twist of the wrist的用法和样例：
The difference between a helping hand and an outstretched palm is a twist of the wrist.
援助之手和摊开的巴掌的区别就是转一下手腕。
He hit the ball with just a flick of the wrist.
他只用手腕轻轻一抖，打出了那个球。
It's an ironic twist of the so called brain-drain.
这是人才外流的一个讽刺性转变。
A small, hook - shaped carpal bone of the wrist.
钩骨腕子上一种小的、钩状的腕骨
A small, hook-shaped carpal bone of the wrist.
钩骨腕子上一种小的、钩状的腕骨
twist of the wrist的海词问答与网友补充：
twist of the wrist的相关资料：
相关词典网站：Carpal Tunnel: How To Prevent Carpal Tunnel Syndrome And The Best Exercises On How To Treat Carpal Tunnel Syndrome So You Can Be Relieved Of Your Wrist ... Carpal Tunnel Cure, Wrist Pain Prevention) - Kindle Store Top eBooks
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):564-71.[Surgical treatment possibilities of advanced carpal collapse (SNAC/SLAC wrist)]. [Article in German]1, , , , , .1Abteilung für Verbrennungen, Plastische und Handchirurgie, Berufsgenossenschaftliche, Ruprecht-Karls-Universit?t Heidelberg. Sauerbie@rumms.uni-mannheim.deAbstractLongstanding and untreated scaphoid fractures and scapholunate dissociations lead to painful destruction of the wrist with carpal collapse. The severity of degenerative arthrosis is classified in three stages and can be treated adequate operatively. SNAC wrist (scaphoid nonunion advanced collapse) after failed fusion of the scaphoid and SLAC wrist (scapholunate advanced collapse) after scapholunate dissociation should be differentiated. The reconstruction of the scaphoid or scapholunate ligament in stage II and III is no reasonable option. Motion preserving procedures such as proximal row carpectomy or midcarpal arthrodesis are preferable in this situation. Thirty-one male patients (average 41 years) were treated for SNAC or SLAC wrist with midcarpal arthrodesis. All patients were reexamined, the mean follow-up was 15 months. Grip strength was measured with the Dexter-System, pain was evaluated by a visual analogue scale (VAS 0-100). Patients' daily activities and general quality of life were estimated with the DASH-questionnaire. Pain was reduced to 50% compared to the preoperative situation. Grip strength improved to 60% of the opposite side. Active range of motion reached 50% of the contralateral wrist. Total DASH-score reached 39.0. Nonunion at the fusion site necessitated additional surgery in four patients resulting in total wrist arthrodesis. 80% of the patients returned to their original occupation. Midcarpal fusion is a reliable procedure for treating the difficult condition of advanced carpal collapse if proper realignment of the carpus is performed. The DASH-score reflects the subjective impressions of the patients in daily life and justifies the choice of a salvage procedure preserving wrist mobility. Total wrist fusion represents the last line of defense.PMID:
[PubMed - indexed for MEDLINE]
Publication TypesMeSH TermsFull Text SourcesOther Literature SourcesMedical
Supplemental Content
External link. Please review our .Services on DemandArticleIndicatorsCited by SciELO Related linksSharePrint version ISSN XArq. Neuro-Psiquiatr. vol.64 no.3a S?o Paulo Sept. 2006 http://dx.doi.org/10.-282X3
Wrist immobilization after carpal tunnel release:
a prospective study
Avalia&&o prospectiva da imobiliza&&o
do pulso ap&s descompress&o cir&rgica do nervo mediano
no t&nel do carpo
Roberto S. MartinsI,II; Mario G. SiqueiraII; Hougelli
Simpl&cioI
IDepartment
of Neurosurgery, Hospital Santa Marcelina, S&o Paulo SP, Brazil
IIPeripheral Nerve Unit, Department of Neurosurgery, University of
S&o Paulo Medical School, S&o Paulo SP, Brazil
This prospective study evaluates the possible
advantages of wrist imobilization after open carpal tunnel release comparing
the results of two weeks immobilization and no immobilization. Fifty two patients
with idiopathic carpal tunnel syndrome were randomly selected in two groups
after open carpal tunnel release. In one group (A, n=26) the patients wore a
neutral-position wrist splint continuosly for two weeks. In the other group
(B, n=26) no wrist immobilization was used. Clinical assessment was done pre-operatively
and at 2 weeks follow-up and included the two-point discrimination test at the
second finger and two questionnaires as an outcome measurement of symptoms severity
and intensity. All the patients presented improvement in the postoperative evaluations
in the three analyzed parameters. There was no significant difference between
the two groups for any of the outcome measurements at the final follow-up. We
conclude that wrist immobilization in the immediate post-operative period have
no advantages when compared with no immobilization in the end result of carpal
tunnel release.
Key words:
carpal tunnel syndrome, surgical decompression, wrist imobilization.
Neste estudo prospectivo avaliamos se h&
vantagens na imobiliza&&o p&s-operat&ria do pulso
ap&s a cirurgia para o tratamento da s&ndrome do t&nel
do carpo comparando este tratamento com a aus&ncia de imobiliza&&o.
Cinq&enta e dois pacientes portadores de s&ndrome do t&nel
do carpo idiop&tica foram randomizados em dois grupos ap&s a cirurgia.
Em um grupo (grupo A, n=26) os pacientes utilizaram uma tala em posi&&o
neutra para imobiliza&&o do pulso por duas semanas. No outro grupo
(B, n=26), nenhum tipo de imobiliza&&o foi adotada. A avalia&&o
foi realizada antes da cirurgia e repetida ap&s duas semanas e incluiu
a mensura&&o da sensibilidade discriminat&ria no segundo
dedo e dois question&rios que avaliaram a gravidade e intensidade dos
sintomas. Em todos os pacientes houve melhora nos par&metros avaliados.
N&o houve diferen&a estatisticamente significativa entre os dois
grupos considerando os par&metros avaliados. Conclu&mos que a imobiliza&&o
do pulso no per&odo p&s-operat&rio imediato n&o
apresenta vantagens quando comparada com a aus&ncia de imobiliza&&o
ap&s a descompress&o cir&rgica do nervo mediano no punho.
Palavras-chave: s&ndrome do t&nel
do carpo, descompress&o cir&rgica, imobiliza&&o,
Carpal tunnel syndrome (CTS) is the most common
peripheral entrapment mononeuropathy and is manifested by characteristic signs
and symptoms resulting from median nerve compression at the wrist and/ or palm1.
Diagnosis is essentially clinical and often patient history alone is indicative
of CTS. The electrophysiologic studies confirm the diagnosis. The treatment
can be conservative, with corticosteroid infiltration, use of symptomatic drugs
and/or wrist splinting2.
The surgical treatment is indicated
when nonoperative management fails, when symptoms are presented for more than
one year and when there is a neurological deficit (motor or sensory).
In spite of been used by many surgeons3,
wrist immobilization after open surgery has been less well studied than surgical
treatment effects4-6. This study was developed with the purpose of
comparing parameters results in two patients groups, submitted or not to wrist
immobilization after open carpal tunnel release.
The research protocol of this study
was approved by the local Ethics Committee. Appropriate informed consent was
obtained both verbally and in writing form from each study subject prior to
surgery. The diagnosis of CTS was based on symptoms and findings on physical
examination. Clinical examination included the presence of typical sensory symptoms,
Tinel sign, Phalen?s and Durkan?s tests, sensory testing by two-point discrimination,
muscle testing and examination of thenar atrophy. All patients had electrophysiological
confirmation of CTS. Entry criteria for the study included all patients with
idiopathic CTS admitted at the Peripheral Nerve Unit at Hospital Santa Marcelina.
Exclusion criteria included inability to complete a self-admini
a previous c occurrence of medical conditions associated
with increased incidence of CTS like diabetes mellitu wrist
musculoskeletal, metabolic or
of space-occupying lesions at the wrist, identified before surgery or at intra- pregnancy.
The conservative treatment was
adopted for six weeks and included wrist splinting at neutral angle and use
of non-steroid anti-inflamatory drugs, if pain was the symptom. The surgical
treatment was adopted in patients with no response to conservative treatment
and in all cases presented with impairment of sensibility and/or motor deficit.
All patients included in the study
had open carpal tunnel release without upper-arm tourniquet under local anesthesia
by the senior author. A standard 3-cm incision was made in the palm along a
line projected proximally from the interspace between the middle and ring finger,
paralleling the thenar crease without transgressing the wrist flexion crease.
After the retinaculum section, the manipulation of the median nerve was limited
to the inspection to discard any additional extrinsic compression. Neither epineurotomy
nor internal neurolysis were performed. The wound was closed with interrupted
5.0 nylon sutures. All patients received the same immediate postoperative care.
Each wrist was immobilized in a soft dressing and light compressive bandage
for 48 hours and, after that, two groups with 26 patients were formed according
to the treatment adopted. In one group, called group A, the wrist was splinting
in a neutral position for two weeks. In another group, the group B, after the
withdrawal of the soft dressing it wasn't used any kind of immobilization and
patients were encouraged to move their hands and fingers freely. No other treatment,
including anti-inflammatory drugs, was used. The evaluations were performed
pre-operatively and repeated fourteen days after the surgery in a blind fashion.
All of the subjects were examined by one author. Each patient completed the
first section of a validated questionnaire described by Levine et al.7
(Severity Symptom Score - SSS). This tool, named Boston questionnaire (BQ),
is a self-reported questionnaire designed to evaluate the outcome specifically
in CTS and has been found to be reproducible, internally consistent and responsive
to clinical change7,8. In the first section of this scale, the symptom
score is determined from 11 questions regarding different attributes of pain,
tingling and numbness with each answer scoring between 1 (no symptom) and 5
(very severe symptoms). A translated version of this questionnaire to portuguese
was used in our study9. This version was previosly validated by Campos
et al.9. The intensity of symptoms (tingling, burning pain and numbness)
was evaluated by another scale (Symptom Intensity Scale - SIS). This was done
by asking the subjects to rate each symptom on an interval scale from 0 to 4,
with zero indicating "no sympton" and 4 indicating "intolerable
sympton". For both questionnaires the results were expressed as a mean
score for the answered questions.
Static two-point discrimination
was measured using a two-point discriminator (North Coast Medical Inc., California,
USA) applied to palmar surface of the second finger distal phalange. As well
as in the evaluation through the described scales, the two-point discrimination
was evaluated pre and post-operatively.
We compared preoperative and postoperative
scores of each evaluation, calculating three indices through the formula (preoperative
value - postoperative value/preoperative value). The indices were named symptom
severity index (SSI), sympton intensity index (SII) and discrimination index
(DI), according to each evaluated parameter.
Statistical analyses were performed by using
Bioestat for Windows program (version 2.0; Ayres M, Bel&m, Brazil). Paired
t tests were performed and the level of significance was set at p&0.05.
Fifty-two patients fullfilled the inclusion criteria
during the study period. We had two exclusions in this study, one patient with
classical symptoms who presented with a persistent median artery with large
diameter at surgery and a patient who presented postopera
this resolved with a 14-day course of oral antibiotic therapy. There were no
median nerve lesion, wound dehiscence or tendon injuries.
The ages of the patients ranged from 26 to 74
years and averaged 49.8 years. There were fourty-six women (88.5 percent) and
the right hand was involved in 63.5 percent of the cases. Seven patients had
bilateral involvement and underwent surgical procedures on separate time for
each hand. The average duration of symptoms at presentation was 29.31 months
(range, 6 to 72 months).
A positive Tinel?s sign was found in 44 patients
(84.5%), in 21 patients in the group A and in 23 patients in group B. A positive
Phalen?s test was identified in 49 patients (94.3%), in 24 patients in group
A and in 25 in group B. A positive Durkan?s test was found in 51 patients, in
25 patients in group A and in all patients in group B.
The severity and intensity of symptoms decreased
following surgery in all the patients. Pre-operatively, the average of SSS was
33.38±7.33 in the group A and 31.77±7.56 in the group B. Post-operatively, the
average of SSS was 11.38±4.57 in the group A and 12.33±4.77 in the group B.
The SSI was 0.64±0.15 in the group A and 0.61±0.12 in the group B ().
No significant changes in SSI were observed comparing the group A and group
B (p=0.059, ).
The average of SIS was 8.65±2.10 in the group
A and 8.23±2.23 in the group B at pre-operative period and was 0.77±1.31 in
the group A and 1.54±1.96 in the group B at post-operative period. The SII was
0.91±0.15 in the group A and 0.80± 0.27 in the group B ().
No significant difference was observed in SII between the two groups (p=0.386).
The average 2-point discrimination score improved
from 5.85±2.80 mm before surgery to 3.69±1.19 mm after surgery in group A and
from 7.92±3.12 mm before surgery to 5.12±2.53 mm after surgery in group B. The
DI was 0.27±0.27 in group A and 0.29±0.28 in group B. There was no statistically
significant difference between the 2 groups when DI was compared (p=0.756).
DISCUSSION
Carpal tunnel syndrome is the most commom entrapment
neuropathy and often occurs after the age of 30 years, with women been affected
three to six times more than men10,11. A large proportion of patients
fail to respond to conservative treatment and, in this population, carpal tunnel
decompression with division of the transverse carpal ligament has been a highly
successful procedure12. While the patient satisfaction is usually
high with the surgery, potential complications do exist and includes pain and
scar disconfort, wound dehiscence, bowstringing of the flexor tendons and inclusion
of the median nerve within the postoperative scar13-15.
To minimise these complications, most surgeons
immobilize patients? wrists for 1 to 4 weeks following open carpal tunnel surgery3.
On the other hand, some authors recommend precocious mobilization of wrist and
fingers after the surgery in order to enable the free longitudinal nerve movement
in the surgical bed, what should avoid possible adherences from neighboring
structures16.
Few studies in literature have investigated the
effects of immobilization following the open carpal tunnel release4-6.
Bury et al. compared 2-weeks of postoperative wrist splinting versus a bulky
dressing after 43 open carpal tunnel releases4. In this study, there
were no statiscally significant differences between the two groups. The evaluation
included subjective parameters of patient satisfaction and objective parameters
of grip and lateral pinch strength, complication rates, and digital and wrist
range of motion4. Cook et al. compared postoperative 2-weeks splinting
with early range-of-motion treatment in a serie with 50 patients5.
They found that there was an earlier return in grip and key pinch strength and
significantly better results, considering a subjective pain scale, in the nonsplinted
group. Finally, Finsen et al. reported no signifficant differences between post-operative
immobilization and non-immobilization after open carpal tunnel release in 82
wrists6. The splint was used for 4 weeks and the authors evaluated
pain and scar disconfort through a visual analogue scale and the grip and keypinch
strength. In general, the published studies do not show sufficient evidence
to justify routine wrist immobilization following open carpal tunnel release.
In the current study there was no difference also between two patients groups
considering the use or not of postoperative immobilization. The use of wrist
immobilization following open carpal tunnel release had not been previously
studied using a validated outcome questionnaire.
It is important to remind that the related studies,
including ours, evaluated only patients with idiopathic CTS. In this patient
subpopulation, the adverse effects of surgery on the flexor tendon mechanics
such as bowstringing of the tendons are known but they are very rare and seldom
lead to serious problems17,18. It is not clear if the non-immobilization
treatment can affect the recovery after surgery in patients where there is an
associated rheumatologic conditions like basal joint arthritis19.
Additional studies are necessary to evaluate if similar results are observed
in this kind of patient.
In conclusion, if we consider the evaluated parameters,
our results suggest that the wrist immobilizaton after open carpal tunnel release
is not necessary in idiopathic CTS.
REFERENCES
1. Kouyoumdjian JA. S&ndrome do t&nel
do carpo: aspectos cl&nico-epidemiol&gicos em 668 casos. Arq Neuropsiquiatr
-207.&&&&&&&&[  ] 2. Shapiro S. Microsurgical carpal tunnel
release. Neurosurgery -70.&&&&&&&&[  ] 3. Duncan KH, Lewis RC, Foreman KA, Nordyke
MD. Treatment of carpal tunnel syndrome by members of the American Society for
Surgery of the Hand : results of a questionnaire. J Hand Surg (Am) -391.
&&&&&&&&[  ] 4. Bury TF, Akelman E, Weiss AC. Prospective,
randomized trial of splinting after carpal tunnel release. Ann Plast Surg -22.&&&&&&&&[  ] 5. Cook AC, Szabo RM, Birkholz SW, King
EF. Early mobilization following carpal tunnel release: a prospective randomized
study. J Hand Surg (Br) -230.&&&&&&&&[  ] 6. Finsen V, Andersen K, Russwurm H. No
advantage from splinting the wrist after open carpal tunnel release: a randomized
study of 82 wrists. Acta Orthop Scand -292.&&&&&&&&[  ] 7. Levine DW, Simmons BP, Koris MJ, et al.
A self-administered questionnaire for the assessment of severity of symptons
and funcional status in carpal tunnel syndrome. J Bone Joint Surg (Am) 5-1592.&&&&&&&&[  ] 8. Greenslade JR, Mehta RL, Belward P, Warwick
DJ. Dash and Boston questionnaire assessment of carpal tunnel syndrome outcome:
what is the responsiveness of an outcome questionnaire? J Hand Surg (Br) 2004;
29:159-164.&&&&&&&&[  ] 9. Campos CC, Manzano GM, Andrade LB, Castelo
A Filho, N&brega JAM. Tradu&&o e valida&&o
do question&rio de avalia&&o de gravidade dos sintomas
e do estado funcional na s&ndrome do t&nel do carpo. Arq Neuropsiquiatr
-55.&&&&&&&&[  ]10. Akelman E, Weiss AC. Carpal tunnel syndrome.
Etiology and endoscopic treatment. Orthop Clin North Am -786.&&&&&&&&[  ]11. Gomes I, Becker J, Ehlers JA, Kapczinski
F, Nora DB. Seasonal distribuiton and demographical characteristics of carpal
tunnel syndrome in 1039 patients. Arq Neuropsiquiatr -599.&&&&&&&&[  ]12. Dawson DM. Entrapment neuropathies of the
upper extremities. N Engl J Med 3.&&&&&&&&[  ]13. Richman JA, Gelberman RH, Rydevik BL, et
al. Carpal tunnel syndrome: morphological changes after release of the transverse
carpal ligament. J Hand Surg (Am) -857.&&&&&&&&[  ]14. Gelberman RH, Eaton RG, Urbaniak JR. Peripheral
nerve compression. J Bone Joint Surg (Am) 4-1878.&&&&&&&&[  ]15. Netscher D, Mosharrafa A, Lee M, et al.
Transverse carpal ligament: its effect on flexor tendon excursion, morphologic
changes of the carpal canal, and on pinch and grip strengths after open carpal
tunnel release. Plast Reconstr Surg -642.&&&&&&&&[  ]16. Nathan PA, Meadows KD, Keniston RC. Rehabilitation
of carpal tunnel surgery patients using a short surgical incision and an early
program of physical therapy. J Hand Surg (Am) 4-1050.&&&&&&&&[  ]17. Kiritsis PG, Kline SC. Biomechanical changes
after carpal tunnel release: a cadaveric model for comparing open, endoscopic,
and step-cut lengthening techniques. J Hand Surg (Am) -180.&&&&&&&&[  ]18. McDonald RI, Lichtman DM, Hanlon JJ, Wilson
JN. Complications of surgical release for carpal tunnel syndrome. J Hand Surg
-76.&&&&&&&&[  ]19. Freeland AE, Tucci MA, Barbieri RA, Angel
MF, Nick TG. Biochemical evaluation of serum and flexor tenosynovium in carpal
tunnel syndrome. Microsurgery -385. &&&&&&&&[  ]&
Received 16 September 2005, received in final
form 14 February 2006. Accepted 10 April 2006.
Dr. Roberto S. Martins - Rua Maestro Cardim
592 / 1101 -
S&o Paulo SP - Brasil. E-mail:}