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
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
Short- and medium-term effects of manual therapy on the upper cervical spine combined with exercise vs isolated exercise in patients with cervicogenic headache: a randomized controlled trial
(Elsevier, 2022) Rodríguez-Sanz, Jacobo; Malo-Urriés, Miguel; Corral-de-Toro, Jaime; Lucha López, María Osoria; López-de-Celis, Carlos; Pérez-Bellmunt, Albert; Hernández-Secorún, Mar; Ruiz de Escudero Zapico, Alazne; Krauss, John; Hidalgo-García, César; Ciencias de la Salud; Osasun Zientziak
Background: Cervicogenic headache is defined as a unilateral headache associated with a lack of range of motion. The effect of manual therapy applied to the upper cervical spine combined with cervical exercises in this patient population is currently unknown. Objective: To determine if adding manual therapy to an exercise and home-exercise program is more effective by reducing symptoms and improving function in the short- and mid-term than just applying exercises in patients with cervicogenic headache. Methods: Randomized controlled trial. 40 participants with cervicogenic headache were recruited (20 = Manual Therapy + Exercise and 20 = Exercise). Each group received four 20-min sessions weekly and a home exercise regime. Upper cervical flexion and flexion-rotation test, HIT-6, headache intensity, craniocervical flexion test, pain pressure thresholds, GROC-scale, and adherence to self-treatment were measured at the beginning and end of the intervention, and again at 3-(short-term) and 6-month (mid-term) follow-ups. Results: The Manual Therapy + Exercise group showed a statistically significant improvement in all short- and mid-term variables (p <.05) compared to the exercise group except for the variable pain pressure thresholds first metacarpal joint right and left short-term and adherence to self-treatment short-term. Conclusion: Four 20-min sessions of manual therapy and an exercise protocol along with a home exercise regime is more effective in the short and mid-term than an exercise protocol and a home exercise regime for patients with cervicogenic headache. © 2022 Elsevier Ltd