and abstracts of scientific meetings up until April 2021.
SELECTION CRITERIA
We included adults with pathologically confirmed primary chordoma, who were irradiated with curative intent, with protons or photons in the form of fractionated RT, SRS (stereotactic radiosurgery), SBRT (stereotactic body radiotherapy), or IMRT (intensity modulated radiation therapy). We limited analysis to studies that included outcomes of participants treated with both protons and photons.
DATA COLLECTION AND ANALYSIS
The primary outcomes were local control, mortality, recurrence, and treatment-related toxicity. We followed current standard Cochrane methodological procedures for data extraction, management, and analysis. We used the ROBINS-I tool to assess risk of bias, and GRADE to assess the certainty of the evidence.
MAIN RESULTS
We included six observational studies with 187 adult participants. We judged all studies to be at high risk of bias. Four studies were included in meta-analysis. We are uncertain if proton compared to photon therapy worsens or has no effect on local control (hazard ratio (HR) 5.34, 95% confidence interval (CI) 0.66 to 43.43; 2 observational studies, 39 participants; very low-certainty evidence). Median survival time ranged between 45.5 months and 66 months. We are uncertain if proton compared to photon therapy reduces or has no effect on mortality (HR 0.44, 95% CI 0.13 to 1.57; 4 observational studies, 65 participants; very low-certainty evidence). Median recurrence-free survival ranged between 3 and 10 years. We are uncertain whether proton compared to photon therapy reduces or has no effect on recurrence (HR 0.34, 95% CI 0.10 to 1.17; 4 observational studies, 94 participants; very low-certainty evidence). One study assessed treatment-related toxicity and reported that four participants on proton therapy developed radiation-induced necrosis in the temporal bone, radiation-induced damage to the brainstem, and chronic mastoiditis; one participant on photon therapy developed hearing loss, worsening of the seventh cranial nerve paresis, and ulcerative keratitis (risk ratio (RR) 1.28, 95% CI 0.17 to 9.86; 1 observational study, 33 participants; very low-certainty evidence). There is no evidence that protons led to reduced toxicity. There is very low-certainty evidence to show an advantage for proton therapy in comparison to photon therapy with respect to local control, mortality, recurrence, and treatment related toxicity.
AUTHORS' CONCLUSIONS
There is a lack of published evidence to confirm a clinical difference in effect with either proton or photon therapy for the treatment of chordoma. As radiation techniques evolve, multi-institutional data should be collected prospectively and published, to help identify persons that would most benefit from the available radiation treatment techniques.
Topics: Adult; Bias; Bone Neoplasms; Chordoma; Disease-Free Survival; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Observational Studies as Topic; Photons; Progression-Free Survival; Proton Therapy; Radiosurgery; Radiotherapy, Adjuvant; Radiotherapy, Intensity-Modulated; Time Factors
PubMed: 34196007
DOI: 10.1002/14651858.CD013224.pub2 -
Journal of Personalized Medicine Jul 2022Carpal tunnel syndrome is a neuropathic disease. It is one of the most frequent musculoskeletal pathologies affecting the upper limbs. One of most frequently used... (Review)
Review
Carpal tunnel syndrome is a neuropathic disease. It is one of the most frequent musculoskeletal pathologies affecting the upper limbs. One of most frequently used non-surgical treatments is corticosteorids. There are several alternatives for corticosteroids administration. One of them is phonophoresis, this being an effective and painless method of treatment. A systematic review and meta-analysis have been conducted over the use of phonophoresis with corticosteroids for the treatment of carpal tunnel syndrome compared to other non-surgical treatment methods. Keywords from Medical Subjects Headings (MeSH) were used in the following databases: Wos, Scopus, CINHAL, SciELO and PeDro. A total of 222 potentially relevant articles were retrieved. Eleven articles analysing the efficacy of phonophoresis with corticosteroids in reducing pain symptoms in individuals with carpal tunnel syndrome were included, 10 of which were used to conduct the meta-analysis. A conclusion could not be reached as to the application of phonophoresis with corticosteroids being better than other treatment methods, except for the perception of pain and an improved motor and sensory nerve conduction in cases of mild to moderate carpal tunnel syndrome.
PubMed: 35887657
DOI: 10.3390/jpm12071160