Objectives To determine the diagnostic capacity of ultrasound (US) in detecting carpal tunnel syndrome (CTS). Methods Volunteer adults with and without CTS symptoms were recruited from offices in metropolitan Manila, where employees’ work was hand/wrist intensive. Carpal tunnel syndrome was independently diagnosed by a reference standard (positive findings on a physical examination and nerve conduction studies). Blinded US measurements were taken of the median nerve (cross‐sectional area, hypervascularity, wrist‐to‐forearm ratio, wrist‐forearm difference, swelling ratio, flattening ratio, and palmar bowing of the flexor retinaculum) at the carpal tunnel inlet and carpal tunnel outlet (CTO). Results A total of 117 eligible consenting participants (234 hands) were included, with 54 hands (23.1%) with a diagnosis of CTS. There were no anthropometric differences between arms with and without CTS. Men and women older than 33 years were 5 times more likely to report CTS than younger people. A CTO wrist‐forearm difference of greater than 0.03 cm had the strongest association with CTS (odds ratio, 4.7; 95% confidence interval, 1.4–15.9), with an area under the curve of 0.58 (sensitivity, 94.4%; specificity, 21.7%). The area under the curve increased to 0.59 when the next strongest measurement (CTO hypervascularity of 1+: odds ratio, 3.8; 95% confidence interval, 1.8–8.1) was included (sensitivity, 98.1%; specificity, 27.7%). Adding further US parameters did not improve the diagnostic capacity of US for CTS. Diagnostic capacity was independent of age and the duration of CTS symptoms. Conclusions Combining US findings for the CTO wrist‐forearm difference and hypervascularity provides a sensitive, alternative diagnostic tool for CTS.
Objectives To determine the most important motor impairments that are predictors of gait velocity and spatiotemporal symmetrical ratio in patients with stroke. Design Cross-sectional, descriptive analysis study. Setting Human performance laboratory of the University of Santo Tomas. Participants Individuals with chronic stroke (N=55; 34 men, 21 women) who are community dwellers. Interventions Not applicable. Main Outcome Measures The gait velocity and spatiotemporal symmetrical ratio (step length; step, stance, swing, single-leg support, and double-leg support stance times) was determined using Vicon motion capture. We also calculated motor impairment of the leg and foot using Brunnstrom’s stages of motor recovery, evaluated muscle strength using the scoring system described by Collin and Wade, and assessed spasticity using by the modified Ashworth Scale. Results Regression analysis showed that plantarflexor strength is a predictor of gait velocity and all temporospatial symmetry ratio. Knee flexor and extensor strength are predictors in single-leg support time and double-leg support time symmetry ratio, respectively. On the other hand, hip adductor and quadriceps spasticity are predictors of swing time and step length symmetry ratio. Conclusion Different motor impairments are predictors of stroke gait abnormality. Interventions should be focused on these motor impairments to allow for optimal gait rehabilitation results.
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