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Biomedical subjects

C B Novak

Publications and source records attributed to C B Novak.

At least 37 records · Page 2Linked to original sources
PubMed1996

Long-term follow-up evaluation of cold sensitivity following nerve injury.

This article reports the long-term follow-up evaluation (mean, 10 years) findings of 50 patients with upper-extremity peripheral nerve injuries. The most common persistent symptom was cold sensitivity (n = 38), and 33 of 38 patients rated its intensity as moderate or severe. Cold sensitivity typically developed within months after initial injury and resolved in only 2 patients. No significant difference in the incidence of cold sensitivity was found between patients with subjectively normal hand sensation (7 of 11) and those who reported abnormal hand sensibility (31 of 37). A cold sensitivity severity score (CSSS) was determined; a significant relationship was found between the CSSS and the patient's subjective rating of cold sensitivity intensity and change in job status or occupation due to injury (p < or = .02). No significant relationships were found between incidence of cold sensitivity and age, mechanism of injury, smoking, or level of nerve injury. A significant relationship was found between cold sensitivity and digital amputation injuries (p < or = .05). Thus, cold sensitivity is a common sequela following nerve injury and does not decrease over time.

Adult↗
PubMed1996

Hand sensibility measures used by therapists.

Sensory evaluations are frequently used to assess patients with functional loss resulting from nerve injury. The results of these tests are routinely utilized by hand surgeons as an indication for conservative management or surgical intervention in the evaluation of surgical outcome and in the determination of disability ratings. Reports in the literature regarding specific tests for sensibility show variation in their application. The purpose of this study was to evaluate which tests are used to evaluate hand sensibility and the techniques of application currently used by hand therapists. Two hundred members of the American Society of Hand Therapists were randomly selected and a survey was sent to these members. The results of this study identify the need to develop standardized protocols for sensory evaluations and the need for therapists to follow the standardized methods for administration of moving and static two-point discrimination, and Semmes-Weinstein monofilaments, if comparisons of results between centers are to be meaningful.

Disability Evaluation↗
PubMed1996

Establishing normal values of moving two-point discrimination in children and adolescents.

To establish normal values of moving two-point discrimination (2pd) in children and adolescents, bilateral median and ulnar nerve distribution in 313 subjects aged 4 to 18 years was evaluated. A moving 2pd of 2 to 3mm for both the median and ulnar nerve distributions bilaterally was found in 270 subjects. 2% (N = 5) had moving 2pds of 4mm for both right and left median nerve distributions. There was a significant increase in mean age with 2, 3 and 4mm of moving 2pd for median and ulnar nerves bilaterally. There was no significant difference between sexes for ulnar nerves bilaterally or left median nerve. A borderline difference was found between the sexes for the right median nerve. Multivariate logistic regression revealed age as a significant predictor of discrimination for all variables. Significantly more subjects had a moving 2pd of 4mm in the ulnar nerve distribution than in the median nerve distribution.

Adolescent↗
PubMed1996

Thoracic outlet syndrome: a current overview.

Thoracic outlet syndrome and the surgery associated with this diagnosis have a controversial reputation. The majority of patients with thoracic outlet syndrome seen in the context of the work place will have a multiplicity of components to their symptomatology, including multilevel nerve compression and muscle imbalance of the neck, shoulder, and back. Identification and conservative management of these problems make the necessity for surgery for thoracic outlet syndrome a rare event. Decompression of the brachial plexus, with or without first rib resection, is a technically demanding surgical procedure requiring expertise in peripheral nerve, vascular and thoracic surgery. Evaluation of these patients requires an understanding of neuromuscular physiology and chronic pain syndromes.

Cumulative Trauma Disorders↗
PubMed1996

Evaluation of the patient with thoracic outlet syndrome.

Clinical evaluation is paramount in making the diagnosis of thoracic outlet syndrome. Complaints of paresthesia and numbness will relate to the nerve compression component of thoracic outlet syndrome, whereas the pain associated with this syndrome is largely caused by muscle imbalance in the neck, shoulders, and upper back. Utilization of a pain evaluation scale assists in assessing a functional overlay to the pain complaints. Detailed sensory testing at rest and after provocation of the patient's symptoms with overhead activity will assist in the diagnosis. Radiographic test results are frequently normal in this patient population. By contrast, vascular testing results are frequently abnormal in a normal patient population. Electrodiagnostic tests are useful in ruling out other, more distal nerve entrapments.

Evoked Potentials, Somatosensory↗
PubMed1996

Conservative management of thoracic outlet syndrome.

Conservative management of thoracic outlet syndrome requires accurate evaluation of the peripheral nervous system, posture, and the cervico-scapular muscles. Patients should be instructed in postural correction in sitting, standing and sleeping, stretching exercises (ie, upper trapezius, levator scapulae, suboccipitals, scalenes, sternocleidomastoid and pectoral muscles), and strengthening exercises of the lower scapular stabilizers beginning in gravity-assisted positions to regain normal movement patterns in the cervico-scapular region. Patient education, compliance to an exercise program, and behavioral modification at home and work are critical to successful conservative management.

Humans↗
PubMed1996

Thoracic outlet syndrome.

Thoracic outlet syndrome (TOS) is the term commonly used to describe patients with symptoms attributed to compression of the brachial plexus and subclavian vein and artery in the region of the thoracic inlet/outlet. TOS remains extremely controversial with respect to its existence, diagnosis, conservative management, and surgical treatment. The diagnosis is based upon clinical evaluation, reproduction of patient symptoms with arm elevation, and the absence of other relevant pathology. Conservative management should be directed towards correction of postural abnormalities and muscle imbalance in the cervicoscapular region. Patient education compliance to a home exercise program and behavioral modification at home, work, and sleep is necessary for a successful outcome. Surgical decompression of the brachial plexus is best achieved through a supraclavicular approach and should be reserved for the few patients in which conservative management has failed to improve symptoms.

Electrodiagnosis↗
PubMed1995

Subjective outcome following surgical management of upper extremity neuromas.

Our study used a telephone survey to evaluate long-term subjective outcome of 70 patients with 112 upper extremity neuromas treated surgically. The mean postinjury time before surgery was 9 years. The mean postsurgical followup was 5 years. Fifty-one of the patients were involved with workers' compensation (WC). Forty-five patients reported good relief of pain. Preoperatively, 46 patients were unemployed because of pain; following surgery 18 of these patients returned to work. Of the 54 patients taking analgesic medication preoperatively, 19 reported less and 10 reported no postoperative analgesic use. No significant difference was found in gender, postinjury time, postsurgical followup time, number of previous surgeries for pain relief, or site of nerve injury between patients who reported improvement versus no symptomatic improvement. Poor subjective outcome occurred in patients (p < .03), with 16 out of 19 of those not involved with WC reporting good pain relief as compared to 29 out of 51 of WC patients.

Adult↗
PubMed1995

Outcome following conservative management of thoracic outlet syndrome.

Conservative management of thoracic outlet syndrome is recommended as the initial treatment of choice, and yet few studies have evaluated patient outcome. This study evaluates patient subjective outcome following conservative management of thoracic outlet syndrome. Forty-two patients (37 women, 5 men), mean age 38 years, participated in a telephone questionnaire. Patients clinically diagnosed with thoracic outlet syndrome who had participated in physical therapy at least 6 months prior to the study were selected. Mean duration of symptoms before treatment was 38 months, and mean follow-up time after therapy was 1 year. Twenty-five patients reported symptomatic improvement, 10 were the same, and 7 had worse symptoms. Sixteen patients reported full work and recreational activities, and 8 patients reported restrictions in both work and recreational activities. Poor overall outcome was related to obesity (p < .04), workers' compensation (p < .04), and associated carpal or cubital tunnel syndrome (p < .04). Neck and shoulder symptoms were improved in 38 patients. Improvement in hand and arm pain was significantly better in those without concomitant distal nerve compression (p < .006).

Adult↗
PubMed1995

Subjective outcome following surgical management of lower-extremity neuromas.

This study evaluated the long-term subjective outcomes of 19 patients (13 females, six males), following surgical resection and proximal transposition of lower-extremity neuromas. The patient mean age was 49 years (S.D.: 18), with a mean post-injury time of 8 years and post-surgery follow-up of 4 years. Thirteen patients reported symptomatic improvement in pain, and six reported no improvement. Of ten subjects who were unemployed prior to surgery, two returned to work and four retired postoperatively. Preoperatively, 13 patients used analgesic medication and postoperatively, eight reported taking less medication; four had completely stopped taking pain medication. Symptomatic pain relief apparently can be achieved with surgical management of lower-extremity neuromas.

Adult↗
PubMed1994

Provocative testing for cubital tunnel syndrome.

This prospective study evaluated the clinical usefulness of provocative testing in 32 subjects with electrodiagnostically proven cubital tunnel syndrome and 33 control subjects. Four provocative tests were included: Tinel's sign, elbow flexion, pressure provocation, and combined elbow flexion and pressure provocation. The mean age of the control group was 41 years and 46 years for the group with cubital tunnel syndrome. In the control group, provocative tests were rarely positive. In 44 extremities with cubital tunnel syndrome, 31 had a Tinel's sign, 33 had a positive elbow flexion test, 39 had symptoms with pressure only, and 41 had symptoms with a combination of pressure provocation and elbow flexion testing. The sensitivity of the Tinel sign was 0.70, and at 30 seconds, the sensitivities of the other provocative tests were: elbow flexion (0.32), pressure provocation (0.55), and pressure-flexion test (0.91). The most sensitive provocative test in the diagnosis of cubital tunnel syndrome was elbow flexion when combined with pressure on the ulnar nerve.

Adult↗
PubMed1994

Subjective and employment outcome following secondary carpal tunnel surgery.

Forty-five patients (50 hands) who had undergone secondary carpal tunnel surgery participated in a telephone questionnaire survey. The mean follow-up time from the second carpal tunnel surgery was 31 months (range, 9-92 mo). Only 24 patients (53%) reported significant improvement in their symptoms. Thirty-nine patients were unemployed workers who had experienced an average time off work of 28.7 months (+/- 4) before their secondary carpal tunnel surgery. Eleven of the 39 previously unemployed workers (28%) returned to work after the secondary carpal tunnel surgery. Factors associated with poor subjective and employment outcome included worker's compensation case involvement (p < 0.003). Occupations associated with repetitive hand movements or vibrating tools were associated with poor employment outcomes (p < 0.006). Although secondary surgery for carpal tunnel syndrome can be effective in relieving symptoms, patients and surgeons must have realistic expectations of the procedure, especially with respect to long-term employment goals.

Adult↗
PubMed1993

Evaluation of patients with thoracic outlet syndrome.

This prospective study evaluated 50 patients with thoracic outlet syndrome. Detailed history and pain scale evaluation preceded physical examination, which included provocative tests (positional and compressive) and sensory evaluation (baseline and postprovocative vibration thresholds and two-point discrimination). Only one patient had a positive nerve conduction study/electromyograph at the brachial plexus level. Thirty-two percent of the patients had a compressive anatomic abnormality as seen on a computed tomography scan. Ninety-four percent had positive provocative position and compression test results. Two-point discrimination was normal in 98%. Clinical assessment of thoracic outlet syndrome is best achieved by reproduction of symptoms with compression and positional provocative testing. Results of the majority of tests (nerve conduction studies/electromyographs, x-ray films, sensory tests) will be normal. Measurements of changes in sensory thresholds during provocation of symptoms may be useful.

Adult↗
PubMed1993

Occupational exposure to hand vibration in northern Ontario gold miners.

Nineteen underground gold mine drillers who operate vibration equipment and a control group of 16 gold mill workers without vibration exposure were evaluated. Assessment included static two-point discrimination, moving two-point discrimination, vibration threshold, and cutaneous pressure threshold. Provocative tests, including Tinel, pressure, and Phalen signs, were performed at the carpal and cubital tunnels. Mean age of the miners was 35 years, and the mean age of the control group was 31 years. The mean time of vibration exposure was 14 years. Numbness, pain, and weakness was reported in 12 miners and 1 control subject. Symptoms of vibration white finger were found in 16 miners and 3 control subjects. The miners had a higher incidence of positive provocative tests at the carpal and cubital tunnels and higher cutaneous pressure thresholds than the control group. Significantly higher vibration thresholds were found in the miners versus the control subjects. A correlation between years of vibration exposure and vibration threshold was found.

Adult↗
PubMed1993

Duration of contact time alters cutaneous pressure threshold measurements.

Semmes-Weinstein monofilaments (SWMs) are standard measures used to assess hand sensibility. The purpose of this study was to evaluate the effect of varying contact time on the measurement of cutaneous pressure thresholds. Thirty-two healthy adult subjects were evaluated with a 20-filament SWM test kit. The index finger of the dominant hand was assessed with the following four distinct monofilament contact times: 0.5, 1.5, 5.0, and 30.0 seconds. With increased duration of monofilament contact time, there was a significant increase in the cutaneous pressure threshold measures (p < 0.05). That is, to perceive a stimulus for a longer period of time, a heavier filament was required. With increasing age, significantly higher pressure thresholds were obtained particularly for the sustained contact time (> 5.0 seconds). Pressure thresholds vary significantly with SWM contact time, emphasizing the importance of maintaining a consistent SWM application protocol.

Adult↗
PubMed1993

Correlation of two-point discrimination and hand function following median nerve injury.

Two-point discrimination (2pd) (moving and static) and object identification were assessed in 43 patients after median nerve repair and graft in the middistal forearm. The mean age was 37 years (range, 16-78 yr). Twenty-six patients underwent primary median nerve repair and 17 had secondary median nerve grafts. The minimum follow-up time was 2 years. The values of moving 2pd and static 2pd ranged from 2 to > 16 mm. Both moving 2pd and static 2pd had strong correlational relationships with hand function as measured by object identification. Correlation coefficients for the relationship between 2pd (moving and static) and total objects identified ranged from 0.66 to 0.74.

Adolescent↗
PubMed1993

Development of a new measure of fine sensory function.

With the loss of sight, the blind individual must rely on tactile senses for function, and yet assessment of hand sensibility is not routinely integrated into evaluations of the blind. The available sensory measures lack the sensitivity to differentiate higher levels of hand sensibility, and therefore, a new more sensitive measure of fine sensory function was developed. A 3 x 3 braille dot cell was developed, and pattern variation was utilized to assess higher discriminatory abilities. Thirty blind and sighted subjects were evaluated, and intertester reliability of fine sensory function (braille pattern identification) was established (r = 0.95). Comparison between braille identification and measures of threshold and innervation density revealed the strongest correlational relationship with two-point discrimination. This study supports the assessment of fine sensory function with braille pattern identification.

Activities of Daily Living↗