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Alfuraih AM, Aldahlawi RH, Habib YS, Alhowimel AS, Bedewi MA. Reliability of Ultrasound Measurements of the Median Nerve in Asymptomatic Subjects Using a Handheld Device. SENSORS (BASEL, SWITZERLAND) 2024; 24:3444. [PMID: 38894235 PMCID: PMC11175092 DOI: 10.3390/s24113444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/18/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024]
Abstract
This study investigated the reliability of measuring the median nerve cross-sectional area (CSA) at the carpal tunnel inlet using a handheld ultrasound device (HUD) compared to a standard ultrasound system, focusing on intra- and inter-operator reproducibility among novice and expert operators. Employing a prospective cross-sectional design, 37 asymptomatic adults were assessed using both devices, with measurements taken by an expert with over five years of experience and a novice with less than six months. The CSA was determined using manual tracing and ellipse methods, with reproducibility evaluated through intraclass correlation coefficients (ICCs) and agreement assessed via Bland-Altman plots. Results showed a high degree of agreement between the devices, with excellent intra-operator reproducibility (ICC > 0.80) for the expert, and moderate reproducibility for the novice (ICCs ranging from 0.539 to 0.841). Inter-operator reliability was generally moderate, indicating acceptable consistency across different experience levels. The study concludes that HUDs are comparable to standard ultrasound systems for assessing median nerve CSA in asymptomatic subjects, with both devices providing reliable measurements. This supports the use of HUDs in diverse clinical environments, particularly where access to traditional ultrasound is limited. Further research with a larger sample and symptomatic patients is recommended to validate these findings.
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Affiliation(s)
- Abdulrahman M. Alfuraih
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj 16278, Saudi Arabia
| | - Rana Hussain Aldahlawi
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 14511, Saudi Arabia;
| | - Yomna S. Habib
- Department of Radiology, University Hospital, Prince Sattam bin Abdulaziz University, Kharj 16278, Saudi Arabia;
| | - Ahmed S. Alhowimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj 16278, Saudi Arabia;
| | - Mohamed Abdelmohsen Bedewi
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Kharj 16278, Saudi Arabia;
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Loomis KJ, Roll SC. External wrist ratio is not a proxy for internal carpal tunnel shape: Implications for evaluating carpal tunnel syndrome risk. Clin Anat 2024:10.1002/ca.24132. [PMID: 38173294 PMCID: PMC11219555 DOI: 10.1002/ca.24132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/05/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
Carpal tunnel syndrome (CTS) is highly prevalent, resulting in decreased function and increased need for costly healthcare services. External wrist ratio (depth/width >0.70) is a strong predictor of the development of CTS and has been suggested to be a proxy for internal carpal tunnel (CT) shape. Conversely, sonography can more directly evaluate CT shape. The purpose of our study was to explore the relationship between wrist ratio and sonographic CT measurements to (1) evaluate the reliability of sonographic CT measurements and (2) explore how external wrist measures relate to anthropometric features of the CT. We used sonographic imaging on a sample of healthy participants (n = 226) to measure CT cross-sectional area, depth, width, and depth/width ratio. We conducted exploratory correlation and regression analyses to identify relationships of these measures with external wrist ratio. Reliability for dominant and nondominant sonographic CT measures ranged from good to excellent (0.79-0.95). Despite a moderate correlation between CT width and depth and their external wrist counterparts (0.33-0.41, p < 0.001), wrist ratio and CT ratio demonstrated weak to no correlation (dominant: r = 0.12, p = 0.053; nondominant: r = 0.20, p = 0.002) and the mean CT ratio was far lower than the mean wrist ratio (0.45 vs. 0.71 bilaterally). Supporting this, we observed several key differences in the relationship between external wrist measures compared to corresponding CT measures. Additionally, regression analyses combining participant factors and CT measurements produced models accounting for less than 15% of the variability in external wrist ratio (linear models) or correctly predicting less than 68% of wrist ratio-based risk categorization (logistic models). Overall, among healthy young adults, wrist shape is not an adequate proxy for CT shape.
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Affiliation(s)
- Katherine J Loomis
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
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Robben E, Dusar FR, Weyns V, Rummens S, Degreef I, Peers K. Ultrasound measurement of subsynovial connective tissue thickness in the carpal tunnel: An intrarater/interrater reliability and agreement study. HAND SURGERY & REHABILITATION 2023; 42:505-511. [PMID: 37709255 DOI: 10.1016/j.hansur.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES Non-inflammatory thickening of the subsynovial connective tissue (SSCT) in the carpal tunnel is commonly found in subjects with carpal tunnel syndrome (CTS), and quantification may shed light on CTS pathogenesis. To date, information on the reliability of ultrasound quantification of SSCT is scarce. Therefore, we investigated intrarater and interrater reliability/agreement for ultrasound quantification of SSCT thickness in subjects with and without CTS, and predictors for tissue thickness. MATERIAL AND METHODS Two investigators quantified SSCT thickness and thickness ratio on ultrasound in 16 healthy subjects (age, 24-65 years; 16 left/14 right wrists) and 17 subjects with CTS (age, 37-83 years; 14 left/14 right wrists). Intra- and inter-rater reliability/agreement were assessed on intraclass correlation coefficients, standard error of measurement and minimal detectable change. A mixed-effects model was used to evaluate potential predictors for SSCT thickness. RESULTS Intra- and inter-rater reliability analysis showed good to excellent intraclass correlation coefficients in both groups, ranging from 0.772 to 0.965. The maximum percentage standard error of measurement was 8%. The maximum minimal detectable change was 14% within raters, and 20% between raters. Both intra- and inter-rater reliability values for thickness ratio were poor. Presence of CTS (ß = 0.180; p = 0.015) correlated positively with SSCT thickness. CONCLUSIONS Ultrasound is a reliable method for quantification of SSCT thickness, but not for thickness ratio. Presence of CTS correlates positively with SSCT thickness.
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Affiliation(s)
- Elise Robben
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium.
| | - Frank-Robbrecht Dusar
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium
| | - Valerie Weyns
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium
| | - Sofie Rummens
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium
| | - Ilse Degreef
- KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium; University Hospitals Leuven, Department of Orthopaedic Surgery, Leuven, Belgium
| | - Koen Peers
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium
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Asghar A, Naaz S, Ansari S, Kumar A, Singh V. The cross-sectional morphology of median nerve in carpal tunnel of healthy, adult population: A systematic review and meta-analysis. Morphologie 2023; 107:99-115. [PMID: 35697557 DOI: 10.1016/j.morpho.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
The cross-section area is a crucial parameter to assess peripheral neuropathy. The ultrasonographic evaluation of cross-section area of median nerve is a low-cost and readily available tool for diagnosis and assessment. However, the intra-nerve dimensional variability and its normative reference value in a healthy subject are missing. The current meta-analysis aims to capture the median nerve cross-section area for healthy subjects and generate a comprehensive ultrasonographic reference data set for each population. METHODS The full text of manuscripts were collected after short-listing the abstracts collected from search strategy. A quality assurance tool was used to capture the risk of bias of each study after reviewing the included manuscripts. The pooled estimate of cross-section area was stratified according to anatomical landmarks, sex, and ancestry. RESULTS A total of 97 observational studies dealt with 6679 wrists of healthy subjects were included. The pooled estimate of the cross-section area of median nerve at carpal tunnel inlet was 8.54mm2 [95% CI: 8.34-8.74mm2]. The same pooled estimate at carpal tunnel outlet was 8.03mm2 [95% CI: 7.46-8.60mm2]. Both these pooled estimates have significant correlation with mean age of population. Age and sex were two primary predictors of the cross-section of median nerve. The flattening ratio, circularity, and wrist-forearm ratio of median nerve were also computed. CONCLUSION These normative data could serve as a reference for assessing median nerve pathologies, including carpal tunnel syndrome. The ethnic variation of pooled estimate and heterogeneity will guide clinician set up the reference value for diagnostic criteria.
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Affiliation(s)
- A Asghar
- Department of Anatomy, AIIMS Patna, Patna, Bihar 801505, India.
| | - S Naaz
- Department of Anaesthesiology, AIIMS Patna, Patna, Bihar 801505, India
| | - S Ansari
- Consultant Radiologist, Paras HMRI, Hospital Patna, Patna, Bihar, India
| | - A Kumar
- Department of Anatomy, AIIMS Patna, Patna, Bihar 801505, India
| | - V Singh
- Speciality Registrar (Orthopaedics), Homerton University Hospital, London, UK
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Jordan D, Li ZM. Cross-sectional changes of the distal carpal tunnel with simulated carpal bone rotation. Comput Methods Biomech Biomed Engin 2022; 25:1599-1607. [PMID: 35062851 PMCID: PMC9701111 DOI: 10.1080/10255842.2022.2028143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 11/03/2022]
Abstract
This study simulated the cross-sectional changes in the distal carpal tunnel resulting from inward rotations of the hamate and trapezium. Rotations which decreased the carpal arch width, increased the carpal arch area. For example, simultaneous rotation of 5 degrees around the hamate and trapezium centroids decreased the carpal arch width by 1.69 ± 0.17 mm and increased the carpal arch area by 6.83 ± 0.68 mm2. Although the bone arch area decreased, decompression of the median nerve would likely occur due to the adjacent location of the nerve near the transverse carpal ligament.
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Affiliation(s)
- David Jordan
- Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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Jiménez-del-Barrio S, Ceballos-Laita L, Bueno-Gracia E, Rodríguez-Marco S, Caudevilla-Polo S, Estébanez-de-Miguel E. Diacutaneous Fibrolysis Intervention in Patients with Mild to Moderate Carpal Tunnel Syndrome May Avoid Severe Cases in Elderly: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10983. [PMID: 36078691 PMCID: PMC9518553 DOI: 10.3390/ijerph191710983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Carpal Tunnel Syndrome (CTS) mainly affects adults of working age. The prevalence of severe cases is higher in elderly patients (>65 years old). Clinical guidelines recommend conservative treatment as the best option in the initial stages of CTS to avoid severe cases. Diacutaneous Fibrolysis (DF) has demonstrated to improve nerve conduction studies and mechanosensitivity. The main purpose was to quantify changes in the cross-sectional area (CSA) of the median nerve, transversal carpal ligament (TCL) thickness, numbness intensity, and the subjective assessment of clinical change after DF treatment in patients with CTS. METHODS a double-blind, randomized, placebo-controlled trial was designed. A number of 44 patients (60 wrists) with CTS were randomized to the DF group or the sham group. CSA and TCL thickness variables were registered by ultrasound. Clinical variables were assessed by the visual analogue scale and GROC scale. SPSS version 24.0 for MAC was used for statistical analysis. The group by time interaction between groups was analyzed using two-way repeated measures analysis of variance. RESULTS The DF group reduced CSA with a mean of 0.45 mm2 (IC 95% 0.05 to 0.86) and TCL thickness with a mean reduction of 0.4 mm (IC 95% 0.6 to 2.1) compared to the sham group (p < 0.01, p < 0,03, respectively). Additionally, the DF group decreased the numbness intensity with a mean reduction of 3.47 (IC 95% 2.50 to 4.44, p < 0.01) and showed a statistically significant improvement on the GROC scale (p < 0.01). CONCLUSIONS DF treatment may significantly reduce CSA and TCL thickness, numbness intensity, and improved clinical perspective. DF applied in patients with mild to moderate CTS may prevent the progression of the disease as they age.
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Affiliation(s)
- Sandra Jiménez-del-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, University of Valladolid, 47002 Valladolid, Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, University of Valladolid, 47002 Valladolid, Spain
| | - Elena Bueno-Gracia
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Sonia Rodríguez-Marco
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Santos Caudevilla-Polo
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
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LIM JX, WANG F, HO YX, ER JH, VIJAYAN J, SEBASTIN SJ. Normative Value of the Cross-Sectional Area of the Median Nerve at the Carpal Tunnel Inlet and Distal Forearm in the Singapore Population. J Hand Surg Asian Pac Vol 2022; 27:649-655. [DOI: 10.1142/s242483552250062x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Ultrasonography is often used in the diagnosis of carpal tunnel syndrome (CTS). However, we were unable to find normative data regarding the cross-sectional area (CSA) of the median nerve in the Singapore population as measured by ultrasound. The aims of this study were to establish normative values of the CSA of the median nerve at the carpal tunnel inlet in a healthy population, 5 cm proximal to the carpal tunnel inlet, and to determine if the CSA correlated with side, age, gender or race. Methods: Sixty-nine wrists of 36 healthy subjects with no history of wrist injury or any signs and symptoms of CTS were examined. The CSA of the median nerve at the carpal tunnel inlet and 5 cm proximal to the carpal tunnel inlet was determined using ultrasound by a trained operator. Results: The mean CSA of the median nerve at the carpal tunnel inlet was 6.41 mm2 (SD 2.18 mm2). These were not significantly different from the values for mean CSA obtained 5 cm proximal to the carpal tunnel inlet. We did not find any correlation between the CSA of the median nerve and age, gender or race. Conclusions: The mean CSA of the median nerve at the carpal tunnel inlet in normal subjects in Singapore was found to be lower than other Asian populations. Wide variations of the median nerve CSA at the carpal tunnel inlet exists in the literature, and this is probably due to the heterogeneity of the study methodology and population. Level of Evidence: Level III (Diagnostic)
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Affiliation(s)
- Jin X. LIM
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Feifan WANG
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Yih X.C. HO
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Jian H. ER
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Joy VIJAYAN
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Sandeep J. SEBASTIN
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
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Ziaeifar M, Noorizadeh Dehkordi S, Haghighatkhah HR, Sarrafzadeh J, Arabloo AM, Zendehdel Jadehkenari A. Intrarater Reliability of Diaphragm Excursion and Resting Thickness Using Ultrasound Imaging in Subjects With Nonspecific Chronic Low Back Pain. J Chiropr Med 2022; 21:15-22. [DOI: 10.1016/j.jcm.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/30/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022] Open
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Turcotte KE, Kociolek AM. Median nerve travel and deformation in the transverse carpal tunnel increases with chuck grip force and deviated wrist position. PeerJ 2021; 9:e11038. [PMID: 33777528 PMCID: PMC7983861 DOI: 10.7717/peerj.11038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background We assessed median nerve travel and deformation concurrently to better understand the influence of occupational risk factors on carpal tunnel dynamics, including forceful chuck gripping and deviated wrist positions. Methods Fourteen healthy right-hand dominant participants performed a chuck grip in 6 experimental conditions: two relative force levels (10% and 40% of maximum voluntary effort); three wrist positions (15° radial deviation, 0° neutral, 30° ulnar deviation). Chuck grip forces were measured with a load cell while the transverse cross-section of the carpal tunnel was imaged via ultrasound at the distal wrist crease. Images of the median nerve were analyzed in ImageJ to assess cross-sectional area, circularity, width, and height as well as travel in the anterior-posterior and medial-lateral axes. Results We found a main effect of deviated wrist position on both anterior-posterior and medial-lateral travel, with the greatest nerve travel occurring in 30° ulnar deviation. There was also a significant interaction between chuck grip force and deviated wrist position on cross-sectional area. Specifically, the area decreased with 40% vs. 10% chuck grip force when the wrist was in 30° ulnar deviation; however, there were no changes in 0° neutral and 15° radial deviation. Discussion Overall, we demonstrated that forceful chuck gripping in deviated wrist positions influenced carpal tunnel dynamics, resulting in both migratory and morphological changes to the median nerve. These changes may, in turn, increase local strain and stress with adjacent structures in the carpal tunnel. Future studies mapping contact stress between structures may further elucidate injury development of work-related carpal tunnel syndrome.
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Affiliation(s)
- Kaylyn E Turcotte
- School of Physical and Health Education, Nipissing University, North Bay, Ontario, Canada
| | - Aaron M Kociolek
- School of Physical and Health Education, Nipissing University, North Bay, Ontario, Canada
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Whitney DG, Alford AI, Devlin MJ, Li Y, Caird MS. Intersite reliability of vertebral bone marrow lipidomics-derived lipid composition among children with varying degrees of bone fragility undergoing routine orthopedic surgery. Bone 2021; 143:115633. [PMID: 32927104 PMCID: PMC7770023 DOI: 10.1016/j.bone.2020.115633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/30/2020] [Accepted: 09/09/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Lipidomics, a branch of metabolomics, is an attractive technique to characterize bone marrow lipid composition, which may be associated with skeletal acquisition and homeostasis. However, the reliability of lipidomics-derived lipid composition of the bone marrow is unknown, especially for pediatric populations with bone fragility. The purpose of this study was to evaluate the intersite reliability and standard error of measurement (SEM) of vertebral bone marrow lipid composition at the thoracic (T11/T12) and lumbar (L1/L2) spine determined by targeted lipidomics among children with varying degrees of bone fragility undergoing routine orthopedic surgery. METHODS Children aged between 12 and 19 years of age, with a confirmed diagnosis of adolescent idiopathic scoliosis or neuromuscular scoliosis and cerebral palsy, and undergoing routine posterior spinal fusion surgery at our institution were initially included in this study. Transpedicular vertebral body bone marrow samples were taken from thoracic (T) or lumbar (L) vertebrae. Further inclusion criteria involved having bone marrow extracted from both T11 and T12 (n = 24) or L1 and L2 (n = 19). Lipid composition was measured using a targeted lipidomics technique and examined as the saturated, monounsaturated, and polyunsaturated index and as individual fatty acids. Relative and absolute test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and SEM. RESULTS For the T11/T12 analysis: the ICC and SEM were 0.59 and 1.7% for the saturated index, 0.31 and 6.2% for the monounsaturated index, and 0.44 and 6.1% for the polyunsaturated index; the ICC showed a considerable range for individual fatty acids from 0.07 (fatty acid 20:2) to 0.82 (15:0) with 62.1% of the fatty acids having poor reliability (i.e., ICC < 0.50). For the L1/L2 analysis: the ICC and SEM were 0.50 and 2.4% for the saturated index, -0.12 and 6.0% for the monounsaturated index, and 0.00 and 4.9% for the polyunsaturated index; the ICC showed a considerable range for individual fatty acids from -0.34 (18:1_n-9) to 0.88 (15:0 and 18:3_n-3) with 79.3% of the fatty acids having poor reliability. CONCLUSIONS The intersite test-retest reliability was poor-to-moderate for index measures and generally poor for individual fatty acids for the thoracic and lumbar spine. At this time, it is not recommended to pool bone marrow adipose tissue across vertebral sites for bone marrow adiposity research or clinical monitoring for pediatric populations with bone fragility.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Ann Arbor, MI 48109, United States of America.
| | - Andrea I Alford
- Department of Orthopaedic Surgery, University of Michigan, A. Alfred Taubman Biomedical Sciences Research Building, Room 2009, Ann Arbor, MI 48109, United States of America
| | - Maureen J Devlin
- Department of Anthropology, University of Michigan, 1085 S. University Ave., Ann Arbor, MI 48109, United States of America
| | - Ying Li
- Department of Orthopaedic Surgery, University of Michigan, A. Alfred Taubman Biomedical Sciences Research Building, Room 2009, Ann Arbor, MI 48109, United States of America
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, A. Alfred Taubman Biomedical Sciences Research Building, Room 2009, Ann Arbor, MI 48109, United States of America
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Whitney DG, Devlin MJ, Alford AI, Modlesky CM, Peterson MD, Li Y, Caird MS. Test-Retest Reliability and Correlates of Vertebral Bone Marrow Lipid Composition by Lipidomics Among Children With Varying Degrees of Bone Fragility. JBMR Plus 2020; 4:e10400. [PMID: 33103029 PMCID: PMC7574707 DOI: 10.1002/jbm4.10400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022] Open
Abstract
The reliability of lipidomics, an approach to identify the presence and interactions of lipids, to analyze the bone marrow lipid composition among pediatric populations with bone fragility is unknown. The objective of this study was to assess the test–retest reliability, standard error of measurement (SEM), and the minimal detectable change (MDC) of vertebral bone marrow lipid composition determined by targeted lipidomics among children with varying degrees of bone fragility undergoing routine orthopedic surgery. Children aged 10 to 19 years, with a confirmed diagnosis of adolescent idiopathic scoliosis (n = 13) or neuromuscular scoliosis and cerebral palsy (n = 3), undergoing posterior spinal fusion surgery at our institution were included in this study. Transpedicular vertebral body bone marrow samples were taken from thoracic vertebrae (T11, 12) or lumbar vertebrae (L1 to L4). Lipid composition was assessed via targeted lipidomics and all samples were analyzed in the same batch. Lipid composition measures were examined as the saturated, monounsaturated, and polyunsaturated index and as individual fatty acids. Relative and absolute test–retest reliability was assessed using the intraclass correlation coefficient (ICC), SEM, and MDC. Associations between demographics and index measures were explored. The ICC, SEM, and MDC were 0.81 (95% CI, 0.55–0.93), 1.6%, and 4.3%, respectively, for the saturated index, 0.66 (95% CI, 0.25–0.87), 3.5%, and 9.7%, respectively, for the monounsaturated index, and 0.60 (95% CI, 0.17–0.84), 3.6%, and 9.9%, respectively, for the polyunsaturated index. For the individual fatty acids, the ICC showed a considerable range from 0.04 (22:2n‐6) to 0.97 (18:3n‐3). Age was positively correlated with the saturated index (r2 = 0.36; p = 0.014) and negatively correlated with the polyunsaturated index (r2 = 0.26; p = 0.043); there was no difference in index measures by sex (p > 0.58). The test–retest reliability was moderate‐to‐good for index measures and poor to excellent for individual fatty acids; this information can be used to power research studies and identify measures for clinical or research monitoring. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation University of Michigan Ann Arbor MI USA.,Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI USA
| | - Maureen J Devlin
- Department of Anthropology University of Michigan Ann Arbor MI USA
| | - Andrea I Alford
- Department of Orthopaedic Surgery University of Michigan Ann Arbor MI USA
| | | | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation University of Michigan Ann Arbor MI USA.,Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI USA
| | - Ying Li
- Department of Orthopaedic Surgery University of Michigan Ann Arbor MI USA
| | - Michelle S Caird
- Department of Orthopaedic Surgery University of Michigan Ann Arbor MI USA
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Ardakani AA, Afshar A, Bhatt S, Bureau NJ, Tahmasebi A, Acharya UR, Mohammadi A. Diagnosis of carpal tunnel syndrome: A comparative study of shear wave elastography, morphometry and artificial intelligence techniques. Pattern Recognit Lett 2020. [DOI: 10.1016/j.patrec.2020.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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13
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Yao B, Gan K, Lee A, Roll SC. Comparing Shape Categorization to Circularity Measurement in the Evaluation of Median Nerve Compression Using Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020; 2020. [PMID: 32064465 DOI: 10.1177/8756479319898471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose This study aimed to develop a subjective categorization of nerve shape and to examine the relationship of shape categorizations to measurement of nerve circularity. Methods Wrists were evaluated with sonography in healthy participants. Images of the median nerve were obtained in the transverse plane at the level of pisiform with the fingers resting, gripping, and pinching. Nerves were categorized as ovoid, angular, or irregular, and the cross-sectional area and perimeter were measured to calculate nerve circularity. Results Across 167 participants, the median nerve shifted from being primarily ovoid at rest to angular shaped when the fingers were in a full fist or pinching. Approximately three-quarters of subjects exhibited a shape change during dynamic movement. Irregular nerves had the lowest circularity values; however, the majority of nerves had similar circularity measures despite having different shapes. Conclusions Subjective categorization of shape has the potential to be a valid technique for evaluation of the median nerve using sonography, and this evaluation may provide additional information regarding nerve compression that is not fully captured by a circularity measure. Further investigation is needed to determine how these two techniques may be best used individually or together to advance clinical diagnosis, prevention, and rehabilitative interventions.
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Affiliation(s)
- Buwen Yao
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Kayla Gan
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Annie Lee
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
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Dimensional changes of the carpal tunnel and median nerve during manual mobilization of the carpal bones - Anatomical study. Clin Biomech (Bristol, Avon) 2018; 59:56-61. [PMID: 30195102 DOI: 10.1016/j.clinbiomech.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/01/2018] [Accepted: 09/01/2018] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional study. BACKGROUND The carpal tunnel is a clinically important fibro-osseous conduit for the median nerve and associated tendons. It is mechanically dynamic and therapeutic manual techniques that appear to move and change tunnel shape is part of clinical practice. OBJECTIVES To measure changes in dimensions of the carpal tunnel and median nerve with manual mobilization of the carpal bones in cadavers. METHODS A total of 20 cryopreserved upper extremities from cadaveric specimens were used in the study. The wrist was cut using an anatomical saw at the level of the pisiform. 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 taken, both in the anatomical position of the wrist and during the mobilization technique of the carpal bones. RESULTS During the mobilization technique, the tunnel CSA (p < 0.011), APD (p < 0.001) and circularity (p < 0.001) significantly increased, while TD (p < 0.001), perimeter (p < 0.004) and flattening ratio (p < 0.001), decreased. The median nerve showed similar behavioral tendencies to the tunnel but only the CSA (p < 0.005), APD (p < 0.005) and flattening ratio (p < 0.004) of the nerve showed significant differences. CONCLUSION Application of external manually applied compressive force across the wrist can increase the CSA of the carpal tunnel and the median nerve in cadavers. These results are consistent with other studies in which similar results were found non-invasively using ultrasound.
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Bueno-Gracia E, Ruiz-de-Escudero-Zapico A, Malo-Urriés M, Shacklock M, Estébanez-de-Miguel E, Fanlo-Mazas P, Caudevilla-Polo S, Jiménez-Del-Barrio S. Dimensional changes of the carpal tunnel and the median nerve during manual mobilization of the carpal bones. Musculoskelet Sci Pract 2018; 36:12-16. [PMID: 29635191 DOI: 10.1016/j.msksp.2018.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Elena Bueno-Gracia
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain.
| | - Alazne Ruiz-de-Escudero-Zapico
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | - Miguel Malo-Urriés
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | | | - Elena Estébanez-de-Miguel
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | - Pablo Fanlo-Mazas
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | - Santos Caudevilla-Polo
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
| | - Sandra Jiménez-Del-Barrio
- Department of Physiatry and Nursery, Faculty of Heath Sciences, University of Zaragoza, C/Domingo Miral s/n, CP: 50009. Zaragoza, Spain
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Pourahmadi MR, Ebrahimi Takamjani I, Jaberzadeh S, Sarrafzadeh J, Sanjari MA, Bagheri R, Jannati E. Test-retest reliability of sit-to-stand and stand-to-sit analysis in people with and without chronic non-specific low back pain. Musculoskelet Sci Pract 2018; 35:95-104. [PMID: 29128293 DOI: 10.1016/j.msksp.2017.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/09/2017] [Accepted: 11/01/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sit-to-stand (STD) and stand-to-sit (SIT) analysis can provide information on functional independence in daily activities in patients with low back pain (LBP). However, in order for measurements to be clinically useful, data on psychometric properties should be available. OBJECTIVES The main purpose was to investigate intra-rater reliability of STD and SIT tasks in participants with and without chronic non-specific LBP (CNLBP). The second purpose was to detect any differences in lumbar spine and hips sagittal plane kinematics and coordination between asymptomatic individuals and CNLBP patients during STD and SIT. DESIGN Cross-sectional study. METHOD Twenty-three CNLBP patients and 23 demographically-matched controls were recruited. Ten markers were placed on specific anatomical landmarks. Participants were asked to perform STD and SIT at a preferred speed. Peak flexion angles, mean angular velocities, lumbar to hip movement ratios, and relative phase angles were measured. The procedure was repeated after 2 h and 6-8 days. Differences between two groups were analyzed using independent t-test. Intraclass correlation coefficient (ICC 3,k), standard error of measurement (SEM), and limits of agreement (LOAs) were also estimated. RESULTS The ICC values showed moderate to excellent intra-rater reliability, with relatively low SEM values (≤10.17°). The 95% LOAs demonstrated that there were no differences between the measured parameters. Furthermore, CNLBP patients had limited sagittal plane angles, smaller angular velocities, and lumbar-hip dis-coordination compared to asymptomatic participants. CONCLUSIONS The results indicated moderate to excellent test-retest reliability of STD and SIT analysis. Moreover, CNLBP patients had altered kinematics during STD and its reverse.
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Affiliation(s)
- Mohammad Reza Pourahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ismail Ebrahimi Takamjani
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Shapour Jaberzadeh
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University Peninsula Campus, Melbourne, Australia
| | - Javad Sarrafzadeh
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rasool Bagheri
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Jannati
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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