Open Access
Reliability of measurement of the carpal tunnel and median nerve in asymptomatic subjects with ultrasound
(Elsevier, 2017) Bueno-Gracia, Elena; Malo-Urriés, Miguel; Ruiz de Escudero Zapico, Alazne; Rodríguez-Marco, Sonia; Jiménez-del-Barrio, Sandra; Shacklock, Michael; Estébanez-de-Miguel, Elena; Tricás-Moreno, José Miguel; Ciencias de la Salud; Osasun Zientziak
Background Morphology of the carpal tunnel changes with varying wrist postures and compressive forces applied to the wrist. These changes may affect the morphology and pressure on the median nerve and could be used as part of the treatment of the carpal tunnel syndrome patients. Reliability of the ultrasonographic measurements of the median nerve has been widely studied. However, there is a lack of investigation regarding reliability of ultrasonographic measurements of the carpal tunnel. Objective The purpose of this study was to assess intra-tester and inter-tester reliability of measurement of dimensions of the carpal tunnel and median nerve with ultrasound in asymptomatic volunteers. Design A cross-sectional methodological study. Methods Aspects measured were mediolateral and anteroposterior diameters, flattening ratio, circularity, perimeter and cross-section area of the carpal tunnel and median nerve. Results Intra-tester reliability was excellent for the carpal tunnel (ICCs from 0.91 to 0.97) and for the median nerve (ICCs from 0.79 to 0.94) measurements. The flattening ratio of the median nerve showed good agreement (ICC = 0.68). Inter-tester reliability was excellent for the carpal tunnel measurements (ICCs from 0.76 to 0.95) and, for the cross sectional area, the perimeter and mediolateral diameter of the median nerve, the ICC values were 0.89, 0.84 and 0.81, respectively. Conclusion In the context of this study, ultrasound was a reliable instrument for measuring carpal tunnel and median nerve dimensions in asymptomatic subjects.
Open Access
Dimensional changes of the carpal tunnel and the median nerve during manual mobilization of the carpal bones
(Elsevier, 2018-04-04) Bueno-Gracia, Elena; Ruiz de Escudero Zapico, Alazne; Malo-Urriés, Miguel; Shacklock, Michael; Estébanez-de-Miguel, Elena; Fanlo-Mazas, Pablo; Caudevilla-Polo, Santos; Jiménez-del-Barrio, Sandra; Ciencias de la Salud; Osasun Zientziak
Introduction: the carpal tunnel is a clinically important fibro-osseous conduit for the median nerve and associated tendons. It is mechanically dynamic, such that the dimensions of the tunnel and median nerve change with position, movement and application of externally applied force with mechanical devices. Therapeutic manual techniques that appear to move and change tunnel shape are part of clinical practice. The aim of this study was therefore to measure changes in dimensions of the carpal tunnel and median nerve with manual mobilization of the carpal bones. Material and methods: an analytical descriptive study with 18 volunteer subjects and a total of 33 records was designed. Ultrasound measurements of the cross-sectional area (CSA), anteroposterior diameter (APD), transverse diameter (TD), perimeter, flattening ratio and circularity of the carpal tunnel and of the median nerve, were measured, both in the anatomical position of the wrist and during mobilization techniques of the carpal bones. Results: during the mobilization technique, the tunnel (p = 0.003) CSA significantly increased. APD also increased significantly for the tunnel (<0.001) while TD decreased. The median nerve showed similar and significant (p < 0.001) changes than the tunnel. However, because several of the obtained differences where smaller than the SDD obtained in a previous study, these differences were considered as irrelevant. Conclusions: manual mobilization of the carpal bones produced significant changes in the dimensions of the carpal tunnel.
Open Access
Relación entre las mediciones ecográficas del nervio mediano y la gravedad electrofisiológica en el síndrome del túnel carpiano
(IMR Press, 2015) Bueno-Gracia, Elena; Tricás-Moreno, José Miguel; Fanlo-Mazas, Pablo; Malo-Urriés, Miguel; Haddad-Garay, María; Estébanez-de-Miguel, Elena; Hidalgo-García, César; Ruiz de Escudero Zapico, Alazne; Ciencias de la Salud; Osasun Zientziak
Introducción La ecografía es una herramienta que ha experimentado un gran desarrollo en el diagnóstico de patologías compresivas neurales, como el síndrome del túnel carpiano (STC). Para planificar el tratamiento es importante establecer la gravedad de la patología, por lo que sería relevante conocer la capacidad de la ecografía para discriminar el grado de afectación del nervio mediano a este nivel. Objetivo Investigar la correlación de las mediciones ecográficas con la gravedad electrofisiológica en pacientes con STC. Pacientes y métodos Se realizaron mediciones ecográficas en 59 sujetos (97 muñecas) remitidos para recibir un electroneurograma (ENG) por sospecha de STC. Según el ENG, los sujetos se clasificaron como sanos, STC leve, moderado o grave. Posteriormente, se analizó la relación entre las mediciones ecográficas y los resultados del ENG según su gravedad. También se calcularon las curvas ROC (receiver operating characteristic) para los valores de corte óptimos en cada grupo atendiendo a su gravedad. Resultados Ambas mediciones ecográficas mostraron correlación con la gravedad del STC determinada por el ENG. El área de sección transversal del nervio mediano en la muñeca (AST-M) mostró la mayor correlación (r = 0,613). Conclusiones Existe relación entre las mediciones ecográficas del nervio mediano, especialmente en el AST-M, y la gravedad del STC en un contexto clínico. Dichas mediciones podrían ser complementarias para diagnosticar el STC y determinar su gravedad.
Open Access
The effect of diacutaneous fibrolysis on local and widespread hyperalgesia and muscle length in patients with patellofemoral pain syndrome: secondary analysis of a pretest-posttest clinical trial
(Human Kinetics, 2021-02-16) Fanlo-Mazas, Pablo; Bueno-Gracia, Elena; Ruiz de Escudero Zapico, Alazne; López-de-Celis, Carlos; Hidalgo-García, César; Rodríguez-Sanz, Jacobo; Lucha López, María Osoria; Ciencias de la Salud; Osasun Zientziak
Context: Localized and widespread hyperalgesia has been observed in patients with patellofemoral pain. Diacutaneous fibrolysis (DF) has shown to be effective in reducing pain in several musculoskeletal conditions including patellofemoral pain syndrome, but no studies have evaluated the effects of this technique in reducing localized and widespread hyperalgesia. Objective: To assess the effect of DF on the pressure pain threshold and muscle length tests in patients with patellofemoral pain syndrome. Design: A single-group, pretest–posttest clinical trial. Setting: University of Zaragoza. Participants: Forty-six subjects with patellofemoral pain (20 males and 26 females: age 27.8 [6.9] y). Intervention: Three sessions of DF. Main Outcome Measures: Pressure pain threshold using a handheld pressure algometer (4 sites around the knee, on tibialis anterior muscle, and one remote site on the upper contralateral limb); muscle length test of the iliotibial band, rectus femoris, and hamstring muscles; and patient-perceived treatment effect score. Results: The application of 3 sessions of DF significantly increased the pressure pain threshold in all sites at posttreatment evaluation (P < .001) and at a 1-week follow-up (P < .001). A significant increase in muscle length was also observed at the posttreatment evaluation (P < .001) and 1-week follow-up (P < .001). Ninety-seven percent of the patients reported subjective improvement at posttreatment and at 1-week follow-up. Conclusion: This study found that local and widespread hyperalgesia was significantly reduced after 3 sessions of diacutaneous fibrolysis and at the 1-week follow-up. A significant improvement on muscle length tests was also observed, with high clinical satisfaction among patients.
Open Access
Validez diagnóstica de la ecografía en el síndrome del túnel carpiano
(Viguera, 2015) Bueno-Gracia, Elena; Haddad-Garay, María; Tricás-Moreno, José Miguel; Fanlo-Mazas, Pablo; Malo-Urriés, Miguel; Estébanez-de-Miguel, Elena; Hidalgo-García, César; Ruiz de Escudero Zapico, Alazne; Ciencias de la Salud; Osasun Zientziak
Introducción. La ecografía ha emergido como una herramienta diagnóstica alternativa de las neuropatías periféricas, como el síndrome del túnel carpiano (STC). Sin embargo, faltan datos sobre la validez diagnóstica de las diferentes mediciones ecográficas para la detección del STC en entornos clínicos. Objetivo. Hallar la validez diagnóstica de las mediciones ecográficas del área de sección transversal del nervio mediano en la muñeca (AST-M) y de la ratio del área del nervio mediano entre la muñeca y el antebrazo (R-MA) en el diagnóstico del STC, utilizando como técnica de referencia el electroneurograma (ENG). Pacientes y métodos. Se realizaron mediciones ecográficas en 59 sujetos (97 muñecas) referidos para someterse a un ENG por sospecha de STC. Los examinadores que realizaron la ecografía desconocían los resultados del ENG. Posteriormente, se calcularon los puntos de corte mediante curvas ROC para cada una de las mediciones (AST-M y R-MA) y se analizó su validez diagnóstica. Resultados. Con un punto de corte de 9,15 mm2, la medición AST-M obtuvo una sensibilidad del 75,81%, una especificidad del 74,29%, una ratio de probabilidad positiva de 2,95 y una ratio de probabilidad negativa de 0,33. Para la medición R-MA y un punto de corte de 1,56, los valores de sensibilidad, especificidad y ratios de probabilidad positiva y negativa fueron 70,97%, 71,43%, 2,48 y 0,4, respectivamente. Conclusión. Tanto el AST-M como la R-MA parecen ser medidas útiles en el diagnóstico del STC tomando como prueba de referencia el ENG.
Open Access
The effect of diacutaneous fibrolysis on patellar position measured using ultrasound scanning in patients with patellofemoral pain syndrome
(Human Kinetics, 2021) Fanlo-Mazas, Pablo; Bueno-Gracia, Elena; Ruiz de Escudero Zapico, Alazne; Tricás-Moreno, José Miguel; Lucha López, María Osoria; Ciencias de la Salud; Osasun Zientziak
Context: Tightness or lack of flexibility of several muscles of the thigh has been associated with patellofemoral joint pain. A tight iliotibial band can lead to laterally located patella and an abnormal patellar tracking pattern. Diacutaneous fibrolysis (DF) is commonly used to reduce muscle tightness, but no studies have evaluated the effects of this technique in the treatment of patients with patellofemoral pain syndrome. Objective: To assess the effect of DF on patellar position in patients with patellofemoral pain syndrome. Design: A single-group, pretest–posttest clinical trial. Setting: University of Zaragoza. Participants: A total of 46 subjects with patellofemoral pain (20 males, 26 females; age: 27.8 [6.9] y). Intervention: Three sessions of DF. Main Outcome Measures: Patellar position measurement using real-time ultrasound scanning; pain intensity measured with visual analog scale and function measured with the Anterior Knee Pain Scale. Results: The application of 3 sessions of DF significantly increased the patellar position at posttreatment evaluation (P < .001) and at 1-week follow-up (P < .001). There was not a significant difference on patellar position between posttreatment and follow-up measurements (P = .28). There were also a statistically significant decrease in pain and increase in function at posttreatment and at 1-week follow-up measurements (P < .001). Conclusion: This study found that patellar position, pain intensity, and function were significantly improved after 3 sessions of DF and at 1-week follow-up.