Clinical Assessment and Diagnostics of Patients With Hand Disorders: A Case Study Approach

[Acute carpal tunnel syndrome regarding clinico-anatomical point of view in personified medicine]

Carpal tunnel syndrome (CTS) requires special attention due to its different reasons and course. Knowledge about the variability of median nerve (MN) topography in carpal canal region, features of diagnosis and treatment extends outlooks on this pathology. Aggregating rare clinical cases from the Medline and Pubmed databases is useful to form personified approach. There are 3 types of topographic variations which should be considered to prevent false-positive diagnosis of pathology: recurrent branch location, early bi- and trifurcations of MN, anastomoses. Since acute CTS is treated only by surgery, every surgical approach is aimed at minimally invasiveness and fast recovery. Endoscopic decompression (ED) is more favorable regarding these aspects. However, this method cannot be considered as perfect due to available data about incomplete decompression and certain incidence of recurrences. The last ones are absent after microsurgical decompression as a rule. It can be concluded that only individual approach is advisable for complete release of CTS without iatrogenic damage and recurrences.

Hand Assessment for Elderly People in the Community

BACKGROUND

Hand conditions are common in elderly persons.

PURPOSE

To assess the prevalence of common hand conditions in elderly persons in a community setting, specifically osteoarthritis of the hand, trigger finger, and carpal tunnel syndrome.

METHODS

The elderly persons were recruited from community groups for elderly persons. Data collection included participants' demographic and clinical data; quick disability, arm, shoulder, and hand (QuickDASH) questionnaire; and presence of hand conditions.

RESULTS

Of the 55 elderly persons recruited, almost a third of them presented with a hand condition (n = 17, 30.8%). Hand conditions were more common in females (39% in females, 7% in males; χ = 4.97, p = .04). Quick-DASH scores were higher in those with hand conditions, indicating lower levels of function (greater disability) (t =-4.61, p = .002).

CONCLUSIONS

Most elderly persons did not seek medical attention for their hand condition until the late stages. Nurses can play an important role in providing community hand assessment, education on hand symptoms, information about available treatment, and adaptive approaches to maximize functioning.