Correlation of neutrophil/lymphocyte and platelet/lymphocyte ratios with the severity of idiopathic carpal tunnel syndrome

Development and validation of a clinical model for predicting the severity of carpal tunnel syndrome

OBJECTIVES

To develop a clinical instrument to assess carpal tunnel syndrome (CTS) severity before electrodiagnostic testing.

METHODS

Data from 1037 patients with CTS (39.1% male) were included. The mean (SD) age was 58.0 (10.8) years. The severity of CTS was based on electrodiagnostic findings.

RESULTS

We devised a composite index incorporating a pain numeric rating scale (NRS) rated from 0 (no pain at all) to 10 (the worst pain ever possible), thenar muscle weakness or atrophy (TW), cross-sectional area (CSA) of the median nerve (mm2), and nocturnal pain (NP). The index was calculated as [scale(NRS)+scale(CSA)+NP+TW]/4, where NP and TW are binary features (0 or 1). The accuracy and area under the curve of the index were 0.85 and 0.71, respectively (Cohen's Kappa = 0.51, McNemar's test P = 0.249). The index increased pretest probabilities by 1.6, 1.8, and 3.3 times with positive likelihood ratios of 3.3, 2.5, and 13.5, and false-positive rates of 26.6, 17.6, and 4.8% for mild, moderate, and severe CTS, respectively. The index thresholds for mild, moderate, and severe CTS were <0.8, ≥0.8 to <1.1, and ≥1.1, respectively.

CONCLUSION

Using a composite index, patients with CTS can be categorized for the severity of the syndrome.

The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 2

The main objective of the osteopath and that of osteopathic manipulative medicine (OMM) is to create space between the different tissues. The sliding capacity of the various tissue layers and between the different body components, up to the possibility of movement between cells is the salutogenic stimulus to allow the circulation of fluids, the biochemical exchange, and the adequate management of the multiple internal and external stimuli that perturb the body living. Movement is allowed by space and space is life. In this second part, the exposure of the anatomical neurological relationships of the five diaphragms continues, highlighting the relationships of the thoracic outlet, the respiratory diaphragm, and the pelvic floor. Finally, there will be clinical reflections to further corroborate the existence of the anatomical continuum and to lay the scientific foundations for an OMM approach to body diaphragms.