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R Padua

Publications and source records attributed to R Padua.

At least 55 records · Page 3Linked to original sources
PubMed1998

Italian multicentre study of carpal tunnel syndrome: study design. Italian CTS Study Group.

In September 1996, during a carpal tunnel syndrome (CTS) symposium, the Italian CTS Study Group was funded. The group designed a strict clinical and neurophysiological protocol for performing a wide multicentre study on idiopathic CTS in hands. In addition to the traditional evaluations, the group also adopted a validated patient-oriented measurement in order to obtain comprehensive and reliable data for the clinical picture. The study was designed to: (1) better assess the clinical picture of the CTS population, especially using new measurement tools (patient-oriented); (2) evaluate the sensitivity of an electrodiagnostic protocol; (3) re-evaluate the validity of a neurophysiological classification; and (4) evaluate the influence of social status and quantify some of the aspects regarding economic and social costs. The study design is described.

Carpal Tunnel Syndrome↗
PubMed1998

Natural history of carpal tunnel syndrome according to the neurophysiological classification.

Although many studies on carpal tunnel syndrome (CTS) have been reported, few data on the natural history of CTS are available. Knowledge of the natural course of the disease has significant clinical and therapeutic value. We prospectively followed up 80 cases of untreated CTS. The evaluation was based on self-administered questionnaires and on neurophysiological investigation. According to the neurophysiological classification, cases of CTS were divided into six groups on the basis of impairment severity: negative, minimal, mild, moderate, severe, and extreme. Disease worsening was inversely related to severity of nerve entrapment. On the contrary, improvement was proportionally related to nerve function impairment (except for extreme cases that never improved), and about one-third of mild and moderate cases improved. Most minimally cases remained neurophysiologically unchanged. We hypothesize that in a good percentage of CTS cases, nerve impairment is self-limited. Our data suggest the utility of further studies on the natural course of this common disease.

Adult↗
PubMed1998

Immunohistochemical investigation on type III and VI collagen organization in human intervertebral discs in the neonatal period.

Nine L5-S1 discs from cadavers following death at ages ranging from 28 weeks of gestation to 1 month after birth were analysed immunohistochemically to investigate type III and VI collagen organization in neonatal discs. The annulus fibrosus stained poorly with the anti-type III antibody. The transition zone and the nucleus pulposus showed a fibrillary framework. No clear pericellular staining was detected. Poor staining with the anti-type VI antibody was detected in the annulus. Single pericellular rings were observed in the transition zone and in the nucleus. The pericellular rings were never multilayered. Type III and VI collagen organization in the newborn is similar to that observed in adults and in the aged. Multiple pericellular rings are never observed. Further research on diseased and healthy intervertebral discs may help clarify which disc changes are age-related and which follow on from degeneration.

Cadaver↗
PubMed1998

Incidence of bilateral symptoms in carpal tunnel syndrome.

We prospectively studied 266 hands in 133 patients with carpal tunnel syndrome (CTS) in order to evaluate: the incidence of bilateral CTS symptoms; correlation between severity, duration of symptoms and bilateral occurrence of CTS; agreement of clinical and neurophysiological findings; and the neurophysiological findings in asymptomatic hands in unilateral CTS. The incidence of bilateral clinical CTS in our population was 87%. Neurophysiological impairment of median nerve was observed in about half of the asymptomatic hands. Follow-up of patients with unilateral CTS showed that contralateral symptoms developed in most cases. We found a significant positive correlation of bilateral CTS with the duration of symptoms, whereas there was no correlation with the severity of symptoms. Our data suggest that bilateral impairment of median nerve is the rule in patients with CTS and probably it has been underestimated in previous studies.

Adult↗
PubMed1998

Carpal tunnel syndrome: indication for surgical treatment based on electrophysiologic study.

A prospective study of 50 hands from 45 consecutive patients surgically treated for idiopathic carpal tunnel syndrome was conducted to determinate the recovery capacity of the median nerve after open surgical release. Subjects were evaluated by clinical history, physical examination, and electrophysiologic testing. Motor and sensory terminal latencies and motor and sensory conduction velocities were examined before surgery and 2 weeks, 2 months, and 6 months after surgical decompression. All patients showed improvement of postoperative electrophysiologic values; the amount of improvement was dependent on the degree of preoperative impairment. Complete restoration of clinical and electrophysiologic nerve function was observed only in patients with mild carpal tunnel syndrome.

Adult↗
PubMed1998

A case of Guyon syndrome with neuroapraxic block resolved after surgical decompression.

Guyon syndrome is the well-known ulnar entrapment at the wrist; usually surgical decompression improves the symptoms. Neurophysiological studies are essential to demonstrate the abnormality of ulnar nerve conduction at the wrist. We report a case of Guyon syndrome onset after 6 h of cycling. Neurophysiological study revealed ulnar neuroapraxic block at the wrist, and axonal impairment. Post-operative clinical and neurophysiological follow-up showed marked clinical improvement and neurophysiological resolution of abnormalities. To our knowledge, no cases of Guyon syndrome with neuroapraxic block are reported in the literature.

Apraxias↗
PubMed1998

Errors in diagnosis of polyneuropathy: three cases of chronic lumbosacral root impairment.

In the last years very precise diagnostic investigations have been introduced to allow accurate diagnosis of pathologies affecting the major part of peripheral nerves; nevertheless, some avoidable misdiagnosis still occurs. For instance, the neurophysiological pattern observed in chronic compression of nerve roots may mimic an axonal polyneuropathy, especially when compression occurs in post-ganglionic tract of dorsal root (in this case sensory nerve conduction studies show decreased or absent response). A clinical-neurophysiological dissociation may be noted in cases with pre-ganglionic impairment of dorsal root (clinical sensory deficit in presence of normal amplitude of sensory response). During the past two years we observed 3 cases with diagnosis of polyneuropathy that, after further studies, appeared affected by severe chronic compression of lumbo-sacral nerve roots. Our data suggest that in those cases with suspected polyneuropathy, in which the neurophysiological picture is characterized by the exclusive axonal (and myelinic) involvement of motor and/or sensory peripheral nerve of lower limbs, neuroimaging of radicular structures must be performed. These further investigations may avoid severe and irreversible damage to neural tissues.

Aged↗
PubMed1997

Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands.

Following the AAEM electrodiagnostic guidelines, we developed a neurophysiological classification of carpal tunnel syndrome (CTS). Six hundred hands with clinical CTS (mean age 51.4 yr., female/male ratio 5.5/1, right/left ratio 1.8/1) were prospectively evaluated and divided into six classes of severity only on the basis of median nerve electrodiagnostic findings: extreme CTS (EXT-absence of thenar motor responses), severe CTS (SEV-absence of sensory response and abnormal distal motor latency-DML), moderate CTS (MOD-abnormal digit-wrist conduction and abnormal DML), mild CTS (MILD-abnormal digit wrist conduction and normal DML), minimal CTS (MIN-exclusive abnormal segmental and/or comparative study), and negative CTS (NEG-normal findings at all tests). Using this neurophysiological classification, the CTS groups appeared normally distributed (EXT 3% of cases, SEV 14%, MOD 36%, MILD 24%, MIN 21%, NEG 3%), and the age of patients and clinical findings appeared to be related to neurophysiological abnormalities. Significant differences in median neurophysiological parameters not included in the classification (such as palm-wrist sensory conduction velocity) were observed in the different CTS groups. The analysis of the groups showed that: 1) the majority of advanced cases (SEV and EXT) occurred in older patients (60-80 years), 2) most of the milder cases (MIN and MILD) occurred in young female patients. The aim of this study was to standardise the neurophysiological evaluation of CTS.

Adult↗
PubMed1997

Carpal tunnel syndrome: neurophysiological results of surgery based on preoperative electrodiagnostic testing.

Fifty-three hands with carpal tunnel syndrome had pre- and postoperative evaluations of median nerve distal motor latency (from wrist to thenar muscles) and orthodromic sensory nerve conduction velocity (from thumb and middle finger to wrist). At 6 months we observed a neurophysiological return to normal in all cases with normal preoperative distal motor latency and in about 50% of the hands with preoperative distal motor latency between 4 and 6 ms. Prolongation of the distal motor latency over 6 ms was not followed by return to neurophysiological normality, although some degree of sensory function was restored in the majority of cases.

Adult↗
PubMed1997

Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands.

OBJECTIVES: To evaluate the following points about carpal tunnel syndrome (CTS): 1) characterization of a wide population; 2) sensitivity of electrodiagnostic tests, and particularly the contribution of disto-proximal ratio test; 3) validity of a neurophysiological classification developed by us. MATERIAL AND METHODS: Prospective study in 500 hands with CTS symptoms. Neurophysiological "standard" tests were always performed: sensory nerve conduction velocity (SNCV) first- and third digit-wrist and distal motor latency (DML). In "standard negative" hands disto-proximal ratio technique (R) was performed. Neurophysiological classification: Extreme CTS (absence of median motor, sensory responses), Severe (absence of sensory response, abnormal DML), Moderate (abnormal SNCV, abnormal DML), Mild (abnormal SNCV, normal DML), Minimal (abnormal R or other segmental/comparative test, normal standard tests). RESULTS: Sensibility of standard tests: 77%. R increased the diagnostic yield by 20%. CTS classification appeared reliable with significant differences between groups. CONCLUSION: R is a useful test, the classification may be useful in clinical/therapeutical decisions.

Adult↗
PubMed1997

Mononeuropathy of a distal branch of the femoral nerve in a body building champion.

A unique case of a body building champion with localised atrophy of the distal portion of the vastus lateralis muscle is reported; neurophysiological evaluation suggests a selective lesion of a distal branch of the vastus lateralis nerve (a motor branch of the femoral nerve). A necroscopic study in four cases was performed to better clarify the site and mechanism of nerve lesion. The data suggest that stretching and compression of the nerve has probably occurred during strenous exercise.

Adult↗
PubMed1996

Radiculomedullary complications of cervical spinal manipulation.

Spinal manipulation is commonly used by some therapists for the treatment of cervical pain. Flexion-extension of the cervical spine produces sliding movements of one vertebra over the one below it, which leads to physiological reduction in the antero-posterior diameter of the spinal canal. Spinal manipulation provokes movements that exceed the physiological limits of these articulations and thereby lead to a more significant reduction of the canal diameter. In patients with pre-existing stenosis of the canal or those with vertebral instability, these movements may cause (or aggravate) myelopathy. For this reason, a thorough neurological examination and cervical spine films should be considered mandatory in patients being considered for spinal manipulation. This report describes four patients with cervical myelopathy and/or radiculopathy caused or aggravated by spinal manipulation. In one patient, magnetic resonance scans before and after chiropractic treatment strongly suggests that the disc prolapse syndrome experienced by the patient was provoked by the spinal manipulation.

Aged↗
PubMed1996

Surgical prognosis in carpal tunnel syndrome: usefulness of a preoperative neurophysiological assessment.

In this study 37 CTS hands underwent pre- and post-operative (15 days 2 and 6 months) evaluation of median nerve distal motor latency (DML) and sensory nerve conduction velocities (SNCV: I digit and III digit-wrist). Pre-operatively, CTS hands were classified as mild (decreased SNCV, normal DML), moderate (decreased SNCV, increased DML) or severe (absent sensory nerve action potentials, increased DML). Post-operatively, all hands presented clinical and neurophysiological improvement. The three groups of patient showed different clinical and neurophysiological responses to nerve decompression: we observed a rapid restitutio ad integrum in mild group, an improvement with normalisation in about 50% of the hands in moderate group, and a high percentage of restore of the sensory responses with no normalisation in severe group. A marked improvement of sensory symptoms was observed in all cases, but some degree of motor and/or sensory deficit was still present six months after surgery in more advanced cases. Preoperative electrophysiological assessment of median nerve function in CTS hands have an important role in predicting the outcome of surgical decompression.

Adult↗