Carpal Tunnel Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

CARPAL TUNNEL

SYNDROME A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Carpal Tunnel Syndrome: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83774-0 1. Carpal Tunnel Syndrome-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on carpal tunnel syndrome. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON CARPAL TUNNEL SYNDROME .................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Carpal Tunnel Syndrome.............................................................. 6 E-Journals: PubMed Central ....................................................................................................... 23 The National Library of Medicine: PubMed ................................................................................ 23 CHAPTER 2. NUTRITION AND CARPAL TUNNEL SYNDROME ........................................................ 67 Overview...................................................................................................................................... 67 Finding Nutrition Studies on Carpal Tunnel Syndrome ............................................................ 67 Federal Resources on Nutrition ................................................................................................... 71 Additional Web Resources ........................................................................................................... 71 CHAPTER 3. ALTERNATIVE MEDICINE AND CARPAL TUNNEL SYNDROME .................................. 73 Overview...................................................................................................................................... 73 The Combined Health Information Database............................................................................... 73 National Center for Complementary and Alternative Medicine.................................................. 74 Additional Web Resources ........................................................................................................... 81 General References ....................................................................................................................... 84 CHAPTER 4. DISSERTATIONS ON CARPAL TUNNEL SYNDROME .................................................... 87 Overview...................................................................................................................................... 87 Dissertations on Carpal Tunnel Syndrome ................................................................................. 87 Keeping Current .......................................................................................................................... 88 CHAPTER 5. CLINICAL TRIALS AND CARPAL TUNNEL SYNDROME ............................................... 89 Overview...................................................................................................................................... 89 Recent Trials on Carpal Tunnel Syndrome ................................................................................. 89 Keeping Current on Clinical Trials ............................................................................................. 91 CHAPTER 6. PATENTS ON CARPAL TUNNEL SYNDROME ............................................................... 93 Overview...................................................................................................................................... 93 Patents on Carpal Tunnel Syndrome........................................................................................... 93 Patent Applications on Carpal Tunnel Syndrome..................................................................... 129 Keeping Current ........................................................................................................................ 145 CHAPTER 7. BOOKS ON CARPAL TUNNEL SYNDROME................................................................. 147 Overview.................................................................................................................................... 147 Book Summaries: Federal Agencies............................................................................................ 147 Book Summaries: Online Booksellers......................................................................................... 148 The National Library of Medicine Book Index ........................................................................... 150 Chapters on Carpal Tunnel Syndrome ...................................................................................... 151 CHAPTER 8. MULTIMEDIA ON CARPAL TUNNEL SYNDROME ...................................................... 159 Overview.................................................................................................................................... 159 Bibliography: Multimedia on Carpal Tunnel Syndrome ........................................................... 159 CHAPTER 9. PERIODICALS AND NEWS ON CARPAL TUNNEL SYNDROME ................................... 161 Overview.................................................................................................................................... 161 News Services and Press Releases.............................................................................................. 161 Newsletter Articles .................................................................................................................... 164 Academic Periodicals covering Carpal Tunnel Syndrome ......................................................... 165 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 167 Overview.................................................................................................................................... 167 U.S. Pharmacopeia..................................................................................................................... 167 Commercial Databases ............................................................................................................... 168 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 173 Overview.................................................................................................................................... 173

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NIH Guidelines.......................................................................................................................... 173 NIH Databases........................................................................................................................... 175 Other Commercial Databases..................................................................................................... 177 The Genome Project and Carpal Tunnel Syndrome................................................................... 177 APPENDIX B. PATIENT RESOURCES ............................................................................................... 181 Overview.................................................................................................................................... 181 Patient Guideline Sources.......................................................................................................... 181 Finding Associations.................................................................................................................. 187 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 189 Overview.................................................................................................................................... 189 Preparation................................................................................................................................. 189 Finding a Local Medical Library................................................................................................ 189 Medical Libraries in the U.S. and Canada ................................................................................. 189 ONLINE GLOSSARIES................................................................................................................ 195 Online Dictionary Directories ................................................................................................... 197 CARPAL TUNNEL SYNDROME DICTIONARY ................................................................... 199 INDEX .............................................................................................................................................. 249

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with carpal tunnel syndrome is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about carpal tunnel syndrome, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to carpal tunnel syndrome, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on carpal tunnel syndrome. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to carpal tunnel syndrome, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on carpal tunnel syndrome. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON CARPAL TUNNEL SYNDROME Overview In this chapter, we will show you how to locate peer-reviewed references and studies on carpal tunnel syndrome.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and carpal tunnel syndrome, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “carpal tunnel syndrome” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Carpal Tunnel Syndrome in Patients with Diabetic Polyneuropathy Source: Diabetes Care. 25(3): 565-569. March 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN, nerve disease) are common conditions in patients with diabetes and therefore frequently occur concomitantly (at the same time). Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. The authors report on a study in which a total of 478 subjects, including reference subjects (without diabetes and without neuropathy),

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nonneuropathic subjects with diabetes, and diabetic subjects with mild, moderate, and severe neuropathy, were evaluated in a cross sectional design for the clinical features of CTS. The prevalence of clinical CTS was 2 percent in the reference population, 14 percent in diabetic subjects without DPN, and 30 percent in those with DPN. Analyses revealed that mean electrodiagnostic parameters are not significant predictors of clinical CTS in patients with diabetes. Generally, the parameters worsened with severity of neuropathy, but none reliably distinguished diabetic patients with and without CTS. The authors recommend that therapeutic decisions for CTS be made independently of electrodiagnostic findings. 3 tables. 19 references. •

Carpal Tunnel Syndrome in the Dialysis Patient Source: Seminars in Dialysis. 3(1): 47-51. January-March, 1990. Summary: Carpal tunnel syndrome (CTS) is a painful and frequently disabling disorder of the median nerve. It has a significantly increased incidence in dialysis patients, occurring in approximately 10 to 15 percent of patients on long-term hemodialysis. It also occurs with increased frequency in patients on peritoneal dialysis. This article briefly reviews the current information and opinions on why this condition is more common in the dialysis patient. The authors then describe the characteristic clinical features of CTS and its differentiation from other diseases causing symptoms in the hands of uremic patients, such as radial artery steal syndrome and uremic neuropathy. Finally, the authors delineate a rational approach to treatment including splinting, steroid injection, or surgery. 17 references.

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Prevalence of Carpal Tunnel Syndrome and Median Mononeuropathy Among Dentists Source: JADA. Journal of the American Dental Association. 132(2): 163-170. February 2001. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2867. Website: www.ada.org. Summary: This article reports on a study undertaken to determine the prevalence in dentists of abnormal sensory nerve conduction or symptoms of carpal tunnel syndrome (CTS), the most common nerve entrapment syndrome. In the cross sectional study, dentists (n = 1,079) were screened during the American Dental Association's Annual Health Screening Program in 1997 and 1998 by means of standard electrodiagnostic measures in the dominant hand and a self reported symptom questionnaire. The authors diagnosed a median mononeuropathy (nerve disease) from a 0.5 or 0.8 millisecond (ms) prolongation of the median sensory evoked peak latency compared to the ulnar latency. They diagnosed CTS if the subject also had accompanying symptoms of numbness, tingling or pain. Thirteen percent of screened dentists were diagnosed with a median mononeuropathy, but only 32 percent of these had symptoms consistent with CTS (4.8 percent overall). When the 0.8 ms prolongation was used as the electrodiagnostic criterion, only 2.9 percent (overall) were diagnosed with CTS. People with diabetes, rheumatoid arthritis, and obesity were more likely to have a median mononeuropathy. The prevalence of symptoms consistent with CTS in the dominant hand among dentists was higher than the prevalence in the general population. However, when electrodiagnostic confirmation is added, the prevalence of CTS was nearly the same as that among the general population. The authors conclude that early recognition of CTS can lead to more effective management. Education regarding ergonomic risk factors can be an effective preventive measure. 1 figure. 4 tables. 25 references.

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'Perfect' Instrumentation Can be Hazardous to Your Health!-or-Ergonomic Applications for the Prevention of Carpal Tunnel Syndrome Source: Access. 9(1): 37-43. January 1995. Contact: Available from American Dental Hygienists' Association (ADHA). 444 North Michigan Avenue, Chicago, IL 60611. (800) 243-2342 or (312) 440-8900; Fax (312) 4408929; E-mail: [email protected]; http://www.adha.org. Summary: This article reviews problems with carpal tunnel syndrome faced by dental hygienists. The authors first explore the factors, some avoidable, some not, that can lead to the development of carpal tunnel syndrome (CTS) in this population. The latter part of the article discusses changes that dental hygienists can make in their own clinical activities that may help reduce the chances of acquiring CTS. Illustrations that depict the ergonomics involved, particularly leverage, are included. The authors include specific suggestions for effective instrumentation that allows minuscule breaks for the muscles surrounding the carpal tunnel. One sidebar lists the symptoms of CTS. 8 figures. 1 table. 7 references.

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An Update on Carpal Tunnel Syndrome Source: Patient Care. 37(2): 52-58. February 2003. Summary: This journal article for health professionals discusses the increasing occurrence of carpal tunnel syndrome (CTS). Physicians are seeing 2.7 million new patients every year due to finger, hand, or wrist symptoms. CTS causes pain and disability and is the basis for a significant number of worker compensation claims. A disorder of the wrist and hand induced by compression on the median nerve between the inelastic carpal ligament and other structures within the carpal tunnel, symptoms may include inflammation, numbness, parasthesia (tingling or burning), and muscle atrophy. Focal nerve enlargement and space occupying lesions may contribute to CTS. Most commonly, CTS involves the dominant hand first but in 35 percent of patients it can be bilateral. It is thought that CTS is caused by repeated flexion and extension at the wrist. Occupations that require repetitive or repeated wrist and hand motions, such as office workers, assembly-line workers, seamstresses, and musicians, are associated with CTS. In addition, CTS has been associated with lupus, rheumatoid arthritis, diabetes, and hyperthyroidism. Diagnostic tests include Tinel's sign and Phalan's maneuver. Electrodiagnosis is useful for testing sensory symptoms in the hand and arm. It can also show the severity and chronicity of the disease and indicate prognosis. MRI scanning can determine the amount of swelling and flattening of the median nerve. Treatment options include splinting, anti-inflammatory agents when splinting is not effective, and surgery. 5 tables and 14 references.

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Does This Patient Have Carpal Tunnel Syndrome? Source: JAMA. Journal of the American Medical Association. 283(23): 3110-3117. June 21, 2000. Summary: This journal article provides health professionals with information on a study that examined the precision and accuracy of history taking and physical examination in diagnosing carpal tunnel syndrome (CTS) in adults. English language literature was searched using the MEDLINE database for articles from January 1966 to February 2000. Bibliographies of all relevant articles were also reviewed. Studies were selected for inclusion if patients presented to clinicians with symptoms suggestive of CTS in which findings from clearly described physical examination maneuvers were independently

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compared with electrodiagnostic testing. Twelve of 42 initially identified articles met these criteria and were included in the study. In patients presenting with hand dysesthesias, the findings that best distinguish between patients with electrodiagnostic evidence of CTS and patients without it were hypalgesia in the median nerve territory, classic or probable Katz hand diagram results, and weak thumb abduction strength. Findings that argue against the diagnosis of CTS were unlikely Katz hand diagram results and normal thumb abduction strength. Several traditional findings of CTS had little or no diagnostic value, including nocturnal paresthesias; Phalen and Tinel signs; thenar atrophy; and 2 point, vibratory, and monofilament sensory testing. Other less commonly used maneuvers, including the square wrist sign, flick sign, and closed fist sign, require validation by other studies before they can be recommended. The article concludes that hand symptom diagrams, hypalgesia, and thumb abduction strength testing are helpful in establishing electrodiagnosis of CTS. The utility of these results is limited, however, by problems inherent in using nerve conduction studies as a criterion standard. 3 figures, 2 tables, and 96 references. (AA-M).

Federally Funded Research on Carpal Tunnel Syndrome The U.S. Government supports a variety of research studies relating to carpal tunnel syndrome. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to carpal tunnel syndrome. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore carpal tunnel syndrome. The following is typical of the type of information found when searching the CRISP database for carpal tunnel syndrome: •

Project Title: TENDINITIS

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MULTIDISCIPLINARY

STUDY

OF

MECHANISMS

FOR

Principal Investigator & Institution: Wang, James H.; Orthopaedic Surgery; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 04-SEP-2002; Project End 31-AUG-2006 Summary: The objective of this project is to elucidate the pathophysiological mechanisms for tendinitis using a novel in vitro model and an animal model. The central working hypothesis in this project is that tendon fibroblasts are responsible for the development of tendinitis by producing PGE2, which is upregulated by increased expression levels of PLA2, COX-1 and COX-2, and that high levels of PGE2 cause dysfunction of the tendon fibroblasts, thus resulting in pathophysiological changes in 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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tendons. The specific aims of this project are: 1) to investigate the role of PLA2 and COX expression in the production of PGE2 by human tendon fibroblasts under repetitive mechanical stretching using a novel in vitro model; 2) to investigate the role of stretching-induced PGE2 in inflammatory gene expression, proliferation and collagen synthesis of the human tendon fibroblasts using a novel in vitro model; and 3) to determine the effect of repeated exposure of the patellar tendon to PGE2 on its biological, biochemical, and biomechanical properties in a rabbit model. To accomplish these aims, a multidisciplinary approach based on mechano-biology, molecular biology and biomechanics will be used.When completed, this project will provide insights into the pathophysiological mechanisms for tendinitis at the cellular and molecular levels. It will also provide clinically valuable data about the effect of repetitive inflammation due to PGE2 on the tendon structure and function, which will help develop strategies to prevent and treat tendinitis effectively. The findings from this study will also be useful in helping design experiments to study other repetitive motion disorders (e.g., carpal tunnel syndrome). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ACUTE STRESS REACTIVITY AND DISEASE EXACERBATION IN RA Principal Investigator & Institution: Boyce, Thomas; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001 Summary: The objectives of this study are: (1) to conduct a laboratory investigation of 20 premenopausal women with RA in order to examine the effects of psychological stress on subjective, neuroendocrine, and immunologic responses that may be relevant to the pathogenesis of RA. For a subgroup of RA patients taking NSAIDs only, we will compare the magnitude of subjective and physiologic responses to a group of 20 healthy women who are diagnosed with carpal tunnel syndrome without RA, and matched for age, race, and NSAID use; (2) to determine if individual differences in the magnitude of physiologic stress responses can be demonstrated in patients with RA; (3) to conduct an exploratory and longitudinal investigation of whether such individual differences are associated with RA disease activity; (4) to carry out exploratory analyses examining potential associations between individual differences in physiologic reactivity and disease and psychosocial factors, including those that have been found to relate to distress and reported pain in RA samples. Examples include level of disease activity, social support, history of major negative events, and the personality traits of introversion and neuroticism, which have related to physiologic reactivity in healthy samples. The GCRC will be used as the site of the 3 hour laboratory investigation, which will be done during the follicular phase of each subject's menstrual cycle, and scheduled between 1-3 pm to control for circadian variations in hormone levels. The GCRC nurses will administer multiple questionnaires, perform frequent timed vital signs, coordinate two stress tasks and draw several timed blood samples during the stress producing tasks. The GCRC lab will perform the initial blood processing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: AN IMPROVED LEVER DRIVE WHEELCHAIR TRANSMISSION Principal Investigator & Institution: Green, Steve C.; President; Green Technologies, Inc. 13387 Green Rd West Fork, Ar 72774 Timing: Fiscal Year 2001; Project Start 02-AUG-2001; Project End 01-JAN-2002

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Summary: During typical wheelchair pushrim propulsion, significant forces must be applied by the wrist, arm and shoulder, despite the fact that they are not in optimum positions. Not surprisingly, pushrim wheelchair propulsion is associated with several common injuries. The most common are shoulder injuries and carpal tunnel syndrome (CTS). Surveys of manual wheelchair users show the prevalence of shoulder pain to be between 31% and 73% and of CTS to be between 49 and 73%. It is the specific aim of this proposed research program to build and test a wheelchair employing a lever drive mechanism with improved kinematics. The improved kinematic design will allow loading the wrists and shoulders through their normal range of motion and eliminating wrist flexion under load. There is reason to believe that straightening the wrists during loading may reduce the incidence of CTS. We have developed a lever drive concept that has the potential to reduce injuries and to deliver improved efficiency while overcoming the shortcomings of past lever drive systems. Our concept provides a continuously variable drive ratio, power delivery on both the push and pull strokes and straight line or arced powers strokes with a locked wrist. PROPOSED COMMERCIAL APPLICATIONS: Wheelchairs are in widespread use throughout the world. In the US alone, there are around 1.5 million wheelchair users. Of those, it is estimated that one half will eventually develop CTS and/or shoulder injuries such as rotator cuff tears. A wheelchair that could reduce the number of these injuries or allow injured users continued mobility would find broad acceptance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AXONAL TRANSPORT AND PERIPHERAL NERVE FUNCTION Principal Investigator & Institution: Topp, Kimberly S.; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-FEB-1997; Project End 31-JAN-2003 Summary: (Adapted from the Applicant's Description): Over the course of a lifetime, a significant percentage of the population needs medical attention for some form of neuropathy, such as low back pain, diabetic neuropathy or carpal tunnel syndrome. Due to their prevalence and complexity of treatment, neuropathies have a major financial impact in health care. Compromise of axonal transport may contribute to the pathophysiology of several clinical neuropathies. The goal of the candidate's proposed research is to understand the role of axonal transport in peripheral nerve function. Axons are dependent on continuous replenishment of membrane proteins and on the feedback provided by materials taken up at nerve terminals. The length of the nerve dictates that bi-directional transport be tightly regulated. Interruption of axonal transport leads to Wallerian degeneration of axons distal to the site of impairment. Therefore, several neuropathies are thought to have impaired axonal transport. However, there have been few controlled investigations of the functional consequences of impaired axonal transport or of the aspects of transport that may contribute to peripheral neuropathy. The proposed specific aims address these two issues, and seek to identify physical interventions that may alter function in neuropathic nerves. The first aim is to determine how the function of peripheral nerves is impaired by disruption of axonal transport. To accomplish this aim, peripher-al nerves in which axonal transport has been experimentally impaired will be tested for their ability to respond to sensory stimuli, using behavioral tests and electrophysiological techniques. The second aim is to determine what aspects of axonal transport are disrupted in peripheral neuropathies. To address this aim, peripheral poly- or mononeuropathy will be experimentally induced, and anterograde or retrograde axonal transport will be tested for impairment, using biochemical and morphological techniques. Additional observations will be made of the

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components required for axonal transport, specifically, energy stores, divalent cations and cytoskeletal structural framework. The third aim is to identify physical interventions that improve or impair axonal transport and nerve function in peripheral neuropathies. To accomplish this aim, neuropathic nerves with demonstrated alterations in axonal transport will be further exposed to nerve compression, extremity mobilization or immobilization. Nerve function will be assessed using behavioral tests and electrophysiological techniques. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOMECHANICAL EVALUATION OF WRIST LIGAMENT INJURIES Principal Investigator & Institution: Short, Walter H.; Orthopedic Surgery; Upstate Medical University Research Administration Syracuse, Ny 13210 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2006 Summary: (provided by applicant): The objective of this project is to develop a better understanding of ligamentous injuries of the wrist. The diagnosis of wrist ligament injuries increases yearly and they are now as common as carpal tunnel syndrome. At our present knowledge of the pathomechanics, early diagnosis and treatment are limited and inconsistent. The information gained from this project will help determine the relative importance of several wrist ligaments. Based upon this information, a noninvasive imaging study will be developed to accurately predict if specific ligaments are injured. In addition, several ligament reconstructions will be tested biomechanically to determine their effectiveness. This information will allow the clinician to treat this problem with a much higher likelihood of success. This project has four specific aims. The first aim is to evaluate the effect of injury to three specific ligaments in various combinations, on the stability of the scaphoid and lunate. The results of this study will allow a determination of the function of these ligaments on the scaphoid and lunate. The second aim of the project is to develop a method to quickly and accurately evaluate patients with wrist ligament injuries. Biomechanical data derived from the first portion of the experiment will be analyzed three-dimensionally to determine the optimal wrist position to radiographically detect changes in carpal bone position following ligament injury. These changes in carpal bone location can be detected by CT scans with the wrist placed in a specific position. It is our hypothesis that injury to a ligament or combination of ligaments results in changes in the orientation of the scaphoid and lunate at specific wrist positions, which are unique to that specific combination of ligament injuries. The third aim is to clinically validate the findings of the second aim. A prospective study of patients undergoing surgery for ligament injuries to the scaphoid and lunate will be performed. CT scans will be obtained of the injured wrist in specific positions and predictions as to which ligaments are torn will be made. Surgical exploration will then ascertain the integrity of the ligaments and validate the predictions. The fourth aim is to biomechanically evaluate two commonly performed surgical reconstructions for instability between the scaphoid and lunate and to determine if carpal stability is restored. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CARPAL TUNNEL SYNDROME AMONG CONSTRUCTION WORKERS Principal Investigator & Institution: Rosecrance, John C.; Assistance Professor; Prev Med & Environmental Hlth; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-DEC-2002

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Summary: The applicant's broad goals are to further develop research skills, become an independent researcher, and become an accomplished educator in occupational safety and health. The Special Emphasis Research Career Award allow the applicant to take advantage of the excellent resources available at the University of Iowa including comprehensive research support services, exceptional mentoring and collaboration with independent researchers in occupational health, and advanced coursework in the Department of Preventive Medicine and Environmental Health. The applicant proposes a cross-sectional study to characterize the prevalence of carpal tunnel syndrome (CTS) among construction apprentices. Data will be collected from 350 construction apprentices that have low exposure to hand and wrist-intensive work (operating engineers) and compared to previously collected data from 430 apprentices in trades that are associated with high exposure to hand and wrist-intensive work (sheet metal, electrical, plumbing workers). Apprentices in the operating engineering trade have a very similar demographic background to the existing cohort and will serve as a comparison group. Electrophysiologic tests and hand symptoms will be used to identify CTS cases among the operating engineer apprentices. Questionnaires will be utilized to determine occupational factors, personal factors, and medical histories associated with CTS. Focus group meetings will be held to determine why many apprentices do not seek medical attention for CTS symptoms. Additionally, electrophysiologic tests and questionnaires will be repeated in the apprentices in two years to assess changes in electrophysiologic variables and symptoms. The data collected in the proposed study will provide a better understanding of the specific work factors associated with CTS, provide pilot data for planning future projects to study the natural history of CTS, and assist in the development of strategies for the prevention of CTS in construction and non-construction workplaces. The proposed research study directly addresses the issue of musculoskeletal disorders of the upper extremity and assists in accomplishing the goals set out in the National Occupational Research Agenda. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARPAL TUNNEL SYNDROME: DIAGNOSTIC AND TREATMENT STRATEGIES Principal Investigator & Institution: Jarvik, Jeffrey G.; Professor; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): While there is good evidence that patients with severe carpal tunnel syndrome (CTS) benefit from surgery, there is less evidence of a benefit for patients with mild to moderate disease. However, mild to moderate disease still accounts for important disability. Electrodiagnostic studies (EDS) have not been shown to accurately predict outcomes for patients with CTS. Recent advances in magnetic resonance (MR) permit high-resolution neurographic imaging of the median net-ve and pilot data suggest that MR neurographic imaging (MRNI) might be a better predictor of outcome than EDS. Thus, MRNI has the potential for playing a major role in the treatment of patients with CTS. We will test more hypotheses 1) that select patients with early, mild or moderate CTS benefit more from early surgery than with conservative therapy, and: 2) that MRNI accurately, identifies those patients more likely to benefit from early surgery. To test our hypotheses, we will recruit 500 patients with early, mild or moderate clinical CTS. After enrollment, patients will complete a standardized hand examination, EDS, symptom and functional status questionnaires, and a baseline high-resolution wrist MRNI. All patients will be treated for 2 weeks with standardized, optimal non-surgical therapy. Patients who improve within 2 weeks will

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be followed for I year. Patients who do not improve will be offered enrollment in trial in which they will be randomly assigned to either surgery or non-surgical therapy. We expect to randomize 200 subjects. We will offer to those patients who are randomized to non-surgical therapy an optimized, standardized hand therapy protocol, pharmaceutical and psychological intervention. We will offer localized ultrasound treatment to those who fail to improve after 3 months and surgery to patients who still have failed to improve after 6 months. The primary outcome measure will be the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ) functional status index at 12 months. Our study design will allow us to determine if there are patients who benefit from early carpal runnel release and whether MRNI accurately identifies them. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHARACTERIZATION OF TENDON DAMAGE ACCUMULATION Principal Investigator & Institution: Wang, Vincent M.; Orthopedics; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2005 Summary: (provided by applicant): Tendon injuries such as those of repetitive overuse and cumulative trauma (e.g., carpal tunnel syndrome) are a major source of pain and disability, yet the mechanism of low-level injury and progression of tendon pathology is unknown. Animal models of tendon healing, while important, do not provide insight into the response of tendons to cumulative wear and tear. A comprehensive series of experiments is proposed herein to systematically characterize damage initiation and progression resulting from controlled levels of imposed mechanical fatigue. A novel mechanical testing protocol will be developed and implemented to reproducibly induce increasing levels of tendon damage which will be quantified using engineering damage parameters. Additional indices of tendon viscoelastic behavior will be obtained from mathematical modeling of the experimental data. Microstructural studies on fatigueloaded tendons will be used to define the physical manifestation of fatigue damage and to correlate the structural changes with mechanical measures of degradation. Successful completion of these proposed studies will establish the necessary damage-degradation relationships needed to assess in vivo cellular responses following tendon injury. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COLLABORATIVE STUDY:WORKPLACE MUSCULOSKELETAL DISORDERS Principal Investigator & Institution: Rempel, David M.; Professor of Medicine; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): This is a 3-year prospective study of 800 employees across a variety of industries, occupations and locations to determine the dose-response relationships between exposure to biomechanical factors and the development of hand, wrist, and elbow musculoskeletal disorders (MSDs), such as epicondylitis, wrist tendonitis and carpal tunnel syndrome. Although there is a substantial body of epidemiologic data linking various workplace factors to the development of upper extremity MSDs, the dose-response relationships between biomechanical factors and specific disorders are not well characterized. This data is critical for employers, employees and government agencies in order to establish the most effective prevention strategies. Companies and jobs will be targeted to achieve a distribution of exposure levels to biomechanical risk factors. Generally, stable, monotask jobs will be selected for

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study. At initial recruitment and then annually the following will be completed for all participants: baseline questionnaire, physical examination focused on the upper extremity, and a job analysis. On a quarterly basis, employees will complete a brief questionnaire and if their reported pain level is above a threshold, the physical exam will be repeated. If the job tasks change the job analysis will be repeated. It is anticipated that approximately 650 employees will be recruited on first site visit with an additional 150 new hires recruited at follow-up visits. The relationships between exposures and the development of specific and pooled musculoskeletal disorders will be examined using a Cox proportional hazards model controlling for historical and significant covariates (e.g., gender, age, psychosocial factors). The data will be evaluated for dose-response and threshold relationships. Participating employees will be notified of physical exam findings and employers and employees will be notified of the final study findings. Study methods, instruments, and data format will be coordinated with the NIOSH Work-related Musculoskeletal Disorders Consortium. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DISABILITY RISK IN WORK-RELATED MUSCULOSKELETAL INJURY Principal Investigator & Institution: Franklin, Gary M.; Environmental Health; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 29-SEP-2006 Summary: The vast majority of cost and lost productivity in workers' compensation is due to work related --musculoskeletal injuries. Among injured workers with these conditions, a small proportion (5-10 percent) develops long-term disability and account for most (80-85 percent) of the cost and lost work. In the absence of an accurate method to identify workers at risk for long-term disability, secondary prevention efforts cannot be well targeted. This is a 5-year, population-based, prospective study among Washington State workers with back injuries and carpal tunnel syndrome (CTS). The principal aim is to develop an accurate predictive model of risk for long-term disability among 5 key risk dimensions: employment related factors; biomedical healthcare related factors; socio-demographic factors; administrative/legal factors; and psychosocial factors. To accomplish this aim, a baseline interview among approximately 3000 eligible workers will be conducted within 2-6 weeks of (workers compensation) claim allowance. A continuous measure of disability outcome (lost time compensation) will be determined from a computerized database at one year. Additional important outcomes will be determined by a follow-up interview at one year (functional status, work status) and from computerized records (work status, wage status). Multivariate survival analysis within and across risk dimensions will be used to develop the principal risk models, including adjustment for injury severity. The reliability of determining severity from medical records will be determined as well (Specific Aim 2). A third aim of this study is to develop a brief risk assessment instrument for both low back and CTS injuries which would be useful to physicians when first treating injured workers. The main focus of these instruments would be on those risk factors which may be modifiable and which may be amenable to early intervention to prevent disability. Statistical analysis for this aim will focus on sensitivity and specificity of specific combinations of risk factors. These risk assessment instruments will be pilot tested among physicians participating in an occupational health care quality improvement project. The fourth aim of this project is to determine reinjury rate and predictors of reinjury among the original low back injury cohort 2 years after the initial injury. The unique study environment in Washington state, including the ability to conduct population-based

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sampling, timely access to survey injured workers, linkage of medical, claims and work status databases, and support from the business and labor communities, will substantially contribute to the success of this study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ERGONOMICS OF SLEEP RELATED CARPAL TUNNEL PAIN Principal Investigator & Institution: Bengtson, Keith; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001 Summary: The hypothesis is that sleep-related carpal tunnel pain is aggravated by certain wrist. Our study goals are to record the distribution of wrist angles for a CTS patient during the coarse of an entire night; to record the distribution of wrist angles for a CTS patient during the thirty seconds prior to each painful awakening; to delineate the wrist angles that are associated with painful nighttime awakenings; and to assess the effect of a neutral wrist splint on sleep architecture for CTS patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EXPERIMENTAL INDUCTION OF CARPAL TUNNEL SYNDROME Principal Investigator & Institution: Diao, Edward; Orthopaedic Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 30-JUN-2005 Summary: Carpal Tunnel Syndrome (CTS) is a common clinical problem that has assumed epidemic proportions and is dramatically increasing in the working population. We have developed an in vivo rabbit model for CTS in which coronary angioplasty balloon catheters are placed within the carpal tunnel and inflated to different pressures for varying lengths of time. We have demonstrated a graded response between carpal tunnel pressure and slowing of the median nerve conduction velocity. Also, we have demonstrated changes in histologic nerve preparations stained with hematoxylin-eosin and osmium (axon dropout and presence of edema and fibrosis). These results demonstrate that key clinical/pathoanatomical features of human CTS are replicated in this model system. The goals of the current proposal are: (1) to utilize this model to investigate the cellular mechanisms by which pressure adversely affects the median nerve, (2) to determine a quantifiable relationship between the time history of carpal tunnel pressure and nerve dysfunction with electron microscopy ultrastructure, blood flow, and MRI, and (3) to investigate whether there exists a threshold of pathoanatomical change below which nerve dysfunction is reversible, and whether such a threshold may be assessed non-invasively. Toward these ends, the current proposal focuses on developing and applying new modalities to the animal CT model: electron microscopy; magnetic resonance imaging. laser doppler blood flow measurement. We hypothesize that in the pathomechanics of CTS, there is a significant relationship between pressure, duration of exposure to pressure and various cellular and vascular events that surround CTS. These data will have significant implications for human CTS. In the future, this model may serve to test the modulation of the threshold pressure for developing CTS by various treatments in an effort to prevent CTS. Ultimately, we wish to realize a comprehensive understanding of pathophysiology of CTS, its prevention, when it occurs, and its treatment. We will simulate clinical CTS reversal, as in carpal tunnel release, by deflating balloon catheters in animals in which CTS has already been induced We anticipate that this model system that specifically relates nerve pathoanatomy, dysfunction and pressure exposure.

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provides the foundation for future study on the efficacy of pharmacologic and other intervention modalities in human clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NIAMS MUILTIDISCIPLINARY CLINICAL RESEARCH CENTER IN. Principal Investigator & Institution: Deyo, Richard A.; Professor; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): The University of Washington proposes a Multidisciplinary Clinical Research Center devoted to the study of spine and upper extremity disorders. These conditions, especially low back pain and carpal tunnel syndrome, are among the most common and disabling conditions in working age populations. This Center will incorporate investigators from the Departments of Medicine, Radiology, Orthopaedics and Sports Medicine, Neurological Surgery, Rehabilitation Medicine, and Psychiatry and Behavioral Sciences in the School of Medicine; and the Departments of Biostatistics and Health Services in the School of Public Health. The Methodology Core will provide key support to each project: assistance with protocol details choice and implementation of outcome measures, central data accumulation, data quality monitoring, analytic strategies, statistical analysis, advice on presentation of results, and education of investigators regarding research architecture and statistical techniques. The projects proposed address key controversies and uncertainties related to spinal disorders and upper extremity complaints. These include: 1. Carpal Tunnel Syndrome. Diagnostic and Treatment Strategies: this incorporates a randomized trial to evaluate the efficacy of surgery for early but well-documented carpal tunnel syndrome, and will determine whether the new technique of MR neurographic imaging (MRNI) accurately identifies the patients most likely to benefit from early surgery. 2. Cohort Study of Treatment for Discogenic Back Pain: a prospective cohort study will compare patients undergoing lumbar arthrodesis for degenerative discogenic pain with those having non-surgical treatments. We seek to identify any differences in baseline characteristics as well as outcomes, and to identify characteristics that may predict unique success from either surgical or nonsurgical therapy. 3. Epidemiology of Lumbar Spine Surgery: Rates and Trends: this analysis of national survey data, state hospital discharge registries, and Medicare claims will update the U.S. rates of various forms of back surgery; examine a possible increase in spine fusion rates with the introduction of interbody fusion cages; quantify the shift of spine surgery to the ambulatory setting; and determine if reoperation rates are increasing over time, as suggested in some earlier analyses. 4. Synthesis of CT and MR images of the Cervical Spine: This feasibility project will assess the potential for combining data from CT and MRI scans of the cervical spine to produce more useful imaging for surgical planning purposes than either test alone. It will require computer modeling, based on precedents in MR-PET scanning. We will determine if surgeons will accept the synthesized images as a replacement for CT-myelography for purposes of surgical planning. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OCCUPATIONAL HEALTH GRADIENTS IN HOSPITAL WORKERS: THE Principal Investigator & Institution: Blanc, Paul D.; Professor of Medicine; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122

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Timing: Fiscal Year 2001; Project Start 28-SEP-2000; Project End 31-AUG-2005 Summary: (Taken from the Investigators' Abstract) Socioeconomic gradients in health status are ubiquitous in space, persistent in time, and pervasive across diverse health outcomes. Yet little is known of how they arise, and specifically, how great a contribution is made to them by working conditions during adult life. Existing occupational cohort studies, such as the landmark Whitehall publications, have failed to convince some observers that work-related "psychosocial" exposures, e.g., the degree of control felt by employees over their jobs, constitute the key causal influences responsible for socioeconomic gradients in the health of the general adult population, especially gradients in chronic disease. Largely missing in the debate thus far is high-quality evidence on gradients from workplaces with a wide range of jobs -- Whitehall, for example, is fundamentally an office worker study. The present proposal is premised on the view that rich insights into the genesis of such health "gradients" may be gained by studying in detail, over some years, a workplace, such as a hospital, that has a very wide range of jobs, and of employees from different social classes. By far the major "shortterm" occupational health problem of this workforce, and many others, is work-related musculoskeletal disorders (WRMSDs) -- a broad class of outcomes including low back pain and upper extremity injuries, such as tendinitis and carpal tunnel syndrome. Both psychosocial and physical-ergonomic exposures at work are now thought to be joint determinants of these musculoskeletal problems. Thus, psychosocial aspects of work are increasingly recognized as risk factors for both sorts of illness processes: traumatic and chronic disease. Yet there appears to be a dearth of research linking socioeconomic and job-category disparities in the risk of WRMSDs, with well-known gradients in many longer-term health outcomes, particularly coronary heart disease and its risk factors (such as hypertension). The investigators propose a study to shed light on the nature and multi-factorial etiology of hospital gradients, across job categories and employee social class backgrounds, in the occurrence of several potentially work-related health outcomes in hospitals. The outcomes studied will be lost-time, work-related musculoskeletal disorders, non-invasive measures of allostatic load (salivary cortisol and blood pressure), overall health-related quality-of-life and injury-specific functional status, mental health status, and total sickness/injury absence from work. The influence of both directly observed physical-ergonomic factors at work and psychosocial occupational exposures on socioeconomic gradients in the risk of these conditions will be assessed. Finally they propose to examine, through qualitative research methods, the social contextual factors within participating hospitals, which influence working conditions. The study team will also work with a labor-management team to develop possible interventions for the problems that are identified by this study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OUTCOMES ASSESSMENT

OF

INJURED

EMPLOYEE

HEALTH

STATUS

Principal Investigator & Institution: Ross, Robert H.; Orthopedics and Rehabilitation; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 29-MAY-2003 Summary: This is pilot intervention study based on the recent emergence of patientbased health outcomes assessment and present availability of the Worker-based outcomes assessment system (WBOAS), a validated instrument developed at the New England Medical Center Health Institute which measures overall health, mental health, pain symptom and fear/avoidance attitudes, provider performance, and employee work role performance across five specific work task/activities. Study subjects are

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medical center employees of Fletcher Allen Health Care (Burlington, VT) with the workrelated musculoskeletal injuries including strain/sprain, cumulative trauma (upper extremity, lower extremity, lower back), tendinitis, and carpal tunnel syndrome. The study tests the utility of the WBOAS, the significance of which for workplace health improvement is great considering the nationwide rise in both injury incidence and injury management and lost productivity costs. The study aims (long term) to further the development and adoption of worker based outcomes assessment for the purpose of improving work role performance and reducing employee injury and re-injury rates and related employer treatment and lost productivity costs and (specific) to demonstrate the full effectiveness of a WBOAS based on the primary care provider as gatekeeper for occupational health care and for the management of work-related musculoskeletal injuries. The study employs a double cohort external control design, the strongest possible quasi-experimental (non-randomized control) design possible, staggered so as to strengthen inference such that in study phase 3 the phase 1-2 control cohort joins the test cohort as a test site as well. The intervention combines information and action. Physical/occupational therapists thus use the WBOAS a) to collect subject-reported baseline, treatment period, and post-treatment period data on the overall health, mental health, pain symptom and fear/avoidance attitudes, provider performance, and work role functioning of injured employees, b) to set and re-set injury treatment and re-injury prevention plans at each visit, and c) to refer subjects as indicated for adjunctive mental health care and workplace redesign. It is expected that, controlling for such covariates as subject demographics, injury severity, comorbidities, and practice variation, compared to control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PERIPHERAL NEUROPATHY, SENSORIMOTOR FUNCTIONS & BALANCE Principal Investigator & Institution: Richardson, James K.; Phys Med and Rehabilitation; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 31-MAY-2005 Summary: (From application). This application requests support for the applicant to receive the didactic training and practical research experience necessary for him to become an independent, patient-oriented investigator. During the first two years of the award didactic course work will predominate, and during the last three research will be the greater focus; however, there will be elements of didactic education and participation in research throughout the duration of an award. The main focus of the coursework will be in biostatistics, epidemiology, and experimental design. Other didactic work will be through attendance at seminars sponsored by the University of Michigan Pepper Center and Institute of Gerontology, as well as appropriate basic science and clinical conferences in other departments. Research to be performed will be under the direction of James Ashton-Miller, who will function as the applicant's mentor. It has been observed that in older patients with even mild peripheral neuropathy (PN) the rate of falls is increased. Specific distal lower extremity afferent and efferent impairments in such patients which underlie their postural instability have also been identified. The proposed research in this application will investigate the efficacy of interventions to compensate for these impairments by means of two randomized, controlled studies. In the first, older adults will be randomized to receive touch of a vertical surface, a standard cane, or a health-related video. Outcomes will include ankle inversion/eversion proprioceptive thresholds and comfortable gait speed and errors on

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a challenging walking task (irregular surface, low light). In the second, older adults with PN will undergo a 12-week strengthening program specifically designed for them or a control regimen. Outcomes will include maximum voluntary strength of ankle inversion/eversion, comfortable gait speed and errors on the same challenging walking task, ability to recover from a lateral leans test, rate of ankle strength development, and unipedal stance time. Stratification of the subjects in the first group by the presence of carpal tunnel syndrome and testing the subjects in the second group at 3 and 12 weeks may give insight into the mechanisms responsible for improvement noted. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTION OF MSDS IN PLANT NURSERY WORK Principal Investigator & Institution: Miles, John A.; Biological & Agricultural Engr; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: We propose to work cooperatively with owner/operators and workers to evaluate the efficacy of specific engineering interventions in the plant cuttings job, including adaptation of Airshirz and ergonomics workstation improvements, in significantly improving prevention of upper extremity MSDs. This is a sub population of farmworkers who have documented history of diagnosed MSDs (specifically Carpal Tunnel Syndrome). In addition, information on MSDs, MSD risk factors, and controls will be disseminated to workers and to grower groups. Project Specific Aims are to: 1. Develop detailed ergonomic descriptions (biomechanical, metobolic, and postural) of targeted risk factors for MSDs involved in making plant cuttings for propagation; 2. Estimate the incidence of MSDs and related symptoms among participating plant propagation workers; 3. Adapt the proved Airshirz cutting tool to the requirements of the plant cuttings job; 4. Assemble and train worker/supervisor ergonomics teams who will interact with researchers to identify and prioritize potential work station and task improvements; 5. Implement the adapted Airshirz cutting tool and other work station and work processes; 6. Evaluate the efficacy of interventions (a) to reduce targeted ergonomics risk factors, (b) to reduce UE MSDs and related symptomatology among participating plant propagation workers, and (c) for potential technology transfer across the nursery industry; 7. Communicate project findings to nursery and other agricultural industry groups, to workers, and to community interests; and 8. Report project findings in appropriate research and professional publications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREVENTION--UPPER EXTREMITY CUMULATIVE TRAUMA DISORDERS Principal Investigator & Institution: Gucer, Patricia W.; Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: (Adapted from Investigator's Abstract) This study continues the investigators' research on outcomes of upper extremity cumulative trauma disorders (UECTDs). Its specific aims are the prevention of work-related UECTDs and improved functional outcomes for individuals suffering UECTDs. Cumulative trauma disorders of the upper extremity remain a major cause of lost-time injuries in American industry. The Bureau of Labor Statistics (BLS) 1995 Report on Lost- Workday Injuries showed that employees disabled by carpal tunnel syndrome experienced the largest median lostwork day rate among disabling conditions. The investigators current descriptive

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epidemiological study has demonstrated that individuals with UECTDs have persisting functional, emotional, and financial problems, despite medical treatment. A randomized trial will be conducted to evaluate the effectiveness of an educational intervention designed to significantly reduce the incidence of subsequent upper extremity cumulative trauma disorders (UECTDs) for employers who receive interventions and significantly improve functional outcomes for injured employees who receive, along with their physicians and employers, interventions compared to those who do not receive intervention. All UECTD claimants identified from Maryland Workers Compensation Commission (WCC) claims in a 12 month period (along with their employers and treating physicians) will be randomized and assigned to either an intervention group or a comparison group. The intervention will be a series of educational efforts including materials to be distributed by mail (written and audiovisual) and an educational on-site meeting/walkthrough. The comparison group will receive no intervention, but will have outcomes measured. The effectiveness of these educational interventions and outcome data will be collected by CATI (computer assisted telephone interview). Subsequent claims during the 12 month observation period will be recorded for each employer in both intervention and comparison groups. Employees will respond to questions about functional, emotional, and financial outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROPECTIVE STUDY OF UPPER EXREMITY MUSCULOSKETAL DISORD* Principal Investigator & Institution: Silverstein, Barbara A.; Research Director; Washington State Dept Lab/Indust of Labor and Industries Olympia, Wa 98504 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 29-SEP-2005 Summary: The goal of this study is to follow a prospective cohort of 1000 workers in two industries to evaluate the relationship between work-related risk factors and the development of non-traumatic soft tissue musculoskeletal disorders of the upper extremities (WMSDs). Musculoskeletal injuries and illnesses account for a tremendous amount of lost workdays and cost to industry in the United States. In this study, two hypotheses will be tested: The presence of the workload factors of hand force, awkward postures of the neck, shoulder, forearm, hands and wrists, and the repetitiveness of the work performed will cause an increase in the incidence of upper extremity work-related musculoskeletal disorders while controlling for individual and psychological factors. The interaction between the workload factors of hand force, awkward postures of the neck, shoulder, forearm, hands and wrists, and repetitiveness of the work performed will increase the risk of developing an upper extremity work-related musculoskeletal disorder. Nationally in 1998, there were 253,300 disorders associated with repetitive motion resulting in lost time including 26,000 cases of carpal tunnel syndrome and 22,000 tendon-related disorders (BLS, 1999) reported by private industry. The National Institute for Occupational Safety and Health (NIOSH) reported that about 700,000 (32 percent) of the cases involving lost workdays annually were attributed to repetitive motion disorders or overexertion (NIOSH, 1997). These reported injuries and illnesses result in a tremendous amount of lost productivity and a detrimental impact on the working and non-working lives of many people. Reducing workplace illnesses and hazards is the first priority of the Washington State Department of Labor and Industries. This research will be conducted in one manufacturing industry and one service industry, with multiple sites of each possible. SHARP surveillance activities using

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workers compensation data have identified manufacturing and service sector industries with high incidence of WMSD claims. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SHAM DEVICE, PILL PLACEBO OR TREATMENT FOR ARM PAIN Principal Investigator & Institution: Kaptchuk, Ted J.; Director of Complementary Specialties; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 30-JUN-2003 Summary: (adapted from investigator's abstract): This application is based on observations that the magnitude of the placebo effect produced by a device is greater than that produced by a pill. If this is generally true, there are significant implications for the design of clinical trials involving medical devices and for our understanding of the role of the placebo effect in randomized controlled trials (RCT). This is a two phase study. In the first phase, the investigators will estimate the relative magnitudes of placebo effects associated with a sham acupuncture procedure versus an inactive oral treatment in patients with persistent upper extremity pain secondary to repetitive strain injury (RSI) most notably, carpal tunnel syndrome (CTS). In the second phase, parallel RCTs of traditional Chinese acupuncture (TCA) and low-dose amitriptyline (AMI) versus their respective placebo treatments will be conducted. In Phase I, 240 patients with RSI will be randomly assigned to receive a placebo device (a recently validated sham acupuncture device) or a placebo pill (dummy AMI). The primary hypothesis in Phase I is that patients will respond better to the sham device than the placebo pill. Phase II will see patients in each arm of Phase I randomly assigned to active or inactive treatment. Patients from the sham acupuncture arm of Phase I will receive either TCA or continue to receive the sham version. Patients in the placebo pill arm of Phase I will receive either AMI or continue receiving the placebo pill. Outcomes in these studies will include assessments of the nature and severity of upper extremity pain, function, grip and pinch strength, and mood. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SHOCK ABSORBING BRACE FOR STUDY OF UPPER EXTREMITY MSD'S Principal Investigator & Institution: Pottenger, Michael D.; Smartwear, Inc. 2608 3Rd St Santa Monica, Ca 90405 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 30-NOV-2003 Summary: (provided by applicant): The use of hand-held power tools can result in absorption of significant vibration energy by the worker's hand and arm, and is a causal factor in the development of various musculoskeletal disorders (MSD's) such as carpal tunnel syndrome (CTS) and hand-arm vibration syndrome (HAVS). A novel brace incorporating vibration damping materials is proposed that will dramatically reduce this energy absorption, resulting in lower incidence of vibration-related occupational MSD's. The National Occupational Research Agenda (NORA) has identified this type of injury as a priority research area. The proposed brace will have utility in the top three NORA-sponsored areas for research tools and approaches: clinical assessment of exposure to environmental vibration: practical use as improved personal protective gear; and evaluating the effects of reduced vibration exposure on MSD incidence. Feasibility will be determined through clinical testing of prototype braces. Frequency response will be measured for each test brace, and performance will be compared to currently available braces. Technical feasibility will be investigated by comparing the

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damping ratios (DR's) obtained from frequency response plots. An ideal brace provides critical damping (DR=1), and technical feasibility will be determined by demonstrating that the proposed brace has a DR closer to unity than currently available braces. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SUBSYNOVIAL CONNECTIVE TISSUE AND CARPAL TUNNEL SYNDROME Principal Investigator & Institution: Amadio, Peter C.; Professor; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): Carpal tunnel syndrome (CTS) is one of the most common causes of work-related disability in the US. The most common pathological finding is non-inflammatory synovial fibrosis and thickening, but whether this fibrosis is a cause of, or merely an associated finding with the compression neuropathy of the median nerve that is characteristic of CTS is unknown. This study will attempt to address this important issue by investigating the motion behavior, mechanical properties, and biological response of the synovium, and specifically the subsynovial connective tissue (SSCT), the gliding interface which links the tendons and synovium in the carpal tunnel. We hypothesize that activity-related damage may occur to the SSCT, resulting in fibrosis, diminished elasticity and increased gliding resistance in the carpal tunnel, setting up a vicious cycle of progressive injury that ultimately impairs permeability of the synovium, increases carpal tunnel pressure, and thereby causes the median neuropathy of CTS. To test this hypothesis, we propose three Specific Aims. Aim 1 is to describe the motion characteristics of the SSCT, by video, fluoroscopic, and ultrasound imaging, in normal human cadavers, patients with CTS, and in candidate animal models of CTS (dog and rabbit); in Aim 2, the mechanical properties and permeability of the SSCT in these same groups will be studied and compared. Aim 3 will characterize the histology and immunohistochemistry of the SSCT in these tissues; if this hypothesis regarding the etiology of CTS is correct, a biological basis for cumulative trauma as an etiology will be established for the first time for CTS. In addition, suitable animal models will be characterized for further experimental investigations of CTS. Finally, a new perspective would be provided, which could serve as a foundation for new therapies and prevention strategies for CTS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: SYNDROME

SURVEILLANCE

OF

WORK-RELATED

CARPAL

TUNNEL

Principal Investigator & Institution: Harrison, Robert J.; Professor of Medicine; Public Health Institute 555 12Th St, 10Th Fl Oakland, Ca 94607 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 29-SEP-2003 Summary: The Occupational Health Branch (OHB) of the California Department of Health Services (DHS) proposes to further develop and enhance its surveillance system for the detection and prevention of occupational carpal tunnel syndrome (CTS). For the past two years, we have been conducting CTS case ascertainment and performing selected work site investigations. We propose to enhance the current CTS surveillance system by expanding and evaluating case ascertainment tools; conducting telephone interviews of workers in high risk industries and occupations; increasing case-based field investigations, hazard identification, and prevention activities; and using the results of these efforts to foster prevention activities. This comprehensive system will

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use the existing SENSOR case definition and will employ protocols and methodologies easily adopted as a model by other states. The program will expand data collection to include electronically transmitted workers' compensation data, which will update our system to be consistent with national trends in information transfer and create a model more easily adopted by other states. Workers with CTS in high-risk industries and occupations will be interviewed by telephone using a standardized questionnaire to identify risk factors that can lead to prevention strategies. Work site investigations will be expanded in order to identify prevention methods and hazard reduction. Findings from all activities will be widely disseminated in the form of reports, educational materials, and scientific publications. The proposed enhanced surveillance program will be evaluated using established criteria such as timeliness, sensitivity, simplicity, flexibility, representativeness and acceptability. By building on the solid foundation of current surveillance activities, we believe we can achieve the goal of building a model work-related carpal tunnel surveillance program that can be used to prevent this important occupational disease in California and in other states. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THERAPEUTIC TOUCH IN TREATMENT OF CARPAL TUNNEL SYNDROME Principal Investigator & Institution: Blankfield, Robert; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: The proposed study seeks to use carpal tunnel syndrome as a model system to test whether or not Therapeutic Touch (TT) actually has a physiological effect upon the tissues of the body. Unlike virtually every other pain syndrome, there is an objective correlate to the subjective symptoms of discomfort in patients with carpal tunnel syndrome. This study utilizes a randomized, single blind, cross over experimental design. Patients with carpal tunnel syndrome will undergo median nerve conduction measurements before and after a series of weekly treatments with therapeutic touch. In order to control for the possibility that something other than therapeutic touch is responsible for the changes in the nerve conduction measurements, patients will undergo a series of "sham" treatments either before or after the TT. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRIAL OF ACUPUNCTURE FOR CARPAL TUNNEL SYNDROME Principal Investigator & Institution: Weinstein, Arthur; Research Professor; Medicine; George Washington University 2121 I St Nw Washington, Dc 20052 Timing: Fiscal Year 2001; Project Start 14-MAY-1999; Project End 31-JUL-2002 Summary: This research tests the feasibility of studying traditional Chinese acupuncture in the context of a large, randomized controlled clinical trial (RCT). The major specific aim of this pilot study is to demonstrate that using a "single blind-mute" methodology, true and sham acupuncture can be administered in a standardized and unbiased fashion. The condition to be studied is carpal tunnel syndrome (CTS), a common, well delineated syndrome causing hand pain with characteristic clinical and objective electrodiagnostic findings. Other aims of this study are: 1) to identify and standardize the most appropriate sham acupuncture points for CTS, 2) to develop a manual which standardizes the administration of true and sham acupuncture that cna be used at any study site performing an RTC, 3) to demonstrate that patient recruitment for and retention in an RCT of acupuncture for CTS us sufficient to justify a full-scale RCT, 4) to

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Carpal Tunnel Syndrome

determine, in a small RCT, whether true acupuncture provides meaningful benefit for pain in CTS compared to sham acupuncture and whether the frequency of administration of acupuncture influences the outcome. In a pretrial session, standardization of the true and sham acupuncture techniques will be accomplished, the blind-mute methodology tested, the acupuncturists trained to deliver acupuncture (true or sham) in an unbiased manner and a Manual of Acupuncture Methods will be developed. This manual will address not only the location of true and sham acupuncture points but also the angle and depth of needing and the optimum technique to preserve credibility of the sham. The credibility of 2 separate sham acupuncture groups (each with a different set of sham points) will be tested. The subsequent RCT will be a 3X3 design involving 144 patients (9 cells at 16 patients per cell) with symptoms of CTS and evidence of median nerve conduction abnormality. Patients will be randomized to receive either true or two types of sham acupuncture at frequencies of once, two or three times weekly for 6 weeks. The patients will ber blinded to treatment group and the acupuncturist will be mute. The primary outcome measure will be validated CTS symptom severity scale measured t baseline and 2 weeks after termination of the acupuncture treatments. The study as outlined addresses the specific aims and, if successful, should enable the undertaking of a full-scale RCT employing acupuncture for CTS or other common causes of hand pain, including work-related repetitive stress injury. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WRIST FLEXION TO IDENTIFY CARPAL TUNNEL SYNDROME Principal Investigator & Institution: Tuckett, Robert P.; Neuroscience Research 2381 Sheridan Rd Salt Lake City, Ut 84108 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 28-FEB-2003 Summary: (Applicant's Abstract): Although most health care practitioners would define carpal tunnel syndrome (CTS) as an entrapment, or compression, of the median nerve at the level of the wrist (e.g. carpal tunnel), the diagnosis is often not clear cut. A major reason for ambiguity is that in its initial stages, CTS often involves inflammation of tendons transversing the wrist that control finger movement and grip. As tendinitis progresses, there is a constellation of inflammatory events including swelling, vascular stasis, and nociceptor sensitization, which account for many of CTS clinical signs. Hence, clinical signs do not clearly differentiate between tendinitis and CIS, which requires direct testing of median nerve function specifically localized to the wrist area. At present, only conduction latency across the wrist fulfills these criteria. The alternative of sensory testing (e.g., two-point discrimination, monofilament or vibratory threshold) lacks specificity; that is, sensory deficits can be attributed to other causes. More recently, a provocative technique has provided evidence of wrist level, median nerve entrapment before symptoms become unequivocal by more traditional procedures, and has been reported to be specific for CTS over other forms of peripheral neuropathy. Topical Testing proposes to investigate ways of improving the efficiency of the initially reported provocative procedure to improve the specificity and sensitivity of CTS diagnosis. If feasibility criteria are satisfied, Phase II will propose an equipment package designed specifically for improved evaluation of carpal tunnel status. PROPOSED COMMERCIAL APPLICATION: Medical market segments for the treatment and rehabilitation of carpal tunnel syndrome include hand surgery, hand therapy, physical therapy, physiatry (PM&R), neurology, and occupational medicine. Potentially large markets for noninvasive instrumentation to screen for carpal tunnel injury include human resources, safety, ergonomics, and industrial hygiene.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “carpal tunnel syndrome” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for carpal tunnel syndrome in the PubMed Central database: •

Carpal tunnel syndrome and computers. by OReilly M.; 2001 Aug 7; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81341

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Clinical examination for carpal tunnel syndrome. by MacIntyre A.; 2001 May 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81011

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Clinical examination for carpal tunnel syndrome. by Best TJ.; 2001 May 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81012

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Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. by Atroshi I, Gummesson C, Johnsson R, Ornstein E.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=156649

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Splinting or surgery for carpal tunnel syndrome? Design of a randomized controlled trial. by Gerritsen AA, Scholten RJ, Assendelft WJ, Kuiper H, de Vet HC, Bouter LM.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=64540

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Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial. by Ebenbichler GR, Resch KL, Nicolakis P, Wiesinger GF, Uhl F, Ghanem AH, Fialka V.; 1998 Mar 7; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28476

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Utility of the clinical examination for carpal tunnel syndrome. by Myers KA.; 2000 Sep 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80493

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text

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Carpal Tunnel Syndrome

The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with carpal tunnel syndrome, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “carpal tunnel syndrome” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for carpal tunnel syndrome (hyperlinks lead to article summaries): •

A hand brace improve symptoms and function in carpal tunnel syndrome. Author(s): MacDermid J. Source: The Australian Journal of Physiotherapy. 2002; 48(2): 134. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12143781&dopt=Abstract

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A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment. Author(s): Giannini F, Cioni R, Mondelli M, Padua R, Gregori B, D'Amico P, Padua L. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2002 January; 113(1): 71-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11801427&dopt=Abstract

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A randomised clinical trial of oral steroids in the treatment of carpal tunnel syndrome: a long term follow up. Author(s): Chang MH, Ger LP, Hsieh PF, Huang SY. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 December; 73(6): 7104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12438475&dopt=Abstract

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A randomized trial of splinting vs. surgery for carpal tunnel syndrome. Author(s): Roitberg B. Source: Surgical Neurology. 2003 January; 59(1): 5-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638558&dopt=Abstract

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A recurrent case of carpal tunnel syndrome in haemodialysis. Author(s): Yamauchi K. Source: Hand Surgery : an International Journal Devoted to Hand and Upper Limb Surgery and Related Research : Journal of the Asia-Pacific Federation of Societies for Surgery of the Hand. 2002 December; 7(2): 299-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596296&dopt=Abstract

journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A review of treatment for carpal tunnel syndrome. Author(s): Wilson JK, Sevier TL. Source: Disability and Rehabilitation. 2003 February 4; 25(3): 113-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648000&dopt=Abstract

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A systematic review of the utility of electrodiagnostic testing in carpal tunnel syndrome. Author(s): Jordan R, Carter T, Cummins C. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2002 August; 52(481): 670-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171229&dopt=Abstract

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Activity-dependent hyperpolarization and impulse conduction in motor axons in patients with carpal tunnel syndrome. Author(s): Cappelen-Smith C, Lin CS, Burke D. Source: Brain; a Journal of Neurology. 2003 April; 126(Pt 4): 1001-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12615655&dopt=Abstract

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Acupuncture for carpal tunnel syndrome. Author(s): Freedman J. Source: Acupuncture in Medicine : Journal of the British Medical Acupuncture Society. 2002 March; 20(1): 39-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926605&dopt=Abstract

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Acute carpal tunnel syndrome caused by anomalous muscle bellies: a case report. Author(s): Kono H. Source: Hand Surgery : an International Journal Devoted to Hand and Upper Limb Surgery and Related Research : Journal of the Asia-Pacific Federation of Societies for Surgery of the Hand. 2003 July; 8(1): 141-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12923952&dopt=Abstract

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Acute carpal tunnel syndrome caused by idiopathic tumoral calcinosis. Author(s): Sanchez-Martin A, Proubasta-Renart I. Source: J South Orthop Assoc. 2001 Summer; 10(2): 92-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132833&dopt=Abstract

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Acute carpal tunnel syndrome due to filarial infection. Author(s): Gallagher B, Khalifa M, Van Heerden P, Elbardisy N. Source: Pathology, Research and Practice. 2002; 198(1): 65-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11866214&dopt=Abstract

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Acute carpal tunnel syndrome: two rare cases. Author(s): Charalambous CP, Zipitis CS, Kumar R, Paul AS. Source: Hand Surgery : an International Journal Devoted to Hand and Upper Limb Surgery and Related Research : Journal of the Asia-Pacific Federation of Societies for Surgery of the Hand. 2003 July; 8(1): 117-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12923946&dopt=Abstract

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An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Author(s): Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, Ehlers JC. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2002 September; 113(9): 1429-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12169324&dopt=Abstract

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An evaluation of provocative testing in the diagnosis of carpal tunnel syndrome. Author(s): Walters C, Rice V. Source: Military Medicine. 2002 August; 167(8): 647-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12188235&dopt=Abstract

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Anatomic variations and carpal tunnel syndrome: 10-year clinical experience. Author(s): Singer G, Ashworth CR. Source: Clinical Orthopaedics and Related Research. 2001 November; (392): 330-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11716404&dopt=Abstract

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Aspartame and symptoms of carpal tunnel syndrome. Author(s): Robbins PI, Raymond L. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 1999 June; 41(6): 418. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10390691&dopt=Abstract

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Assessment of outcome of carpal tunnel syndrome: a comparison of electrophysiological findings and a self-administered Boston questionnaire. Author(s): Cochrane Database Syst Rev. 2003;(3):CD001552 Source: Journal of Hand Surgery (Edinburgh, Lothian). 2002 June; 27(3): 259-64. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12917909

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Assessment of the scientific basis for genetic testing of railroad workers with carpal tunnel syndrome. Author(s): Schulte PA, Lomax G. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2003 June; 45(6): 592-600. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802212&dopt=Abstract

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Axonal degeneration in association with carpal tunnel syndrome. Author(s): Caetano MR. Source: Arquivos De Neuro-Psiquiatria. 2003 March; 61(1): 48-50. Epub 2003 April 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715018&dopt=Abstract

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Beta-2-microglobulin-associated amyloidosis in chronic hemodialysis patients with carpal tunnel syndrome. Author(s): Ullian ME, Hammond WS, Alfrey AC, Schultz A, Molitoris BA. Source: Medicine; Analytical Reviews of General Medicine, Neurology, Psychiatry, Dermatology, and Pediatrics. 1989 March; 68(2): 107-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2646507&dopt=Abstract

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Bifid median nerve as a cause of carpal tunnel syndrome. Report of one case. Author(s): Orsi R, De Tullio V. Source: Ital J Orthop Traumatol. 1991 September; 17(3): 419-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1783558&dopt=Abstract

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Bilateral carpal tunnel syndrome and galactorrhoea. Author(s): Kotowicz MA, Turtle JR, Crouch R. Source: The Medical Journal of Australia. 1988 March 7; 148(5): 252-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3343956&dopt=Abstract

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Bilateral carpal tunnel syndrome as a clue for the diagnosis of systemic amyloidosis. Author(s): Nestle FO, Burg G. Source: Dermatology (Basel, Switzerland). 2001; 202(4): 353-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11455159&dopt=Abstract

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Bilateral carpal tunnel syndrome associated with interleukin 2 therapy. Author(s): Heys SD, Mills KL, Eremin O. Source: Postgraduate Medical Journal. 1992 July; 68(801): 587-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1437960&dopt=Abstract

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Bilateral carpal tunnel syndrome in a child on growth hormone replacement therapy: a case report. Author(s): Ong BC, Klugman JA, Jazrawi LM, Stutchin S. Source: Bull Hosp Jt Dis. 2001-2002; 60(2): 94-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12003362&dopt=Abstract

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Bilateral carpal tunnel syndrome in a normal child. Author(s): Wilson KM, Buehler MJ. Source: The Journal of Hand Surgery. 1994 November; 19(6): 913-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7876488&dopt=Abstract

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Bilateral carpal tunnel syndrome secondary to tophaceous compression of the median nerves. Author(s): Tsai CY, Yu CL, Tsai ST. Source: Scandinavian Journal of Rheumatology. 1996; 25(2): 107-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8614765&dopt=Abstract

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Bilateral Carpal tunnel syndrome with type 1 diabetes mellitus in childhood. Author(s): Kayali H, Kahraman S, Sirin S, Beduk A, Timurkaynak E. Source: Pediatric Neurosurgery. 2003 May; 38(5): 262-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12686771&dopt=Abstract

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Bilateral clinical-neurophysiological assessment of median nerve in carpal tunnel syndrome patients. Author(s): Padua L, LoMonaco M, Gregori B, Di Lazzaro V, Padua R, Tonali P. Source: Muscle & Nerve. 1998 February; 21(2): 264-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9466612&dopt=Abstract

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Bilateral palmaris profundus causing bilateral carpal tunnel syndrome. Author(s): Stark RH. Source: The Journal of Hand Surgery. 1992 January; 17(1): 182-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1538105&dopt=Abstract

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Bilateral palmaris profundus causing bilateral carpal tunnel syndrome. Author(s): Floyd T, Burger RS, Sciaroni CA. Source: The Journal of Hand Surgery. 1990 March; 15(2): 364-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2324472&dopt=Abstract

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Biochemical and histological analysis of the flexor tenosynovium in patients with carpal tunnel syndrome. Author(s): Tucci MA, Barbieri RA, Freeland AE. Source: Biomed Sci Instrum. 1997; 33: 246-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9731366&dopt=Abstract

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Biochemical evaluation of serum and flexor tenosynovium in carpal tunnel syndrome. Author(s): Freeland AE, Tucci MA, Barbieri RA, Angel MF, Nick TG. Source: Microsurgery. 2002; 22(8): 378-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12497576&dopt=Abstract

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Biological markers of inflammation and carpal tunnel syndrome in dialysis patients. Author(s): Curatola G, Malara E, Sisca S, Enia G, Postorino M, Cutrupi S, Zoccali C, Maggiore Q. Source: Nephron. 1990; 56(4): 453-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2127823&dopt=Abstract

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Biomechanical and epidemiological investigation of carpal tunnel syndrome at workplaces with high risk factors. Author(s): Loslever P, Ranaivosoa A. Source: Ergonomics. 1993 May; 36(5): 537-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8500474&dopt=Abstract

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Bionursing: carpal tunnel syndrome. Author(s): Jordan S, Torrance C. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1995 November 29-December 5; 10(10): 31-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8679476&dopt=Abstract

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Blisters, ulceration and autonomic neuropathy in carpal tunnel syndrome. Author(s): Cox NH, Large DM, Paterson WD, Ive FA. Source: The British Journal of Dermatology. 1992 June; 126(6): 611-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1610713&dopt=Abstract

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Body mass index and carpal tunnel syndrome. Author(s): Kouyoumdjian JA, Morita MD, Rocha PR, Miranda RC, Gouveia GM. Source: Arquivos De Neuro-Psiquiatria. 2000 June; 58(2A): 252-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10849623&dopt=Abstract

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Brief communication: effect of pharmacologic doses of vitamin B6 on carpal tunnel syndrome, electroencephalographic results, and pain. Author(s): Bernstein AL, Dinesen JS. Source: Journal of the American College of Nutrition. 1993 February; 12(1): 73-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8440821&dopt=Abstract

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Canal pressures before, during, and after endoscopic release for idiopathic carpal tunnel syndrome. Author(s): Schuind F. Source: The Journal of Hand Surgery. 2002 November; 27(6): 1019-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12457352&dopt=Abstract

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Carpal tunnel syndrome - is high-frequency ultrasound a useful diagnostic tool? Author(s): Leonard L, Rangan A, Doyle G, Taylor G. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2003 February; 28(1): 77-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12531674&dopt=Abstract

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Carpal tunnel syndrome after 22 years of Colle's fracture. Author(s): Goyal V, Bhatia M, Behari M. Source: Neurology India. 2003 March; 51(1): 113-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12865540&dopt=Abstract

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Carpal tunnel syndrome after distal release of the flexor digitorum profundus and subsequent retraction of the lumbrical muscle into the carpal tunnel. Author(s): Imran D, Bainbridge LC. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1999 June; 24(3): 303-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10433442&dopt=Abstract

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Carpal tunnel syndrome and cubital tunnel syndrome: work-related musculoskeletal disorders in four symptomatic radiologists. Author(s): Ruess L, O'Connor SC, Cho KH, Hussain FH, Howard WJ 3rd, Slaughter RC, Hedge A. Source: Ajr. American Journal of Roentgenology. 2003 July; 181(1): 37-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818826&dopt=Abstract

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Carpal tunnel syndrome and trigger wrist caused by a lipoma arising from flexor tenosynovium: a case report. Author(s): Sonoda H, Takasita M, Taira H, Higashi T, Tsumura H. Source: The Journal of Hand Surgery. 2002 November; 27(6): 1056-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12457357&dopt=Abstract

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Carpal tunnel syndrome due to gouty infiltration of the lumbrical muscles and flexor tendons. Author(s): Tan G, Chew W, Lai CH. Source: Hand Surgery : an International Journal Devoted to Hand and Upper Limb Surgery and Related Research : Journal of the Asia-Pacific Federation of Societies for Surgery of the Hand. 2003 July; 8(1): 121-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12923948&dopt=Abstract

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Carpal tunnel syndrome in the elderly. Author(s): Nakasato YR. Source: J Okla State Med Assoc. 2003 March; 96(3): 113-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12688223&dopt=Abstract

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Carpal tunnel syndrome secondary to intratendinous infiltration by tophaceous gout. Author(s): Mockford BJ, Kincaid RJ, Mackay I. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 2003; 37(3): 186-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841622&dopt=Abstract

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Carpal tunnel syndrome. Author(s): Jones GB. Source: Curr Med Drugs. 1967 May; 7(9): 23-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12889096&dopt=Abstract

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Carpal tunnel syndrome. Author(s): Bland JD. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2003 February; 53(487): 149-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12817364&dopt=Abstract

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Carpal tunnel syndrome: comparison of the median sensory nerve conduction findings from the index and middle fingers. Author(s): Wee AS, Abernathy SD. Source: Electromyogr Clin Neurophysiol. 2003 June; 43(4): 251-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836591&dopt=Abstract

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Carpal tunnel syndrome: current theory, treatment, and the use of B6. Author(s): Holm G, Moody LE. Source: Journal of the American Academy of Nurse Practitioners. 2003 January; 15(1): 18-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12613409&dopt=Abstract

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Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. Author(s): Hafner E, Kendall J, Kendall P. Source: Journal of Manipulative and Physiological Therapeutics. 1999 June; 22(5): 348-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10395439&dopt=Abstract

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Comparing open surgery with endoscopic releasing in the treatment of carpal tunnel syndrome. Author(s): Kiymaz N, Cirak B, Tuncay I, Demir O. Source: Minimally Invasive Neurosurgery : Min. 2002 December; 45(4): 228-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12494358&dopt=Abstract

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Comparison of nerve conduction techniques in 95 mild carpal tunnel syndrome hands. Author(s): Kouyoumdjian JA, Morita Mda P. Source: Arquivos De Neuro-Psiquiatria. 1999 June; 57(2A): 195-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10412517&dopt=Abstract

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Comparison of outcomes of untreated carpal tunnel syndrome and asymptomatic controls in meat packers. Author(s): Gorsche RG, Wiley JP, Brant R, Renger RF, Sasyniuk TM, Burke N. Source: Occupational Medicine (Oxford, England). 2002 December; 52(8): 491-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12488521&dopt=Abstract

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Computer use and carpal tunnel syndrome: a 1-year follow-up study. Author(s): Andersen JH, Thomsen JF, Overgaard E, Lassen CF, Brandt LP, Vilstrup I, Kryger AI, Mikkelsen S. Source: Jama : the Journal of the American Medical Association. 2003 June 11; 289(22): 2963-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799404&dopt=Abstract

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Computer use and risk of carpal tunnel syndrome. Author(s): Hedge A. Source: Jama : the Journal of the American Medical Association. 2003 October 8; 290(14): 1854; Author Reply 1854-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14532310&dopt=Abstract

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Computer use and risk of carpal tunnel syndrome. Author(s): Nathan PA, Meadows KD, Istvan JA. Source: Jama : the Journal of the American Medical Association. 2003 October 8; 290(14): 1853-4; Author Reply 1854-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14532309&dopt=Abstract

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Detection of modified beta 2-microglobulin (beta 2m) from amyloid deposits in tenosynovial tissue of carpal tunnel syndrome (CTS) Author(s): Odani H, Mizutani A, Hidaka H, Fujisawa K, Shinzato T, Maeda K. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 1994 June; 227(1-2): 209-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7955417&dopt=Abstract

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Diagnosis and staging of carpal tunnel syndrome: comparison of magnetic resonance imaging and intra-operative findings. Author(s): Kleindienst A, Hamm B, Hildebrandt G, Klug N. Source: Acta Neurochirurgica. 1996; 138(2): 228-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8686550&dopt=Abstract

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Diagnosis and treatment of carpal tunnel syndrome. Author(s): Browne CR. Source: Orthop Rev. 1994 March; 23(3): 217. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8022641&dopt=Abstract

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Diagnosis and treatment of hand-arm vibration syndrome and its relationship to carpal tunnel syndrome. Author(s): Falkiner S. Source: Aust Fam Physician. 2003 July; 32(7): 530-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12901208&dopt=Abstract

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Diagnosis of carpal tunnel syndrome. Author(s): Pal B. Source: Rheumatology (Oxford, England). 2001 May; 40(5): 595-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11371677&dopt=Abstract

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Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography. Author(s): Lee D, van Holsbeeck MT, Janevski PK, Ganos DL, Ditmars DM, Darian VB. Source: Radiologic Clinics of North America. 1999 July; 37(4): 859-72, X. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10442084&dopt=Abstract

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Diagnosis of carpal tunnel syndrome: electrodiagnostic and magnetic resonance imaging evaluation. Author(s): Jarvik JG, Yuen E. Source: Neurosurg Clin N Am. 2001 April; 12(2): 241-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11525204&dopt=Abstract

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Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. Author(s): Atroshi I, Gummesson C, Johnsson R, Ornstein E. Source: Bmc Musculoskeletal Disorders [electronic Resource]. 2003 May 7; 4(1): 9. Epub 2003 May 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12734018&dopt=Abstract

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Diagnostic testing in carpal tunnel syndrome. Author(s): Foye PM, Stitik TP. Source: The Journal of Hand Surgery. 2000 January; 25(1): 183-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10642491&dopt=Abstract

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Different case definitions to describe the prevalence of occupational carpal tunnel syndrome in meat industry workers. Author(s): Isolani L, Bonfiglioli R, Raffi GB, Violante FS. Source: International Archives of Occupational and Environmental Health. 2002 April; 75(4): 229-34. Epub 2002 January 30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11981656&dopt=Abstract

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Disability issues with carpal tunnel syndrome. A case discussion. Author(s): Sylvain JR, Andary MT. Source: Phys Med Rehabil Clin N Am. 2001 August; 12(3): 695-708, Xii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11478199&dopt=Abstract

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Disability outcomes in a worker's compensation population: surgical versus nonsurgical treatment of carpal tunnel syndrome. Author(s): Shin AY, Perlman M, Shin PA, Garay AA. Source: Am J Orthop. 2000 March; 29(3): 179-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10746468&dopt=Abstract

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Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Author(s): Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Source: Arthritis and Rheumatism. 2002 July; 46(7): 1914-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12124876&dopt=Abstract

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Dispersion of the distal compound muscle action potential in chronic inflammatory demyelinating polyneuropathy and carpal tunnel syndrome. Author(s): Cleland JC, Logigian EL, Thaisetthawatkul P, Herrmann DN. Source: Muscle & Nerve. 2003 August; 28(2): 189-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872323&dopt=Abstract

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DNA rearrangements on both homologues of chromosome 17 in a mildly delayed individual with a family history of autosomal dominant carpal tunnel syndrome. Author(s): Potocki L, Chen KS, Koeuth T, Killian J, Iannaccone ST, Shapira SK, Kashork CD, Spikes AS, Shaffer LG, Lupski JR. Source: American Journal of Human Genetics. 1999 February; 64(2): 471-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9973284&dopt=Abstract

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Does carpal canal stenosis predict outcome in women with carpal tunnel syndrome? Author(s): Bekkelund SI, Pierre-Jerome C. Source: Acta Neurologica Scandinavica. 2003 February; 107(2): 102-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12580858&dopt=Abstract

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Does fibromyalgia affect the outcomes of local steroid treatment in patients with carpal tunnel syndrome? Author(s): Akkus S, Kutluhan S, Akhan G, Tunc E, Ozturk M, Koyuncuoglu HR. Source: Rheumatology International. 2002 July; 22(3): 112-5. Epub 2002 June 08. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12111086&dopt=Abstract

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Does surgery for carpal tunnel syndrome improve outcomes? Author(s): Tudiver F, Johnson ED. Source: The Journal of Family Practice. 2003 January; 52(1): 70-2; Discussion 72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12540318&dopt=Abstract

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Duration of symptomatology and median segmental sensory latency in 993 carpal tunnel syndrome hands (668 cases). Author(s): Kouyoumdjian JA. Source: Arquivos De Neuro-Psiquiatria. 1999 June; 57(2A): 198-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10412518&dopt=Abstract

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Dynamic MR imaging of carpal tunnel syndrome. Author(s): Brahme SK, Hodler J, Braun RM, Sebrechts C, Jackson W, Resnick D. Source: Skeletal Radiology. 1997 August; 26(8): 482-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9297753&dopt=Abstract

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Early diagnosis of carpal tunnel syndrome: comparison of digit 1 with wrist and distoproximal ratio. Author(s): Sharma KR, Rotta F, Romano J, Ayyar DR. Source: Neurology & Clinical Neurophysiology [electronic Resource] : Ncn. 2001; 2001(2): 2-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396863&dopt=Abstract

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Effects of an aerobic exercise program on median nerve conduction and symptoms associated with carpal tunnel syndrome. Author(s): Nathan PA. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2002 April; 44(4): 303-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11977412&dopt=Abstract

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Effects of an aerobic exercise program on median nerve conduction and symptoms associated with carpal tunnel syndrome. Author(s): Nathan PA, Wilcox A, Emerick PS, Meadows KD, McCormack AL. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2001 October; 43(10): 840-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11665452&dopt=Abstract

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Electrodiagnosis in carpal tunnel syndrome. Author(s): Kilmer DD, Davis BA. Source: Hand Clin. 2002 May; 18(2): 243-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371027&dopt=Abstract

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Electrodiagnosis in carpal tunnel syndrome. Author(s): Jordan R, Carter T, Cummins C. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2001 July; 51(468): 582. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11462326&dopt=Abstract

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Electromyographic evaluation after endoscopic carpal tunnel release in idiopathic carpal tunnel syndrome. Author(s): Senda M, Hashizume H, Terai Y, Inoue H, Nagashima H. Source: Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 1999; 4(3): 187-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10370159&dopt=Abstract

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Electrophysiological assessment of the carpal tunnel syndrome in hemodialysis patients: formula for predicting surgical results. Author(s): Mizumoto D, Hashizume H, Senda M, Nagoshi M, Inoue H. Source: Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 2003; 8(1): 8-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12560879&dopt=Abstract

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Electrophysiological evaluation of 140 hands with carpal tunnel syndrome. Author(s): Goyal V, Bhatia M, Padma MV, Jain S, Maheshwari MC. Source: J Assoc Physicians India. 2001 November; 49: 1070-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11868858&dopt=Abstract

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Electrophysiological studies in mild idiopathic carpal tunnel syndrome. Author(s): Girlanda P, Quartarone A, Sinicropi S, Pronesti C, Nicolosi C, Macaione V, Picciolo G, Messina C. Source: Electroencephalography and Clinical Neurophysiology. 1998 February; 109(1): 44-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11003063&dopt=Abstract

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Enabling meta-analysis in systematic reviews on carpal tunnel syndrome. Author(s): Gerritsen AA, de Vet HC, Scholten RJ, van Tulder MW, Bouter LM. Source: The Journal of Hand Surgery. 2002 September; 27(5): 828-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12239672&dopt=Abstract

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Endoscopic release in carpal tunnel syndrome: analysis of clinical results in 200 cases. Author(s): Serra L, Panagiotopoulos K, Bucciero A, Mehrabi FK, Pescatore G, Santangelo M, Vizioli L. Source: Minimally Invasive Neurosurgery : Min. 2003 February; 46(1): 11-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12640577&dopt=Abstract

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Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome. Author(s): Waseem M. Source: The Journal of Bone and Joint Surgery. British Volume. 2003 May; 85(4): 620; Author Reply 620. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12793577&dopt=Abstract

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Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome. A prospective, randomised, blinded assessment. Author(s): Ferdinand RD, MacLean JG. Source: The Journal of Bone and Joint Surgery. British Volume. 2002 April; 84(3): 375-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12002496&dopt=Abstract

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Endoscopic versus open surgical treatment of carpal tunnel syndrome. Author(s): Trumble TE, Gilbert M, McCallister WV. Source: Neurosurg Clin N Am. 2001 April; 12(2): 255-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11525205&dopt=Abstract

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Enlarged median nerve in idiopathic carpal tunnel syndrome. Author(s): Nakamichi KI, Tachibana S. Source: Muscle & Nerve. 2000 November; 23(11): 1713-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11054750&dopt=Abstract

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Entrapment neuropathy of the palmar cutaneous branch of the median nerve concomitant with carpal tunnel syndrome: a case report. Author(s): Wada T, Imai T, Ishii S. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2002 December; 27(6): 583-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12475522&dopt=Abstract

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Evaluating the source and content of orthopaedic information on the Internet. The case of carpal tunnel syndrome. Author(s): Beredjiklian PK, Bozentka DJ, Steinberg DR, Bernstein J. Source: The Journal of Bone and Joint Surgery. American Volume. 2000 November; 82A(11): 1540-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11097441&dopt=Abstract

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Evaluation of age, body mass index, and wrist index as risk factors for carpal tunnel syndrome severity. Author(s): Kouyoumdjian JA, Zanetta DM, Morita MP. Source: Muscle & Nerve. 2002 January; 25(1): 93-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11754190&dopt=Abstract

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Evaluation of the Spanish version of the DASH and carpal tunnel syndrome healthrelated quality-of-life instruments: cross-cultural adaptation process and reliability. Author(s): Rosales RS, Delgado EB, Diez de la Lastra-Bosch I. Source: The Journal of Hand Surgery. 2002 March; 27(2): 334-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11901395&dopt=Abstract

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Examination of patients for carpal tunnel syndrome sensibility, provocative, and motor testing. Author(s): Palumbo CF, Szabo RM. Source: Hand Clin. 2002 May; 18(2): 269-77, Vi. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371029&dopt=Abstract

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Factors that determine reexploration treatment of carpal tunnel syndrome. Author(s): O'Malley MJ, Evanoff M, Terrono AL, Millender LH. Source: The Journal of Hand Surgery. 1992 July; 17(4): 638-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1629542&dopt=Abstract

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False positive electrodiagnostic tests in carpal tunnel syndrome. Author(s): Redmond MD, Rivner MH. Source: Muscle & Nerve. 1988 May; 11(5): 511-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3374521&dopt=Abstract

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Familial amyloid polyneuropathy in a Spanish family with a transthyretin deletion (deltaVal 122) presenting with carpal tunnel syndrome. Author(s): Munar-Ques M, Saraiva MJ, Ordeig-Calonge J, Moreira P, Perez-Vidal R, Puig-Pujol X, Monells-Abel J, Badal-Alter JM. Source: Clinical Genetics. 2000 November; 58(5): 411-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11140845&dopt=Abstract

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Familial amyloidotic polyneuropathy presenting with carpal tunnel syndrome and a new transthyretin mutation, asparagine 70. Author(s): Izumoto S, Younger D, Hays AP, Martone RL, Smith RT, Herbert J. Source: Neurology. 1992 November; 42(11): 2094-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1436517&dopt=Abstract

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Familial autosomal-dominant carpal tunnel syndrome presenting in a 5-year-old case. Author(s): Stogbauer F, Young P, Funke H. Source: Muscle & Nerve. 1998 April; 21(4): 551. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9533796&dopt=Abstract

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Familial autosomal-dominant carpal tunnel syndrome presenting in a 5-year-old-case report and review of the literature. Author(s): Vadasz AG, Chance PF, Epstein LG, Lou JS. Source: Muscle & Nerve. 1997 March; 20(3): 376-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9052822&dopt=Abstract

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Familial bilateral carpal tunnel syndrome: report of two families. Author(s): Leifer D, Cros D, Halperin JJ, Gallico GG 3rd, Pierce DS, Shahani BT. Source: Archives of Physical Medicine and Rehabilitation. 1992 April; 73(4): 393-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1554316&dopt=Abstract

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Familial carpal tunnel syndrome due to amyloidogenic transthyretin His 114 variant. Author(s): Murakami T, Tachibana S, Endo Y, Kawai R, Hara M, Tanase S, Ando M. Source: Neurology. 1994 February; 44(2): 315-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8309582&dopt=Abstract

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Familial carpal tunnel syndrome: a report of a Finnish family. Author(s): Mahjneh I, Saarinen A, Siivola J. Source: Acta Neurologica Scandinavica. 2001 December; 104(6): 377-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903093&dopt=Abstract

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Fibroma of tendon sheath as a cause of carpal tunnel syndrome. Author(s): Evangelisti S, Reale VF. Source: The Journal of Hand Surgery. 1992 November; 17(6): 1026-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1430929&dopt=Abstract

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Fibromyalgia and carpal tunnel syndrome. Author(s): Perez-Ruiz F, Calabozo M, Alonso-Ruiz A, Ruiz-Lucea E. Source: Annals of the Rheumatic Diseases. 1997 July; 56(7): 438-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9486010&dopt=Abstract

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Flexor tendon anomalies in a patient with carpal tunnel syndrome. Author(s): Slater RR. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2001 August; 26(4): 373-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11469843&dopt=Abstract

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Flexor tenosynovectomy in the treatment of carpal tunnel syndrome: some theoretical and procedural differences. Author(s): Khan MI. Source: The Journal of Bone and Joint Surgery. American Volume. 2002 September; 84A(9): 1717-8; Author Reply 1718. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12208934&dopt=Abstract

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Follow-up results of surgery for carpal tunnel syndrome in local anesthesia. Author(s): Flaschka G, Eder H, Mullegger G, Gindl HK. Source: Zentralblatt Fur Neurochirurgie. 1991; 52(3): 123-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1796671&dopt=Abstract

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Forearm mixed nerve conduction velocity: questionable role in the evaluation of retrograde axonal atrophy in carpal tunnel syndrome. Author(s): Chang MH, Wei SJ, Chiang HL, Wang HM, Hsieh PF, Huang SY. Source: Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society. 2003 May-June; 20(3): 196-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881666&dopt=Abstract

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Forearm velocity in carpal tunnel syndrome: when is slow too slow?. Author(s): Donahue JE, Raynor EM, Rutkove SB. Source: Archives of Physical Medicine and Rehabilitation. 1998 February; 79(2): 181-3. Erratum In: Arch Phys Med Rehabil 1998 June; 79(6): 723. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9474001&dopt=Abstract

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Function of thick and thin nerve fibers in carpal tunnel syndrome before and after surgical treatment. Author(s): Lang E, Spitzer A, Pfannmuller D, Claus D, Handwerker HO, Neundorfer B. Source: Muscle & Nerve. 1995 February; 18(2): 207-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7823980&dopt=Abstract

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Functional deficits in carpal tunnel syndrome. Author(s): Sesto ME, Radwin RG, Salvi FJ. Source: American Journal of Industrial Medicine. 2003 August; 44(2): 133-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12874845&dopt=Abstract

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Functional psychomotor deficits associated with carpal tunnel syndrome. Author(s): Jeng OJ, Radwin RG, Rodriquez AA. Source: Ergonomics. 1994 June; 37(6): 1055-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8026451&dopt=Abstract

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F-wave analysis in patients with carpal tunnel syndrome. Author(s): Fisher MA, Hoffen B. Source: Electromyogr Clin Neurophysiol. 1997 January-February; 37(1): 27-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9063659&dopt=Abstract

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Gaining the upper hand on carpal tunnel syndrome. Author(s): Barrer SJ. Source: Occup Health Saf. 1991 January; 60(1): 38, 40-1, 43. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2003000&dopt=Abstract

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Ganglion cysts and carpal tunnel syndrome. Author(s): Kerrigan JJ, Bertoni JM, Jaeger SH. Source: The Journal of Hand Surgery. 1988 September; 13(5): 763-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3241055&dopt=Abstract

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Generic health instruments do not comprehensively capture patient perceived improvement in patients with carpal tunnel syndrome. Author(s): Vaile JH, Mathers DM, Ramos-Remus C, Russell AS. Source: The Journal of Rheumatology. 1999 May; 26(5): 1163-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10332984&dopt=Abstract

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Genetic linkage analysis of the carpal tunnel syndrome. Author(s): Sparkes RS, Spence MA, Gottlieb NL, Gray RG, Crist M, Sparkes MC, Marazita M. Source: Human Heredity. 1985; 35(5): 288-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4043979&dopt=Abstract

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Giant cell arteritis of the median nerve simulating carpal tunnel syndrome. Author(s): Merianos P, Smyrnis P, Tsomy K, Hager J. Source: Hand. 1983 October; 15(3): 249-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6642296&dopt=Abstract

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Giant cell arteritis presenting as a carpal tunnel syndrome. Author(s): Dennis RH 2nd, Ransome JR. Source: Journal of the National Medical Association. 1996 August; 88(8): 524-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8803435&dopt=Abstract

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Giant lipoma of the deep palmar space, mimicking persistent carpal tunnel syndrome. Author(s): De Smet L, Bande S, Fabry G. Source: Acta Orthop Belg. 1994; 60(3): 334-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7992615&dopt=Abstract

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Gloves, behavior changes can reduce carpal tunnel syndrome. Author(s): Sebright JA. Source: Occup Health Saf. 1986 September; 55(9): 18, 20, 22. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3763095&dopt=Abstract

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Granulomatous tenosynovitis and carpal tunnel syndrome caused by Sporothrix schenckii. Author(s): Stratton CW, Lichtenstein KA, Lowenstein SR, Phelps DB, Reller LB. Source: The American Journal of Medicine. 1981 July; 71(1): 161-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7246574&dopt=Abstract

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Hand elevation: a new test for carpal tunnel syndrome. Author(s): Ahn DS. Source: Annals of Plastic Surgery. 2001 February; 46(2): 120-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11216604&dopt=Abstract

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Hand/wrist pain and carpal tunnel syndrome. Author(s): Coe J. Source: J Occup Med. 1988 July; 30(7): 537, 540. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3397777&dopt=Abstract

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Heat sensitivity of sensory fibers in carpal tunnel syndrome. Author(s): Burke D, Kiernan MC, Mogyoros I, Lin C. Source: Muscle & Nerve. 1999 July; 22(7): 969-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10398223&dopt=Abstract

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Heat sensitivity of sensory fibers in carpal tunnel syndrome. Author(s): Wang AK, Raynor EM, Blum AS, Rutkove SB. Source: Muscle & Nerve. 1999 January; 22(1): 37-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9883855&dopt=Abstract

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Hemodialysis-associated carpal tunnel syndrome. A clinical review. Author(s): Zamora JL, Rose JE, Rosario V, Noon GP. Source: Nephron. 1985; 41(1): 70-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4033844&dopt=Abstract

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Hereditary neuropathy with liability to pressure palsies is not a major cause of idiopathic carpal tunnel syndrome. Author(s): Stockton DW, Meade RA, Netscher DT, Epstein MJ, Shenaq SM, Shaffer LG, Lupski JR. Source: Archives of Neurology. 2001 October; 58(10): 1635-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11594922&dopt=Abstract

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Hereditary neuropathy with liability to pressure palsies: electrophysiological and genetic study of a family with carpal tunnel syndrome as only clinical manifestation. Author(s): Del Colle R, Fabrizi GM, Turazzini M, Cavallaro T, Silvestri M, Rizzuto N. Source: Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2003 June; 24(2): 57-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12827539&dopt=Abstract

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High incidence of carpal tunnel syndrome in diabetic patients after combined pancreas and kidney transplantation. Author(s): Muller-Felber W, Landgraf R, Reimers CD, Scheuer R, Wagner S, Nusser J, Abendroth A, Illner WD, Land W. Source: Acta Diabetologica. 1993; 30(1): 17-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8329726&dopt=Abstract

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High prevalence of undetected carpal tunnel syndrome in patients with fibromyalgia syndrome. Author(s): Perez-Ruiz F, Calabozo M, Alonso-Ruiz A, Herrero A, Ruiz-Lucea E, Otermin I. Source: The Journal of Rheumatology. 1995 March; 22(3): 501-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7783070&dopt=Abstract

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Higher incidence of carpal tunnel syndrome in oophorectomized women. Author(s): Pascual E, Giner V, Arostegui A, Conill J, Ruiz MT, Pico A. Source: British Journal of Rheumatology. 1991 February; 30(1): 60-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1991220&dopt=Abstract

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Histology of the transverse carpal ligament and flexor tenosynovium in idiopathic carpal tunnel syndrome. Author(s): Nakamichi K, Tachibana S. Source: The Journal of Hand Surgery. 1998 November; 23(6): 1015-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9848552&dopt=Abstract

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Histo-mechanical aspects of carpal tunnel syndrome. Author(s): Lin R, Lin E, Engel J, Bubis JJ. Source: Hand. 1983 October; 15(3): 305-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6642310&dopt=Abstract

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Histopathology and clinical results of carpal tunnel syndrome in idiopathic cases and hemodialysis patients. Author(s): Kinugasa K, Hashizume H, Nishida K, Shigeyama Y, Inoue H. Source: Acta Medica Okayama. 1997 April; 51(2): 63-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9142342&dopt=Abstract

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How accurate are the history and physical examination in diagnosing carpal tunnel syndrome (CTS)? Author(s): Cochrane Database Syst Rev. 2002;(4):CD001554 Source: The Journal of Family Practice. 2000 September; 49(9): 782-3. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12519560

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How does neurophysiological assessment influence the management and outcome of patients with carpal tunnel syndrome? Author(s): Richards AJ. Source: British Journal of Rheumatology. 1995 June; 34(6): 581-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7633805&dopt=Abstract

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How does neurophysiological assessment influence the management and outcome of patients with carpal tunnel syndrome? Author(s): Boniface SJ, Morris I, Macleod A. Source: British Journal of Rheumatology. 1994 December; 33(12): 1169-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8000749&dopt=Abstract

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How often are preoperative electrodiagnostic studies obtained for carpal tunnel syndrome in a Medicaid population? Author(s): Mainous AG 3rd, Nelson KR. Source: Muscle & Nerve. 1996 February; 19(2): 256-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8559183&dopt=Abstract

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Hunter's syndrome as a cause of childhood carpal tunnel syndrome: a report of three cases. Author(s): Norman-Taylor F, Fixsen JA, Sharrard WJ. Source: Journal of Pediatric Orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America. 1995; 4(1): 106-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7719824&dopt=Abstract

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Hyperostotic macrodactyly and lipofibromatous hamartoma of the median nerve associated with carpal tunnel syndrome. Author(s): Nogueira A, Pena C, Martinez MJ, Sarasua JG, Madrigal B. Source: Chir Main. 1999; 18(4): 261-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10855329&dopt=Abstract

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Hypoplastic scaphoid--an unusual cause of carpal tunnel syndrome. Author(s): Radford PJ, Matthewson MH. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1987 June; 12(2): 236-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3624986&dopt=Abstract

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Idiopathic carpal tunnel syndrome. Clinical, electrodiagnostic, and magnetic resonance imaging correlations. Author(s): Zagnoli F, Andre V, Le Dreff P, Garcia JF, Bellard S. Source: Rev Rhum Engl Ed. 1999 April; 66(4): 192-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10339774&dopt=Abstract

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Impact of occupational variables in carpal tunnel syndrome. Author(s): Bekkelund SI, Pierre-Jerome C, Torbergsen T, Ingebrigtsen T. Source: Acta Neurologica Scandinavica. 2001 March; 103(3): 193-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11240568&dopt=Abstract

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Incidence of bilateral symptoms in carpal tunnel syndrome. Author(s): Padua L, Padua R, Nazzaro M, Tonali P. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1998 October; 23(5): 603-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9821602&dopt=Abstract

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Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review. Author(s): van Dijk MA, Reitsma JB, Fischer JC, Sanders GT. Source: Clinical Chemistry. 2003 September; 49(9): 1437-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928223&dopt=Abstract

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Injection with methylprednisolone for carpal tunnel syndrome. Local steroid injections only reduce inflammation temporarily. Author(s): Wallace WA. Source: Bmj (Clinical Research Ed.). 2000 March 4; 320(7235): 645-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10698895&dopt=Abstract

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Injection with methylprednisolone for carpal tunnel syndrome. Study does not show long term benefits of injection for the syndrome. Author(s): Hayward AC. Source: Bmj (Clinical Research Ed.). 2000 March 4; 320(7235): 646. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10744412&dopt=Abstract

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Injection with methylprednisolone for carpal tunnel syndrome. Study is needed to determine best treatment for this syndrome. Author(s): Davies T. Source: Bmj (Clinical Research Ed.). 2000 March 4; 320(7235): 646. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10744413&dopt=Abstract

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Inter-observer reproducibility and responsiveness of a clinical severity scale in surgically treated carpal tunnel syndrome. Author(s): Mondelli M, Ginanneschi F, Rossi S, Reale F, Padua L, Giannini F. Source: Acta Neurologica Scandinavica. 2002 November; 106(5): 263-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371919&dopt=Abstract

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Interventions for the primary prevention of work-related carpal tunnel syndrome. Author(s): Lincoln AE, Vernick JS, Ogaitis S, Smith GS, Mitchell CS, Agnew J. Source: American Journal of Preventive Medicine. 2000 May; 18(4 Suppl): 37-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10793280&dopt=Abstract

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Interview data versus questionnaire data in the diagnosis of carpal tunnel syndrome in epidemiological studies. Author(s): Thomsen JF, Mikkelsen S. Source: Occupational Medicine (Oxford, England). 2003 February; 53(1): 57-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576567&dopt=Abstract

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Intralesional therapy in carpal tunnel syndrome: a sonographic-guided approach. Author(s): Grassi W, Farina A, Filippucci E, Cervini C. Source: Clin Exp Rheumatol. 2002 January-February; 20(1): 73-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11892715&dopt=Abstract

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Intramuscular lipoma in an anomalous muscle belly of the middle finger lumbrical as a cause of carpal tunnel syndrome and trigger wrist. Author(s): Cossey AJ, Stranks GJ. Source: Orthopedics. 2003 January; 26(1): 85-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555841&dopt=Abstract

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Intraneural median nerve pressure in carpal tunnel syndrome. Author(s): Okutsu I, Hamanaka I, Chiyokura Y, Miyauchi Y, Sugiyama K. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2001 April; 26(2): 155-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11281670&dopt=Abstract

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Is the occurrence of carpal tunnel syndrome in men underestimated? Author(s): Padua L, Aprile I, Caliandro P, Padua L, Tonali P; Gruppo Italiano Studio Sindrome Tunnel Carpale. Source: Epidemiology (Cambridge, Mass.). 2001 May; 12(3): 369. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11338322&dopt=Abstract

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Is there a familial carpal tunnel syndrome? An evaluation and literature review. Author(s): Gossett JG, Chance PF. Source: Muscle & Nerve. 1998 November; 21(11): 1533-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9771681&dopt=Abstract

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Italian multicentre study of carpal tunnel syndrome. Differences in the clinical and neurophysiological features between male and female patients. Author(s): Padua L, Padua R, Aprile, Tonali P. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1999 October; 24(5): 579-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10597936&dopt=Abstract

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Italian multicentre study of carpal tunnel syndrome: clinical-neurophysiological picture and diagnostic pathway in 461 patients and differences between the populations enrolled in the northern, central and southern centres. Italian CTS Study Group. Author(s): Padua L, Aprile I, Lo Monaco M, Padua R, Pasqualetti P, Nazzaro M, Tonali P. Source: Italian Journal of Neurological Sciences. 1999 October; 20(5): 309-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10933440&dopt=Abstract

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Italian multicentre study of carpal tunnel syndrome: study design. Italian CTS Study Group. Author(s): Padua L, Padua R, LoMonaco M, Romanini E, Tonali P. Source: Italian Journal of Neurological Sciences. 1998 October; 19(5): 285-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10933448&dopt=Abstract

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It's all in the wrist: carpal tunnel syndrome. Author(s): Smith ER. Source: Rehab Manag. 2003 August-September; 16(7): 26-7, 68. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12961995&dopt=Abstract

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I've been diagnosed with carpal tunnel syndrome. Should I have surgery? Author(s): Feinberg AW. Source: Health News. 2002 August; 8(8): 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12206143&dopt=Abstract

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JAMA patient page. Carpal tunnel syndrome. Author(s): Parmet S. Source: Jama : the Journal of the American Medical Association. 2002 September 11; 288(10): 1310. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12238494&dopt=Abstract

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Lack of predictive power of the “tethered” median stress test in suspected carpal tunnel syndrome. Author(s): Kaul MP, Pagel KJ, Dryden JD. Source: Archives of Physical Medicine and Rehabilitation. 2000 March; 81(3): 348-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10724081&dopt=Abstract

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Lack of utility of Semmes-Weinstein monofilament testing in suspected carpal tunnel syndrome. Author(s): Pagel KJ, Kaul MP, Dryden JD. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 August; 81(8): 597-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172069&dopt=Abstract

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Less common causes of carpal tunnel syndrome. Author(s): Choudhary S, Krishna A, Mohan D. Source: Annals of Plastic Surgery. 1997 November; 39(5): 552-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9374157&dopt=Abstract

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Ligament lengthening compared with simple division of the transverse carpal ligament in the open treatment of carpal tunnel syndrome. Author(s): Karlsson MK, Lindau T, Hagberg L. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 1997 March; 31(1): 65-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9075290&dopt=Abstract

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Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee. Author(s): Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. Source: Muscle & Nerve. 1993 December; 16(12): 1392-414. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8232399&dopt=Abstract

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Literature review: nervepace digital electroneurometer in the diagnosis of carpal tunnel syndrome. Author(s): David WS, Chaudhry V, Dubin AH, Shields RW Jr; American Association of Electrodiagnostic Medicine. Source: Muscle & Nerve. 2003 March; 27(3): 378-85. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635127&dopt=Abstract

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Local corticosteroid injection for carpal tunnel syndrome. Author(s): Marshall S, Tardif G, Ashworth N. Source: Cochrane Database Syst Rev. 2002; (4): Cd001554. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519560&dopt=Abstract

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Local corticosteroid injection for carpal tunnel syndrome. Author(s): Marshall S, Tardif G, Ashworth N. Source: Cochrane Database Syst Rev. 2000; (4): Cd001554. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11034724&dopt=Abstract

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Local insulin injection improves median nerve regeneration in NIDDM patients with carpal tunnel syndrome. Author(s): Ozkul Y, Sabuncu T, Yazgan P, Nazligul Y. Source: European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies. 2001 July; 8(4): 329-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11422429&dopt=Abstract

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Local vs systemic corticosteroids in the treatment of carpal tunnel syndrome. Author(s): Wong SM, Hui AC, Tang A, Ho PC, Hung LK, Wong KS, Kay R, Li E. Source: Neurology. 2001 June 12; 56(11): 1565-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11402116&dopt=Abstract

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Long-cane modification for carpal tunnel syndrome: a case report. Author(s): Aquilante K, Kern T, Courtney A. Source: J Am Optom Assoc. 1996 June; 67(6): 316-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8888851&dopt=Abstract

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Long-term clinical and electrophysiological results of local steroid injection in patients with carpal tunnel syndrome. Author(s): Ayhan-Ardic FF, Erdem HR. Source: Funct Neurol. 2000 July-September; 15(3): 157-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11062844&dopt=Abstract

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Long-term outcomes of symptomatic electrodiagnosed carpal tunnel syndrome. Author(s): Kouyoumdjian JA, Morita MP, Molina AF, Zanetta DM, Sato AK, Rocha CE, Fasanella CC. Source: Arquivos De Neuro-Psiquiatria. 2003 June; 61(2A): 194-8. Epub 2003 June 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12806496&dopt=Abstract

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Long-term symptom outcomes of carpal tunnel syndrome and its treatment. Author(s): DeStefano F, Nordstrom DL, Vierkant RA. Source: The Journal of Hand Surgery. 1997 March; 22(2): 200-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9195415&dopt=Abstract

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Low back pain and carpal tunnel syndrome. Two troublesome presentations in the workplace. Author(s): Laine DE. Source: Adv Nurse Pract. 1999 June; 7(6): 49-50, 74. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10624180&dopt=Abstract

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Low-dose, short-term oral prednisone in the treatment of carpal tunnel syndrome. Author(s): Herskovitz S, Berger AR, Lipton RB. Source: Neurology. 1995 October; 45(10): 1923-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7477994&dopt=Abstract

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Lumbrical and interossei recording in carpal tunnel syndrome. Author(s): Muellbacher W, Mamoli B, Zifko U, Grisold W. Source: Muscle & Nerve. 1994 March; 17(3): 359-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8166825&dopt=Abstract

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Lumbrical and interossei recording in severe carpal tunnel syndrome. Author(s): Boonyapisit K, Katirji B, Shapiro BE, Preston DC. Source: Muscle & Nerve. 2002 January; 25(1): 102-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11754192&dopt=Abstract

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Lumbrical-interosseous latency comparison in the diagnosis of carpal tunnel syndrome. Author(s): Sheean GL, Houser MK, Murray NM. Source: Electroencephalography and Clinical Neurophysiology. 1995 December; 97(6): 285-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8536577&dopt=Abstract

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Lysyl oxidase activity in the cells of flexor retinaculum of individuals with carpal tunnel syndrome. Author(s): Bose KK, Chakraborty J, Khuder S, Smith-Mensah WH, Robinson J. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2000 June; 42(6): 582-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10874650&dopt=Abstract

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Magnetic resonance assessment of the double-crush phenomenon in patients with carpal tunnel syndrome: a bilateral quantitative study. Author(s): Pierre-Jerome C, Bekkelund SI. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 2003; 37(1): 4653. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625395&dopt=Abstract

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Magnetic resonance imaging findings in respect to carpal tunnel syndrome. Author(s): Pasternack II, Malmivaara A, Tervahartiala P, Forsberg H, Vehmas T. Source: Scand J Work Environ Health. 2003 June; 29(3): 189-96. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828388&dopt=Abstract

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Management of carpal tunnel syndrome in the working population. Author(s): Kasdan ML, Lewis K. Source: Hand Clin. 2002 May; 18(2): 325-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371035&dopt=Abstract

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Management of carpal tunnel syndrome. Author(s): Viera AJ. Source: American Family Physician. 2003 July 15; 68(2): 265-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892346&dopt=Abstract

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Median nerve injury mimicking carpal tunnel syndrome. Author(s): Wigley RD. Source: N Z Med J. 2002 January 25; 115(1146): 25. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11936337&dopt=Abstract

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Median sensory nonresponders in carpal tunnel syndrome workup. Author(s): Kaul MP, Pagel KJ. Source: Archives of Physical Medicine and Rehabilitation. 2002 August; 83(8): 1120-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12161834&dopt=Abstract

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Median-to-ulnar sensory nerve action potential amplitude ratio as an electrodiagnostic adjunct for carpal tunnel syndrome. Author(s): Nesathurai S, Gwardjan A, Kamath AN. Source: Archives of Physical Medicine and Rehabilitation. 1999 July; 80(7): 756-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10414758&dopt=Abstract

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Medical history of carpal tunnel syndrome. Author(s): Michelsen H, Posner MA. Source: Hand Clin. 2002 May; 18(2): 257-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371028&dopt=Abstract

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MR imaging and electrophysiological evaluation in carpal tunnel syndrome. Author(s): Deryani E, Aki S, Muslumanoglu L, Rozanes I. Source: Yonsei Medical Journal. 2003 February; 44(1): 27-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12619172&dopt=Abstract

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MR nerve imaging in a prospective cohort of patients with suspected carpal tunnel syndrome. Author(s): Jarvik JG, Yuen E, Haynor DR, Bradley CM, Fulton-Kehoe D, Smith-Weller T, Wu R, Kliot M, Kraft G, Wang L, Erlich V, Heagerty PJ, Franklin GM. Source: Neurology. 2002 June 11; 58(11): 1597-602. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12058085&dopt=Abstract

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MRI vs EMG: which has the upper hand in carpal tunnel syndrome? Author(s): Fleckenstein JL, Wolfe GI. Source: Neurology. 2002 June 11; 58(11): 1583-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12058080&dopt=Abstract

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Mycobacterium kansasii causing carpal tunnel syndrome with concomitant pulmonary Mycobacterium tuberculosis infection. Author(s): Blue ML, Payne WG, Mannari RI, Moffitt MR, Walusimbi MG, Robson MC. Source: Southern Medical Journal. 2002 September; 95(9): 1095-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356122&dopt=Abstract

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Natural history of carpal tunnel syndrome according to the neurophysiological classification. Author(s): Padua L, Padua R, Lo Monaco M, Aprile I, Paciello N, Nazzaro M, Tonali P. Source: Italian Journal of Neurological Sciences. 1998 December; 19(6): 357-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10935830&dopt=Abstract

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Needle electromyography in carpal tunnel syndrome. Author(s): Wee AS. Source: Electromyogr Clin Neurophysiol. 2002 June; 42(4): 253-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12056340&dopt=Abstract

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Neovascularization and other histopathologic findings in an autogenous saphenous vein wrap used for recalcitrant carpal tunnel syndrome: a case report. Author(s): Chou KH, Papadimitriou NG, Sarris I, Sotereanos DG. Source: The Journal of Hand Surgery. 2003 March; 28(2): 262-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671858&dopt=Abstract

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Nerve conduction studies as a routine diagnostic aid in carpal tunnel syndrome. Author(s): Wright SA, Liggett N. Source: Rheumatology (Oxford, England). 2003 April; 42(4): 602-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649413&dopt=Abstract

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Nerve conduction studies for carpal tunnel syndrome: essential prelude to surgery or unnecessary luxury? Author(s): Smith NJ. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2002 February; 27(1): 83-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11895352&dopt=Abstract

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Neurophysiology not required before surgery for typical carpal tunnel syndrome. Author(s): Finsen V, Russwurm H. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2001 February; 26(1): 61-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11162020&dopt=Abstract

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Nodular cutaneous amyloidosis and carpal tunnel syndrome due to the amyloidogenic transthyretin His 114 variant. Author(s): Mochizuki H, Kamakura K, Masaki T, Hirata A, Tokuda T, Yazaki M, Motoyoshi K, Ikeda S. Source: Amyloid : the International Journal of Experimental and Clinical Investigation : the Official Journal of the International Society of Amyloidosis. 2001 June; 8(2): 105-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11409031&dopt=Abstract

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Nonneurologic hand pain versus carpal tunnel syndrome: do psychological measures differentiate? Author(s): Crossman MW, Gilbert CA, Travlos A, Craig KD, Eisen A. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2001 February; 80(2): 100-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11212009&dopt=Abstract

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Nonoperative carpal tunnel syndrome treatment. Author(s): Osterman AL, Whitman M, Porta LD. Source: Hand Clin. 2002 May; 18(2): 279-89. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371030&dopt=Abstract

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Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Author(s): O'Connor D, Marshall S, Massy-Westropp N. Source: Cochrane Database Syst Rev. 2003; (1): Cd003219. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12535461&dopt=Abstract

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Objective evaluation of sensory function in patients with carpal tunnel syndrome using the current perception threshold. Author(s): Nishimura A, Ogura T, Hase H, Makinodan A, Hojo T, Katsumi Y, Yagi K, Mikami Y, Kubo T. Source: Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 2003; 8(5): 625-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14557926&dopt=Abstract

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Occupational and personal risk factors for carpal tunnel syndrome in industrial workers. Author(s): Roquelaure Y, Mechali S, Dano C, Fanello S, Benetti F, Bureau D, Mariel J, Martin YH, Derriennic F, Penneau-Fontbonne D. Source: Scand J Work Environ Health. 1997 October; 23(5): 364-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9403467&dopt=Abstract

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Occurrence of carpal tunnel syndrome among slaughterhouse workers. Author(s): Frost P, Andersen JH, Nielsen VK. Source: Scand J Work Environ Health. 1998 August; 24(4): 285-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9754860&dopt=Abstract

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Off-road machine controls: investigating the risk of carpal tunnel syndrome. Author(s): Oliver M, Rickards J, Biden E. Source: Ergonomics. 2000 November; 43(11): 1887-903. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11105978&dopt=Abstract

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Operative treatment of carpal tunnel syndrome in Denmark. Results of a questionnaire. Author(s): Ebskov LB, Boeckstyns ME, Sorensen AI. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1997 December; 22(6): 761-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9457583&dopt=Abstract

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Optimizing the number of tests for carpal tunnel syndrome. Author(s): Robinson LR, Micklesen PJ, Wang L. Source: Muscle & Nerve. 2000 December; 23(12): 1880-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11102914&dopt=Abstract

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Oral drug of choice in carpal tunnel syndrome. Author(s): Chang MH, Chiang HT, Lee SS, Ger LP, Lo YK. Source: Neurology. 1998 August; 51(2): 390-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9710008&dopt=Abstract

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Oral steroid in the treatment of carpal tunnel syndrome. Author(s): Hui AC, Wong SM, Wong KS, Li E, Kay R, Yung P, Hung LK, Yu LM. Source: Annals of the Rheumatic Diseases. 2001 August; 60(8): 813-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11482310&dopt=Abstract

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Orthodromic inching test in mild carpal tunnel syndrome. Author(s): Seror P. Source: Muscle & Nerve. 1998 September; 21(9): 1206-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9703449&dopt=Abstract

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Outcomes assessment in carpal tunnel syndrome. Author(s): Patterson JD, Simmons BP. Source: Hand Clin. 2002 May; 18(2): 359-63, Viii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371039&dopt=Abstract

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Pharmacotherapy of carpal tunnel syndrome. Author(s): de Pablo P, Katz JN. Source: Expert Opinion on Pharmacotherapy. 2003 June; 4(6): 903-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12783587&dopt=Abstract

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Physical therapy intervention following surgical treatment of carpal tunnel syndrome in an individual with a history of postmastectomy lymphedema. Author(s): Donachy JE, Christian EL. Source: Physical Therapy. 2002 October; 82(10): 1009-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12350215&dopt=Abstract

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Poor outcome for neural surgery (epineurotomy or neurolysis) for carpal tunnel syndrome compared with carpal tunnel release alone: a meta-analysis of global outcomes. Author(s): Chapell R, Coates V, Turkelson C. Source: Plastic and Reconstructive Surgery. 2003 September 15; 112(4): 983-90; Discussion 991-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12973213&dopt=Abstract

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Power spectrum analysis of compound muscle action potential in carpal tunnel syndrome patients. Author(s): Ogura T, Kubo T, Okuda Y, Lee K, Kira Y, Aramaki S, Nakanishi F. Source: Journal of Orthopaedic Surgery (Hong Kong). 2002 June; 10(1): 67-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401924&dopt=Abstract

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Prevalence of carpal tunnel syndrome in a general population. Author(s): Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Source: Jama : the Journal of the American Medical Association. 1999 July 14; 282(2): 153-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10411196&dopt=Abstract

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Prevalence of musculoskeletal symptoms and carpal tunnel syndrome among dental hygienists. Author(s): Anton D, Rosecrance J, Merlino L, Cook T. Source: American Journal of Industrial Medicine. 2002 September; 42(3): 248-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12210693&dopt=Abstract

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Preventing cumulative trauma injury carpal tunnel syndrome. Author(s): Ligh RQ. Source: J Calif Dent Assoc. 2002 September; 30(9): 671, 674-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12365846&dopt=Abstract

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Primary care management of carpal tunnel syndrome. Author(s): Burke FD, Ellis J, McKenna H, Bradley MJ. Source: Postgraduate Medical Journal. 2003 August; 79(934): 433-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954952&dopt=Abstract

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Protocol of outcome evaluation for surgical release of carpal tunnel syndrome. Author(s): Reale F, Ginanneschi F, Sicurelli F, Mondelli M. Source: Neurosurgery. 2003 August; 53(2): 343-50; Discussion 350-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925250&dopt=Abstract

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Protracted Mycobacterium kansasii carpal tunnel syndrome and tenosynovitis. Author(s): Lidar M, Elkayam O, Goodwin D, Yaron M, Caspi D. Source: Isr Med Assoc J. 2003 June; 5(6): 453-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841025&dopt=Abstract

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Quantitative MR imaging of carpal tunnel syndrome. Author(s): Monagle K, Dai G, Chu A, Burnham RS, Snyder RE. Source: Ajr. American Journal of Roentgenology. 1999 June; 172(6): 1581-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10350293&dopt=Abstract

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Quantitative MRI and electrophysiology of preoperative carpal tunnel syndrome in a female population. Author(s): Pierre-Jerome C, Bekkelund SI, Mellgren SI, Nordstrom R. Source: Ergonomics. 1997 June; 40(6): 642-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9174415&dopt=Abstract

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Quantitative sensory thresholds in carpal tunnel syndrome. Author(s): Merchut MP, Kelly MA, Toleikis SC. Source: Electromyogr Clin Neurophysiol. 1990 February-March; 30(2): 119-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2155775&dopt=Abstract

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Quantitative vibrometry and electrophysiological assessment in screening for carpal tunnel syndrome among industrial workers: a comparison. Author(s): Werner RA, Franzblau A, Johnston E. Source: Archives of Physical Medicine and Rehabilitation. 1994 November; 75(11): 122832. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7979934&dopt=Abstract

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Raynaud's phenomenon in idiopathic carpal tunnel syndrome: postoperative alteration in its prevalence. Author(s): Chung MS, Gong HS, Baek GH. Source: The Journal of Bone and Joint Surgery. British Volume. 2000 August; 82(6): 8189. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10990303&dopt=Abstract

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Re: neurophysiology not required before surgery for typical carpal tunnel syndrome. Author(s): Clay NR. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2001 December; 26(6): 600; Author Reply 600-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898779&dopt=Abstract

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Re: neurophysiology not required before surgery for typical carpal tunnel syndrome. Author(s): Kay NR. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2001 December; 26(6): 600; Author Reply 600-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11884122&dopt=Abstract

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Reaction time and movement time in patients with carpal tunnel syndrome: an electromyographic study. Author(s): Turhanoglu AD, Beyazova M. Source: Clinical Biomechanics (Bristol, Avon). 2003 June; 18(5): 380-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12763432&dopt=Abstract

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Recovery after carpal tunnel syndrome operation: the influence of the opposite hand, if operated on in the same session. Author(s): Huracek J, Heising T, Wanner M, Troeger H. Source: Archives of Orthopaedic and Trauma Surgery. 2001 July; 121(7): 368-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11510899&dopt=Abstract

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Recurrent carpal tunnel syndrome. Author(s): Steyers CM. Source: Hand Clin. 2002 May; 18(2): 339-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371037&dopt=Abstract

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Recurrent carpal tunnel syndrome: treatment options. Author(s): Pizzillo MF, Sotereanos DG, Tomaino MM. Source: J South Orthop Assoc. 1999 Spring; 8(1): 28-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132849&dopt=Abstract

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Relationship between the self-administered Boston questionnaire and electrophysiological findings in follow-up of surgically-treated carpal tunnel syndrome. Author(s): Mondelli M, Reale F, Sicurelli F, Padua L. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2000 April; 25(2): 128-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11062567&dopt=Abstract

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Remission of a recurrent carpal tunnel syndrome by a new device of the hemodialysis method in a long-term hemodialysis patient. Author(s): Shiota E, Fujinaga M. Source: Clinical Nephrology. 2000 March; 53(3): 230-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10749305&dopt=Abstract

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Role of ancillary procedures in surgical management of carpal tunnel syndrome: epineurotomy, internal neurolysis, tenosynovectomy, and tendon transfers. Author(s): Ting J, Weiland AJ. Source: Hand Clin. 2002 May; 18(2): 315-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371034&dopt=Abstract

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Senile systemic amyloidosis presenting as bilateral carpal tunnel syndrome. Author(s): Takei Y, Hattori T, Gono T, Tokuda T, Saitoh S, Hoshii Y, Ikeda S. Source: Amyloid : the International Journal of Experimental and Clinical Investigation : the Official Journal of the International Society of Amyloidosis. 2002 December; 9(4): 252-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557754&dopt=Abstract

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Splinting for carpal tunnel syndrome: prognostic indicators of success. Author(s): Gerritsen AA, Korthals-de Bos IB, Laboyrie PM, de Vet HC, Scholten RJ, Bouter LM. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2003 September; 74(9): 1342-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933954&dopt=Abstract

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Splinting vs surgery for carpal tunnel syndrome. Author(s): Bleecker ML. Source: Jama : the Journal of the American Medical Association. 2003 January 22-29; 289(4): 420; Author Reply 421-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12533116&dopt=Abstract

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Splinting vs surgery for carpal tunnel syndrome. Author(s): Johnson EW. Source: Jama : the Journal of the American Medical Association. 2003 January 22-29; 289(4): 420; Author Reply 421-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12533115&dopt=Abstract

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Splinting vs surgery for carpal tunnel syndrome. Author(s): Menkes DL. Source: Jama : the Journal of the American Medical Association. 2003 January 22-29; 289(4): 420-1; Author Reply 421-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12533114&dopt=Abstract

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Splinting vs surgery for carpal tunnel syndrome. Author(s): Sucher BM. Source: Jama : the Journal of the American Medical Association. 2003 January 22-29; 289(4): 421; Author Reply 421-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12533113&dopt=Abstract

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Splinting vs surgery for carpal tunnel syndrome. Author(s): Klauser A, Schirmer M. Source: Jama : the Journal of the American Medical Association. 2003 January 22-29; 289(4): 421; Author Reply 421-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12533111&dopt=Abstract

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Splinting vs surgery for carpal tunnel syndrome. Author(s): Weintraub MI. Source: Jama : the Journal of the American Medical Association. 2003 January 22-29; 289(4): 422; Author Reply 422-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12533109&dopt=Abstract

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Surgical treatment options for carpal tunnel syndrome. Author(s): Scholten RJ, Gerritsen AA, Uitdehaag BM, van Geldere D, de Vet HC, Bouter LM. Source: Cochrane Database Syst Rev. 2002; (4): Cd003905. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519618&dopt=Abstract

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Surgical versus non-surgical treatment for carpal tunnel syndrome. Author(s): Verdugo RJ, Salinas RS, Castillo J, Cea JG. Source: Cochrane Database Syst Rev. 2003; (3): Cd001552. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917909&dopt=Abstract

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Tenelectrodes: a new stimulator for inching technique in the diagnosis of carpal tunnel syndrome. Author(s): Kang YK, Kim DH, Lee SH, Hwang M, Han MS. Source: Yonsei Medical Journal. 2003 June 30; 44(3): 479-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12833586&dopt=Abstract

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The association of age, sex and the number of sides of carpal tunnel syndrome. Author(s): Sungpet A, Suphachatwong C, Kawinwonggowit V. Source: J Med Assoc Thai. 1999 March; 82(3): 220-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10410474&dopt=Abstract

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The prevalence of hand pain in Ibadan--implications for the carpal tunnel syndrome. Author(s): Oyedele OO, Shokunbi MT, Malomo AO. Source: West Afr J Med. 2002 July-September; 21(3): 204-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744568&dopt=Abstract

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The reason for forearm conduction slowing in carpal tunnel syndrome: an electrophysiological follow-up study after surgery. Author(s): Chang MH, Wei SJ, Chen LW. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2003 June; 114(6): 1091-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804677&dopt=Abstract

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The relationship between basal joint arthritis and carpal tunnel syndrome: an MRI pilot study. Author(s): Goldfarb CA, Kiefhaber TR, Stern PJ, Bielecki DK. Source: The Journal of Hand Surgery. 2003 January; 28(1): 21-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12563633&dopt=Abstract

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The value of diagnostic testing in carpal tunnel syndrome. Author(s): Szabo RM, Slater RR Jr, Farver TB, Stanton DB, Sharman WK. Source: The Journal of Hand Surgery. 1999 July; 24(4): 704-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10447161&dopt=Abstract

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Trapeziometacarpal joint osteoarthritis and carpal tunnel syndrome: a new surgical approach for concomitant treatment. Author(s): Stahl S, Shapira D. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2003 June; 28(3): 246-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809658&dopt=Abstract

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Treating carpal tunnel syndrome with lasers and TENS. Author(s): Bodofsky E. Source: Archives of Physical Medicine and Rehabilitation. 2002 December; 83(12): 1806; Author Reply 1806-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12474192&dopt=Abstract

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Treatment of worker's compensation cases of carpal tunnel syndrome: an outcome study. Author(s): Lyall JM, Gliner J, Hubbell MK. Source: J Hand Ther. 2002 July-September; 15(3): 251-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12206328&dopt=Abstract

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Two weeks of prednisolone was as effective as four weeks in improving carpal tunnel syndrome symptoms. Author(s): Graham BA. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 August; 85-A(8): 1624. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925658&dopt=Abstract

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Ulnar bursa distention following volar subluxation of the distal radioulnar joint after distal radial fracture: a rare cause of carpal tunnel syndrome. Author(s): Nishikawa T, Kurosaka M, Mitani M, Matsubara N, Harada T, Mizuno K. Source: Journal of Orthopaedic Trauma. 2001 August; 15(6): 450-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11514776&dopt=Abstract

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Ultrasonographic evaluation of the carpal tunnel syndrome in hemodialysis patients. Author(s): Ikegaya N, Hishida A, Sawada K, Furuhashi M, Maruyama Y, Kumagai H, Kobayashi S, Yamamoto T, Yamazaki K. Source: Clinical Nephrology. 1995 October; 44(4): 231-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8575122&dopt=Abstract

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Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Author(s): Nakamichi K, Tachibana S. Source: Muscle & Nerve. 2002 December; 26(6): 798-803. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12451604&dopt=Abstract

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Ultrasound therapy effect in carpal tunnel syndrome. Author(s): Oztas O, Turan B, Bora I, Karakaya MK. Source: Archives of Physical Medicine and Rehabilitation. 1998 December; 79(12): 15404. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9862296&dopt=Abstract

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Uniportal endoscopic surgery of carpal tunnel syndrome: technique and clinical results. Author(s): Filippi R, Reisch R, El-Shki D, Grunert P. Source: Minimally Invasive Neurosurgery : Min. 2002 June; 45(2): 78-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12087503&dopt=Abstract

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Unusual ulnar sensory innervation and Martin-Gruber anastomosis in a patient with a carpal tunnel syndrome. Author(s): Simonetti S, Krarup C. Source: Journal of Neurology. 2000 February; 247(2): 141-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10751120&dopt=Abstract

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US demonstration of a thrombosed persistent median artery in carpal tunnel syndrome. Author(s): Fumiere E, Dugardeyn C, Roquet ME, Delcour C. Source: Jbr-Btr. 2002; 85(1): 1-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11936477&dopt=Abstract

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Usefulness of additional nerve conduction techniques in mild carpal tunnel syndrome. Author(s): Kouyoumdjian JA, Morita MP, Molina AF. Source: Arquivos De Neuro-Psiquiatria. 2002 December; 60(4): 923-7. Epub 2003 January 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12563381&dopt=Abstract

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Usefulness of segmental and comparative tests in the electrodiagnosis of carpal tunnel syndrome: the Italian multicenter study. Italian CTS Study Group. Author(s): Padua L, Giannini F, Girlanda P, Insola A, Luchetti R, Lo Monaco M, Padua R, Uncini A, Tonali P. Source: Italian Journal of Neurological Sciences. 1999 October; 20(5): 315-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10933441&dopt=Abstract

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Utility of the clinical examination for carpal tunnel syndrome. Author(s): Myers KA. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2000 September 5; 163(5): 605. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11006775&dopt=Abstract

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Value of electrodiagnostic tests in carpal tunnel syndrome. Author(s): Dudley Porras AF, Rojo Alaminos P, Vinuales JI, Ruiz Villamanan MA. Source: Journal of Hand Surgery (Edinburgh, Lothian). 2000 August; 25(4): 361-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11058004&dopt=Abstract

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Value of latency measurements to the small palm muscles compared to other conduction parameters in the carpal tunnel syndrome. Author(s): Trojaborg W, Grewal RP, Weimer LH, Sheriff P. Source: Muscle & Nerve. 1996 February; 19(2): 243-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8559178&dopt=Abstract

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Value of some clinical provocative tests in carpal tunnel syndrome: do we need electrophysiology and can we predict the outcome? Author(s): De Smet L. Source: Hand Clin. 2003 August; 19(3): 387-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12945635&dopt=Abstract

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Value of the carpal compression test in the diagnosis of carpal tunnel syndrome. Author(s): Gonzalez del Pino J, Delgado-Martinez AD, Gonzalez Gonzalez I, Lovic A. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1997 February; 22(1): 38-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9061521&dopt=Abstract

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Value of the lumbrical-interosseous technique in carpal tunnel syndrome. Author(s): Kaul MP, Pagel KJ. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 September; 81(9): 691-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172522&dopt=Abstract

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Variation in the treatment of carpal tunnel syndrome. Author(s): Scholten RJ, de Krom MC, Bertelsmann FW, Bouter LM. Source: Muscle & Nerve. 1997 October; 20(10): 1334-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9324097&dopt=Abstract

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Vascular factors in carpal tunnel syndrome. Author(s): Boland RA, Adams RD. Source: J Hand Ther. 2002 January-March; 15(1): 22-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11866348&dopt=Abstract

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Vitamin B6, vitamin C, and carpal tunnel syndrome. Author(s): Franzblau A, Rock CL, Werner RA, Albers JW. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 1998 April; 40(4): 305-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9571520&dopt=Abstract

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Vitamin B6, vitamin C, and carpal tunnel syndrome. A cross-sectional study of 441 adults. Author(s): Keniston RC, Nathan PA, Leklem JE, Lockwood RS. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 1997 October; 39(10): 949-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9343760&dopt=Abstract

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von Willebrand's disease presenting as acute carpal tunnel syndrome. Author(s): Parthenis DG, Karagkevrekis CB, Waldram MA. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1998 February; 23(1): 114. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9571501&dopt=Abstract

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What is carpal tunnel syndrome? Author(s): Franzblau A, Werner RA. Source: Jama : the Journal of the American Medical Association. 1999 July 14; 282(2): 186-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10411203&dopt=Abstract

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When exactly can carpal tunnel syndrome be considered work-related? Author(s): Falkiner S, Myers S. Source: Anz Journal of Surgery. 2002 March; 72(3): 204-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12071453&dopt=Abstract

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Which nonsurgical treatments for carpal tunnel syndrome are beneficial? Author(s): Piehl JH. Source: American Family Physician. 2003 August 15; 68(4): 649-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12952381&dopt=Abstract

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Wisconsin occupational carpal tunnel syndrome surveillance: the incidence of surgically treated cases. Author(s): Hanrahan LP, Higgins D, Anderson H, Smith M. Source: Wis Med J. 1993 December; 92(12): 685-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8109131&dopt=Abstract

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Work practice and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women. Author(s): Trail IA. Source: The Journal of Bone and Joint Surgery. British Volume. 2000 April; 82(3): 461-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10813191&dopt=Abstract

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Work practices and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women. Author(s): Chell J, Stevens A, Davis TR. Source: The Journal of Bone and Joint Surgery. British Volume. 1999 September; 81(5): 868-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10530852&dopt=Abstract

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Workers' compensation recipients with carpal tunnel syndrome: the validity of selfreported health measures. Author(s): Katz JN, Punnett L, Simmons BP, Fossel AH, Mooney N, Keller RB. Source: American Journal of Public Health. 1996 January; 86(1): 52-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8561242&dopt=Abstract

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Work-related carpal tunnel syndrome: fix the jobs; don't blame the workers. Author(s): Burt S, Hales T. Source: Archives of Internal Medicine. 1999 June 28; 159(12): 1371-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10386516&dopt=Abstract

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Worksite and personal factors associated with carpal tunnel syndrome in an Egyptian electronics assembly factory. Author(s): Abbas MF, Faris RH, Harber PI, Mishriky AM, El-Shahaly HA, Waheeb YH, Kraus JF. Source: International Journal of Occupational and Environmental Health : Official Journal of the International Commission on Occupational Health. 2001 January-March; 7(1): 31-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11210010&dopt=Abstract

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Wrist and palm indexes in carpal tunnel syndrome. Author(s): Kouyoumdjian JA, Morita MP, Rocha PR, Miranda RC, Gouveia GM. Source: Arquivos De Neuro-Psiquiatria. 2000 September; 58(3A): 625-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10973101&dopt=Abstract

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Yoga for carpal tunnel syndrome. Author(s): Harrast M, Kraft G. Source: Jama : the Journal of the American Medical Association. 1999 June 9; 281(22): 2088. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10367817&dopt=Abstract

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Yoga for carpal tunnel syndrome. Author(s): Deitchman S, Gerr F. Source: Jama : the Journal of the American Medical Association. 1999 June 9; 281(22): 2087-8; Author Reply 2088-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10367816&dopt=Abstract

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Yoga for carpal tunnel syndrome. Author(s): Mackinnon SE, Novak CB. Source: Jama : the Journal of the American Medical Association. 1999 June 9; 281(22): 2087; Author Reply 2088-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10367815&dopt=Abstract

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Yoga for carpal tunnel syndrome. Author(s): Daniell HW. Source: Jama : the Journal of the American Medical Association. 1999 June 9; 281(22): 2087; Author Reply 2088-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10367814&dopt=Abstract

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CHAPTER 2. NUTRITION AND CARPAL TUNNEL SYNDROME Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and carpal tunnel syndrome.

Finding Nutrition Studies on Carpal Tunnel Syndrome The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “carpal tunnel syndrome” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “carpal tunnel syndrome” (or a synonym): •

A family of familial hypercholesterolemia with cerebral infarction and without coronary heart disease. An unusual case with corneal opacity, polyneuropathy and carpal tunnel syndrome in the family: therapy with probucol and tocopherol nicotinate. Author(s): Department of Neurology, National Minamiokayama Hospital, Okayama, Japan. Source: Ihara, Y Nobukuni, K Namba, R Kamisaka, K Kibata, M Kajinami, K Fujita, H Mabuchi, H Shirabe, T Ohshima, K et al. J-Neurol-Sci. 1991 November; 106(1): 10-8 0022510X

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Acute carpal tunnel syndrome as a complication of oral anticoagulant therapy. Author(s): Orthopaedic Department, Northern General Hospital, Sheffield, UK. Source: Black, P R Flowers, M J Saleh, M J-Hand-Surg-[Br]. 1997 February; 22(1): 50-1 0266-7681

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Alternative treatment of the carpal tunnel syndrome. Author(s): Department of Occupational Medicine, University Hospital, Olomouc, Czech Republic. Source: Fialova, J Bartousek, J Nakladalova, M Cent-Eur-J-Public-Health. 1999 November; 7(4): 168-71 1210-7778

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Carpal tunnel syndrome and vitamin B6. Source: Kasdan, M L Janes, C Plast-Reconstr-Surg. 1987 March; 79(3): 456-62 0032-1052

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Clinical aspects of treatment of carpal tunnel syndrome with vitamin B6. Author(s): Titus County Memorial Hospital, Mt. Pleasant, Texas 75455. Source: Ellis, J M Folkers, K Ann-N-Y-Acad-Sci. 1990; 585302-20 0077-8923

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Conservative management of carpal tunnel syndrome: a reexamination of steroid injection and splinting. Author(s): Division of Hand, Upper Extremity, and Microvascular Surgery, Brown University School of Medicine, Rhode Island Hospital, Providence. Source: Weiss, A P Sachar, K Gendreau, M J-Hand-Surg-[Am]. 1994 May; 19(3): 410-5 0363-5023

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Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. Author(s): Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. [email protected] Source: Gerritsen, A A de Krom, M C Struijs, M A Scholten, R J de Vet, H C Bouter, L M J-Neurol. 2002 March; 249(3): 272-80 0340-5354

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Corticosteroid injection for the treatment of carpal tunnel syndrome. Author(s): Department of Rheumatology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK. Source: O'Gradaigh, D Merry, P Ann-Rheum-Dis. 2000 November; 59(11): 918-9 00034967

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Effect of ascorbic acid and growth factors on collagen metabolism of flexor retinaculum cells from individuals with and without carpal tunnel syndrome. Author(s): Department of Physiology and Molecular Medicine, Medical College of Ohio, Toledo 43614-5804, USA. Source: Allampallam, K Chakraborty, J Robinson, J J-Occup-Environ-Med. 2000 March; 42(3): 251-9 1076-2752

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For carpal tunnel syndrome, skip the B6. Source: Tufts-University-diet-and-nutrition-letter (USA). (September 1996). volume 14(7) page 1-2. occupational hazards pyridoxine stress 0747-4105

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Generic health instruments do not comprehensively capture patient perceived improvement in patients with carpal tunnel syndrome. Author(s): Department of Medicine, University of Alberta, Edmonton, Canada. Source: Vaile, J H Mathers, D M Ramos Remus, C Russell, A S J-Rheumatol. 1999 May; 26(5): 1163-6 0315-162X

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Local corticosteroid injection for carpal tunnel syndrome. Author(s): Medicine, University of Ottawa, 505 Smyth Road, Ottawa, Ontario, Canada, K1H 8M2. [email protected] Source: Marshall, S Tardif, G Ashworth, N Cochrane-Database-Syst-Revolume 2000; (4): CD001554 1469-493X

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Local insulin injection improves median nerve regeneration in NIDDM patients with carpal tunnel syndrome. Author(s): Department of Neurology, University of Harran, Faculty of Medicine, Sanliurfa, Turkey. Source: Ozkul, Y Sabuncu, T Yazgan, P Nazligul, Y Eur-J-Neurol. 2001 July; 8(4): 329-34 1351-5101

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Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. Source: Rozmaryn, L M Dovelle, S Rothman, E R Gorman, K Olvey, K M Bartko, J J JHand-Ther. 1998 Jul-September; 11(3): 171-9 0894-1130

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Nerve conduction studies after treatment for carpal tunnel syndrome. Author(s): Laboratory for Electromyography, Paris. Source: Seror, P J-Hand-Surg-[Br]. 1992 December; 17(6): 641-5 0266-7681

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Pyridoxine in carpal tunnel syndrome. Author(s): University of North Carolina, Chapel Hill 27599. Source: Copeland, D A Stoukides, C A Ann-Pharmacother. 1994 September; 28(9): 1042-4 1060-0280

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Spontaneous acute carpal tunnel syndrome in an anticoagulated patient. Author(s): Permanente Medical Group Santa Teresa Medical Center, San Jose, California, USA. Source: Bindiger, A Zelnik, J Kuschner, S Gellman, H Bull-Hosp-Jt-Dis. 1995; 54(1): 52-3 0018-5647

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Steroid injection for carpal tunnel syndrome. Author(s): Hand Unit, District General Hospital, Grimsby, UK. Source: Irwin, L R Beckett, R Suman, R K J-Hand-Surg-[Br]. 1996 June; 21(3): 355-7 02667681

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Successful therapy with vitamin B6 and vitamin B2 of the carpal tunnel syndrome and need for determination of the RDAs for vitamins B6 and B2 for disease states. Author(s): Institute for Biomedical Research, University of Texas, Austin 78712. Source: Folkers, K Ellis, J Ann-N-Y-Acad-Sci. 1990; 585295-301 0077-8923

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The advanced glycation endproduct, pentosidine, in the carpal ligament in patients with carpal tunnel syndrome undergoing hemodialysis: comparison with idiopathic carpal tunnel syndrome. Author(s): Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. [email protected]

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Source: Takahashi, M Hoshino, H Kushida, K Murata, H Baba, S Inoue, T Nephron. 1998 December; 80(4): 444-9 0028-2766 •

The effect of local infiltration with morphine before carpal tunnel release. Author(s): Hand Surgery Unit, Rambam Medical Center, Haifa, Israel. Source: Stahl, S Ben David, B Moscona, R A J-Bone-Joint-Surg-Am. 1997 April; 79(4): 551-4 0021-9355

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The effects of hypothyroidism and thyroid replacement on the development of carpal tunnel syndrome. Author(s): Departments of Orthopaedics and Surgery, Division of Plastic Surgery, and the Hand and Upper Extremity Service, University of California, Davis, School of Medicine, Sacramento, CA, USA. Source: Palumbo, C F Szabo, R M Olmsted, S L J-Hand-Surg-[Am]. 2000 July; 25(4): 7349 0363-5023

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The relationship of vitamin B6 status to median nerve function and carpal tunnel syndrome among active industrial workers. Author(s): Department of Environmental and Industrial Health, University of Michigan School of Public Health, Ann Arbor 48109-2029, USA. Source: Franzblau, A Rock, C L Werner, R A Albers, J W Kelly, M P Johnston, E C JOccup-Environ-Med. 1996 May; 38(5): 485-91 1076-2752

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Treatment of carpal tunnel syndrome with vitamin B6. Source: Ellis, J M South-Med-J. 1987 July; 80(7): 882-4 0038-4348

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Using pyridoxine to treat carpal tunnel syndrome. Randomized control trial. Author(s): Department of Family Medicine, University of Alberta, Edmonton. Source: Spooner, G R Desai, H B Angel, J F Reeder, B A Donat, J R Can-Fam-Physician. 1993 October; 392122-7 0008-350X

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Using ultrapure water in hemodialysis delays carpal tunnel syndrome. Author(s): Sainte Marguerite Hospital, Nephrology Department, Marseille-France. Source: Baz, M Durand, C Ragon, A Jaber, K Andrieu, D Merzouk, T Purgus, R Olmer, M Reynier, J P Berland, Y Int-J-Artif-Organs. 1991 November; 14(11): 681-5 0391-3988

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Vitamin B6 (pyridoxine) therapy for carpal tunnel syndrome. Author(s): Department of Orthopaedics, Montefiore Medical Center, Bronx, New York, USA. Source: Jacobson, M D Plancher, K D Kleinman, W B Hand-Clin. 1996 May; 12(2): 253-7 0749-0712

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Vitamin B6 levels in patients with carpal tunnel syndrome. Author(s): Department of Medical Biology, University of Tennessee Medical Center, Knoxville, TN 37920. Source: Fuhr, J E Farrow, A Nelson, H S Arch-Surg. 1989 November; 124(11): 1329-30 0004-0010

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Vitamin B6, vitamin C, and carpal tunnel syndrome. A cross-sectional study of 441 adults. Author(s): Portland Hand Surgery and Rehabilitation Center, Peripheral Nerve Laboratory, Ore. 97210, USA. Source: Keniston, R C Nathan, P A Leklem, J E Lockwood, R S J-Occup-Environ-Med. 1997 October; 39(10): 949-59 1076-2752

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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to carpal tunnel syndrome; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Pyridoxine Source: Integrative Medicine Communications; www.drkoop.com Riboflavin Source: Integrative Medicine Communications; www.drkoop.com Vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10067,00.html Vitamin B2 (riboflavin) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B6 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B6 (pyridoxine) Source: Integrative Medicine Communications; www.drkoop.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND CARPAL TUNNEL SYNDROME Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to carpal tunnel syndrome. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “carpal tunnel syndrome” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Foods that Fight Pain: Revolutionary New Strategies for Maximum Pain Relief Source: New York, NY: Harmony Books. 1999. 347 p. Contact: Available from Harmony Books. 231 Broad Street, Nevada City, CA 95959. (530) 265-9564. PRICE: $14.00. ISBN: 0609804367. Summary: This book is intended to help people fight pain by using common foods, traditional supplements, and herbs. It explains which foods contribute to pain and how to avoid them, which foods are pain-safe but high in nutrition, and which foods can actively soothe pain by improving blood circulation, relieving inflammation, and balancing hormones. An introduction describes how food can fight pain at any of the stages of the pain process: the initial injury, the inflammatory response, the pain message traveling through the nerves, and the brain's perception of pain. Part 1 discusses conditions related to poor circulation, such as backaches and chest pain. Part 2

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addresses conditions caused by food sensitivities and inflammation, including migraines, other headaches, joint ailments, stomach aches and digestive problems, and fibromyalgia. Part 3 discusses hormone-related conditions such as menstrual pain, breast pain, and cancer pain. Part 4 discusses metabolic and immune problems, including carpal tunnel syndrome, diabetes, herpes and shingles, sickle cell anemia, kidney stones, and urinary infections. Part 5 discusses the roles of exercise, rest, and sleep in pain relief; describes several stress-reducing exercises; and explains why the body rebels against certain foods. The book includes menus and recipes, a glossary of ingredients, a list of resources, a list of suggested readings, and an index. •

NIH Consensus Conference: Acupuncture Source: JAMA. Journal of the American Medical Association. 280(17): 1518-1524. November 4, 1998. Summary: This journal article presents the findings of the consensus conference on acupuncture, sponsored by the Office of Alternative Medicine and the Office of Medical Applications of Research, National Institutes of Health. The purpose of the conference was to provide clinicians, patients, and the general public with a reliable assessment of the use and effectiveness of acupuncture for a variety of conditions. A multidisciplinary panel evaluated evidence presented by experts and in the scientific literature, and developed a consensus statement addressing five issues: the efficacy of acupuncture compared with placebo or sham acupuncture, the place of acupuncture in clinical practice, the biological effects of acupuncture, the integration of acupuncture into the health care system, and directions for future research. The panel concluded that many of the efficacy studies of acupuncture provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls. However, promising results have emerged showing the efficacy of acupuncture for adult postoperative and chemotherapy nausea and vomiting, and in postoperative dental pain. In other conditions such as addiction, stroke rehabilitation, headache, menstrual cramps, fibromyalgia, myofascial pain, osteoarthritis, tennis elbow, low back pain, carpal tunnel syndrome, and asthma, acupuncture may be useful as an adjunct treatment, an acceptable alternative, or part of a comprehensive management plan. This article has 66 references.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to carpal tunnel syndrome and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “carpal tunnel syndrome” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to carpal tunnel syndrome: •

A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures. Author(s): Bonebrake AR, Fernandez JE, Marley RJ, Dahalan JB, Kilmer KJ.

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Source: Journal of Manipulative and Physiological Therapeutics. 1990 NovemberDecember; 13(9): 507-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2273332&dopt=Abstract •

A treatment for carpal tunnel syndrome: results of a follow-up study. Author(s): Bonebrake AR, Fernandez JE, Dahalan JB, Marley RJ. Source: Journal of Manipulative and Physiological Therapeutics. 1993 March-April; 16(3): 125-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8492055&dopt=Abstract

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A treatment for carpal tunnel syndrome: results of follow-up study. Author(s): Bonebrake AR. Source: Journal of Manipulative and Physiological Therapeutics. 1994 October; 17(8): 565-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7836882&dopt=Abstract

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A treatment for carpal tunnel syndrome: results of follow-up study. Author(s): Richards S, Nguyen T. Source: Journal of Manipulative and Physiological Therapeutics. 1994 May; 17(4): 267-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8046285&dopt=Abstract

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Acupuncture for carpal tunnel syndrome. Author(s): Freedman J. Source: Acupuncture in Medicine : Journal of the British Medical Acupuncture Society. 2002 March; 20(1): 39-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926605&dopt=Abstract

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Being on the other side. Author(s): McLaren S. Source: Beginnings. 1996 October; 16(9): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9006151&dopt=Abstract

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Biopsychosocial rehabilitation for repetitive-strain injuries among working-age adults. Author(s): Karjalainen KA, Malmivaara AO, van Tulder MW, Roine RP, Jauhiainen S, Hurri HO, Koes BW. Source: Scand J Work Environ Health. 2000 October; 26(5): 373-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11103835&dopt=Abstract

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Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study. Author(s): Naeser MA, Hahn KA, Lieberman BE, Branco KF.

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Source: Archives of Physical Medicine and Rehabilitation. 2002 July; 83(7): 978-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12098159&dopt=Abstract •

Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies--an open protocol study. Author(s): Branco K, Naeser MA. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 1999 February; 5(1): 5-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10100028&dopt=Abstract

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Carpal tunnel syndrome: conservative and nonconservative treatment. A chiropractic physician's perspective. Author(s): Davis PT, Hulbert JR. Source: Journal of Manipulative and Physiological Therapeutics. 1998 June; 21(5): 356-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9627867&dopt=Abstract

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Case control study on dialysis arthropathy: the influence of two different dialysis membranes: data from the EDTA Registry. Author(s): Brunner FP, Brynger H, Ehrich JH, Fassbinder W, Geerlings W, Rizzoni G, Selwood NH, Tufveson G, Wing AJ. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1990; 5(6): 432-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2122319&dopt=Abstract

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Case report: acupuncture for carpal tunnel syndrome. Ultrasound assessment of adjunct therapy. Author(s): Banner R, Hudson EW. Source: Can Fam Physician. 2001 March; 47: 547-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11281088&dopt=Abstract

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Chiropractic manipulation for non-spinal pain--a systematic review. Author(s): Ernst E. Source: N Z Med J. 2003 August 8; 116(1179): U539. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14513080&dopt=Abstract

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Chiropractic manipulation in carpal tunnel syndrome. Author(s): Valente R, Gibson H. Source: Journal of Manipulative and Physiological Therapeutics. 1994 May; 17(4): 246-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8046280&dopt=Abstract

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Choice of controls in case-control studies. Author(s): Perillo MG. Source: Journal of Manipulative and Physiological Therapeutics. 1993 NovemberDecember; 16(9): 578-85. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8133192&dopt=Abstract

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Clinical management of carpal tunnel syndrome: a 12-year review of outcomes. Author(s): Feuerstein M, Burrell LM, Miller VI, Lincoln A, Huang GD, Berger R. Source: American Journal of Industrial Medicine. 1999 March; 35(3): 232-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9987556&dopt=Abstract

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Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trail. Author(s): Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Source: Journal of Manipulative and Physiological Therapeutics. 1998 June; 21(5): 317-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9627862&dopt=Abstract

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Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. Author(s): Hafner E, Kendall J, Kendall P. Source: Journal of Manipulative and Physiological Therapeutics. 1999 June; 22(5): 348-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10395439&dopt=Abstract

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Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. Author(s): Gerritsen AA, de Krom MC, Struijs MA, Scholten RJ, de Vet HC, Bouter LM. Source: Journal of Neurology. 2002 March; 249(3): 272-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11993525&dopt=Abstract

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Endoscopic carpal tunnel release: a prospective analysis of factors associated with unsatisfactory results. Author(s): Straub TA. Source: Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1999 April; 15(3): 269-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10231104&dopt=Abstract

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Endoscopic carpal tunnel release: the guide tube technique. Author(s): Lewicky RT.

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Source: Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1994 February; 10(1): 39-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8166900&dopt=Abstract •

Examination of sensory nerve fibers by needle recording in the carpal tunnel syndrome; use of the orthodromic method with special attention to the paresthetic forms. Author(s): Para F, Kyral V, Matulova H. Source: Sb Ved Pr Lek Fak Karlovy Univerzity Hradci Kralove. 1994; 37(2): 73-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7784802&dopt=Abstract

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Interventions for the primary prevention of work-related carpal tunnel syndrome. Author(s): Lincoln AE, Vernick JS, Ogaitis S, Smith GS, Mitchell CS, Agnew J. Source: American Journal of Preventive Medicine. 2000 May; 18(4 Suppl): 37-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10793280&dopt=Abstract

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Manipulative treatment of carpal tunnel syndrome: biomechanical and osteopathic intervention to increase the length of the transverse carpal ligament. Author(s): Sucher BM, Hinrichs RN. Source: J Am Osteopath Assoc. 1998 December; 98(12): 679-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9885488&dopt=Abstract

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Myofascial manipulative release of carpal tunnel syndrome: documentation with magnetic resonance imaging. Author(s): Sucher BM. Source: J Am Osteopath Assoc. 1993 December; 93(12): 1273-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8307807&dopt=Abstract

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Myofascial release of carpal tunnel syndrome. Author(s): Sucher BM. Source: J Am Osteopath Assoc. 1993 January; 93(1): 92-4, 100-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8423131&dopt=Abstract

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Neurological rehabilitation: acupuncture and laser acupuncture to treat paralysis in stroke, other paralytic conditions, and pain in carpal tunnel syndrome. Author(s): Naeser MA. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 1997 Winter; 3(4): 425-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9449066&dopt=Abstract

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Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Author(s): Walker WC, Metzler M, Cifu DX, Swartz Z. Source: Archives of Physical Medicine and Rehabilitation. 2000 April; 81(4): 424-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10768530&dopt=Abstract

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Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Author(s): O'Connor D, Marshall S, Massy-Westropp N. Source: Cochrane Database Syst Rev. 2003; (1): Cd003219. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12535461&dopt=Abstract

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Palpatory diagnosis and manipulative management of carpal tunnel syndrome. Author(s): Sucher BM. Source: J Am Osteopath Assoc. 1994 August; 94(8): 647-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7960973&dopt=Abstract

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Palpatory diagnosis and manipulative management of carpal tunnel syndrome: Part 2. 'Double crush' and thoracic outlet syndrome. Author(s): Sucher BM. Source: J Am Osteopath Assoc. 1995 August; 95(8): 471-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7673008&dopt=Abstract

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Parameters of thick and thin nerve-fiber functions as predictors of pain in carpal tunnel syndrome. Author(s): Lang E, Claus D, Neundorfer B, Handwerker HO. Source: Pain. 1995 March; 60(3): 295-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7596625&dopt=Abstract

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Sensitive median-ulnar motor comparative techniques in carpal tunnel syndrome. Author(s): Sander HW, Quinto C, Saadeh PB, Chokroverty S. Source: Muscle & Nerve. 1999 January; 22(1): 88-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9883861&dopt=Abstract

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Splinting vs surgery for carpal tunnel syndrome. Author(s): Sucher BM. Source: Jama : the Journal of the American Medical Association. 2003 January 22-29; 289(4): 421; Author Reply 421-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12533113&dopt=Abstract

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Splinting vs surgery for carpal tunnel syndrome. Author(s): Weintraub MI.

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Source: Jama : the Journal of the American Medical Association. 2003 January 22-29; 289(4): 422; Author Reply 422-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12533109&dopt=Abstract •

The effectiveness of magnet therapy for treatment of wrist pain attributed to carpal tunnel syndrome. Author(s): Carter R, Aspy CB, Mold J. Source: The Journal of Family Practice. 2002 January; 51(1): 38-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11927062&dopt=Abstract

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The effects of biofeedback on carpal tunnel syndrome. Author(s): Thomas RE, Vaidya SC, Herrick RT, Congleton JJ. Source: Ergonomics. 1993 April; 36(4): 353-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8472685&dopt=Abstract

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Therapeutic touch in the treatment of carpal tunnel syndrome. Author(s): Blankfield RP, Sulzmann C, Fradley LG, Tapolyai AA, Zyzanski SJ. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2001 September-October; 14(5): 335-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11572538&dopt=Abstract

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Treating carpal tunnel syndrome with lasers and TENS. Author(s): Bodofsky E. Source: Archives of Physical Medicine and Rehabilitation. 2002 December; 83(12): 1806; Author Reply 1806-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12474192&dopt=Abstract

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Yoga for carpal tunnel syndrome. Author(s): Harrast M, Kraft G. Source: Jama : the Journal of the American Medical Association. 1999 June 9; 281(22): 2088. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10367817&dopt=Abstract

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Yoga for carpal tunnel syndrome. Author(s): Deitchman S, Gerr F. Source: Jama : the Journal of the American Medical Association. 1999 June 9; 281(22): 2087-8; Author Reply 2088-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10367816&dopt=Abstract

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Yoga for carpal tunnel syndrome. Author(s): Mackinnon SE, Novak CB.

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Source: Jama : the Journal of the American Medical Association. 1999 June 9; 281(22): 2087; Author Reply 2088-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10367815&dopt=Abstract •

Yoga for carpal tunnel syndrome. Author(s): Daniell HW. Source: Jama : the Journal of the American Medical Association. 1999 June 9; 281(22): 2087; Author Reply 2088-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10367814&dopt=Abstract

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Yoga-based intervention for carpal tunnel syndrome: a randomized trial. Author(s): Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR Jr. Source: Jama : the Journal of the American Medical Association. 1998 November 11; 280(18): 1601-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9820263&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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The following is a specific Web list relating to carpal tunnel syndrome; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Amyloidosis Source: Integrative Medicine Communications; www.drkoop.com Carpal Tunnel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Hypothyroidism Source: Integrative Medicine Communications; www.drkoop.com Raynaud's Phenomenon Source: Integrative Medicine Communications; www.drkoop.com Scleroderma Source: Integrative Medicine Communications; www.drkoop.com

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Alternative Therapy Acupuncture Source: Healthnotes, Inc.; www.healthnotes.com Acupuncture Source: Integrative Medicine Communications; www.drkoop.com Acupuncture Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663,00.html Aston-patterning Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10118,00.html Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672,00.html Chiropractic Source: Integrative Medicine Communications; www.drkoop.com Feldenkrais Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,695,00.html

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Hellerwork Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,700,00.html Magnet Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,715,00.html Massage Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,716,00.html Myotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,931,00.html Osteopathy Source: Integrative Medicine Communications; www.drkoop.com Osteopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,724,00.html Trager Approach Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,741,00.html Yoga Source: Integrative Medicine Communications; www.drkoop.com Yoga Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,746,00.html •

Homeopathy Arnica Source: Healthnotes, Inc.; www.healthnotes.com Calcarea Phosphorica Source: Healthnotes, Inc.; www.healthnotes.com Causticum Source: Healthnotes, Inc.; www.healthnotes.com

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Hypericum Source: Healthnotes, Inc.; www.healthnotes.com Rhus Toxicodendron Source: Healthnotes, Inc.; www.healthnotes.com Ruta Graveolens Source: Healthnotes, Inc.; www.healthnotes.com Viola Odorata Source: Healthnotes, Inc.; www.healthnotes.com •

Herbs and Supplements Bromelain Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,760,00.html Ginger Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,787,00.html Glucosamine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,790,00.html Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,798,00.html Msm Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,807,00.html Turmeric Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10062,00.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html.

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This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. SYNDROME

DISSERTATIONS ON CARPAL TUNNEL

Overview In this chapter, we will give you a bibliography on recent dissertations relating to carpal tunnel syndrome. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “carpal tunnel syndrome” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on carpal tunnel syndrome, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Carpal Tunnel Syndrome ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to carpal tunnel syndrome. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A Comparison of Exposure to Risk Factors in Construction Trades with High and Low Prevalence of Carpal Tunnel Syndrome by Anton, Daniel Christophe; Phd from The University of Iowa, 2002, 199 pages http://wwwlib.umi.com/dissertations/fullcit/3059936

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A Study of Posture As a Suspected Cause of Carpal Tunnel Syndrome: a Worksite Health Promotion Perspective by Johnson, Jamie Lee; Phd from Southern Illinois University at Carbondale, 2002, 136 pages http://wwwlib.umi.com/dissertations/fullcit/3065159

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Effects of Pyridoxine on Carpal Tunnel Syndrome: a Randomized Clinical Trial Pilot Study by Holm, Gregory Bernt; Phd from University of South Florida, 2002, 139 pages http://wwwlib.umi.com/dissertations/fullcit/3071309

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Screening for Carpal Tunnel Syndrome at Work Sites by Bowman, O. Jayne, Phd from Texas A&m University, 1994, 150 pages http://wwwlib.umi.com/dissertations/fullcit/9506593

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The Development of a Logistic Model for Carpal Tunnel Syndrome Risk Assessment by Kong, Dongjoon; Phd from The Pennsylvania State University, 2002, 189 pages http://wwwlib.umi.com/dissertations/fullcit/3051686

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Workplace Ergonomic Effects and the Development of Carpal Tunnel Syndrome by Josephs, Harold; Phd from The Union Institute, 2002, 261 pages http://wwwlib.umi.com/dissertations/fullcit/3034523

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND CARPAL TUNNEL SYNDROME Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning carpal tunnel syndrome.

Recent Trials on Carpal Tunnel Syndrome The following is a list of recent trials dedicated to carpal tunnel syndrome.8 Further information on a trial is available at the Web site indicated. •

Carpal Tunnel Syndrome: Diagnosis and Treatment Trial Condition(s): Carpal Tunnel Syndrome Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: The Carpal Tunnel Syndrome Diagnosis and Treatment Trial is project #1 of the Multidisciplinary Clinical Research Center focused on upper extremity pain. It is a randomized trial comparing surgical and nonsurgical treatments for patients with early, mild to moderate carpal tunnel syndrome. In addition the study will evaluate the ability of a new magnetic resonance (MR) technique at predicting who will likely benefit from carpal tunnel syndrome (CTS) surgery. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00032227

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Sham Device, Pill Placebo or Treatment For Arm Pain Condition(s): Cumulative Trauma Disorders; Repetitive Strain Injury; Carpal Tunnel Syndrome; Pain

8

These are listed at www.ClinicalTrials.gov.

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Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study investigates the role of two active interventions and their placebo effects in randomized control trials. The study conducts two parallel trials of treatments for upper extremity pain secondary to repetitive stress disorder, including carpal tunnel syndrome. The active interventions are amitriptyline and acupuncture. The placebo are sham acupuncture device and placebo pill. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00029497 •

Work and Health Disparities Among Rural Women Condition(s): Tendonitis; Carpal Tunnel Syndrome; Cumulative Trauma Disorders; Overuse Syndrome Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Environmental Health Sciences (NIEHS) Purpose - Excerpt: This is a study of the effects of fast paced assembly line work on women. We are studying problems women in poultry processing have with their muscles, tendons, and nerves as well as acute injuries they have in the workplace. We are also studying how their work affects the quality of their lives. Study Type: Observational Contact(s): Robin Argue, MPH 919 286-1722 [email protected] Web Site: http://clinicaltrials.gov/ct/show/NCT00042419

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Acupuncture for Carpal Tunnel Syndrome Condition(s): Carpal Tunnel Syndrome Study Status: This study is completed. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This study will look at the effectiveness of acupuncture for treating carpal tunnel syndrome (CTS). People who participate in this study will have CTS that has been diagnosed by physical examination and neurological testing. We will randomly assign study participants to receive one of the three types of acupuncture either once, twice, or three times weekly for a total of 6 weeks. Acupuncturists will treat one group of patients with true acupuncture. They will give the other two groups of patients one of two alternative acupuncture treatments that do not use the true acupuncture points. The patients and evaluators will not know the type of acupuncture (True, Alternative 1, or Alternative 2) that is being used. The acupuncturists will not communicate with the patients and will not be involved in patient evaluation. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000394

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Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “carpal tunnel syndrome” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON CARPAL TUNNEL SYNDROME Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “carpal tunnel syndrome” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on carpal tunnel syndrome, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Carpal Tunnel Syndrome By performing a patent search focusing on carpal tunnel syndrome, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on carpal tunnel syndrome: •

Anti-carpal tunnel device (ACTD) for computer operators Inventor(s): Tajiri; Akira (19371 E. Parlier Ave., Reedley, CA 93654) Assignee(s): none reported Patent Number: 5,581,277 Date filed: March 6, 1995 Abstract: A computer mouse assembly for preventing Carpal Tunnel Syndrome includes a computer mouse and a palm support having a curved upper surface. The palm surface has a substantially flat lower surface that is adjustably mounted on the upper surface of the computer mouse. The palm support serves to prevent the user's wrist from significantly bending, thereby preventing Carpal Tunnel Syndrome despite extended use of the computer mouse. A first piece of hook or loop type material is attached to the computer mouse. A second piece of hook or loop type material is attached to the lower surface of the palm support. The palm support is mounted on the upper surface of the computer mouse by interconnecting the first piece of hook or loop type material to the second piece of hook or loop type material. The palm support may be moved to various positions on the surface of the computer mouse in order to adapt to the differing hand sizes of a variety of different users. The palm support may be attached to the computer mouse in other ways, such as by adhesive or snaps, or may be integrally molded with the mouse housing. Excerpt(s): This invention relates generally to a computer mouse that protects the user from developing Carpal Tunnel Syndrome or from aggravating an existing such condition and, more specifically, to a computer mouse having a curved member on its upper surface that can be repositioned to adapt to different shapes and sizes of hands. According to the third edition of the American Medical Association Family Medical Guide, nerves run through confined spaces at certain points in the body where they can become severely pinched if surrounding tissues become swollen. A major nerve particularly subject to this kind of damage is one that carries signals between the brain and hand. As it travels through the wrist, this nerve passes through a tunnel formed by the wrist bones (known as the carpals) and a tough membrane on the underside of the wrist that binds the bones together. The tunnel is rigid, so that if tissues within it swell for some reason, they press on and pinch the nerve. This leads to a condition called Carpal Tunnel Syndrome. American Medical Association Family Medical Guide, 3rd Edition (Random House 1994), page 300. The symptoms of Carpal Tunnel Syndrome are a tingling, intermittent numbness of part of the hand often accompanied by pains that shoot up the forearm from the wrist. If severe, permanent numbness and limited movement of the thumb and possibly the fingers can result. Common treatments for this unfortunate condition include wearing a splint about the wrist, cortisone injections and even operations to open and enlarge the tunnel. Web site: http://www.delphion.com/details?pn=US05581277__

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Apparatus and methods for assessment of neuromuscular function Inventor(s): Gozani; Shai N. (Brookline, MA) Assignee(s): NeuroMetrix, Inc. (Cambridge, MA) Patent Number: 5,851,191 Date filed: July 1, 1997 Abstract: Apparatus and methods are provided for the assessment of neuromuscular function. Using an apparatus of the invention, stimuli are applied to a nerve that traverses the wrist of an individual. The stimuli are applied at a point that is proximal to the wrist. Stimulation of the nerve causes a muscle innervated by that nerve to respond. The muscle response generates a myoelectric potential, which is detected by an apparatus of the invention at a point that is proximal to the wrist. The delay between stimulation of a nerve and detection of a muscular response to that stimulation is processed to indicate an assessment of neuromuscular function. For example, a sufficient delay between application of stimulus and muscle response may indicate the presence of Carpal Tunnel Syndrome. Excerpt(s): The invention relates to apparatus and methods for assessment of neuromuscular function. More specifically, the invention relates to apparatus and methods for diagnosing peripheral nerve and muscle pathologies based on assessments of neuromuscular function. There are many clinical and non-clinical situations that call for a rapid, reliable and low-cost assessments of neuromuscular function. Reliable and automated devices are needed to monitor neuromuscular function in surgical and intensive care settings. For example, muscle relaxants significantly improve surgical procedures and post-operative care by regulating the efficacy of nerve to muscle coupling through a process called neuromuscular blockade. They are, however, difficult to use in a safe and effective manner because of the wide variation and lack of predictability of patient responses to them. In another setting, an easy to use and reliable indicator would be beneficial in assessing potential contamination exposure situations by chemical agents. These agents disrupt neuromuscular function and effectively cause neuromuscular blockage, putting soldiers and civilians at risk. The most common causes of neuromuscular disruption are, however, related to pathologies of the peripheral nerves and muscles. Neuromuscular disorders, such as, for example, Carpal Tunnel Syndrome (CTS), are very common and well known to the general public. Despite their extensive impact on individuals and the health care system, detection and monitoring of such neuromuscular pathologies remains expensive, complicated, and highly underutilized. Web site: http://www.delphion.com/details?pn=US05851191__

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Apparatus for treating carpal tunnel syndrome Inventor(s): Fulk; Paul F. (W. Carrollton, OH) Assignee(s): Paratech Industries, Inc., (Dayton, OH) Patent Number: 5,653,678 Date filed: March 27, 1995 Abstract: An apparatus for relieving symptoms of carpal tunnel syndrome includes restraining the elbow of the patient from movement while applying a controllable

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tension to the wrist in a direction away from the elbow. The apparatus further includes a mechanism for rotating the wrist while the forearm is under tension. Excerpt(s): The present invention relates to the treatment of hand disorders and, more particularly, to a method and apparatus for relieving hand disorders due to carpal tunnel syndrome. In recent years, a medical problem formerly described as wrist level median nerve entrapment, but now commonly referred to as carpal tunnel syndrome (CTS) has taken on an ever-increasing significance, particularly in monetary payouts by states for worker's compensation claims and by insurance companies for claims related to CTS surgery. People have reported having aggravated symptoms of weakness and clumsiness in hand functions, often accompanied by pains that shoot up the arm from the wrist. Sensations such as tingling and intermittent numbness of the thumb, index finger and the middle and radial part of the ring finger are the most common symptoms. Workers that are at risk for carpal tunnel syndrome due to repetitive tasks include computer operators, typists, stenographers, garment workers, seamstresses, chiropractors, masseurs, butchers, packers, assembly line workers, tennis players, golfers and others involved in activities where the impact and twisting of the forearm and hand result in injury. The common treatment by physicians has been the prescription of diuretics, injection of steroid drugs, use of a splint at night, and, if all else failed to provide relief, ultimately surgery. In the chiropractic field, the common treatment has been to grip the patient's elbow in one hand, take the other hand near the wrist, apply a slight twist and perform a quick outward jerk on the wrist. The action would be repeated several times, but it had limitations in effectiveness. Not only is this a strenuous activity for the chiropractor, but it is difficult to apply and maintain even pressure for anything but a moment with each manipulation. And, in particular, this manual technique is incapable of providing and maintaining a controllable steady pressure at a level which can differ from patient to patient due to sex, age, strength and other factors. Web site: http://www.delphion.com/details?pn=US05653678__ •

Appliance and method for treating carpal tunnel syndrome Inventor(s): Porrata; Humberto L. (144 W. 23 St., #3E, New York, NY 10011) Assignee(s): none reported Patent Number: 6,146,347 Date filed: June 1, 1998 Abstract: A method and appliance for treating carpal tunnel syndrome has a splint with dorsal, thenar and hypothenar portions for applying pressure to the respective dorsal aspect of the hand and to thenar and hypothenar areas of a palmar aspect of the hand to induce stretching of the carpal ligament and flexor retinaculum. The thenar and hypothenar portions of the splint are connected to opposite sides of the dorsal portion and are spaced from the dorsal portion to allow for the insertion of the hand to be treated. The splint is preferably formed from a unitary piece of substantially rigid material and is sized and shaped to closely receive the hand with the dorsal, thenar and hypothenar portions substantially aligned with and covering the respective dorsal aspect, and thenar and hypothenar areas of the palmar aspect of the hand. An inflatable bladder, connected to a controllable fluid source, is located to contact, the dorsal aspect of the hand between the thenar and hypothenar areas of the palmar aspect to induce stretching of the carpal ligament and flexor retinaculum. A pressure gauge is connected to the bladder for monitoring. The controllable source of pressurized fluid is adjustable

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during treatment. The thenar portion of the splint can be releasably attachable with securing means to aid in insertion of the hand into the splint. In the method of use, the hand is inserted into the splint and the bladder is pressurized to apply pressure and induce stretching. The pressure is maintained at a constant or varying level for a predetermined period of time. Excerpt(s): This invention pertains to the field of methods and appliances for the treatment of carpal tunnel syndrome. Carpal tunnel syndrome is caused by a deleterious increase in pressure on the median nerve which passes through the carpal tunnel (or canal) in the hand, adjacent 10 the wrist. The deleterious increase in pressure, which is brought on by prolonged repetitive motion of the hand and digits, is often caused by inflammation or damage to tendons for the hand which pass through the carpal tunnel along with the median nerve. Pressure increases can also be caused by narrowing of the carpal canal and by generalized swelling of the structures in the hand. The carpal tunnel is formed by the eight carpal bones of the hand adjacent the wrist, which bones are arranged in two rows forming a generally U-shaped inverted arch-like "tunnel" structure. The three large carpal bones of the proximal row (i.e., closest to the chest), beginning laterally (i.e., from the outside with the hand directed downward and the palm facing forward), are the scaphoid, lunate, and triquetrum; the smaller pisiform bone sits on the palmar surface of the triquetrum. The distal row, from lateral to medial, consists of the trapezium, trapezoid, capitate, and hamate carpal bones. Web site: http://www.delphion.com/details?pn=US06146347__ •

Automatic keyboard moving apparatus Inventor(s): Mathews, Sr.; William P. (613 Richland, Waco, TX 76710), Patterson, Jr.; John L. (248 Earle Rd., Hewitt, TX 76643), Pryor; Pat (435 Elmwood Rd., Waco, TX 76712) Assignee(s): none reported Patent Number: 5,564,844 Date filed: December 6, 1994 Abstract: An apparatus for the automatic adjustment of the inclination angle of a keyboard during use by an operator. The unit operates by a motorized camshaft raising and lowering the back end of a hinged platform that supports a computer keyboard or other input device. The rate of change of the inclination angle and the inclination height are adjustable by the operator. The apparatus is useful in the prevention or alleviation of the effects of repetitive motion disease or carpal tunnel syndrome. Excerpt(s): The present invention relates generally to an apparatus for selectively changing the inclination angle of a keyboard during use by an operator, and more particularly, the invention concerns a method and apparatus by which the symptoms of carpal tunnel syndromes and other types of repetitive motion diseases may be reduced. Carpal tunnel syndrome is a condition of the hand which results in pain and discomfort and has been recognized and treated for many years. It is believed that certain occupations cause or aggravate carpal tunnel syndrome (Armstrong, 1983; Armstrong and Chaffin, 1979). Armstrong (1983) called it "one of a family of occupational illnesses". It is said that use of the hand with the wrist in certain static postures causes compression of the median nerve, and that occupations involving prolonged use of such postures can cause or worsen the condition (Armstrong, 1983; Brian et al. 1947; Tanzer, 1959). To alleviate the effects of carpal tunnel syndrome, often the treatment involves taking antiinflammatory medications, using wrist braces to restrict motion in the wrist, and,

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ultimately, surgery on the carpal tunnel. These treatments are directed to the treatment of the condition--not the prevention of its occurrence--and are not entirely satisfactory. Carpal tunnel syndrome occurring after repetitive motion does not generally respond well to the treatments useful for inflammatory or anatomic changes. It is believed that the proposed pathophysiology of the repetitive motion condition combined with prolonged repetitive flexion of the fingers against resistance (i.e., the keyboard) inhibits venous return from the fingers, causing edema within the carpal tunnel. As the compartmentalized edema increases, the hydrostatic pressure likewise increases, compromising the microvasculature of the median nerve. Symptoms of pain, proprioceptive dysfunction and, if left untreated, denervation muscular atrophy occur. Web site: http://www.delphion.com/details?pn=US05564844__ •

Carpal ligament stretch pad Inventor(s): Pharaoh; Raymond G. (30 Valley Bend Ct., Germantown, MD 20876) Assignee(s): none reported Patent Number: 6,322,479 Date filed: April 25, 2000 Abstract: The invention is a therapeutic rehabilitation device for person having carpal tunnel syndrome or recovering from carpal tunnel surgery, the device being made of a formed flexible pad of moldable thermoplast covered in foam padding for post surgical treatment of the flexor retinaculum ligament using palm pressure or by applying pressure between the index finger and thumb. Excerpt(s): None. The following United States patents are disclosed herein and incorporated into this application for utility patent. All relate to therapy devices for the hand. In U.S. Pat. No. 6,010,431 to Taylor, a method and polymeric foam apparatus is disclosed which is design to reduce the problems associated with repetitive stress injuries by pushing down on the upper surface of the device, urging the sides of the palm apart, the device having a central cutout portion allowing for the inward penetration of the palm region. Web site: http://www.delphion.com/details?pn=US06322479__

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Carpal tunnel protector Inventor(s): Kaplan; Hyman I. (Lincolnwood, IL) Assignee(s): Kaplan; Evelyn (Lincolnwood, IL), Kaplan; Robert D. (Scottsdale, AZ) Patent Number: 6,443,921 Date filed: August 7, 1998 Abstract: A glove for preventing carpal tunnel syndrome. It includes a flexible openended sleeve with a side thumb hole. It has a cushion on the inner surface of the front of the glove, which covers the carpal tunnel area. The sleeve is highly yieldable and elastic and is essentially of single thickness throughout. Excerpt(s): The present invention relates to a protector for preventing the occurrence of carpal tunnel syndrome. Carpal tunnel syndrome is a very common ailment, resulting from repeated particular movements and activity of the fingers and hand in certain

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occupations. The carpal tunnel leads from the wrist, forwardly between the ball of the thumb and the heel of the hand and into the area of the palm or metacarpus. Nerves from the arm extend through the carpal tunnel and lead to the fingers. Web site: http://www.delphion.com/details?pn=US06443921__ •

Carpal tunnel release apparatus and method Inventor(s): Akelman; Edward (Barrington, RI), Collins; Michael S. (San Diego, CA), Weiss; Arnold Peter (Barrington, RI) Assignee(s): Kinetikos Medical Incorporated (San Diego, CA) Patent Number: 6,019,774 Date filed: December 10, 1998 Abstract: A carpal tunnel release apparatus and method including a surgical knife including an elongated handle having a forward portion and a rearward portion with the forward portion of the handle terminating in a cutting head. The cutting head has top edge and a bottom edge with the cutting head terminating in a substantially linear cutting edge extending from proximate the bottom edge of the cutting head toward the top edge of the cutting head. The cutting edge intersects and forms an angle with an upper guide finger which is the only structure which projects forwardly past the plane of the cutting edge and which at least partially forms the top edge of the cutting head. The guide apparatus includes an elongated bar defining one or more elongated grooves therein. A bottom portion of the forward portion of the knife is at least partially receivable within the groove of the guide member such that lateral movement of the forward portion is substantially restricted and such that the forward portion of the handle is slidably movable forward or backward while guided within the groove. Excerpt(s): The present invention relates generally to surgical apparatuses and methods, and more particularly, to carpal tunnel release surgical apparatuses and methods. There are a variety of apparatuses and methods designed for use in performing carpal tunnel release surgery. Carpal tunnel syndrome is a commonly known problem resulting from compression of the median nerve within the carpal tunnel in the hand which is the name for an anatomic passageway in the wrist and palm. Conditions that crowd or reduce the size of the carpal tunnel and initiate symptoms associated with carpal tunnel syndrome, which is typically characterized by some combination of wrist pain, forearm aching, and/or pain, tingling and numbness in the index and middle fingers as well as the thumb. It is typical for middle-aged people whose jobs necessitate repeated exposure to certain movements and/or vibrating tools, such as those which can be experienced by utilizing computer keyboards, typewriters as well as work which can be associated with assembly lines to experience carpal tunnel syndrome. It is well known that when carpal tunnel syndrome symptoms become persistent and progressive, division of the deep transverse carpal ligament is often recommended for treatment. A variety of apparatuses and methods for surgically releasing the transverse carpal ligament have been developed and are known in the art. Examples of such apparatuses and methods include, for example, U.S. Pat. No. 5,334,214 to Putnam which discloses a guidance mechanism and cuffing mechanism for subcutaneous insertion in spaced-apart incisions for dividing the transverse carpal ligament. The guidance mechanism is placed below the transverse carpal ligament, and the cutting mechanism is placed above the transverse carpal ligament. The guidance mechanism forms a slot adapted to receive a portion of the cutting mechanism such that as the cuffing mechanism is advanced, it is guided by the guidance mechanism with a portion of the

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cuffing mechanism sliding through and fitted within the slot of guidance mechanism as a knife portion of the cutting mechanism divides a carpal tunnel ligament. Web site: http://www.delphion.com/details?pn=US06019774__ •

Carpal tunnel syndrome traction system Inventor(s): Castelli; Judith M. (211 Buckskill Rd., East Hampton, NY 11937) Assignee(s): none reported Patent Number: 6,530,893 Date filed: April 2, 2001 Abstract: This invention encompasses, methods, devices and system for prevention and relief of carpal tunnel syndrome in the wrist through the use of traction. The device contains a wrist member, an anchor member connected at one end each of an interconnecting adjustable interface member. The apparatus for applying extremity traction contains a tensioning cable and a retaining device attached to the tensioning cable as well as an anchor member. Excerpt(s): This invention relates to prevention and relief of carpal tunnel syndrome through the use of traction. More particularly, it relates to relieving carpal tunnel syndrome and conditions of the lower extremities. One end of the device anchors to a fixed anchor, such as a door knob, and the other end is attachable to the wrist. Traction can be an effective non-surgical treatment of Carpal Tunnel Syndrome and other associated conditions such as pain, numbness, tingling in the fingers, swelling and pain in the elbows, forearms, wrists, hands and fingers. Such treatment can also be effective for the lower extremity including of disorders of the foot, ankle, knee, etc., and for treatment of the neck. The effectiveness of applying traction in the treatment of Carpal Tunnel Syndrome is based on its ability to re-stretch the muscles, tendons, ligaments, nerves and blood vessels in the forearm and wrist areas which relieves pressure on the median nerve and which in turn allows for reduction of the inflammation, pain and weakness which is typical of Carpal Tunnel Syndrome (C.T.S.). Web site: http://www.delphion.com/details?pn=US06530893__

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Carpal tunnel syndrome wrist brace Inventor(s): Harris; Alvin R. (Hackensack, NJ), Vaughan; Christopher L. (Claremont, ZA) Assignee(s): Becton Dickinson and Company (Franklin Lakes, NJ) Patent Number: 5,769,804 Date filed: July 26, 1996 Abstract: A carpal tunnel syndrome wrist brace including a shell having a first and second edge lined with a plurality of eyelets and both edges being connected together by a tongue stitched therebetween. The shell includes a thumb hole for receiving a thumb and is shaped to fit a patient's wrist such that the patient can insert the hand and wrist into the proximal end of the shell and extend four fingers through the distal end of the shell with the thumb through the thumb hole. The shell is then secured to the patient's wrist to activate immobilization of the wrist using a pair of hook and loop fasteners and a plurality of laces.

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Excerpt(s): The present invention relates to a carpal tunnel syndrome wrist brace and, more particularly, relates to a wrist brace for relieving the symptoms and slowing the progression of Carpal Tunnel Syndrome ("CTS"). A number of treatments have been proposed and used to relieve the symptoms of CTS including surgery, steroid injections into the carpal tunnel, diuretics, and splints. Of course, more conservative treatment is desired but depends on the cause of nerve compression. If symptoms are provoked by particular activities, modification of hand use during these activities is often prescribed. These modifications may include eliminating the activity, decreasing its duration, or interrupting it with periodic rest periods. A variety of medications have been used including hormones and many times braces, with or without splints, are used as both a preventive measure or as therapy for CTS. The problem with using splints, braces or other support equipment is that if they are used inappropriately, or if they change the way in which a worker performs a task, these devices can cause a different type of physical problem. In addition to the above, CTS braces currently on the market provide immobilization of the wrist using a rigid support member consisting of a variety of shapes and materials, i.e., thermoformable plastics or metal. Such braces provide varying degrees of immobilization of the wrist: however, they do not provide control over flexion-extension in ulnar deviation. Web site: http://www.delphion.com/details?pn=US05769804__ •

Carpel tunnel support Inventor(s): Koby; Aurelia (2918 5th Ave., Ste 200, San Diego, CA 92103), MacMorran; Ian (2918 5th Ave., Ste 200, San Diego, CA 92103) Assignee(s): none reported Patent Number: 6,213,969 Date filed: June 16, 1997 Abstract: To address the problem of continuing work while suffering from possibly debilitating carpal; tunnel syndrome, a working wrist splint is provided to restrain the wrist joint to a therapeutically advantageous neutral position, yet allowing sufficient movement of the thumb and fingers to enable keyboard functioning. The form of the splint is a stretch fabric sleeve with a thumb opening, a finger aperture, a resiliently deformable wrist support ball at the bottom of the splint and a stiffening batten in a pocket at the top over the back of the wearer's hand. Excerpt(s): Carpal Tunnel Syndrome (CTS) is a steadily increasing problem among workers who perform repetitive tasks generally, and among typists and other keyboard workers in particular. The pain resulting from injury to the median nerve and the nine tendons that pass through the bony passageway through the wrist can be excruciating, very difficult to treat and almost impossible to fully cure. Loss of productivity due to CTS among keyboard workers and even occasional keyboard users is estimated to be in the billions of dollars annually, and in some cases is so severe as to destroy a sufferer's ability to earn a livelihood at all. A previous patent specification filed by one of the applicant inventors as U.S. Ser. No. 08/509491 described a resting arm splint that was proven efficacious in treatment of CTS by maintaining the wrist in a resting neutral position for extended periods of time at night, and contemplated that the wearer would regenerate hand and wrist functions through a resting period and then be able to remove the resting splint for a working period. In that invention, while effective for its design purpose, the bulk and extent of the semi-rigid battened splint from fingers to mid-forearm prevented sufficient movement of the hand and fingers to be operable in a

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working environment, and specifically would interfere with keyboard operation. The further development of the within invention addresses the need for a CTS treatment modality that can relieve pain by restraint of the wrist joint to a neutral position, yet be compact and light enough to enable working functionality at a keyboard. Further, appliance for this purpose should be comfortable enough to be worn for long periods in a working environment and be easily donned or doffed. Finally, if such a therapeutic appliance could be achieved, it would also operate as a preventive to further repetitive strain injury, and in some cases serve as a preventive if worn by a pre-injury user. While injured users may more readily be attracted to use of the within described carpel tunnel splint, the invention has been specifically designed to be attractive and comfortable in use so as to appeal to the pre-injury keyboardist, as it has been discovered that supporting and urging the wearer's hand and wrist to a neutral position is more comfortable and productive. In this regard, the carpel tunnel splint incorporates a stiffening batten that is necessary for therapeutic application to an injured user but optional to a pre-injury user, as that user finds the most comfortable mode of wear and usage in the operating environment. Comfort is an important consideration, since in the fast pace and urgency of the working environment, workers will shed uncomfortable, bulky or restrictive devices, no matter how therapeutic they may be. While the majority of CTS complaints may result from keyboard work, other occupations also endure CTS or repetitive strain injuries and can benefit from the within invention. Contemplating other occupations, the device has been further designed to be adaptable to other working environments, in particular by replaceablility of the two elements of the appliance that support and stiffen the wrist, as the moldable wrist pad and the stiffening batten described later are contained in pockets in which other forms, sizes and resiliencies of material may be inserted. Web site: http://www.delphion.com/details?pn=US06213969__ •

Computer mouse Inventor(s): Weiss; Josef (23 Murphy Ct. #1, Newton, MA 02458) Assignee(s): none reported Patent Number: 6,492,975 Date filed: October 3, 2000 Abstract: The present invention is an improved computer mouse for inputting cursor commands into a computer of the type having a flat base with a tracking means for use on a flat work surface and switches operable with the fingers of the user. The improved computer mouse comprises a housing having a flat base, a vertical rear wall at a right angle to said flat base, a top and front surface disposed between the front edge of the base and the upper edge of the rear wall. The base having a front to rear dimension less than the height of the rear wall, so that the mouse is readily tiltable rearwardly. Also provided is a means for disabling the mouse when so tilted. The top and front surface being so disposed and elevated such that the user's hand is positioned above the work surface: (i) so that his/her fingers drape over the mouse touching the work surface or slightly thereabove, and (ii) so that the user's wrist is straight or substantially straight whereby repetitive or prolonged use of the mouse will lessen the likelihood of developing carpal tunnel syndrome, tendonitis or a related condition. Excerpt(s): The present invention relates generally to a computer mouse, and in particular to a computer mouse which eliminates user susceptibility to injuries such as carpal tunnel syndrome, tendonitis, and others. Computers are usually equipped with a

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mouse to control the movement of the cursor. In the past, the computer mouse was designed mainly with the functional aspects of the mouse in mind and little effort was placed with regard to the user's body. As many computer users have suffered injuries such as carpal tunnel syndrome, tendonitis and others caused by the prolonged use of a computer mouse, manufacturers now attempt to design computer equipment including the computer mouse with the safety of the user in mind. However, to this day, most computer mouse developed heretofore do not prevent injuries to a user's wrist such as those mentioned above. Many mouse designed for use with a computer are sized such that a user's wrist rests on a work surface rear of the mouse and the user's hand extends over the mouse. This position places the wrist in a compressed and vulnerable position, susceptible to wrist injuries such as those identified above. Prolonged compression of the wrist can result in other problems as well which may cause other injuries, such as: pressure on the wrist, tension in the fingers, the elbow and shoulder can become tense and locked which can cause further tension in the neck and head, the torso can fall forward creating additional pressure in the user's arm. Web site: http://www.delphion.com/details?pn=US06492975__ •

Configuration for a computer input device Inventor(s): Chu; Chou-Ming (Taipei, TW), Fiore; Michele (Milan, IT) Assignee(s): Acer Incorporated (Taipei, TW) Patent Number: 5,818,360 Date filed: April 28, 1997 Abstract: This invention discloses an ergonomically designed keyboard which alleviates carpal tunnel syndrome. It comprises a keyboard and a tilting mechanism which tilts the keyboard so that the keys proximate to the user become elevated relative to the keys farther away from the user; that is, the keyboard slopes downwards away from the user. The tilting mechanism allows automatic keyboard tilting upon opening a notebook computer's screen lid, and also manual angular adjustment of the keyboard to fit the user's needs. Excerpt(s): This invention relates generally to key-in input devices, and more particularly to flexible input devices which can be changed to an inclining position. Many conventional keyboards allow a keyboard to be tilted, with the keyboard surface sloping ascendantly away from the user. This configuration may be suitable for use when the keyboard is placed on a desktop. Because the keyboard is usually at an elevated position relative to the elbow, tilting the distal end of the keyboard, which is the end farther away from the user, allows the keyboard surface to become substantially parallel to the user's forearms, thereby placing less stress on the user's wrists. However, when this keyboard is placed at a substantially level or lower position than the user's elbows, the upward tilted keyboard forces the user to place his/her hand in an unnatural orientation. Frequent use of such prior art keyboard placed in a position approximately level to or lower than the user's elbows can lead to stress injuries, such as carpal tunnel syndrome. This is especially true for business people who use laptop computers frequently during their travels. Web site: http://www.delphion.com/details?pn=US05818360__

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Device for use on a traction machine to treat carpal tunnel syndrome and other problems of the wrist Inventor(s): Repice, II; Ronald M. (299 Stanton Ct., Glen Mills, PA 19342), Repice; Ronald M. (640 Georgetown Rd., Glen Mills, PA 19342) Assignee(s): none reported Patent Number: 5,632,726 Date filed: November 6, 1995 Abstract: A device for mounting onto a traction machine having a base console, an elongated standard extending upward therefrom, and an elongated traction cable suspended vertically downward from the standard and having a free end connector. The device comprises an upper arm support plate, a wrist band, and an adjustable mounting sleeve. The wrist band is arranged to be releasably secured about one wrist of a person and connected to the connection means of the traction machine to be suspended therefrom. The upper arm support plate is an elongated member releasably secured by a bracket to the sleeve for supporting the upper arm of the person and includes an adjustable strap for extending about the upper arm of the person to releasably secure it in place on support plate. The adjustable sleeve is slidably mounting on the standard and includes releasable securement means, e.g., at least one set screw, for releasably securing it at any vertical position along the standard. Thus, the person, when seated, can readily dispose his/her upper arm on the support plate irrespective of the height of the base portion of the traction machine and with his/her forearm being oriented vertically upward and with the wrist band secured about the wrist of the person, so that the machine can apply tension to the wrist to alleviate the pain caused by carpal tunnel syndrome or some other disorder of the wrist, e.g., a strain, sprain or subluxation. Excerpt(s): This invention relates generally to medical equipment and more particularly to devices for use with traction equipment to treat carpal tunnel syndrome and other problems of the wrist by applying traction thereto. Various traction machines are commercially available for applying traction to selected portions of the anatomy of a person to treating some medical condition or problem of the person. For example, Barrington Equipment Company, of Wauconda, Ill. presently markets a pneumatic traction machine, believed to be manufactured by Para Tech Industries, Inc., under the trade designation Para Tech CTD MARK I, for applying traction to the wrist of a person suffering from carpal tunnel syndrome. While this device appears suitable for its intended purposes, it leaves much to be desired from the standpoint of ease of use and patient comfort. In this regard the Para Tech CTD MARK I device comprises a console from which a post or pole projects upward. A VELCRO.RTM. wrist sleeve is connected to the post for encircling the wrist of the person to be treated while preventing any movement of the arm with respect to the post. To achieve that end the person must sit beside the machine with his or her forearm oriented horizontally at a predetermined height with respect to the machine. The machine's post is arranged to be moved away from the person by a pneumatic actuator so that the person's arm and wrist is extended, i.e., traction applied thereto. This extension or traction of the arm and wrist is said to reduce the compression of the carpal tunnel ligament upon the median nerve, whereupon the carpal bones now open to allow more room in the carpal tunnel. Since the machine is of a fixed height and since the forearm of the person being treated has to be oriented horizontally, that person must seat himself/herself so that his/her forearm is at the predetermined appropriate height for the application of traction thereto. Depending upon the height of the person, he/she may have to sit bent or hunched over

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(if the machine is too low for him/her), or else sit unnaturally erect and upright (if the machine is too high for him/her) to be in the proper position for the application of traction to his/her forearm and wrist. This can result in patient discomfort or tiring, particularly for treatments requiring long duration traction. Accordingly, it is a general object of this invention to provide a device which overcome the disadvantages of the prior art. Web site: http://www.delphion.com/details?pn=US05632726__ •

Diagnostic apparatus and method for evaluation of carpal tunnel syndrome Inventor(s): Williams; George Roger (3024 SE. 40th St., Edmond, OK 73013) Assignee(s): none reported Patent Number: 6,045,517 Date filed: April 7, 1998 Abstract: This invention is a diagnostic device for measuring the extensibility of certain key carpal ligaments so as to determine the tendency of the subject to carpal tunnel damage. It consists of a structure to secure the arm and hand in a predetermined position on a stationary platform and the metacarpals of the hand in a predetermined position on a carriage moveable relative to the platform, so that the radius and ulnar bones of the forearm may be aligned in a fixed plane parallel with the moveable plane of the metacarpals of the hand. Once secure, a force is applied to the carriage in a dorsal direction perpendicular to the metacarpal plane, so as to measure the metacarpal glide. This force places stress on the ligaments of the volar joint between the proximal and distal carpal row, and resulting displacement, tension, and creep strength values are measured by a load cell and a lineometer. Using these values, the following can be determined: (1) extent of volar carpal ligament contracture and deformity; (2) requirements of ligament retraining; (3) diagnostic criteria for predicting carpal tunnel syndrome; and (4) values to assist health professionals in determining whether or not surgery for decompressing peripheral neuropathy is warranted. Excerpt(s): This invention relates generally to medical diagnostic devices. More particularly, the present invention provides an apparatus and a method for measuring the tension of carpal ligaments under applied translation forces which in turn will provide indicators of future or existing carpal tunnel syndrome. Carpal tunnel syndrome is a condition in which the median nerve is compressed by the surrounding contents of the median nerve canal. This condition is believed to be caused by a biomechanical ligament imbalance in the volar carpal ligaments, which is in turn related to the increased ratio of power produced by the flexor muscles over extensor muscles as they interact with the hand. The flexor muscle tendons of the forearm acting on the wrist, fingers and thumb exert a collective static force power many times greater, volarly, than the extensor muscle tendons acting to stabilize the same members of the wrist and hand dorsally. The ratio of these opposing forces is normally four to one. However, work demands often increase this ratio through hypertrophy of the flexor muscle tendon units by intensity and duration of tasks requiring dominantly finger, thumb, and wrist function. Web site: http://www.delphion.com/details?pn=US06045517__

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Dilating surgical forceps having illumination means on blade inner surface Inventor(s): Redmon; Henry A. (12029 Orange Grove Dr., Tampa, FL 33618) Assignee(s): none reported Patent Number: 5,569,300 Date filed: April 12, 1995 Abstract: A surgical instrument is provided for performing surgery to relieve the symptoms of carpal tunnel syndrome. The surgical instrument includes a pair of pivotally connected legs with each leg including a handle portion and a blade portion with the blade portions terminating in a nose. The nose is inserted through an incision in the wrist area and progressively "worked" into an area between the transverse carpal ligament. The surgical instrument is rotated approximately 90 degrees and the handle portions are then squeezed to spread the blade portions to create a surgical area fully exposing the transverse carpal ligament. One of the blade portions carries illuminating means for illuminating the surgical area or arena to assure that only the transverse carpal ligament is severed to prevent damage to the median nerve, tendons and the like passing through the carpal tunnel. Upon the severance of the transverse carpal ligament, the surgical instrument is reversed relative to the movements just described for effecting the withdrawal thereof and the incision is subsequently sutured. Excerpt(s): The invention relates to a surgical instrument for and a method of performing subcutaneous surgery, specifically the utilization of the surgical instrument to illuminate the carpal tunnel area of a patient to effect the severance of the transverse carpal ligament. The carpal tunnel is a small channel formed by the carpal bones of the wrist. The median nerve runs through it and provides sensation and feeling to much of a person's hand. Tendons that connect to the fingers also run through the carpal tunnel. The median nerve and those tendons stretch and retract and press the top of the carpal tunnel during repetitive hand motions, and long term stress irritates the tendons causing the same to swell. As the tendons swell even more they press against the median nerve causing irritation, irritation feeds upon itself, cycle after cycle, and thus is the beginning of carpal tunnel syndrome. The first warning symptoms of carpal tunnel syndrome generally are slight tingling in one's fingertips which can continue accompanied by increasing pain until pain reaches an excruciating level. Hand function is also severely impaired. Web site: http://www.delphion.com/details?pn=US05569300__

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Dynamic support to correct/prevent carpal tunnel syndrome Inventor(s): Brill; Bonnie E. (295 Graystone Ter., Suite 1, San Francisco, CA 94114) Assignee(s): none reported Patent Number: 5,916,187 Date filed: November 6, 1997 Abstract: A supportive material and exercise device to correct/prevent Carpal Tunnel Syndrome. The supportive material constitutes an elongated member or strap which may be attached to a glove for retaining the hand in a cupping position so as to reform the Carpal Tunnel area of the hand allowing the natural remodeling of the connective tissue support by approximation support and to strengthen muscles therein. The exercise device, which can be worn interchangeably with the strap or glove, is designed

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to increase strength in the fingers, thumb and hand, thereby reducing the probability of damage to the Carpal Tunnel area and restoring strength to that area. Excerpt(s): This invention relates to supportive devices used in medical intervention of human joint problems and exercise apparatus for correction of human joint problems, and more particularly to a supportive material in the form of an elongated strap which may be used alone or on a glove and to an exercise device for Carpal Tunnel Syndrome. Carpal Tunnel Syndrome is a well-known, commonly occurring hand condition, sometimes referred to as median compression neuropathy within the carpal canal. The most common symptoms of this condition include intermittent pain and numbness of the hand. Such pain or numbness results from compression of the median nerve, which extends from the wrist centrally into the palm of the hand between the palm heel and the ball of the thumb (thenar). In Carpal Tunnel Syndrome, the median nerve is compressed producing the symptoms of pain or numbness. Treatment of Carpal Tunnel Syndrome varies according to the severity of the condition. Severe conditions usually require hand surgery to sever the transverse carpal ligament, which often results in a weakened hand; albeit, it does relieve the pressure on the median nerve. For less severe cases the use of a splint, which immobilizes the wrist, is sometimes effective. The typical splint provides a cock-up for the wrist and inhibits normal wrist motions. Although there has been some success with this apparatus and anti-inflammatory drugs, there has been a concurrent cost and loss of function. Carpal Tunnel Syndrome has become such a disabling condition as to cause permanent disability in a portion of the work force. Greatly affected are workers in industries which require repeated manual operations with the hands, such as computer operators, cashiers, typists, workers in meat processing operations, the paper industry, and construction. Carpal Tunnel Syndrome is a leading cause of workman's compensation claims in such industries. Protective gloves have been proposed as one means of preventing Carpal Tunnel Syndrome due to wrist flexion (Occupational Health and Safety September 1986, pp. 18-20). A glove proposed for this purpose, in the foregoing publication, includes a tough pigskin shell wrapped around the wearer's wrist. This glove is heavy, cumbersome, and restricts free action of the wrist. Other prior efforts, such as exemplified by U.S. Pat. No. 4,701,963 issued Oct. 27, 1987 to V. P. Overton, and U.S. Pat. No. 5,214,799 issued Jun. 1, 1993 to J. J. Fabry, are gloves that provide added padding to protect the wrist and hand from vibration and shocks through dampening action. Although impact may be reduced through this pad, it does not aid in structural support of the Carpal Tunnel. Web site: http://www.delphion.com/details?pn=US05916187__ •

Flexible keyboard Inventor(s): Weber; Michael R. (14535 Bruce B. Down Blvd. 2221, Tampa, FL 33613), Weber; Paul J. (2881 E. Oakland Park Blvd., Ft. Lauderdale, FL 33306) Assignee(s): none reported Patent Number: 5,616,897 Date filed: February 2, 1995 Abstract: A flexible or roll-up electronic keyboard is provided for use with electronic devices. The keyboard is formed with a plurality of section of flexible plastic materials and embodies a dual-walled bottom which includes a network of support members which can be inflatable to provide a rigidity to the structure of the keyboard sufficient to prevent false signals. At least one separately inflatable accordion-pleated wedge means is also provided to enable variable adjustment of the plane or planes of the keyboard

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relative to the hands of its operator, sufficient to reduce the risk of nerve disorders such as carpal tunnel syndrome in the operator. Excerpt(s): The present invention relates to keyboards or interface controls used as data input means for various electronic devices. More particularly, the present invention relates to a flexible electronic keyboard for portable electronic apparatus including industrial equipment, consumer products or appliances such as computers, telephones, musical instruments, toys, etc. The miniaturization of electronic equipment has been a major focus in the research and development of these devices. In the case of portable electronic devices including personal computers, calculators, telephones and the like, miniaturization has been limited by the keyboard component. The keyboard component must have sufficiently large keys or keypads which are ergonomically feasible to the general population. Rigid keyboards, now in use, have fixed distance between the keys and/or between the switches to which the keys are physically connected. For this reason a full-sized keyboard presents a difficult design challenge to the miniaturization process. Use of the typical, full size keyboard would be self-defeating when applied to "notebook" or "laptop" computers, i.e. Thus, because of their compact size, "notebook" and "laptop" computers have included keyboards of less than full size, i.e., the size of an average desktop general computer keyboard. Typically a laptop keyboard has a width of about 35 cm as opposed to an equally functional desktop computer keyboard having a width of 50 cm. Further, because the alphanumeric keys must be of a sufficient size to accommodate even large fingers, certain keys are often deleted or rearranged from their normal position on the keyboard as a sizing constraint. Such modifications can thus result in excessive motion and typing errors and can sacrifice available options associated with the missing conventional keys. Web site: http://www.delphion.com/details?pn=US05616897__ •

Foot pedal computer mouse including modular auxiliary unit Inventor(s): Price; Jonathan (4326 Lorcom La., Arlington, VA 22207), Prince; Peter M. (1258 Spring Hill Rd., McLean, VA 22102-2300), Wujcik; David C. (8102 Falstaff Rd., McLean, VA 22102-2300) Assignee(s): none reported Patent Number: 6,611,250 Date filed: June 21, 2000 Abstract: A mouse assembly includes a modular auxiliary unit that is operable in complement with a floor or pedal assembly. The modular auxiliary unit includes structure for conveniently securing the unit as well as a mouse functionality section, such as a track ball or the like. The floor or pedal assembly includes one or more clicking pedals and a scrolling wheel for foot-operated mouse manipulations. The assembly facilitates mouse-type operations while reducing risks of injury associated with repetitive motions such as carpal tunnel syndrome and tendinitis. Excerpt(s): The present invention relates to a computer mouse apparatus and, more particularly, to a computer mouse apparatus that is adapted for use by a user's feet and including a modular auxiliary unit for additional functionality. Conventional hand mouse operation can be uncomfortable particularly over extended periods of time and has been known to be the cause of stress injuries or repetitive motion injuries such as carpal tunnel syndrome and tendinitis. It is desirable to perform computer mouse manipulations with a user's feet to reduce such stress injuries and increase the user's

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comfort. A number of existing foot pedal mouse devices have appreciated the desirability of performing mouse operations with the user's feet. These devices, however, are typically multi-pedal systems that are bulky and uncomfortable to use as well as being expensive. The existing foot mouse pedals are also limited in mouse operation functionality. Web site: http://www.delphion.com/details?pn=US06611250__ •

Forearm splint system for treatment and prevention of carpal tunnel syndrome and other cumulative trauma disorders Inventor(s): Singer, Jr.; Richard F. (7312 Gold Ring Ter., Derwood, MD 20855) Assignee(s): none reported Patent Number: 6,120,472 Date filed: November 6, 1998 Abstract: A forearm splint system and method of use for treatment and prevention of carpal tunnel syndrome and other cumulative trauma disorders including adjustable tensioning means causes rotation of two curved, semi-rigid pieces of material within the splint system. The rotation causes rotation and repositioning of the distal radius and ulna bones, resulting in widening of the carpal tunnel, decreased compression of the median nerve, and improved frictionless gliding and sliding of the flexor tendons. Excerpt(s): A group of conditions that has presented a challenge to both health care providers and ergonomists are the upper extremity cumulative trauma disorders. This includes carpal tunnel syndrome, DeQuervain's tenosynovitis, cubital tunnel syndrome, Guyon's tunnel syndrome, intersection syndrome, and repetitive strain injury. There has been a steady increase in the number of reported cases of cumulative trauma disorders over the past several years. This is in part due to the increased awareness of these conditions among the general public. The increase in cumulative trauma disorders can also be attributed to the growing use of computers, although an individual can develop a cumulative trauma disorder without having used a computer. Manual use of the keyboard and/or mouse requires frequent, highly coordinated use of one's forearms, wrists, hands, fingers and thumbs for accurate data entry. This requires very brief but very frequent contractions of the muscles and their associated tendons. This may prevent adequate relaxation between contractions and lead to the development of cumulative trauma or overuse of these tissues. The carpal tunnel, and structures therein, are the most frequently effected tissues in upper extremity cumulative trauma disorders. The structures within the carpal tunnel include the finger and thumb flexor tendons, the flexor carpi radialis tendon, the flexor carpi ulnaris tendon and the median nerve. The volar surface, or what may be called the roof of the carpal tunnel, is formed by the flexor retinaculum and the transverse carpal ligament. The dorsal surface, or what may be called the floor of the carpal tunnel, is formed by the pronator quadratus muscle, the distal radioulnar joint, the radiocarpal joint, the triangular fibrocartilage complex, the proximal row of carpal bones and the associated joint capsules and ligaments. Carpal tunnel syndrome is a compression neuropathy of the median nerve as it passes through the carpal tunnel. The median nerve supplies sensation to the volar, also known as palmar, aspect of the thumb, index, middle finger and the radial (thumbside) half of the ring finger. Symptoms of carpal tunnel syndrome include numbness, tingling, burning sensations and pain. This involves not only the area of innervation described but may also radiate above the wrist into the forearm. Intact sensation to this part of the hand is

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essential for the coordinated, highly repetitive use of the fingers, thumbs and wrist flexors to operate the computer keyboard and mouse. Web site: http://www.delphion.com/details?pn=US06120472__ •

Glove for preventing carpal tunnel syndrome Inventor(s): Spitzer; A. Robert (4375 Borland Ave., West Bloomfield, MI 48323) Assignee(s): none reported Patent Number: 6,006,751 Date filed: July 22, 1998 Abstract: A glove assembly (20) adapted to inhibit or prevent carpal tunnel syndrome includes a flexible glove body (22) having a front side (24) and a back side (26) which defines a wrist opening (28) and at least one finger opening (30). The glove assembly (20) further includes a resilient protector (32), secured to the front side (24) of the glove body (22), for preventing the application of pressure to a median nerve. The resilient protector (32) defines a recess (36) extending substantially parallel with both sides (38) of the median nerve. It is also interrupted along its extent thereby imparting greater flexibility and ease of movement to a wearer of the glove assembly (20). A grip is also disclosed which includes a resilient protector interrupted along its extent. Excerpt(s): The invention relates to a glove which is adapted to inhibit or prevent carpal tunnel syndrome. Particularly, the present invention relates to a glove assembly which inhibits or prevents carpal tunnel syndrome while providing increased flexibility and ease of movement to the wearer of the glove assembly. Carpal tunnel syndrome is a common condition which occurs due to the compression of the median nerve. It is sometimes referred to as median compression neuropathy within the carpal canal. Carpal tunnel syndrome is a particular problem for workers in industries which require manual operations with hand held implements or tools or in office situations wherein a worker may be required to spend several hours a day resting their hands on a typewriter or computer terminal and may also be sports related. Carpal tunnel syndrome is a clinical syndrome characterized by numbness, weakness, paraesthesia or atrophy in the territory of the median nerve distal to the course through the carpal tunnel in the wrist. The transverse carpal ligament forms over the median nerve and may compress the median nerve as a result of pressure on the hand, producing the above described symptoms. Traumatic injury is exacerbated because of the narrowness of the carpal canal. There is no opportunity for the nerve to be displaced away from any compressive forces. Compressive injury can be exacerbated by the development of edema in the tissues within the canal, which because of the relatively fixed size, can cause added injury due to compression of the nerve within the canal. An additional component of the injury is associated with friction between the nerve and the adjacent tendons caused by repetitive motions (injury) which may be worsened by compression and further reduce the available space within the canal. Web site: http://www.delphion.com/details?pn=US06006751__

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Guitar pick with gripping means Inventor(s): Chance; Allen (Marina Del Rey, CA), Gray; William T. (Topanga, CA) Assignee(s): Big Rock Engineering (Topanga, CA) Patent Number: 6,054,643 Date filed: October 5, 1998 Abstract: An ergonomic musician's pick or pick holder for use with string instruments, such as a guitar, mandolin, bass guitar, or ukelele, has a curved finger grip portion on one side adapted to form a finger cradle for either the thumb or index finger of a user and has a flat generally planar area on another side against which the other fingers of a user may be pressed to allow the user to securely and comfortably grasp the pick for playing. The grip portion positively locates the fingers in a generally predetermined angular relationship to the string engaging pick tip. Different individual picks of the invention may have different angular relationships. The pick functions in the same way to bring the same advantages of the invention to any conventional and some nonstandard or custom picks. Holder provides the added advantage that various picks may be used and the angular relationship may be more easily varied through various arrangements for attaching the pick to the holder. The simplicity of construction allows use of various materials in various thicknesses, sizes, and hardnesses, and materials to satisfy a wide range of playing conditions and preferences. The pick and holder have a folded configuration which is efficiently manufactured and allows convenient storage on the instrument strap or stings. The ergonomic grip design allows a more relaxed, and low pressure grip which is less likely to cause physical problems such as carpal tunnel syndrome and arm and back pain. Excerpt(s): The present invention relates generally to a pick for stringed instruments, and more particularly to a pick and pick holder device having an improved ergonomic grip that allows a more comfortable, less tense grip that avoids physical tension and stress related problems and facilitates improved playing. Stringed instruments have been known since at least the Middle Ages and means for plucking these strings evolved from the use of pieces of sea shell and tortoise shells. As the stringed instruments, and particularly guitars, evolved and the intensity of the music increased to that now being played by rock bands on electric guitars, the requirement for improved gripping capabilities has similarly increased. With the faster, more intense playing, it is important that the conventional pick be gripped tightly and securely to achieve the proper pick alignment and possession. It has been found that with the tight gripping of the prior art picks, there has been a tendency for the picks to move in the user's finger and to cause stress and fatigue for the user. The problem of providing adequate gripping capability for musical picks has been approached in many different ways in the prior art From the inventors' experience, picks have been made from various materials and in a variety of different shapes--some have been made with holes or with crosshatch non-slip patterns embossed into the plastic--but this never really achieved the positive grip that was sought. Some users put tape on a pick in order to achieve better gripping or have even taped or glued the pick to their thumbs. Web site: http://www.delphion.com/details?pn=US06054643__

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Impact absorbing keyboard, contoured to the natural shape of the hand Inventor(s): Caplan; Leslie S. (San Francisco, CA) Assignee(s): Prosper Street Technologies, L.L.C. (San Francisco, CA) Patent Number: 6,183,149 Date filed: January 13, 1999 Abstract: An attachment to or a keyboard itself or other devices which require extending the fingers and hands so as to reach keys of the device. The invention includes at least one key pillow. The key pillow either replaces or fits over at least one key of a keyboard or other such device to advantageously alter the consistency, texture, shape, or height of the traditional key to which the key pillow corresponds. The key pillow is shaped so as to extend into the comfort zone of a user to thereby minimize the stretching and twisting required of the user's fingers, hands, wrists, and arms. The key pillow may be applied to a keyboard of a portable computer, where the at least one key pillow is inflatable. The at least one key pillow may also be applied to devices such as a computer mouse. The key pillow must extend into a comfort zone of the user. Also, a palm rest is designed so as to maintain the user's hands at a certain height above the lip of the keyboard, which may or may not include key pillows. The palm rests have a height which reduces the introduction of tension into the user's arms and upper body and thus, are suitable for reducing the occurrence of carpal tunnel syndrome and other RSIs. The palm rest may be formed in combination with the keyboard or totally separate therefrom. Excerpt(s): The present invention relates to keyboards and other devices which require manipulation via extension of the fingers, and in particular to a keyboard designed to minimize stress and injury related to carpal tunnel syndrome and other repetitive stress and strain injuries. Incidents of Repetitive Strain Injuries (RSI), also known as Cumulative Trauma Disorder (CTD), such as Carpal Tunnel Syndrome (CTS) are increasing at an astronomical rate, affecting nearly two million workers annually and costing an estimated $20 billion per year in workers' compensation, medical benefits, and lost wages. RSI to the upper extremities results, in part, from the repetitive reaching, stretching, bending, flexing, and twisting of fingers. Maintaining the wrist in an awkward position during these repetitive motions increases the likelihood of injury. Holding the body and upper extremities in a static position (either sitting or standing) associated with keyboard use and data input also increases the likelihood of injury. Over time, these awkward repetitive motions can inflame soft tissue, creating pressure on various nerves and causing pain, numbness, and tingling sensations in the upper extremities. RSI may result in pain, numbness, weakness, or loss of dexterity or use of the hands and fingers. Computer keyboard operators such as secretaries, data entry personnel, computer programmers, and journalists are among the most frequent victims of RSI. From the standpoint of typing speed, keyboards have advantageously evolved to the point where pauses in typing required by typewriters for carriage returns, paper feeds, and manual error corrections are no longer required While disadvantageous from an efficiency standpoint, these typing pauses provided breaks in the repetitive motions associated with typing. Consequently, the occurrence of repetitive strain injuries was much lower than it is today. Web site: http://www.delphion.com/details?pn=US06183149__

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Instrument and method for transection of a ligament Inventor(s): Clifford; Mark (Los Altos, CA), Keller; Wade (San Jose, CA), Kermode; David (Pella, IA), Kermode; Jim (Sunnyvale, CA) Assignee(s): Surgical Insight, Inc. (Sunnyvale, CA) Patent Number: 5,769,865 Date filed: February 25, 1997 Abstract: In a procedure for the treatment of carpal tunnel syndrome, the carpal ligament is spread by use of a cutting device passing through the interior of a cannula inserted into the carpal tunnel through an incision in the patient's wrist, the cannula containing an inflatable balloon at its distal end to secure the position of the cutting device against the carpal ligament, and the cutting device comprising a blade whose position is remotely controlled from the proximal end of the device. Other features of the procedure are the use of a blunt-tipped hypodermic needle and exchange wire to establish a path to the site under the carpal ligament, an endoscope or other visualization device to be inserted through the cannula with the cutting device, and a removable sheath over the cannula to contain the inflatable balloon until inflation is desired. Excerpt(s): This invention resides in the field of treatments for carpal tunnel syndrome and other physiological conditions treatable by transection of a ligament. Carpal tunnel syndrome is an extremely debilitating condition caused by compression of the median nerve within the carpal tunnel. The compression may stem from a variety of conditions, including repetitive movements of the hand or wrist, as well as rheumatoid arthritis, and edema in the final trimester of pregnancy. The compression interferes with the function of the median nerve, and its symptoms include numbness and tingling in the fingers and in some cases pain radiating as far as the shoulder or base of the neck. Ultimate effects may include an impaired grasping ability, loss of sleep from pain, numbness in the hand, and weakness or atrophy of the thenar muscles. One method of treatment is the injection of cortisone or other medications into the carpal tunnel. If symptoms persist or recur, however, or if the patient experiences severe sensory deficit or loss of function in the thenar muscles, treatment is indicated which involves surgical division or release of the carpal ligament which forms the anterior (palm-side) wall of the carpal tunnel and extends in a direction transverse to the carpal tunnel. Web site: http://www.delphion.com/details?pn=US05769865__

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Keyball Inventor(s): Kolsrud; Arild T. (Parsippany, NJ) Assignee(s): Lucent Technologies, Inc. (Murray Hill, NJ) Patent Number: 6,053,646 Date filed: July 31, 1998 Abstract: An input device for inputting data into a computer or a video game is provided. The input device includes two keyballs mounted to a base. The keyballs may be swiveled relative to the base. Each keyball includes a plurality of switches for activation by the finger tips and thumb tips of a typist. By moving the keyballs and pressing the switches, the typist can enter data in a manner which mimics a conventional typing method. During operation, the typist's hands need not leave the

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keyballs. Therefore, the input device can reduce strains, and the likelihood of injuries such as carpal tunnel syndrome, to the wrists of the typist. Excerpt(s): This invention relates to an input device for supplying data to an electronic device, such as a computer. More particularly, the present invention relates to a pair of ergonomically shaped input devices. While typing, the professional typist always performs the same motion when pressing a specific key. For example, a typist begins with the four fingers of his left hand resting on the "A", "S", "D", and "F" keys, (from the pinky finger to the index finger, respectively), and the four fingers of his right hand resting on the ":", "L", "K", and "J" keys (from the pinky finger to the index finger, respectively). In order to press the "P" key, the typist moves his right hand upward and very slightly to the left, then presses the "P" key with the tip of his right pinky finger. In order to press the "B" key, the typist moves his left hand down and to the right, then presses the "B" key with the tip of his left index finger. The above typing method has been used by typists for many years and has become an industry standard typing method. Unfortunately, a serious drawback to the typing method, when applied to the conventional keyboard 1, has been the possibility of developing carpal tunnel syndrome in the wrists of the typist. During the conventional typing method, the weight of the hands must be borne by the muscles and tendons of the forearms and wrists. Over the career of the typist, the repetition of typing sessions may cause the typist to develop carpal tunnel syndrome or possibly arthritic complications. Web site: http://www.delphion.com/details?pn=US06053646__ •

Keyboard positioning system Inventor(s): Ambrose; Frederic C. (13 Pilgrim Heights Rd., Provincetown, MA 02657) Assignee(s): none reported Patent Number: 5,567,067 Date filed: August 4, 1995 Abstract: A keyboard positioning system in which the keyboard is positioned with its rear edge substantially lower than its forward, or operator edge in order that the operator might use the keyboard with the plane of the operator's hands parallel to, or below the line of the operator's forearm, thus reducing the incidence of carpal tunnel syndrome. A hand support bar is provided to support the operator's hands while keyboarding. Excerpt(s): In a separate development, the medical community has become increasingly aware of an extremely irritating, but non-lethal physical affliction, known generally as the "carpal tunnel" syndrome. In this affliction, the median nerve, which extends down the arm and out to the human hand, can be damaged at the point at which it passes through the human wrist joint. The occurrence of this affliction has a large number of unpleasant physical consequences. Generally, the affliction is associated with situations in which the hand and wrist are bent upward and backward and, while in that position, significant weight is applied to the wrist. This phenomenon which is very common among serious bicycle riders can result in long term pain and disability. It has been observed that the carpal tunnel syndrome is frequently associated with persons who are professional keyboard operators. It appears that the forward tilt of the keyboard, which is universally accepted as the proper design for a keyboard, may well force the operator, on a long term, continuous basis, to arch back the hand and wrist in such a way that, over the many years that the operator may be sitting before the keyboard, permanent

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work place injury could result. This unfortunate circumstance may well be resulting in serious long term human suffering and, of course, the financial liabilities and difficulties which can be associated with such human suffering. This problem is compounded by another aspect of conventional keyboard design. Ordinarily, the operator is required to sit before the keyboard with hands extended over the keyboard. Holding the hands over the keyboard for hours at a time places tremendous stress on the operator's shoulder and neck muscles. In conventional mechanical typewriters, this uncomfortable and potentially harmful condition was constantly relieved by the peripheral activities required by the mechanical typewriter; i.e., hitting the carriage return bar and changing sheets of paper. With modern word processing systems, the operator can literally spend hours without removing his or her hand, from the keyboard. The long term effect of holding one's hands over the keyboard, day after day, year after year, may well cause harmful neck and shoulder muscle stress. These and other difficulties experienced with the prior art devices, have been obviated in a novel manner by the present invention. It is therefore, an outstanding object of the invention to provide a keyboard positioning system in which the keyboard is tipped backward so that the operator's hands and wrist assume a position which does not cause irritation or damage to nerves which pass through the wrist joint. Another object of the invention is the provision of a keyboard positioning system which holds the keyboard in a position in which it is tipped backwards in order to provide a more comfortable and restful orientation for professional or long term keyboard operators. Web site: http://www.delphion.com/details?pn=US05567067__ •

Keyboard support platform Inventor(s): Hogle; Glenn (La Mesa, CA), Hogle; Sherri (La Mesa, CA), Roeder; Michael (San Diego, CA) Assignee(s): Active Input Solutions, LLC (San Diego, CA) Patent Number: 6,579,022 Date filed: March 9, 2000 Abstract: A keyboard support platform includes a keyboard support plate hingedly attached to a base. A motorized drive assembly or an inflatable bladder urges the keyboard support plate to move from a position below horizontal, through a horizontal position, to a position above horizontal. A computer keyboard may be placed on the keyboard support plate. Accordingly, as the keyboard support plate moves the keyboard will also move. While a user is typing, he or she will have to follow the motion of the keyboard thereby causing the position of his or her wrist to continuously change. As such, the risk of developing computer-related hand and wrist injuries such as Carpal Tunnel Syndrome, tendinitis, and static muscle fatigue from keeping the wrist motionless while typing for extending periods of time is reduced. Excerpt(s): The present invention relates to computer keyboard support structures. With increased computer usage in the home and office, a very common injury is repetitive stress injury, including Carpal Tunnel Syndrome (CTS). A major cause of CTS is repetitive motion, e.g., typing at a computer for an extended period of time. During the act of typing, the flexor tendons leading from the forearm to the thumb and fingers rub against the interior wall of the carpal tunnel. Without breaks in the movement or changing wrist position, tendons become inflamed due to an increase in intracarpal pressure (ICP) which, in turn, leads to a lack of proper blood flow. If the tendons in the carpal tunnel become inflamed, pressure may be put on the medial nerve at the wrist

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thereby causing pain, numbness, tingling, and weakness in the thumb and fingers. In order to provide the most beneficial range of motion, it happens that a device such as the '844 patent should move the wrist through what is known as the "neutral zone." The neutral zone is a zone of wrist movement in which the wrist is moved from a point of flexion approximately thirty-five degrees (35.degree.) below horizontal, across the horizontal (zero degrees), to a point of extension fifteen degrees (15.degree.) above horizontal. On the other hand, wrist movement outside the neutral zone, i.e., beyond thirty degrees below horizontal or fifteen degrees above horizontal, excessive flexion without opposing extension, or excessive extension without opposing flexion, can cause unacceptable ICP greatly increasing the likelihood of developing CTS. Web site: http://www.delphion.com/details?pn=US06579022__ •

Method an apparatus for treatment of compressive syndrome conditions Inventor(s): Morgan, Jr.; Clyde E. (20124 W. 151st St., Olathe, KS 66061) Assignee(s): none reported Patent Number: 6,315,748 Date filed: September 18, 2000 Abstract: An orthopedic device (10) is provided for the treatment of physical disorders characterized by region(s) of localized, undue compression of body tissue leading to nerve compression and/or damage, such as carpal tunnel syndrome. A carpal tunnel syndrome treatment device (10) in accordance with the invention includes a central, resilient, stretchable tensioning segment (12) with a plurality of relatively less stretchable adhesive straps (14-18) secured to the segment (12). In use, the segment (12) is placed on the back of a patient's hand (20), whereupon the straps (14-18) are pulled and adhered to the patient's palm in a fashion to expand the segment (12). In this orientation, the control segment (12) exerts continuous yielding or tensile forces through the straps (14-18) which in turn reduces carpal tunnel syndrome nerve compression and alleviates symptoms. Excerpt(s): The present invention is broadly concerned with improved method and apparatus for the treatment of compressive syndrome physical disorders characterized by a region of localized, undue compression of body tissue, for example, carpal tunnel syndrome. More particularly, the invention is concerned with such methods and devices wherein use is made of a central tensioning segment formed of resilient, stretchable material (e.g., synthetic elastomer or latex rubber) together with a plurality of adhesive attachment straps of limited stretchability secured to the tensioning segment for securement of the device on a person's body. The tensioning segment exerts a continuous yielding or tensile force through the straps, serving to at least partially reduce the troublesome tissue compression. Carpal tunnel syndrome and related conditions result from repeated trauma to the tendons and soft tissue structures forming a part of the wrist. Excessive pressure on the carpal tunnel contents, including the flexor tendons, nerves and bursa, results in abnormal function, weakness, inflammation, pain, numbness and ultimately in nerve tissue injury. The flexor retinaculum is a thick, relatively unyielding ligamentous band that crosses the groove on the palmer surface of the carpal bones. It is composed of the palmer (volar) carpal ligament and transverse (anterior annular) carpal ligament. The palmer carpal ligament is attached medially and laterally to the styloid processes of the radius and ulna. The transverse carpal ligament is attached medially to the pisiform bone and the hamulus of the hamate, and laterally to the tuberosity of the scaphoid and palmer surface of the ridge of the greater

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multangular (trapezium). The fibers of these ligaments merge at the distal end of palmer and proximal end of the transverse ligament. Together with the carpal bones and articulations, they form a tunnel through which pass the deep flexor tendons and median nerve. Web site: http://www.delphion.com/details?pn=US06315748__ •

Method and apparatus for preventing injury to an electronic computer keyboard operator Inventor(s): Uke; Alan K. (355-14th St., Del Mar, CA 92014) Assignee(s): none reported Patent Number: 5,676,476 Date filed: December 14, 1995 Abstract: The keystroke resistance and keystroke length of an electronic QWERTY style keyboard for personal computers and other electronic devices are increased to at least one hundred grams and ten millimeters, respectively, to reduce the incidence of carpal tunnel syndrome and other injuries associated with repetitive movements in long term keyboard operation. Excerpt(s): The present invention relates generally to electronic keyboards for computers, electric typewriters and similar manual data input devices utilizing the standard QWERTY key format, and more particularly, to a method, and ergonomic design for an electronic keyboard for preventing injury to the forearms, wrists and hands of an operator. Conventional electronic keyboards for computers, typewriters, or similar machines typically have a set of keys all aligned substantially in a single plane that may be flat or slightly tilted toward the operator. Electronic adding machines normally have a keypad with ten keys arranged with three keys per row. Therefore, they do not require the operator to pivot his or her wrist from side-to-side. The standard QWERTY key format used by the majority of computer operators throughout the world has three rows of at least ten keys in standard positions and arranges the alphabetic keys in parallel rows and parallel columns. The alphabetic keys include the twenty-six letter keys and typically four punctuation keys. In addition to the alphabetic keys, conventional keyboards also have numeric and/or function keys which are typically located above, below, or on one or both sides of the alphabetic keys. The function keys typically include, for example, the tab, shift, and return keys as well as the alt, control, and option keys. During the typing operation, the operator's forearms are positioned at inwardly directed angles from the operator's sides toward the keyboard, with the palms down and the hands generally flat. The wrists are bent and the hands are angled outwardly relative to the forearms in order to align the operator's fingers in directions running from the front to the back of the keyboard. The operator repeatedly pivots his or her hands at the wrist joints side-to-side over the keyboard in order to select and actuate the individual keys. Adverse physical conditions may arise in the operator's wrists, hands and fingers resulting from the kind of repetitive motions associated with typing on a conventional electronic keyboard, particularly for long periods on any given day or successive days. Such adverse conditions are compounded by the crude design of conventional electronic keyboards which encourages the side-to-side flexing of the operator's wrists, hands and fingers into particularly awkward and unnatural angles for prolonged periods of time. Typing injuries may fall into one of a few overlapping categories: repetitive stress disorder, repetitive motion injury, cumulative trauma disorder, and carpal tunnel syndrome. These conditions often require medical attention

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and, in severe cases, the worker may be unable to perform normal work functions. The cost in human suffering, and on-going medical expenses may be severe. Web site: http://www.delphion.com/details?pn=US05676476__ •

Method and apparatus for self-diagnostic evaluation of nerve sensory latency Inventor(s): Enroth; Richard J. (1120 Jacqueline Dr., Hollister, CA 95023), Grace; Lawrence J. (50 Donna La., Hollister, CA 95023) Assignee(s): none reported Patent Number: 6,553,245 Date filed: November 2, 2000 Abstract: A portable apparatus which allows a user to perform self-diagnostic evaluation of nerve sensory latency between a pair of epidermal locations proximal to nerve conduction paths. The device provides a simple and low-cost self-diagnostic apparatus which may be used for the detection and ongoing monitoring of sensory latency, such as sensory latency which is the result of carpal tunnel syndrome. The apparatus is powered by a single battery which provides power to all circuitry of the apparatus. Upon power activation, the device generates a series of high voltage stimulus pulses at an electrode in epidermal contact with the user/operator. The nerve response voltage is detected by a second electrode located along nerve pathway and the time delay between stimulus and response is displayed and periodically updated as each new response is detected. Excerpt(s): This invention pertains generally to neurological diagnostic techniques, and more particularly to an apparatus for performing self-diagnostic measurements of nerve sensory latency such as may be exhibited as a result of carpal tunnel syndrome. Median nerve compression in the wrist, also called "carpal tunnel syndrome" is becoming an increasingly common disorder that causes pain and suffering, as well as a substantial economic impact. Carpal tunnel syndrome has various causes and predispositions which include genetic, toxic, metabolic and traumatic factors. The leading causes of the disorder stem from cumulative trauma or repetitive motion mechanisms. Primarily, the causative factors are related to the nature of the work performed and the ergonomic environment of the workplace. Carpal tunnel syndrome has become an agonizing disorder for many sufferers while a far larger segment of the population experiences various levels of discomfort and disability. Concomitant economic costs exist which are more easily quantified as costs for medical treatment, disability payments, insurance premiums, along with the economic impact of decreased worker and industrial productivity. Web site: http://www.delphion.com/details?pn=US06553245__

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Method for treating carpal tunnel syndrome Inventor(s): Fulk; Paul F. (West Carrollton, OH) Assignee(s): Para Tech Industries, Inc. (Dayton, OH) Patent Number: 5,707,345 Date filed: August 30, 1993

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Abstract: A method and apparatus for relieving symptoms of carpal tunnel syndrome includes restraining the elbow of the patient from movement while applying pressure to the wrist to move the wrist in a direction away from the elbow. The method further includes rotating the wrist during movement of the wrist away from the elbow. Excerpt(s): The present invention relates to the treatment of hand disorders and, more particularly, to a method and apparatus for relieving hand disorders due to carpal tunnel syndrome. In recent years a new medical problem has appeared. People have reported having aggravating symptoms of weakness and clumsiness in hand functions with altered sensations such as numbness of the thumb, index finger and the middle and radial part of the ring finger. These symptoms were described as wrist level median nerve entrapment and later identified as carpal tunnel syndrome. Workers that are at risk for carpal tunnel syndrome due to repetitive tasks include computer operators, typists, stenographers, garment workers, seamstresses, chiropractors, masseurs, butchers, packers, assembly line workers, tennis players, golfers and other people involved in sport activities or where the impact and twisting of the forearm and hand preclude themselves to injury and ultimately resulting in carpal tunnel syndrome. It is therefore a principal object of the present invention to provide a method and apparatus for relieving the symptoms of carpal tunnel syndrome. Web site: http://www.delphion.com/details?pn=US05707345__ •

Method of retarding and ameliorating carpal tunnel syndrome Inventor(s): Cysewski; Gerald R. (Kailua-Kona, HI), Lorenz; R. Todd (Kailua-Kona, HI) Assignee(s): Cyanotech Corporation (Kailua-Kona, HI) Patent Number: 6,258,855 Date filed: February 8, 2000 Abstract: Astaxanthin is a potent antioxidant, over 500 times more powerful than Vitamin E and 10 times stronger than other carotenoids such as zeaxanthin, lutein, canthaxanthin and beta-carotene. Astaxanthin has also been shown to enhance and modulate the immune system. Disclosed is a method and treatment for retarding and ameliorating carpal tunnel syndrome (CTS) and tenosynovitis. The method comprises administering a source of astaxanthin in a therapeutically effective amount to prevent, retard and ameliorate carpal tunnel syndrome and tenosynovitis. Excerpt(s): This invention relates to the treatment and prevention of carpal tunnel syndrome. More particularly the invention relates to a method for treatment and prevention of carpal tunnel syndrome using, as a basis, the protective properties of astaxanthin. Most particularly the invention relates to treatment and prevention of carpal tunnel syndrome using orally administered astaxanthin. Carpal Tunnel Syndrome (CTS) is an ailment caused by excess pressure of the median nerve in the wrist resulting in numbness, tingling, and pain in the arm, hand, and fingers. Usually, CTS is considered a disorder caused by repetitive stress, physical injury, or other conditions that cause the tissues around the median nerve to become swollen. It occurs either when the protective lining of the tendons within the carpal tunnel becomes swollen or when the ligament that forms the roof becomes thicker and broader. Compression on the median nerve fibers by the swollen tendons and thickened ligament slows down the transmission of nerve signals through the carpal tunnel. The result is pain, numbness, and tingling in the wrist, hand and fingers except the little finger which is not affected by the median nerve. The carpal tunnel is an opening into the hand that is

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made up of the bones of the wrist on the bottom and the transverse carpal ligament on the top. The tunnel is the space in the wrist bones where nine tendons for bending the hand and the median nerve pass from the forearm to the hand, the median nerve is relatively large, about the size of a pencil and contains thousands of small individual nerve fibers. The nerve also supplies a branch to the thenar muscle that allows the thumb to move, lift the thumb up and out from the hand and allow the thumb to turn and pinch the other fingertips (opposition). The other nerve fibers bring feeling from the tip of the thumb, index, middle, and part of the ring fingers. Web site: http://www.delphion.com/details?pn=US06258855__ •

Neuropathy relief vacuum traction assist system for carpal tunnel relief Inventor(s): Mathis; Timothy (Rome, NY) Assignee(s): Inductive Technologies, Inc. (Rome, NY) Patent Number: 6,129,692 Date filed: July 30, 1999 Abstract: An apparatus for relieving carpal tunnel syndrome is comprised of a support plate adapted to be mounted on the wrist of a wearer. An elevated bridge is mounted on the support plate out of contact with the wrist of the wearer. A soft, flexible patch is adhesively secured to the skin of the wrist opposite the support plate and an elastic device is adjustably connected between the patch and the bridge for applying a negative pressure to the carpal tunnel area. Excerpt(s): The present invention is directed to a neuropathy relief vacuum traction assist system and more specifically to an apparatus adapted to be mounted on the wrist for applying a negative pressure to the skin on the under side of the wrist to relieve the effects of carpal tunnel syndrome. Carpal tunnel syndrome (CTS) is a very common and debilitating occupational illness affecting millions of people world wide. Carpal tunnel syndrome is the result of median nerve compression at the wrist. The carpal tunnel is a narrow channel that contains nine flexor tendons and the median nerve. The floor of the tunnel is formed by the concave-shaped carpal bones and the palmar wrist ligaments. The roof of the canal is formed by the transverse carpal ligament. The distal palmar wrist crease represents the level of the proximal border of the ligament. The thin antebrachial fascia blends with the thick transverse carpal ligament. Median nerve compression in the carpal tunnel is caused by increased pressure in the carpal tunnel due to a discrepancy between the size of the canal and its contents. Normal pressure within the carpal tunnel is 2.5 mm Hg, increasing to approximately 30 mm Hg on full wrist flexion or extension. In patients with carpal tunnel syndrome, pressure is approximately 30 mm Hg within the tunnel and increases to 90 mm Hg on full wrist flexion or extension. Web site: http://www.delphion.com/details?pn=US06129692__

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Orthesis for the carpal tunnel syndrome Inventor(s): Spits; Marc (Achel, BE) Assignee(s): World Health Club S.A. (LU) Patent Number: 6,095,994 Date filed: November 6, 1998 Abstract: The invention relates to an orthesis for the prevention and/or treatment of carpal tunnel syndrome, comprising a substantially rigid hand fixation brace having two ends, one of which is provided with a part to be fastened to the wrist and underarm while the other is provided with a finger coupling part. The finger coupling part which is formed as a finger supporting brace, preferably only engages the index and middle finger, while the top of the finger supporting brace is open to allow finger movement in the upward direction. Excerpt(s): The present invention relates to an orthesis for the prevention and/or treatment of carpal tunnel syndrome. Due to excessive use of the fingers and the thumb, for instance when making gripping movements or when typing, the nerve tendons and flexing tendons that control these finger movements, may become irritated. Such an injury caused by excessive use is also known as RSI (Repetitive Strain Injury). At the base of the hand palm, nerve tendons and flexing tendons of the fingers run through a tunnel, the carpal tunnel, which has a length of approximately 2 cm, and is defined at the dorsal side by bone and at the palmar side by a tendon plate. The irritation of the nerve tendons and flexing tendons may cause swelling of the tendon sheaths, thereby pinching the nerves in the carpal tunnel which in turn interferes with the functionality of the tendons. The resulting pain and unusual feeling in the hand palm and fingers caused by this irritation of the tendons at the base of the hand palm are known as the carpal tunnel syndrome. Naturally, it is preferable to prevent the occurrence of carpal tunnel syndrome. Very often, when a person does suffer from such symptoms, a long period of absolute rest is prescribed, which in terms of working hours and loss thereof, is very costly. Web site: http://www.delphion.com/details?pn=US06095994__

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Physiology based wrist support Inventor(s): Klimoski; David B. (P.O. Box 21641, Concord, CA 94521) Assignee(s): none reported Patent Number: 5,865,783 Date filed: March 10, 1997 Abstract: This invention relates to a finger restraint device to be worn by sufferers of hand and wrist injuries such as carpal tunnel syndrome, tendinitis, arthritis, and wrist sprain. The device comprises a finger restraining system in the form of a finger, hand and wrist covering which will support the wearer's fingers in a curled position, or to provide a core around which the fingers would normally grasp and be restrained by the covering. This places flexor and extensor tendons in a state of isotonic tension, and promotes a natural position with alignment of the wrist and tendons, ligaments, nerves, and blood vessels in the hand and wrist. Excerpt(s): This application claims the benefit of U.S. Provisional Application 60/016,854, filed May 3, 1996. This invention relates to the field of medical devices for

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treatment, and alleviation of symptoms of carpal tunnel syndrome, arthritis, tendinitis, and wrist sprain. Common methods of treatment of these injuries and to alleviate symptoms are to restrict movement or immobilize the wrist using splits or external compression thus reducing trauma caused by bending the wrist. Prior art devices allow the fingers to move and flex. This means tendons, and ligaments can rub against nerves, bone structures, and blood vessels that may be further injured. This inappropriate movement may exacerbate the existing injury because the wrist is restrained from assuming a natural position. Web site: http://www.delphion.com/details?pn=US05865783__ •

Radiative keyboard heating apparatus Inventor(s): Klopotek; Peter J. (2 Bayberry La., Framingham, MA 01701) Assignee(s): none reported Patent Number: 5,758,019 Date filed: April 30, 1996 Abstract: Methods and apparatus are disclosed for warming a typist's hands to provide relief from arthritis, muscle fatigue, Carpal Tunnel Syndrome and general discomfort. A radiative hand warming apparatus includes, including a source of hand-warming radiation, and a holder for supporting the radiation source in proximity to a keyboard or other manual operation device, such that the user's hands can be warmed by radiant energy during typing. In one embodiment, the source of hand-warming radiation emits radiation having an intensity of about 10 to about 150 milliwatts/square centimeter as measured at the typist's hands. The radiation source can be, for example, an infrared (IR) radiation source. Such an infrared radiation source preferably emits IR radiation in at least a portion of the spectrum from about 1 to about 30 micrometers. Excerpt(s): The technical field of this invention is heating elements and, in particular, apparatus for heating hands during repetitive manual operations, such as keystroke execution of word processing equipment and the like. The hands and fingers of typists are typically subjected to both cold air and repetitive stresses as the result of keystroke execution during word processing. Typists oft complain about coldness in their fingers and the associated subjective feeling of stiffness. This stiffness can become so acute as to impair the efficiency of typing. In addition, there are many clinically recognized syndromes and/or injuries which appear to be exacerbated by exposure to cold air. For example, Carpal Tunnel Syndrome ("CTS") is a well-known illness which can affect typists. This syndrome is associated with inflammation of one or more different tendons in the hand. When a typist suffering from CTS works in a cold environment, the pain associated with this syndrome is often aggravated. The lower temperature of the hands appears to reduce the circulatory support for tendons so that tendon inflammation becomes more pronounced and may also become chronic. Web site: http://www.delphion.com/details?pn=US05758019__

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Round brush apparatus for brushing a person's hair Inventor(s): Jiovanni; Matthew (3450 N. Elaine Pl., Apartment 2, Chicago, IL 60657) Assignee(s): none reported Patent Number: 6,158,073 Date filed: February 1, 1999 Abstract: A round brush apparatus is disclosed for brushing a person's hair. The apparatus includes an elongate brush body having a first and a second end. The brush body includes a first member, which extends from the first end of the body towards the second end of the body. A plurality of bristles extends radially outwardly from the first member. A second member extends from the first member to the second end of the brush body. A handle portion has a first and a second extremity with the first extremity of the handle portion being drivingly connected to the second member of the brush body. The handle portion includes a handle, which extends from the second extremity of the handle portion towards the first extremity of the handle portion. A motor is disposed within the handle the motor being electrically connected to a power source. A tubular extension extends from the handle to the first extremity of the handle portion. The tubular extension removably receives therein the second member of the brush body, the arrangement being such that when the motor is energized, the motor rotates the second member of the brush body and the first member secured thereto so that carpal tunnel syndrome and the like disorders associated with manual round brushing of the person's hair is inhibited. Excerpt(s): The present invention relates to a round brush apparatus for brushing a person's hair. More specifically, the present invention relates to a motorized round brush apparatus. In a beauty salon, a hair stylist will round brush a client's hair during a blow dry procedure or following the application of a perm in order to impart curl to the client's hair. Typically, a round brush includes a handle and a cylindrical extension having bristles extending radially therefrom. By the application of a rotary motion of the wrist of the hair stylist, the round brush is rotated in order to impart a wave or curl to the client's hair. Consequently, a hair stylist will spend many hours each day using a manual round brush. However, by application of the rotary motion of the wrist, many hair stylists have induced wrist problems including carpal tunnel syndrome, which is a very painful inflammation in the region of the wrist. Web site: http://www.delphion.com/details?pn=US06158073__

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Stack turner and replenisher and method Inventor(s): Monsees; Claude E. (80 Carowood Dr., Charlotte, NC 28226) Assignee(s): none reported Patent Number: 5,743,374 Date filed: August 25, 1995 Abstract: A stack turner and replenisher 10 is provided for keeping a hopper of a carton prefeeder P filled with carton blanks, traditionally a job that requires a human worker and causes carpal tunnel syndrome due to the inverting motion required. Stack turner 10 allows for the movement of a stack of blanks in a lateral direction as well as in an inverted u-shaped path. Clamp 53, with adjustable upper and lower plates 54,55, is used to pick up a stack of blanks from a source of such blanks. Clamp 53 then moves

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upwardly, laterally, and downwardly along groove 52, while an upper portion 50 of stack turner 10 simultaneously moves laterally toward prefeeder P. Clamp 53 then deposits the blanks in the hopper of prefeeder P. Finally, stack turner 10 retraces its path in order to pick up another stack of blanks and repeat the procedure, thus ensuring that the hopper of prefeeder P is always filled with carton blanks. Stack turner 10 also squares the stack of blanks both vertically and horizontally. Excerpt(s): In the art of box making, very high machine speeds cause supplies, i.e., carton blanks, to be processed fairly quickly. An example of a machine that feeds such supplies to a folder/gluer is U.S. Pat. No. 5,238,239, to LaChapelle and assigned to Roberts Systems, Inc. Machines such as these are known as prefeeders because they prepare carton blanks for folding and gluing by separating individual blanks from a stack of blanks. Traditionally, the carton blanks fed by prefeeders are manufactured at an earlier time and accumulated in upright stacks on an outfeed conveyor. A human worker picks up these individual stacks one-at-a-time, inverts them, and places them in the hopper or magazine of the prefeeder. The inversion step places great stress on the machine operator's wrists and is the source of repetitive motion or carpal tunnel syndrome. With the trend towards automation and the desire to decrease the incidence of carpal tunnel syndrome, there is much room for improvement within the art. Web site: http://www.delphion.com/details?pn=US05743374__ •

Therapeutic support glove Inventor(s): Picchione, II; Nicholas (East Greenwich, RI) Assignee(s): Data Building, Inc. (Warwick, RI) Patent Number: 6,029,277 Date filed: March 18, 1999 Abstract: A therapeutic support glove for providing relief for such things as hand fatigue, carpal tunnel syndrome, arthritis, tendinitis and other known ailments associated with the human hand including a cuff portion having two pockets defining corresponding cavities at the opposite interior surfaces thereof. The pockets are positioned in opposing relation to each other so that when the glove is worn on the user's hand, one of the pockets is adjacent the outer portion of the user's wrist, and the other pocket is adjacent the inner portion of the user's wrist no matter which of the user's hand the glove is worn on. An elongated opening extends along the top edge of the pockets for insertion of a selected therapeutic pack within the pocket cavity. The arrangement is such that the therapeutic pack may preferably be positioned adjacent the inner portion of the user's wrist for implementation of the desired therapeutic process. The glove further includes a hand portion secured to the cuff portion providing means for covering the inner palm portion and back portion of the user's hand. The hand portion has openings formed therein at the terminal end thereof for insertion of the user's fingers when putting the glove on the user's hand, so that the user's fingers remain uncovered and unrestricted when the glove is in use. Excerpt(s): This invention relates generally to gloves, and more particularly, to a therapeutic hand glove which helps produce relief from hand fatigue, carpal tunnel syndrome, arthritis, tendinitis and other uncomfortable aches and pains associated with the human hand. Specifically, the glove has pockets formed on both sides of the glove cuff for insertion of a selected heat pack, cold pack, or magnetic pack for the desirable therapeutic purpose. The dual pocket construction allows the glove to be worn on either

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of the user's hand wherein the inserted therapeutic pack is located adjacent the user's wrist for implementing the desired therapy. Various types of gloves having pouches or pockets formed therein have heretofore been known in the prior art. In this regard, the majority of these type of gloves are contemplated for use in cold weather and provide varying means for distributing heat to portions of the human hand, including the fingers and finger tips. One problem traditionally associated with these type of heating gloves is the difficulty with inserting and removing varying heating elements which are retained within the cavity of the pocket incorporated into the glove. A number of gloves have pocket flaps or releasable securing means for retaining the heating element within the cavity of the pocket of the glove. However, these securing means often times provide awkward and frustrating obstacles for quickly and easily replacing and removing the heating element from the pocket of the glove. Further, these types of gloves usually have a number of layers incorporated therein for better protection against the cold outdoor winter elements. The instant invention is directed to a therapeutic support glove for providing relief for such things as hand fatigue, carpal tunnel syndrome, arthritis, tendinitis and other known ailments associated with the human hand. The support glove comprises a cuff portion which entirely surrounds the user's wrist, and a hand portion which covers the inner palm portion and back portion of the user's hand. The cuff portion has two pockets at the interior surface of the cuff of the glove. The pockets are positioned in opposing relation to each other so that when the glove is worn on either of the user's hands, one of the pockets is always adjacent the outer portion of the user's wrist, and the other pocket is adjacent the inner portion of the user's wrist. An elongated opening extends along the top edge of the pockets for insertion of the selected therapeutic pack within the pocket cavity, so that the therapeutic pack may be positioned adjacent the inner portion of the user's wrist for implementation of the desired therapeutic process. The hand portion of the glove is stitched to the cuff portion and has openings formed therein at the opposite end thereof for insertion of the user's fingers when putting the glove on the user's hand, so that the user's fingers remain uncovered and unrestricted when the glove is in use, as is well known in the art. Web site: http://www.delphion.com/details?pn=US06029277__ •

Thumb-actuated computer pointing-input device Inventor(s): Shipman; Dale Howard (193 Glen Rd., Woodcliff Lake, NJ 07675) Assignee(s): none reported Patent Number: 6,104,383 Date filed: February 20, 1998 Abstract: A computer pointing-input device has a low risk of inducing Repetitive Stress Syndrome and Carpal Tunnel Syndrome in a user by providing thumb and hand actuated controls. A main body (16) of the device is held laterally in a hand of the user with the thumb of the hand resting on a thumb switch (21). The palm of the hand rests on the main body (16) and an outer edge of the palm of the hand rests on a hand switch (31). The thumb switch (21) is operable by a downward pressure from the user's thumb, and the hand switch (31) is operable by downward pressure from the outer side of the user's palm. Excerpt(s): This invention relates to computer pointing-input devices, and in particular to computer pointing-input devices which reduce effort and bio-mechanical stress encountered by a user during normal operation. Computer pointing-input devices used for manipulating a wide range of controls and cursors and other objects presented to the

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user by windows-type operating systems and application software are well known in the art. U.S. Pat. No. 3,835,464 granted to Xerox Corporation in 1974 disclosed a handheld computer pointing-input device generally referred to as a "mouse." Many modifications have been made to make such mouse pointing-input devices more functional, easier to use, and less stressful on the hand and arm of the user operating the device; however, the basic function of the mouse device remains substantially the same. A conventional mouse pointing-input device has a housing which is shaped to be held by a hand of a user. This housing typically has at least one operator-manipulatable control positioned on an upper surface. The mouse pointing-input device is typically moveable over a flat surface within comfortable reach of a keyboard of a computer. Movements of the device over the surface are sensed to provide a pointing-input control signal to the computer. Various methods are known in the art to sense movement of mouse pointing-input devices. Similarly, various methods of transmitting to the computer pointing-input control signals and signals encoding the states of the operatormanipulatable controls on the mouse pointing-input device are well-known in the art. Web site: http://www.delphion.com/details?pn=US06104383__ •

Wrist brace for carpal tunnel syndrome prevention and treatment Inventor(s): Gould; David (140 Ample Way, Shepherdsville, KY 40165) Assignee(s): none reported Patent Number: 5,766,141 Date filed: November 6, 1996 Abstract: A wrist brace for correction of carpal tunnel syndrome and prevention thereof includes an elongated, flexible resilient member having a plurality of outwardly extending lips along an upper side portion of the flexible member. The outwardly extending lips are of preselected heights and lengths and at preselected positions to provide strategically located leverage and pressure points to relieve the restriction of the medial nerve and allows for substantially the normal use of the hand and wrist in a work or sport environment. Excerpt(s): The present invention relates to support devices for treatment and prevention of carpal tunnel syndrome and more particularly to a wrist brace for carpal tunnel syndrome which can be worn without interfering with the movement of the hand and fingers of the wrist brace wearer. Carpal tunnel syndrome is a painful condition caused by excessive pressure and stress on the medial nerve that runs through the wrist. Excess pressure and stress is usually caused by repetitive use of the hands and wrists in a working or sports environment. Once the symptoms of pain, numbness and tingling and lack of strength appear in the wrist, the carpal tunnel syndrome worsens and if not treated or the wrist and adjoining hand are not rested for a sufficient period of time, usually a period of several days in order to let the medial nerve heal, permanent damage of the nerve may occur. And, many jobs subject workers to stressful anterior pressure of the wrist. Over the last few years, and particularly with the emphasis on the use of computers in the work place, many workers spend entire work days at computers continually manipulating their fingers, hands and wrists. Thus, the number of persons experiencing carpal tunnel syndrome has been on a steady rise. There have been a number of proposals in the prior art dealing with carpal tunnel syndrome which are intended to provide treatment or to relieve some of the pressure and stress upon the medial nerve. Most of the devices proposed have included wrist splints and braces which are to prevent the stress and pressure on the medial nerve and in most instances

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the devices immobilize the thumb, wrist and hand and therefore the person suffering the carpal tunnel syndrome has limited, if any, use of the hand that is effected with wearing these devices. Web site: http://www.delphion.com/details?pn=US05766141__ •

Wrist pad Inventor(s): Montague; Dale (207 Frankfort Ave., Huntington Beach, CA 92648) Assignee(s): none reported Patent Number: 5,562,270 Date filed: January 5, 1994 Abstract: A device which uses a wrist rest in combination with a computer mouse pad to provide a non-fatiguing environment for manipulation of a computer mouse to control the cursor on a computer display. The wrist rest is designed to place the wrist of the hand manipulating the mouse at a level to provide maximum comfort. The height allows movement of the mouse without a continuous upward bend of the wrist and with movement of the hand that does not cause tension in the arm, neck and shoulder muscles. The wrist rest is also configured in a keyboard/keypad version such that the hand is elevated relative to the keys to be actuated thus relieving tension. The wrist rest and pad are made of a suitable material that does not breakdown under pressure of continuous use yet provides fluid-like pressure distribution for the wrist. The wrist rest and pad may also be used with a protective cover. The wrist rest may have removable cushions which are suitable for use in exercises and the base can have a recession for holding an exercise instruction card which aids in preventing injuries such as carpal tunnel syndrome caused by repetitive motion work. Excerpt(s): 1. Field of Invention. This invention relates to devices used with computer input devices for control of the cursor on a display and with keyboards. The mobile manual input device to control the cursor usually has a ball and tracking mechanism to be moved on a surface or pad and is commonly known as a mouse. Pointing/tracking ball devices are also used to control the cursor. Keyboards and keypads are used to enter data and commands into the computer system. 2. Description of Prior Art. Web site: http://www.delphion.com/details?pn=US05562270__

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Wrist traction device and method Inventor(s): Johnson; Gordon C. (Murfreesboro, TN), Johnson; Ronald K. (Murfreesboro, TN), Johnson; William R. (Ft. Oglethorpe, GA) Assignee(s): JB, Ltd. L.L.C. (Ooltewah, TN) Patent Number: 6,221,037 Date filed: January 18, 1999 Abstract: The present invention provides the method for placing the patient's wrist in traction to alleviate symptoms of carpal tunnel syndrome. The preferred apparatus utilizes a harness to connect the patient's hand to a traction device and a stabilizing attachment to restrain the patient's arm in an anatomically neutral position while isolating the patient's soldier and elbow from the traction device.

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Excerpt(s): The present invention provides a method for placing a patient's wrist in traction for the purpose of treating carpal tunnel syndrome, and provides a device such as the illustrated embodiment to hold the patient's arm in an anatomically neutral position while a harness connects the patient's hand to a traction unit. The carpal bones or carpus of the wrist form a deeply concave gutter through which the Median Nerve and flexor tendons pass. The gutter is converted into a tunnel by a ligament, the flexor retinaculum. The crowded long flexor tendons emerge from the carpal tunnel and diverge as they pass down the hand. Usually, the flexor tendons are very slick and glide against each other in the carpal tunnel as the hand is used to grasp objects. However, any condition which causes irritation or inflammation of the tendons or surrounding tissue increases the pressure in the carpal tunnel because the carpal bones and flexor retinaculum ligament are not able to stretch in response to the swelling. Increased pressure in the carpal tunnel begins to squeeze the Median Nerve and the hand will feel numb or ache. This is commonly referred to as carpal tunnel syndrome. The traditional treatments in the early stages of carpal tunnel syndrome include administering antiinflammatory medication and splinting or immobilizing the wrist to allow the inflammation and swelling to subside. In more advanced cases, the flexor retinaculum ligament is cut, thereby opening a wall of the carpal tunnel and allowing sufficient space in the wrist to prevent the median nerve from being squeezed. Web site: http://www.delphion.com/details?pn=US06221037__ •

Wrist-band for the prevention and the treatment of the carpal tunnel syndrome and its positioning operating mode Inventor(s): Massi; Gabriele (Piazza Liberta, 22, I-52027 San Giovanni Valdarno, IT), Massi; Stefano (Piazza Liberta, 22, I-52027 San Giovanni Valdarno, IT) Assignee(s): none reported Patent Number: 6,383,157 Date filed: March 7, 2000 Abstract: A wrist-band for preventing and treating carpal tunnel syndrome by allowing limited movements of the wrist of the user according to the bending extension movements. The wrist band includes a multi-layer soft and flexible band which is suitable for being positioned on an a portion between the hand and the forearm corresponding to the carpiulnaris articulation of the user. The band includes five adjacent portions. A first portion is a terminal portion having three rounded sides connected together. A second portion is connected to the first portion and includes a superior rounded side and an inferior rectilinear side. A third portion is connected to the second portion and is suitable for overlapping the first portion. A fourth portion is connected to the third portion and is of a size smaller than the first, second and third portions. The fifth portion is a terminal tongue-shaped portion having a fastener thereon so as to secure the wrist band around the wrist of the user. Excerpt(s): The present invention relates to orthopedic remedies. More particularly, the present invention relates to wrist bands as used for the prevention and treatment of carpal tunnel syndrome. Problems of the wrist are currently well known that have symptoms due to factors such as it cervical arthrosis or to insufficient circulation. These problems are often submitted to specialized treatment at a late stage or are treated in an improper manner. To better illustrate the problems associated with the wrist, the movements of the human wrist are described herein. The carpiradialis and carpimedian articulation movements are used to cause the positioning of the hand in relation to the

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forearm. These movements can be characterized as bending movements, extension movements, radial and cubital inclination movements, and circling and rotation movements. In order to accomplish the bending movement, the palmar face of the hand bends according to the front surface of the forearm. For an extension movement, the dorsal face of the hand bends according to a rear surface of the forearm. The cubital inclination movement or adduction movement is accomplished by bending the hand toward the cubital side of the forearm. The radial inclination movement or abduction movement is carried out by bending the hand toward the radial side. The sequence and combination of the above-described movements causes the circling motion. In contrast, the rotation of the hand is obtained by the movement of the hand about its own axis. Web site: http://www.delphion.com/details?pn=US06383157__

Patent Applications on Carpal Tunnel Syndrome As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to carpal tunnel syndrome: •

Apparatus and method for treating carpal tunnel syndrome Inventor(s): Porrata, Alejandro A.; (New York, NY), Porrata, Humberto L.; (Lauderdale, FL) Correspondence: Edward Etkin, Esq.; 4804 Bedford Avenue, Suite 3C; Brooklyn; NY; 11235; US Patent Application Number: 20030018286 Date filed: July 18, 2002 Abstract: The apparatus of the present invention stretches the carpal ligament and the flexor retinaculum, as well as the superficial structures and muscles of the hand, in a safe manner under precise control of the patient or a healthcare professional. The inventive apparatus includes a bilateral housing for receiving the patient's right or left hand with two bottom capture regions for capturing and retaining the thenar and hypothenar regions of the patient's hand. The housing also includes a top portion with a pressure element adapted and configured to contact at least a portion of the central longitudinal dorsal region of the patient's hand. The pressure element is connected to active pressure source, such that when the hand is inserted into the housing, the pressure element may be activated to exert pressure on the respective central dorsal region of the hand while the hypothenar and thenar regions of the hand are disposed within and retained by the first and second capture regions, thus exerting forces opposite to the pressure exerted by the pressure element. This forces the thenar and hypothenar regions apart, thus, advantageously transversely stretching the carpal ligament, the flexor retinaculum, and superficial structures and muscles of the hand. An optional pressure monitor is connected to the pressure element to enable the patient or medical practitioner to monitor the use of the inventive apparatus. One or more heating elements may optionally be utilized in the housing to improve muscle elasticity during treatment. To effectuate treatment, the pressure caused by the pressure element is maintained at a constant or varying level for a predetermined period of time.

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This has been a common practice outside the United States prior to December 2000.

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Excerpt(s): This application is a continuation-in-part of the commonly assigned copending U.S. patent application Ser. No. 09/908,154 entitled "Bilateral Appliance and Method for Treating Carpal Tunnel Syndrome" which was filed on Jul. 18, 2001. This invention relates generally to treatment of carpal tunnel syndrome, and more particularly to a non-invasive apparatus and method for treatment of carpal tunnel syndrome. Carpal tunnel syndrome is a physiological disorder that afflicts over 850,000 people each year in the United States alone. In order to better understand the cause of the carpal tunnel syndrome and the difficulty in treating this serious disorder, a detailed explanation of the physiological factors and causes of carpal tunnel syndrome is presented below. Carpal tunnel syndrome is caused by a deleterious increase in pressure on the median nerve which passes through the carpal tunnel (or canal) in the hand, adjacent to the wrist. The deleterious increase in pressure, which is commonly brought on by prolonged repetitive motion of the hand and digits, is often caused by inflammation or damage to tendons for the hand which pass through the carpal tunnel along with the median nerve. Pressure increases can also be caused by narrowing of the carpal canal, and by generalized swelling of the structures in the hand. Thus, when the carpal tunnel is narrowed from ligament shortening, muscle development or structural inflammation, the median nerve is undesirably compressed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Carpal tunnel splint for wear during non-working periods Inventor(s): Chow, James C. Y.; (Mount Vernon, IL) Correspondence: POLSTER, LIEDER, WOODRUFF & LUCCHESI; 763 SOUTH NEW BALLAS ROAD; ST. LOUIS; MO; 63141-8750; US Patent Application Number: 20030163075 Date filed: February 26, 2002 Abstract: A splint (10) worn by a sufferer of carpal tunnel syndrome. A first sleeve (12) fits over the person's hand (H) and extends up their arm (A) past their wrist (W). This sleeve is worn during non-working portions of the person's day and includes a support (14) formed in the palm portion of the sleeve to support the carpal tunnel and relieve pressure on the median nerve passing through it. This alleviates pain caused by carpal tunnel syndrome. A second sleeve (22) also fits over the person's hand and extends up their arm past their wrist. This second sleeve, which is also worn during non-working portions of the day, extends further up the person's arm than the first sleeve. A support (24) of this second sleeve extends along the back of the person's hand to also relieve pressure on the median nerve and alleviate the pain caused by carpal tunnel syndrome. Excerpt(s): This invention relates to body supports, and more particularly to a splint worn on the hand and wrist by someone suffering from carpal tunnel syndrome. The splint is for use during non-working periods in which support of the wrist and treat the carpal tunnel syndrome. Treatment of a carpal tunnel injury often requires the sufferer to wear a splint to support the carpal tunnel and relieves the pressure on the nerve. Representative examples of such splints are shown, for example, in U.S. Pat. Nos. 6,213,969, 6,106,492, 6,120,472, 5,468,220, 5,417,645, and 4,966,137. The main purpose of these and other similar splints is to allow the wearer to perform those work related functions they are required to perform as part of their job, and which are often the cause of their injury in the first place. While these splints are generally effective, they are primarily for use during the working portions of the person's day. Wearing the splint at other times has certain disadvantages. First, the type and degree of support needed in

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their working environment is not necessarily what is required, or preferred, at other times. Rather, during non-working times, a more neutral support that allows the wearer to perform a broader range of activities without discomfort is desirable. Second, many splints worn during working periods have straps, belts, or the like which secure the splint in place. However, if worn to bed, these straps and belts can scratch the wearer causing injury. Or, the wearer may subconsciously remove the splint, aggravating their injury. Third, in industrial settings, and even in some office environments, the splint worn during working hours can get very dirty because of the type of work the wearer does. Wearing the splint at other times can therefore be unsanitary as well as unsightly. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Co-dynamic adjustable orthotic appliance for carpal tunnel syndrome Inventor(s): Williams, George Roger; (Edmond, OK) Correspondence: JAMES F HARVEY III; HARVEY & ASSOCIATES; 3750 WEST MAIN STREET; SUITE 120; NORMAN; OK; 73072; US Patent Application Number: 20030144692 Date filed: January 28, 2003 Abstract: The present invention provides an orthotic appliance for the carpus of a human hand for the treatment of carpal tunnel syndrome using co-dynamic, rather than traditional static or dynamic, techniques. The appliance may apply a 2 pound dorsally directed force about the region of the pisiform bone in the neutral carpal position of a human hand upon co-contraction of the hand and up to 8 pounds dorsally directed during arc of motion in carpal flexion, as the wrist and hand is encouraged to actively move in all planes of motion without negatively affecting the normal activities of daily living. The appliance may comprise a biasing structure for applying the dorsally directed force and a base structure for maintaining the biasing structure in its proper configuration during normal hand motion. Excerpt(s): The present invention relates generally to the field of orthotics and splints for the carpus of a human hand, and more particularly to an orthotic for the treatment of carpal tunnel syndrome using dynamic and co-dynamic, rather than static, techniques. Carpal Tunnel Syndrome ("CTS") is a condition resulting from the compression of the median nerve that travels through an area in carpus of the hand between the carpal bones and a ligament known as the flexor retinaculum. The compression results in numbness, tingling, weakness in the grip, and pain. CTS produces pain and paresthesia in the arm and often-referred symptoms to the shoulders and neck. There are many theories as to the causes of CTS. Some believe that it results from irritation of bursa, tendon sheaths, and nerve causing tunnel swelling from repetitive motion. Others attribute CTS to carpal fractures or arthritic joint changes. Still other schools of thought attribute CTS to systemic disease, mechanical stress, or traumatic dislocation. The compression theory that is widely accepted holds that irritated and inflamed tissue resulting from these events within the carpal tunnel compresses the median nerve within the confined space formed by the flexor retinaculum and the carpal bones. Discussion will later allude to the order of events rather than questioning the different perspective. The vast number of cases of CTS is generally believed to be due to repetitive motion. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Disposable finger sleeve for appendages Inventor(s): Brunner, Michael S.; (Roswell, GA), Lau, Jark C.; (Roswell, GA), McDevitt, Jason P.; (Alpharetta, GA), Metz, John; (Vernon, CT), Yang, Kaiyuan; (Roswell, GA) Correspondence: DORITY & MANNING, P.A.; POST OFFICE BOX 1449; GREENVILLE; SC; 29602-1449; US Patent Application Number: 20030050589 Date filed: April 4, 2001 Abstract: A device that can be used to treat appendage ailments is provided. The device, or appendage sleeve, can be used for wounds, cuts, and blisters, as well as joint related ailments, such as arthritis and carpal tunnel syndrome. In some instances, the appendage sleeve can at least partially made from an elastomeric material, such as an elastomeric nonwoven, so that the sleeve can more aptly fit onto a finger or toe. Furthermore, the sleeve can also possess a barrier that is liquid impermeable, but vapor permeable so that the finger or toe of a user is more comfortable. Various additives can be applied to the sleeve to aid for therapeutic purposes. Excerpt(s): U.S. Ser. No. 60/195,517, filed on Apr. 6, 2000; U.S. Ser. No. 60/195,071, filed on Apr. 6, 2000; U.S. Ser. No. 60/194,929, filed on Apr. 6, 2000; U.S. Ser. No. 60/195,072, filed on Apr. 6, 2000; U.S. Ser. No. 60/194,930, filed on Apr. 6, 2000; and U.S. Ser. No. 60/257,137, filed on Dec. 20, 2000. A variety of appendage ailments and injuries have continuously plagued people over the years. For example, fingers and toes can become wounded, cut, or blistered. Moreover, the joints of fingers and toes can suffer from a number of ailments, such as arthritis or carpal tunnel syndrome, or become jammed, sprained, hyper-extended, dislocated, or broken. In addition, fingers and toes can also be afflicted with warts, or corns. Further, toenails can frequently suffer from fungal infection, referred to as onychomycosis. Additionally, hikers, athletes, joggers, and others often suffer from "blacktoe", the result of repetitive, forceful striking of the end of a shoe or boot with a toenail. Traditionally, these appendage ailments have been treated in a variety of ways. For instance, when treating finger cuts or wounds, bandages can be wrapped around the wound to allow healing. Typically, these bandages have a tacky surface formed by an adhesive so that the bandages can stick to a finger for a certain period of time. One example of such bandages are BAND-AIDS, made by Johnson & Johnson, which are commonly used to cover finger and toe wounds. In some instances, these bandages can also deliver an active ingredient to the wound or cut to aid in healing. However, these bandages are not generally comfortable to a user, and can often easily slip off the appendage. For this reason, bandages with enhanced flexibility and elasticity have been developed. Moreover, bandages having various other properties have also been described. For instance, U.S. Pat. No. 4,414,970 to Berry describes a moisture vapor transmitting elastic bandage, while U.S. Pat. No. 5,503,908 to Faass describes a self-adhesive, elastic composite material. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Dynamic splint for carpal tunnel syndrome treatment Inventor(s): Williams, George Roger; (Edmond, OK) Correspondence: JAMES F HARVEY III; HARVEY & ASSOCIATES; 3750 WEST MAIN STREET; SUITE 120; NORMAN; OK; 73072; US Patent Application Number: 20020035342 Date filed: December 3, 2001 Abstract: A method and appliance for the application of a continuous, low level force tending to oppose rotational movement of the hand about the carpus. This opposing force tends to relieve contractatures of the transverse carpal, volar carpal, and intra carpal ligaments over time, thus relieving the pain caused by carpal tunnel syndrome and correcting altered kinematics associated therewith. This opposing force tends to increase the carpal volume. According to the principles of the invention, a dynamic splint appliance is described which provides free movement of the patient's wrist with minimal impediment during activities of daily living, both at home and at work, while simultaneously applying this opposing force. The appliance consists of a forearm component to maintain alignment and to provide support and stabilization for a biasing means positioned on the ulnar side of the forearm, the biasing means consisting of a double coil spring located at approximately the ulnar side of the carpus and connected to a palmar component fastened to the ulnar side of the hand. The biasing component provides resistive force to volar glide in a manner which accurately models the kinematics of the carpus and forearm. Excerpt(s): The present invention relates generally to medical therapeutic systems, and deals more particularly with methods and devices for treating and curing functional disorders of the human carpus. More particularly, the present invention provides a splint for providing dynamic pressure to the transverse carpal, volar carpal, and intracarpal ligaments, in a manner tending to relieve contractures of these ligaments and thus relieve the pain caused thereby. Carpal tunnel syndrome (CTS) is a painful condition caused by compression of the median nerve of the forearm. The median nerve and the flexor tendons pass from the forearm to the hand through the wrist canal, or carpal tunnel. The median nerve in particular can be compressed by one or more factors such as a reduction in carpal tunnel volume or swelling of tissues passing through the carpal tunnel. Such compression of the median nerve causes intense pain to the patient, often necessitating extended therapy or surgery to alleviate the problem. It is commonly believed that CTS is caused by prolonged repetitive activity, such as holding the hand, wrist, and forearm in an awkward position for extended lengths of time while exerting the associated muscles. Prolonged exertion at a keyboard or manual labor are common, but by no means the only, associations with CTS. The direct cause of CTS is believed to be a biomechanical ligament imbalance in the volar carpal ligaments, where the term "volar" indicates a direction towards the palm of the hand as opposed to "dorsal" which indicates a direction towards the back of the hand. Specifically, this biomechanical imbalance of the ligaments is believed to comprise a thickening of the palmer transverse carpal ligament (PTCL, also known as the retinacular ligament), a thickening of the volar intracarpal ligaments, and contraction of an assortment of volar carpal ligaments. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Finger worn and operated input device and method of use Inventor(s): Xiong, Yongming; (Fremont, CA) Correspondence: Mr. Yongming Xiong; 43133 Gallesgos Avenue; Fremont; CA; 94539; US Patent Application Number: 20030214481 Date filed: May 14, 2002 Abstract: The present invention provides a finger worn and finger operated input device for personal computer, workstation or computer based instrumentation. The finger operated method in the present invention eliminated the necessary of a stationary support table or pad. The special operation method of the device also eliminated the affect from tremor and movement of user's hand. Therefore user can operate the device at any comfortable posture. A method for dynamically adjusting the mapping sensitivity from the device to cursor movement based on the touch pressure between the fingertips ensures that user can achieve large and small cursor movement on the same small sensor area. user can friendly operates the said device with natural finger movement and gestures to help minimize strain on neck, shoulder, hand and wrist muscles, thereby alleviating the possibility of Repetitive Strain Injury (RSI) and Carpal Tunnel Syndrome (CTS) which normally associated with desktop mouse devices. The present invention further provide ergonomic peripheral input system for computer by in conjunction use with a virtual keyboard on computer screen. The present invention also has advantage in other special applications such as for projection presentations. Excerpt(s): The present invention relates to a finger worn and operated computer input device and method of use, more particularly, a device and method of use for controlling the positioning, movement and operation of a viewpoint or cursor on a display screen associated with a computer. Users of a computer typically enter input using either a keyboard or a pointing device. Prior art pointing devices for positioning a cursor and entering commands into a computer are well known such as mouse, trackball, touch pad, pen stylus, and the like. The mouse typically includes: (1) a housing or top portion upon which the user's hand rests (2) two or three keys integral with the housing which can be depressed for supplying additional signals to the computer for selecting choices from a displayed menu (3) a bottom portion or base which contains a pair of motion transducers and electronics to detect the movement of the mouse on a support surface in two orthogonal directions. A mouse controller reads the state of those sensors and takes account of current mouse position. The mouse controller sends a packet of data to the computer data interface controller causes a position indicator (cursor) on a video display connected to the computer to move in relatively the same direction and magnitude. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Finger-scale mouse casing structure Inventor(s): Wei, Meng-Yu; (Taipei, TW) Correspondence: EZRA SUTTON, P. A.; Plazza 9, 900 Route 9; Woodbridge; NJ; 07095; US Patent Application Number: 20010006381 Date filed: December 21, 2000

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Abstract: A finger-scale mouse casing structure is proposed, which allows the user to hold and move the mouse in a more effortless manner than the prior art, and also allows the overall mouse size to be made more compact than the prior art. This finger-scale mouse casing structure comprises: a base part for accommodating a movementdetection circuit; a first sidewall which is substantially upright erected on a first lateral side of the base part; a second sidewall which is substantially upright erected on a second lateral side of the base part; and a set of buttons disposed on the base part. With this finger-scale mouse casing structure, the user can hold and move the mouse simply by moving his/her thumb and fingers, without having to turn his/er wrist and elbow, thus preventing the Carpal tunnel syndrome. Moreover, the overall mouse size can be made to the finger scale, which is significantly more compact than the conventional palm-scale mouse casing structure: Excerpt(s): This invention relates to computer technology, and more particularly, to a finger-scale mouse casing structure which allows the user to hold and move the mouse in a more effortless manner than the prior art, and also allows the overall mouse size to be made more compact than the prior art. A mouse is an essential peripheral device of a computer system running on a graphic-based operating system, which allows the user to operate the computer more conveniently. Conventional mouse devices are typically encased in a palm-scale mouse casing structure which is sized to suit a human's palm. The palm-scale mouse casing structure, however, is considered too large to take up much of the desktop area and would cause stress and injury to the user's hand after lengthy time of use. One drawback to the forgoing palm-scale mouse-casing structure, however, is that it requires the user to turn his/her wrist and elbow when moving the mouse around the desk-top, and therefore, in the event that the movement is lengthy in distance, it may cause stress and injury to the user's hand. As a consequence, after lengthy time of use, it can easily cause the so-called Carpal tunnel syndrome to the users hand. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Hand and wrist support Inventor(s): Crocker, John; (York, GB) Correspondence: JACOBSON HOLMAN PLLC; 400 SEVENTH STREET N.W.; SUITE 600; WASHINGTON; DC; 20004; US Patent Application Number: 20030169236 Date filed: April 14, 2003 Abstract: A hand and wrist support for a user of a computer keyboard, mouse or the like comprises a body member having associated with an upper surface an upper support means to engage the user's hand or wrist in use which upper support means comprises at least a pair of raised areas defining a central channel therebetween. The areas provide support to a users hand, and in particular respectively to the thenar muscles and the joint of the fourth metacarpal and the carpals to provide a through that runs parallel with the line of a user's median nerve. The device serves in particular as a comfort aid to a user of a computer, but might also have value as a prophylactic device for the prevention of carpal tunnel syndrome and median nerve compression syndrome, and/or as a therapeutic device for the treatment of carpal tunnel syndrome and median nerve compression syndrome arising from excessive computer use.

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Excerpt(s): The invention relates to a hand and/or wrist support for use by users of computers and similar devices, and in particular for use by users of a computer mouse, to provide increased comfort and support to the hand and/or wrist, and in particular to inhibit or prevent or alleviate the symptoms of carpal tunnel syndrome and carpal tunnel syndrome-like symptoms. Carpal tunnel syndrome has been recognised as a potential problem and an industrial disease in a range of working environments for some time. Classically, the problem tends to arise where an operator carries out a repetitive task involving repetitive flexion of the wrist. For example, the problem is known to exist amongst garment workers, users of hand tools and power tools and the like. Conventionally, carpal tunnel syndrome has been attributed to pressure and/or friction damage on the median nerve as it passes through the carpal tunnel under the transverse carpal ligament or flexor retinaculum at the distal end of the wrist. The effects are at best debilitating, and can in severe cases require surgery to reduce the pressure on the median nerve. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Independent electrical implement system Inventor(s): Carrancho, Tony M.; (Hayward, CA) Correspondence: Christopher J. Whewell; Western Patent Group; 6020 Tonkowa Trail; Georgetown; TX; 78628; US Patent Application Number: 20030121682 Date filed: December 28, 2001 Abstract: Provided herein is a system that comprises re-chargeable batteries which enables a workman to use hand-held power implements having greatly reduced weight over systems of prior art. By minimizing the weight of the hand-held implement, stress on the users hand and wrist which are normally necessary to counterbalance gravitational forces acting on the implement are greatly diminished, thus dramatically reducing the propensity for a workman using such a system to develop carpal tunnel syndrome. Excerpt(s): The present invention relates to a system for using and powering electrical power tools. More particularly, it relates to a system which provides a hand-held power tool having reduced weight over the same tools of prior art, to alleviate the symptoms of Carpal Tunnel Syndrome in persons using such power tools for extended time periods on a daily basis. Carpal tunnel syndrome is a disorder characterized by a specific pattern of numbness, tingling, pain or weakness caused by nerve compression in the wrist. It occurs because the carpal tunnel (the rather narrow passageway for the median nerve, a major nerve that provides sensation to the thumb, index finger, middle finger and half of the ring finger) is normally quite narrow, and even a small additional narrowing or other injury leads to nerve irritation. There are several common causes of carpal tunnel, including: arthritis or fracture near the wrist; pregnancy; diabetes; overuse (as in typists, cashiers or certain athletes); and thyroid disease, particularly an underactive thyroid. In each of these conditions, there is either nerve injury or added pressure in the carpal tunnel. Often the condition occurs without a clear reason. Carpal tunnel syndrome can occur in one or both hands. Symptoms of carpal tunnel syndrome may include burning, tingling or numbness of the fingers, difficulty gripping tools or other implements, and problems making a fist. Symptoms may appear first at night and are most noticeable in the thumb and the index and middle fingers. People with carpal tunnel syndrome often describe awakening with a tingling sensation and the need to "shake out" the hands to

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recover normal sensation. There may be pain in the wrist that radiates into the hand or into the forearm. If the condition is not treated, the muscles of the thumb may eventually waste away so that the normal "hill" of muscles at the base of the thumb eventually flattens. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

METHOD AND MEANS FOR EXERCISING HAND AND WRIST MUSCLES Inventor(s): BOORSTEIN, MICHAEL; (KENTFIELD, CA) Correspondence: CHARLES E TOWNSEND JR; TOWNSEND & TOWNSEND & CREW; TWO EMBARCADERO CENTER; 8TH FLOOR; SAN FRANCISCO; CA; 941113834 Patent Application Number: 20010051561 Date filed: January 5, 1999 Abstract: A means and method for exercising particularly hand, wrist, and lower forearm muscles and tendons as a preventive measure against overstressing the muscles and tendons leading to possible carpal tunnel syndrome. A specific exercise device consisting basically of a rod with two cushiony hand grips is disclosed to enable the user to practice the exercise method. Excerpt(s): This invention relates to a means and method for exercising hand, wrist and other muscles, tendons and ligaments in the forearms, upper arms, shoulders and neck of an individual for the purpose of stretching same at regular intervals as a preventive measure to lessen chances of injury, including carpal tunnel syndrome, due to repetitive and persistent overstress on said hand and wrist muscles in particular. It is generally recognized that there are many individuals in the modem day workplace, particularly those who spend many hours a day working on a computer keyboard or the like, who suffer from painful stress in their wrists due to the persistent and repetitive nature of such type of work. In the extreme, a significant number of individuals are diagnosed as having contracted carpal tunnel syndrome which occurs when their wrists are exposed to persistent and repetitive strain, causing the tissue surrounding the tendons to become so enlarged that they compress the median nerve which runs through the carpal tunnel, a passage in the wrist. It is generally recognized that carpal tunnel syndrome can cause reduced muscle control; impaired or lost nervous function; diminished grip strength or numbness, tingling and pain; and reduced inability to grasp and manipulate objects within the hand. Much attention has been devoted to treatments for carpal tunnel syndrome after the condition has severely advanced. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for topical treatment of carpal tunnel syndrome Inventor(s): Crandall, Wilson T.; (Verona, VA) Correspondence: WILSON T CRANDALL; P O BOX 346; VERONA; VA; 24482; US Patent Application Number: 20020164389 Date filed: April 19, 2002 Abstract: This invention relates to the topical treatment of the Carpal Tunnel Syndrome by the use of a selected protein kinase C inhibitor and an effective penetrating agent selected from Lecithin organogel or poloxamer 407 lecithin organogel. The protein

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kinase C inhibitors may be selected from sphingosine, sphinganine, phytosphingosine, curcumin, tetrahydrocurcumin, curcuminoids or apigenin Excerpt(s): The present application is a continuation-in-part of pending U.S. Provisional applications Ser. Nos. 60/100,530, 60/114,813 and 60/123,594 filed on Sep. 16, 1998, Jan. 6, 1999 and Mar. 10, 1999 and U.S. Pat. No. 6,306,383 Oct. 23, 2001. The present invention is related to a process and composition for topically inhibiting protein kinase C. More particularly, the present invention relates to topically applying the composition disclosed herein in order to treat the tendons affected by tenosynovitis in Carpal Tunnel syndrome which may cause a compression of the median nerve, and over a protracted period of time a perineural fibrosis which can produce a neuropathy of the median nerve. Mukhtar in Pharmacology of the Skin describes the communication between cells as being mediated by different biomolecules, such as hormones. These so called primary messengers bind to specific receptors on the cell surface. The binding of the primary messenger of a primary messenger to its receptor conveys a certain information to the cell which is subsequently transduced through the membrane by a chain of signaling. This process involves various membrane structures and leads to the activation of an enzyme located at the intracellular side of the membrane. The stimulated enzyme generates a second messenger which evokes the cellular response; in most cases, by the activation of other enzymes. By these steps, the initial extracellular signal is converted into an intracellular signal. This process is called signal transduction. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for treating non-neuropathic pain Inventor(s): Galer, Bradley Stuart; (West Chester, PA) Correspondence: IP Department; Schnader Harrison Segal & Lewis; 36th Floor; 1600 Market Street; Philadelphia; PA; 19103; US Patent Application Number: 20030124174 Date filed: October 25, 2001 Abstract: A method including topically administering an effective amount of local anesthetic to a patient is disclosed. The method is effective for inducing analgesia for treating non-neuropathic pain. Non-neuropathic pain suitable for treatment according to the invention includes pain associated with sports injuries; sprains; strains; soft-tissue injury; repetitive motion injury; carpal tunnel syndrome; injury to tendons, ligament, and muscles; conditions such as fibromyalgia, bursitis, castrochondritis, myofascial pain, and pain associated with arthritis, inflammation, contusions, post-surgical pain, and nociceptive pain. Preferably, the lidocaine is applied via a transdermal patch applied near the locus of pain. Excerpt(s): The invention relates to methods of treating non-neuropathic pain. Specifically, the invention relates to methods of treating non-neuropathic pain by topically administering a local anesthetic, such as lidocaine, in an effective amount near the pain location. Most specifically, the invention relates to methods of treating nonneuropathic pain by administering a topical lidocaine patch to a patient, where the transdermal drug delivery results in no clinically meaningful serum drug levels nor produces anesthesia at the site of delivery, i.e. analgesia without anesthesia. Pain can be treated with either analgesics or anesthetics. A distinguishing feature of analgesics is that they reduce the perception of pain without causing numbness or complete loss of sensation associated with anesthetics. Because of this classification, and the known

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drugs and their mechanisms of action, it is surprising to learn that a product, traditionally classified as an anesthetic, is useful as a general analgesic. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and compositions for treating carpal tunnel syndrome Inventor(s): Caldwell, Larry; (San Jose, CA), Galer, Bradley S.; (West Chester, PA) Correspondence: BOZICEVIC, FIELD & FRANCIS LLP; 200 MIDDLEFIELD RD; SUITE 200; MENLO PARK; CA; 94025; US Patent Application Number: 20030118632 Date filed: December 26, 2001 Abstract: Methods are provided for treating a host suffering from a condition resulting from pressure applied to the median nerve of the carpal tunnel, e.g. carpal tunnel syndrome. In the subject methods, an effective amount of a topical NSAID formulation is applied to the palmar dermal surface proximal to the target median nerve. Practice of the above methods results in an amelioration of at least one symptom associated with the condition being treated. Also provided are kits for practicing the subject methods. Excerpt(s): The technical field of the invention is carpal tunnel syndrome. Carpal tunnel syndrome is caused by pressure exerted on the median nerve at the wrist. The median nerve supplies sensation to the thumb-side of the palm, and to the thumb, index finger, middle finger, and the thumb-side of the ring finger. It also supplies movement to part of the hand. The nerve enters the hand through a gap formed by the wrist bones (called the carpal bones) and the tough membrane that holds the bones together (the transverse carpal ligament). This gap is called the carpal tunnel. The passageway is rigid, so swelling of any of the tissues in this area can cause compression of the nerve (a condition also known as entrapment of the nerve). Carpal Tunnel Syndrome is found most often in women 30 to 60 years old, but it is also found in men and in all age groups. Some of the conditions associated with carpal tunnel syndrome include pregnancy, premenstrual syndrome (PMS), and menopause; this is probably because of hormone changes that cause fluid retention and swelling of the tissues. Other conditions associated with carpal tunnel syndrome include rheumatoid arthritis, renal failure, diabetes mellitus, acromegaly, hypothyroidism, multiple myeloma, obesity, recent tuberculosis, fungal infection, and high blood pressure. Injury or trauma to the area, including (but not limited to) repetitive movement of the wrists, can cause swelling of the tissues and carpal tunnel syndrome. This injury may be from sports such as racquetball and handball, or from sewing, typing, driving, assembly-line work, painting, writing, use of tools (especially hand tools or tools that vibrate), repetitive stress or movement, or similar activities. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Pad for vibration dampening and carpel tunnel syndrome prevention Inventor(s): Spitzer, A. Robert; (Southfield, MI) Correspondence: Kenneth I Kohn; Kohn & Associates; Suite 410; 30500 Northwestern Highway; Farmington Hills; MI; 48334; US Patent Application Number: 20030205232 Date filed: March 28, 2003 Abstract: A hand pad apparatus (10) for protecting the median nerve, dampening vibration, and absorbing shock including a protecting mechanism (12) for preventing the application of pressure to the median nerve. The protecting mechanism (12) includes parallel cushion portions (24) defining a recess (14) therebetween and a recess maintaining mechanism (22) for maintaining the recess between the cushion portion from reducing the size of the recess. A method of combining median nerve protection, vibration dampening, and shock absorbing to inhibit or prevent carpal tunnel syndrome and a method of determining the proper width of a recess defined by parallel portions of a cushioned pads by determining the type of the cushioned pad material. Excerpt(s): This invention generally relates to the field of grips and pads for the protection of a median nerve from pressure thereon, dampening of vibration and absorption of shock. Carpal tunnel syndrome is a common hand condition that occurs by the compression of a median nerve. The transverse carpal ligament forms over the median nerve and compresses it as a result of pressure on the hand, producing symptoms of pain, numbness, weakness, paraesthesia, or atrophy in the territory of the median nerve distal to the course through the carpal tunnel in the wrist. Traumatic injury is exacerbated because of the narrowness of the carpal canal. There is no opportunity for the nerve to be displaced away from any compressive forces. Additionally, compressive injury is exacerbated by the development of edema in the tissues within the canal, which, because of the relatively fixed size, causes added injury due to compression of the nerve within the canal. An additional component of the injury is associated with friction between the nerve and the adjacent tendons caused by repetitive motions that are worsened by compression and further reduce the available space within the canal. Carpal tunnel syndrome is a particular problem for workers in industries that require manual operations with hand held implements or tools or in office situations wherein a worker is required to spend several hours a day resting their hands on a typewriter or computer terminal. Carpal tunnel syndrome also occurs due to sports related activities. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Portable adjustable traction appliance to treat carpal tunnel syndrome and other problems of the wrist Inventor(s): Repice, Ronald M.; (Glen Mills, PA), Repice, Ronald M. II; (Glen Mills, PA) Correspondence: Kenneth R. De Rosa; Wolf, Block, Schorr and Solis-Cohen LLP; 1650 Arch Street; Philadelphia; PA; 19103; US Patent Application Number: 20010031937 Date filed: November 29, 2000 Abstract: A portable appliance for treating carpal tunnel syndrome and/or other problems of the wrist of a person. The appliance comprises a releasably securable sleeve

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means for securement to a person's forearm, a stationary member positioned on the sleeve means, a moveable member slidably coupled to the stationary member, a cuff means secured to an end of the moveable member and a bias means coupled between the stationary member and the moveable member. The bias means is provided for urging the moveable member to slide from a retracted position to an extended position thus causing the cuff means to securelyengage a portion of the person's hand adjacent the person's wrist to apply a predetermined tensile load to the person's wrist in a direction parallel to the longitudinal axis of the forearm. Excerpt(s): This invention relates generally to medical equipment and more particularly to a portable adjustable traction appliance for treating carpal tunnel syndrome and other disorders of the wrist, e.g., a strain, sprain or subluxation, by applying tension thereto. Carpal tunnel syndrome is the result of a compromised or narrowed carpal canal leading to compression injury of the median nerve in the wrist. The carpal tunnel is the canal in the wrist through which the median nerve and flexor tendons pass from the forearm to the hand. Prolonged repetitive motion at a keyboard is a common, but by no means the only cause of carpal tunnel syndrome. Various traction machines are commercially available for applying traction to selected portions of the anatomy of a person to treat some medical condition or problem of the person. For example, Barrington Equipment Company, of Wauconda, Ill. presently markets a pneumatic traction machine, believed to be manufactured by Para Tech Industries, Inc. under the trade designation Para Tech CTDMARK I for applying traction to the wrist of a person suffering from carpal tunnel syndrome. While this device appears suitable for its intended purposes, it leaves much to be desired from the standpoint of ease of use and patient comfort. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Safety device for prevention of carpal tunnel syndrome Inventor(s): Reinhardt, Richard C.; (Granite City, IL) Correspondence: OSTROLENK FABER GERB & SOFFEN; 1180 AVENUE OF THE AMERICAS; NEW YORK; NY; 100368403 Patent Application Number: 20030135142 Date filed: January 14, 2003 Abstract: A device to prevent and treat carpal tunnel syndrome that restricts wrist extension to a maximum of about 20 degrees, while allowing a user his or her full range of wrist flexion motion. The device may comprise a wrist portion that receives the wrist, a dorsal portion that includes a rigid or possibly flexible insert, and two eyelets through which the second and third fingers are received. Excerpt(s): The application is based on and claims priority to U.S. Provisional Application No. 60/348,915, filed Jan. 15, 2002, entitled SAFETY DEVICE FOR PREVENTION OF CARPAL TUNNEL SYNDROME, of which the entire disclosure is incorporated herein by reference. The present invention is related to ergonomics, and more particularly, is directed to an ergonomic flexible brace for people with carpal tunnel syndrome. Thousands of people suffer from carpal tunnel syndrome. Carpal tunnel syndrome is an ailment that affects the median nerve of a person's wrist due to pressure through an opening in the wrist called a carpal tunnel. The condition causes many uncomfortable symptoms such as pain, tingling and numbness in the hands and arms. A combination of poor wrist posture and repetitive motion is a classic cause for

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carpal tunnel syndrome. For many sufferers of carpal tunnel syndrome, relief comes in the form of overuse of medications, for example, prescription and over the counter pain relievers. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Sytems for the prevention or treatment of carpal tunnel syndrome Inventor(s): Limonadi, Farhad M.; (Portland, OR) Correspondence: KLARQUIST SPARKMAN, LLP; 121 SW SALMON STREET; SUITE 1600; PORTLAND; OR; 97204; US Patent Application Number: 20030013580 Date filed: August 1, 2002 Abstract: Apparatuses and methods for preventing and/or treating carpal tunnel syndrome are disclosed. One such apparatus comprises a splint (20) for wearing on a portion of an upper extremity of an individual, a warning mechanism (16, 19) carried by the splint and a switch mechanism carried by the splint and electrically coupled to the warning mechanism. The switch mechanism (15) is operable to activate the warning mechanism upon extension or flexion of the hand beyond a predetermined range of motion and thereby alert the user of such undesirable motion of the band. Excerpt(s): The present invention relates to preventing and treating hand disorders, and more particularly, to preventing and treating carpal tunnel syndrome. Carpal tunnel syndrome is a nerve disorder in the hand that is caused by swollen, inflamed or scarred tissue as well as repetitive or excessive motion injuries that cause excessive pressure on the median nerve within the carpal tunnel. The median nerve supplies sensation to the volar, also known as the plamar, aspect of the thumb, index finger, middle finger and the ring finger. Symptoms of carpal tunnel syndrome include tingling, numbness, burning sensations, pain. This involves not only the area of innervation described but may also radiate above the wrist into the forearm. An individual with carpal tunnel syndrome may also experience stiffness or cramping of hands, and may loss the ability to grasp objects or operate certain devices commonly used in the individual's household or workplace. Treatment for carpal tunnel syndrome has included rest from provocative activities, anti-inflammatory medications, steroid injections, surgery, and/or the use of wrist splints to fix the wrist in either a neutral or extended position. While these measures may control symptoms temporarily, they have proven to be less successful in permanently controlling or relieving symptoms. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Therapeutic infrared energy wrist cover Inventor(s): Gordon, Lawrence; (Watauga, TX) Correspondence: John W. Montgomery; Haynes and Boone, LLP; Suite 4300; 1000 Louisiana Street; Houston; TX; 77002-5012; US Patent Application Number: 20020072786 Date filed: December 13, 2000 Abstract: A therapeutic infrared emitting wrist cover 12 that provides a wrist cover 12, constructed for placement over a human wrist 10, that contains an infrared energy

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generating system 14. The wrist cover 12 emits infrared energy into the wrist 10 at a localized area corresponding to the carpal tunnel for the purpose of providing therapeutic heat inside the wrist 10 in order to relieve the symptoms and to prevent further trauma associated with carpal tunnel syndrome. Excerpt(s): This invention relates in general to a heat generating system for the relief of pain and the reduction of trauma associated with carpal tunnel syndrome and, in particular, to an infrared energy emitting wrist cover for the purpose of providing penetrating heat localized in the subsurface carpel tunnel structure. Without limiting the scope of the present invention, its background is described in connection with an infrared energy generating system contained within a wrist cover. It should be noted that the principles of the present invention are applicable in a variety of embodiments, including, but not limited to, an infrared energy generating wrist pad and an infrared energy generating wrist saddle. Heretofore, in this field, a variety of resistance heating systems have been developed to provide therapeutic heat to different areas of the body. The current state of the art in therapeutic resistance heating systems allows for application of heat conductively transferred to the surface of a traumatized area of the body through surface contact. These systems typically apply the heat generated over a broad surface area, without localizing the heat generated to the often small area traumatized. Additionally, the typical resistance heating system, usually resistance metal wire elements, causes the materials used to house the heating system to become hot, preventing much of the heat generated from serving its intended purpose of heating the traumatized body area and providing the potential for the housing to cause burns to the surface of the skin. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Wearable computing system, method and device Inventor(s): Harrison, Shelton E. JR.; (Los Angeles, CA) Correspondence: Shelton Harrison, Jr.; 6643 Poplar Pike; Memphis; TN; 38119; US Patent Application Number: 20030209604 Date filed: May 16, 2003 Abstract: Disclosed is a wrist-wearable electronic interface movably mounted on an arm-attachment mechanism. Interface moves from under-sleeve wrist-adjacent position to palm-adjacent position where it can be manipulated by the hand of the arm wearing the device. Alternately adaptable to telephones, audio recorders, remote controls, auto ID equipment, telephone call-blocking, and more. Alternative embodiment provides a wrist-mounted docking station. Another alternative embodiment includes a superior carpal tunnel syndrome therapy device. The system also includes novel battery chargers: (1) window-mounted, solar-powered; (2) mounted in an automobile that also includes an improved odometer, license plate, and cabin air filtration system. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/724,701, filing date Nov. 28, 2000, which was a continuation of U.S. patent application Ser. No. 09/117,150, which has now matured into U.S. Pat. No. 6,184,804. The latter application was the United States national case filing of PCT filing PCT/US97/01356, filing date Jan. 22, 1997, which claimed the priority filing date of provisional patent application No. 60/010,648, filed on Jan. 26, 1996. This application also claims the priority filing date of provisional patent application No. 60/381,624, filed May 17, 2002; provisional patent application No. 60/383,526, filed May 28, 2002; and

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provisional patent application No. 60/395,367, filed Jul. 12, 2002. All of these related applications are hereby incorporated by reference in their entirety into the present disclosure. None. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Wrist support for use with a computer mouse Inventor(s): Dillon, Carmen; (Brantford, CA) Correspondence: John H. Thomas, P.C.; 1561 East Main Street; Richmond; VA; 23219; US Patent Application Number: 20020113175 Date filed: February 12, 2002 Abstract: There is disclosed a wrist support for supporting a hand, wrist and forearm of a person during operation a computer mouse. The support forms a channel or cradle, which receives the palm, wrist and upper forearm. The support further comprises a thumb support extending and a fifth finger support extending to create an abducted position of the thumb and fifth finger relative to the remainder of the hand to relieve pressure on the median nerve in the wrist, leaving the second, third, and forth finger to operate the mouse. This configuration may ease strain on the wrist and may be advantageously used by persons with carpal tunnel syndrome. This support is constructed from hard plastic material and has a base which glides freely over hard flat surfaces. Excerpt(s): The present invention relates generally to wrist supporting devices, and, more particularly, to wrist supports for use with a computer mouse. The median nerve travels through an anatomic space at the base of the palm of the hand known as the carpal tunnel. When external pressure is applied to the carpal tunnel, that pressure is transmitted to the median nerve. If a person puts significant stress upon the heel of the hand, either as a result of repetitive impacts (vibrational or otherwise) or as a result of long term weight bearing impacts, then injury to the median nerve of the hand may occur. The injury is typically experienced as numbness and tingling of the thumb, index, middle, and part of the ring fingers of the hand. This phenomenon is know as repetitive stress injury, or carpal tunnel syndrome. Computer users may be at risk for carpal tunnel syndrome as a result of frequent use of a computer mouse. When moving a computer mouse to control a cursor on a computer screen ("mousing"), the user tends to balance the weight of his/her hand on the heel of the hand in order to keep the fingers freely mobile in order to operate the mouse buttons. Furthermore, the user will tend to pivot on his/her hand on its heel in order to move the computer mouse laterally. Additionally, when a computer user rests the weight of his/her forearm on the heel of the hand significant pressure is applied to the wrist, with the result that the user's wrist is frequently hypo and/or hyper flexed. Repeated or prolonged flexion of the wrist in either direction may pinch the carpal tunnel and irritate the medial nerve which passes through the carpal tunnel. Computer users frequently spend long periods of time at the computer and they typically use a computer mouse throughout the time when the computer is in use. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with carpal tunnel syndrome, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “carpal tunnel syndrome” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on carpal tunnel syndrome. You can also use this procedure to view pending patent applications concerning carpal tunnel syndrome. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON CARPAL TUNNEL SYNDROME Overview This chapter provides bibliographic book references relating to carpal tunnel syndrome. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on carpal tunnel syndrome include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “carpal tunnel syndrome” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on carpal tunnel syndrome: •

Carpal Tunnel Syndrome and Other Disorders of the Median Nerve Source: Wolburn, MA: Butterworth-Heinemann. 1993. 377 p. Contact: Available from Butterworth-Heinemann. 225 Wildwood Avenue, Wolburn, MA 01801. (800) 366-2665. PRICE: $100.00 plus shipping and handling. ISBN 0750692294. Summary: This book for health professionals presents an overview of carpal tunnel syndrome and other disorders of the median nerve. The first two chapters describe the anatomy of the median nerve and review the evolution of understanding of carpal tunnel syndrome. These are followed by chapters on the common symptoms and physical findings in carpal tunnel syndrome, the diagnosis of those conditions that are most likely to be confused with carpal tunnel syndrome or the conditions that carpal tunnel syndrome might mimic, and the relationship of carpal tunnel syndrome to other

148 Carpal Tunnel Syndrome

medical conditions. Other topics addressed in subsequent chapters include the use of electrodiagnostic methods for evaluation of carpal tunnel syndrome, the interpretation of electrodiagnostic findings in carpal tunnel syndrome, the use of quantitative sensory testing and thermography for evaluating sensory phenomena of positive character and dysfunction of small caliber fiber systems, and the role of imaging in the evaluation of carpal tunnel. In addition, chapters discuss the pathologic, physiologic, and clinical correlations of acute and chronic mechanical nerve injury; the controversy over the role of activities or occupations in causing carpal tunnel syndrome; and the treatment of carpal tunnel syndrome with splinting, steroid injections, vitamin B6 therapy, diuretics, anti-inflammatories, and surgery. Final chapters focus on median nerve causalgia, median neuropathy proximal and distal to the carpal tunnel, and tumors of the median nerve. It also includes numerous figures, tables, and references.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “carpal tunnel syndrome” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “carpal tunnel syndrome” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “carpal tunnel syndrome” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

101 Questions and Answers about Carpal Tunnel Syndrome: What It Is, How to Prevent It, and Where to Turn for Treatment by Steven J., MD McCabe; ISBN: 0737305924; http://www.amazon.com/exec/obidos/ASIN/0737305924/icongroupinterna

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A Colour Atlas of Treatment of Carpal Tunnel Syndrome (Single Surgical Procedures) by W. Bruce Conolly; ISBN: 0723410046; http://www.amazon.com/exec/obidos/ASIN/0723410046/icongroupinterna

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Carpal Tunnel Syndrome by Kate Montgomery, et al; ISBN: 1878069039; http://www.amazon.com/exec/obidos/ASIN/1878069039/icongroupinterna

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Carpal Tunnel Syndrome by Louis Patry, et al; ISBN: 2921146703; http://www.amazon.com/exec/obidos/ASIN/2921146703/icongroupinterna

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Carpal Tunnel Syndrome (Cd-Rom For Windows & Macintosh) by Cmc Research; ISBN: 1886877475; http://www.amazon.com/exec/obidos/ASIN/1886877475/icongroupinterna

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Carpal Tunnel Syndrome (Pamphlet) (1989); ISBN: 9990419159; http://www.amazon.com/exec/obidos/ASIN/9990419159/icongroupinterna

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Carpal Tunnel Syndrome : A Guide for Patients by Robert Belsoe; ISBN: 1885274084; http://www.amazon.com/exec/obidos/ASIN/1885274084/icongroupinterna

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Carpal Tunnel Syndrome and Other Disorders of the Median Nerve by Richard B Rosenbaum, Jose Ochoa; ISBN: 0750673141; http://www.amazon.com/exec/obidos/ASIN/0750673141/icongroupinterna

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Carpal Tunnel Syndrome and Other Repetitive Strain Injuries (Diseases and People) by Philip Johansson; ISBN: 0766011844; http://www.amazon.com/exec/obidos/ASIN/0766011844/icongroupinterna

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Carpal Tunnel Syndrome and Repetitive Stress Injuries: The Comprehensive Guide to Prevention, Treatment and Recovery by Tammy Crouch (1996); ISBN: 1883319501; http://www.amazon.com/exec/obidos/ASIN/1883319501/icongroupinterna

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Carpal Tunnel Syndrome Book: Prevent & Treat Cts, Tendinit Ies & Related Trauma Disorder by Mark A. Pinsky (Author) (1993); ISBN: 0446365270; http://www.amazon.com/exec/obidos/ASIN/0446365270/icongroupinterna

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Carpal Tunnel Syndrome-- Causes, Symptoms, and Surgery: Index of New Information Including Complications by American Health Research Institute (1996); ISBN: 0788311034; http://www.amazon.com/exec/obidos/ASIN/0788311034/icongroupinterna

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Carpal Tunnel Syndrome Chart by Anatomical Chart (2003); ISBN: 1587793210; http://www.amazon.com/exec/obidos/ASIN/1587793210/icongroupinterna

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Carpal Tunnel Syndrome: A Comprehensive Approach to Early Diagnosis and Management by Mark P. Koniuch, John J. Palazzo (Editor); ISBN: 1556420951; http://www.amazon.com/exec/obidos/ASIN/1556420951/icongroupinterna

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Carpal Tunnel Syndrome: A Guide to Daily Activities by Roger Preventing and Treating Carpal Tunnel Syndrome Williams (Editor), Aota (2002); ISBN: 1569001804; http://www.amazon.com/exec/obidos/ASIN/1569001804/icongroupinterna

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Carpal Tunnel Syndrome: How to Relieve & Prevent Wrist "Burnout"!" by Rosemarie A. Atencio (1994); ISBN: 0963736019; http://www.amazon.com/exec/obidos/ASIN/0963736019/icongroupinterna

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Carpal Tunnel Syndrome: The Invisible Threat (The Work Habit Library) by Kate Montgomery (1994); ISBN: 1880688034; http://www.amazon.com/exec/obidos/ASIN/1880688034/icongroupinterna

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Color Atlas of Treatment of Carpal Tunnel Syndrome by W. Bruce Conolly; ISBN: 0874895103; http://www.amazon.com/exec/obidos/ASIN/0874895103/icongroupinterna

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Compression Neuropathies, Including Carpal Tunnel Syndrome (Clinical Symposia, Vol 49, No 2) by Allan Jacobs (1998); ISBN: 9999981852; http://www.amazon.com/exec/obidos/ASIN/9999981852/icongroupinterna

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Conquering Carpal Tunnel Syndrome : And Other Repetitive Strain Injuries by Sharon J. Butler, Jacqueline Entwistle Freeman (Illustrator) (1996); ISBN: 1572240393; http://www.amazon.com/exec/obidos/ASIN/1572240393/icongroupinterna

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Eating Do's & Don'ts for Nutritional Management of Carpal Tunnel Syndrome by Mary Tumosa-Lawler; ISBN: 097022110X; http://www.amazon.com/exec/obidos/ASIN/097022110X/icongroupinterna

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Employee Guide to: Carpal Tunnel Syndrome in Industry/Workbook by Tel-A-T, Inc Staff Tel-A-Train; ISBN: 1563551535; http://www.amazon.com/exec/obidos/ASIN/1563551535/icongroupinterna

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Employee Guide to: Office Ergonomics Including Carpal Tunnel Syndrome/Workbook (1990); ISBN: 1563551594; http://www.amazon.com/exec/obidos/ASIN/1563551594/icongroupinterna

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End Your Carpal Tunnel Pain Without Surgery: A Daily Program to Prevent and Treat Carpal Tunnel Syndrome by Kate Montgomery (1998); ISBN: 1558535918; http://www.amazon.com/exec/obidos/ASIN/1558535918/icongroupinterna

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It's Not Carpal Tunnel Syndrome! RSI Theory & Therapy for Computer Professionals by Suparna Damany, et al; ISBN: 0965510999; http://www.amazon.com/exec/obidos/ASIN/0965510999/icongroupinterna

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Natural & Herb Remedies for Carpal Tunnel Syndrome (Storey Country Wisdom Bulletin, A-245) by Norma Pasekoff Weinberg (2000); ISBN: 1580173047; http://www.amazon.com/exec/obidos/ASIN/1580173047/icongroupinterna

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Occupational Therapy Practice Guidelines for Adults With Carpal Tunnel Syndrome (The Aota Practice Guidelines Series Adults With Carpal Tunnel Syndrome) by Aota Staff (Editor) (1999); ISBN: 1569001219; http://www.amazon.com/exec/obidos/ASIN/1569001219/icongroupinterna

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Occupational Therapy Practiced Guidelines for Adults With Carpal Tunnel Syndrome (2000); ISBN: 1569001472; http://www.amazon.com/exec/obidos/ASIN/1569001472/icongroupinterna

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OSHA Carpal Tunnel Syndrome Manual and CD, Introductory But Comprehensive OSHA (Occupational Safety and Health) Training for the Managers and Employees in a Worker Safety Program, Covering Work Ergonomics of the Arm, and for Individuals Interested in Health Maintenance by Daniel Farb, Bruce Gordon (2003); ISBN: 1932634843; http://www.amazon.com/exec/obidos/ASIN/1932634843/icongroupinterna

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Preventing and Treating Carpal Tunnel Syndrome (Order No. 1118) by Roger Williams, Clarence Goosen (Illustrator); ISBN: 1569000123; http://www.amazon.com/exec/obidos/ASIN/1569000123/icongroupinterna

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Relief from Carpal Tunnel Syndrome and Other Repetitive Motion Disorders (The Dell Medical Library) by Nora Tennenhaus, et al; ISBN: 044020979X; http://www.amazon.com/exec/obidos/ASIN/044020979X/icongroupinterna

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Rsi: Repetitive Strain Injury: Repetitive Strain Injury, Carpal Tunnel Syndrome and Other Office Numbers (Thorsons Health) by Wendy Chalmers Mill; ISBN: 0722529198; http://www.amazon.com/exec/obidos/ASIN/0722529198/icongroupinterna

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The Natural Treatment of Carpal Tunnel Syndrome by Ray C., Jr., M.D. Wunderlich; ISBN: 0879836091; http://www.amazon.com/exec/obidos/ASIN/0879836091/icongroupinterna

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The Pain Relief Breakthrough: The Power of Magnets to Relieve Backaches, Arthritis, Menstrual Cramps, Carpal Tunnel Syndrome, Sports Injuries, and More by Julian, M.D. Whitaker, Brenda D. Adderly; ISBN: 0452280885; http://www.amazon.com/exec/obidos/ASIN/0452280885/icongroupinterna

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Treating Arthritis, Carpal Tunnel Syndrome, and Joint Conditions (Physicians' Guides to Healing , No 2) by Alan Pressman, et al; ISBN: 042515694X; http://www.amazon.com/exec/obidos/ASIN/042515694X/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site,

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http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “carpal tunnel syndrome” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

Carpal tunnel syndrome & overuse injuries: prevention, treatment & recovery Author: Crouch, Tammy.; Year: 1975; Berkeley, Calif.: North Atlantic Books, c1992; ISBN: 155643135X

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Carpal tunnel syndrome: prevention & treatment: a nonsurgical, drug free approach: the repetitive strain injury of the wrist and hand Author: Montgomery, Kate.; Year: 1984; San Diego, CA: Sports Touch, c1994; ISBN: 1878069357

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Carpal tunnel syndrome: selected references. Author: National Institute for Occupational Safety and Health. Division of Standards Development and Technology Transfer.; Year: 1989; Cincinnati, OH: U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, Division of Standards Development and Technology Transfer, [1989]

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Carpal tunnel syndrome and other disorders of the median nerve Author: Rosenbaum, Richard B.,; Year: 1993; Boston: Butterworth-Heinemann, c1993; ISBN: 0750692294 http://www.amazon.com/exec/obidos/ASIN/0750692294/icongroupinterna

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Carpal tunnel syndrome, a clinical and pathological study. Author: Yamaguchi, Donald Mitsuo,; Year: 2002; [Minneapolis] 1962

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Carpal tunnel syndrome. Author: National Mine Health and Safety Academy.; Year: 1975; [Washington, D.C.]: U.S. Dept. of Labor, Mine Safety and Health Administration, National Mine Health and Safety Academy, 1991

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Neural surgery for carpal tunnel syndrome (CTS) (update) Author: ECRI (Organization). Health Technology Assessment Information Service.; Year: 1966; Plymouth Meeting, PA: ECRI, c2002

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Orthopaedic clinical policies: carpal tunnel syndrome, Colles' fracture, femoral neck fracture, herniated lumbar disk, osteoarthrosis of the hip, tear, medial meniscus. Author: American Academy of Orthopaedic Surgeons. Task Force on Clinical Policies.; Year: 1991; Park Ridge, Ill. (222 S. Prospect Ave., Park Ridge 60068-4058): American Academy of Orthopaedic Surgeons, c1989

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Revision of the carpal tunnel syndrome: a computed tomographic study Author: Jessurun, Winston.; Year: 1987; Groningen [Netherlands]: Van Denderen, 1983

Chapters on Carpal Tunnel Syndrome In order to find chapters that specifically relate to carpal tunnel syndrome, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and carpal tunnel syndrome using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book 11

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “carpal tunnel syndrome” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on carpal tunnel syndrome: •

Complications of Chronic Dialysis Therapy Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 192-212. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Chronic dialysis therapy has extended the lives of hundreds of thousands of patients. The treatment, however, can be associated with significant acute and chronic complications. This chapter on the complications of chronic dialysis therapy is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. Many complications in patients with end stage renal disease (ESRD) are part of the uremic syndrome and are unrelated to the dialysis treatment itself. Dialysis related complications include central nervous system (CNS) abnormalities (headache, weakness, fatigue, apathy, nausea), hypotension (low blood pressure), fluid overload (edema), hypertension (high blood pressure), congestive heart failure, arrhythmias, muscle cramping, chills and fever (febrile reactions), allergic reactions, and itching (pruritis). The author discusses medical problems associated with ESRD, including anemia and its treatment (often with erythropoietin or transfusions), the complications of blood transfusions, renal osteodystrophy (bone disease related to abnormalities of calcium and phosphorus metabolism), joint disorders (including pseudogout, which is related to elevated uric acid levels), dialysis amyloidosis, carpal tunnel syndrome (CTS), gastrointestinal problems (peptic ulcer disease, constipation, and ascites, or fluid collection in the peritoneal cavity), hepatitis, neuropathy, reproduction problems, and insomnia (inability to sleep). The authors concludes with a discussion of dialysis in the elderly, the role of exercise for dialysis patients, dialysis for people with diabetes mellitus, and the psychological consequences of long term dialysis.

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Exercise in Diabetic Patients with Disabilities Source: in Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p.601-611. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $69.95 plus shipping and handling. ISBN: 1580400191. Summary: Disability and diabetes commonly coexist. Diabetes is a risk factor for stroke, amputation, and neuropathy (nerve disease). This chapter on exercise in diabetic patients with disabilities is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. Stroke is a common disabling condition in people with diabetes. Exercise therapy is a key component of rehabilitation after stroke. Recent studies have provided increasing evidence that exercise can facilitate stroke recovery. The high prevalence of coronary artery disease in people with diabetes who sustain a stroke should be considered when

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prescribing exercise for these individuals. Both diabetes and stroke may be risk factors for carpal tunnel syndrome (CPS). Treatment of CPS may be complicated by coexisting disability (e.g., hemiparesis, muscle weakness, in the other arm). Leg amputation may occur as a complication of diabetes and imposes increased energy costs for ambulation (walking). The energy requirements of walking with an above-the-knee amputation are substantially higher than with a below-the-knee amputation. Neuropathy is an important cause of disability in individuals with diabetes. Ankle dorsiflexion weakness ('foot drop') may be effectively managed with the use of an ankle foot orthosis. In severe cases of neuropathy, a Charcot arthropathy may develop in the foot or ankle. This has a substantial impact on the ability to exercise and may result in amputation in some cases. Lower extremity braces may be useful as a compensatory tool for individuals with leg weakness from stroke or neuropathy. Either plastic lightweight braces or metal braces attached to shoes may be appropriate in different situations. The least restrictive brace possible should generally be prescribed. 1 figure. 31 references. •

Diabetic Polyneuropathy Source: in Veves, A.; Giurini, J.M.; LoGerfo, F.W. Diabetic Foot: Medical and Surgical Management. Totowa, NJ: The Humana Press, Inc. 2002. p.75-98. Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 2561699. Fax (973) 256-8341. E-mail: [email protected] PRICE: $135.00, plus shipping and handling. ISBN: 0896039250. Summary: Polyneuropathy is one of the most common complications of diabetes and the most common form of neuropathy (nerve disease) in the developed world. Diabetic polyneuropathy encompasses several neuropathic syndromes, the most common of which is distal symmetrical neuropathy, the main initiating factor for foot ulceration. This chapter on diabetic polyneuropathy is from a textbook on the medical and surgical care of foot problems in people with diabetes. The author discusses the classification of polyneuropathy; symmetrical neuropathies, including distal symmetrical neuropathy, and acute painful neuropathies; asymmetrical neuropathies, include proximal motor neuropathy, cranial mononeuropathies, truncal radiculopathy, and pressure palsies (notably carpal tunnel syndrome); the pathogenesis of distal symmetrical neuropathy, including chronic hyperglycemia (high blood glucose levels), oxidative stress, increased polyol pathway flux, nonenzymatic glycation, neurotrophic factors, protein kinase C activation, and vascular factors; autonomic neuropathy, including cardiovascular, gastrointestinal (gastroparesis), abnormal sweating, and abnormalities of bladder function; the management of diabetic neuropathy through glycemic control, tricyclic compounds, anticonvulsants, topical capsaicin, intravenous lignocaine and oral mexiletine, and alpha lipoic acid; and the management of disabling painful neuropathy that is nonresponsive to pharmacological (drug) treatment. 3 figures. 6 tables. 101 references.

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Solving Neuropathy Problems Source: in Touchette, N. Diabetes Problem Solver. Alexandria, VA: American Diabetes Association. 1999. p. 197-216. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $19.95 for members; plus shipping and handling. ISBN: 1570400091.

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Summary: This chapter deals with solving neuropathy problems in people who have diabetes. Too much glucose in the blood can, over time, damage the nerves in the body. Although the nerves of the central nervous system are not usually affected by high blood glucose, the nerves of the peripheral nervous system can become damaged over time. Damage may occur to the sensory nerves that send information about how things feel from the skin and from internal organs to the brain or the motor nerves that send information from the brain to the muscles of the body about how to move. Autonomic nerves that control internal organs or autonomic processes may also be damaged. Both small and large nerve fibers may be affected. Neuropathies may also be classified as focal or diffuse. Mononeuropathy, or focal neuropathy, is caused by damage to a single nerve or group of nerves. The chapter explains how to recognize and handle cranial neuropathy; plexopathy; radiculopathy; and entrapment syndromes such as carpal tunnel syndrome, ulnar nerve entrapment, radial nerve entrapment, and peroneal nerve entrapment. Polyneuropathy is the most common type of neuropathy that occurs in people who have diabetes. This type of neuropathy can affect nerves in many parts of the body. The chapter explains how to recognize, handle, treat, and prevent this condition. Autonomic neuropathy can cause problems with bladder functions; result in cardiovascular problems such as orthostatic hypotension, an abnormal heart rate, and a silent heart attack; cause an inability to sweat; and interfere with the warning signs of hypoglycemia and contribute to hypoglycemia unawareness. The chapter explains how to recognize, handle, treat, and prevent these autonomic neuropathies. •

Surgical Approach to Hand Involvement Source: in Clements, P.J.; Furst, D.E., Eds. Systemic Sclerosis. Baltimore, MD: Williams and Wilkins. 1996. p. 569-579. Contact: Available from Williams and Wilkins, Special Sales Department. (800) 358-3583. Summary: This chapter for health professionals focuses on surgical approaches to treating hand manifestations of systemic sclerosis (SSc). The use of digital sympathectomy and microsurgical revascularization to treat Raynaud's phenomenon and digital ischemia is discussed. Other surgical procedures reviewed include amputation to treat frank gangrene; amputation, skin grafts, flexor tendon lengthening, arthrodesis, and arthroplasty to treat proximal interphalangeal and metacarpophalangeal joint contractures; excision combined with pulsed-fluid irrigation and fragmentation of the calcific deposits with a dental burr to treat calcinosis; and surgical carpel tunnel release to treat carpal tunnel syndrome. Issues concerning anesthesia are briefly considered. 28 references and 7 figures.

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Neuropathy in Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 339-348. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This chapter on neuropathy in diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Population-based studies of neuropathy (inflammation and degeneration of peripheral nerves) indicate that

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neuropathy is a common complication of IDDM and NIDDM, with 60 to 70 percent of patients affected. Subclinical neuropathy is much more common than clinical neuropathy. Distal symmetrical polyneuropathy is the most common type of neuropathy, followed by carpal tunnel syndrome, other mononeuropathies, and autonomic neuropathy. Prevalence of neuropathy increases with age, duration of diabetes, and worsening of glucose tolerance. In the Diabetes Control and Complications Trial (DCCT), intensive treatment of diabetes with near-normalization of glycemia reduced by 60 percent the 5-year incidence of neuropathy in those without neuropathy at study entry. 16 figures. 3 tables. 29 references. (AA-M). •

Rheumatologic Disease Source: in Daugirdas, J.T. and Ing, T.S., eds. Handbook of Dialysis. 2nd ed. Boston, MA: Little, Brown and Company. 1994. p. 662-672. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $37.95. ISBN: 0316173835. Summary: This chapter on rheumatologic disease in dialysis patients is from a handbook that outlines all aspects of dialysis therapy, emphasizing the management of dialysis patients. Topics include dialysis-related amyloidosis, including carpal tunnel syndrome and destructive spondyloarthropathy; crystal-associated arthropathies; viral arthritis; muscle weakness; extensor tendon rupture; connective tissue disorders; and the use of rheumatologic drugs in dialysis patients, including NSAIDs, drugs for gout, and corticosteroids. For each condition, the authors discuss incidence, symptoms, diagnosis, pathophysiology, prevention, and management. The authors present information in outline form, for easy reference. 3 tables. 21 references.

•

Chapter 8-D: Musculoskeletal Signs and Symptoms: Regional Rheumatic Pain Syndromes Source: in Klippel, J.H., et al., eds. Primer on the Rheumatic Diseases. 12th ed. Atlanta, GA: Arthritis Foundation. 2001. p. 174-188. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 300091616. (800) 207-8633. Fax (credit card orders only) (770) 442-9742. Website: www.arthritis.org. PRICE: $69.95 plus shipping and handling. ISBN: 0912423293. Summary: This chapter provides health professionals with information on the symptoms, causes, diagnosis, and management of regional rheumatic pain syndromes, focusing on disorders involving the muscles, tendons, entheses, joints, cartilage, ligaments, fascia, bone, and nerves. Disorders of the shoulder region include rotator cuff tendinitis, rotator cuff tear, bicipital tendinitis, adhesive capsulitis, suprascapular neuropathy, long thoracic nerve paralysis, brachial plexopathy, and thoracic outlet syndrome. Various conditions affect the elbow region, including olecranon bursitis, lateral and medial epicondylitis, tendinitis of musculotendinous insertion of biceps, and ulnar nerve entrapment. Disorders affecting the wrist and hand include ganglion, de Quervain's tenosynovitis, tenosynovitis of the wrist, pronator teres syndrome, anterior and posterior interosseous nerve syndrome, radial nerve palsy, superficial radial neuropathy, carpal tunnel syndrome, ulnar nerve entrapment at the wrist, volar flexor tenosynovitis, and Dupuytren's contracture. Disorders of the hip region include trochanteric, iliopsoas, and ischial bursitis; piriformis syndrome; and meralgia paresthetica. Disorders affecting the knee region include popliteal cysts, anserine and

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prepatellar bursitis, medial plica syndrome, popliteal tendinitis, Pellegrini-Stieda syndrome, patellar tendinitis, rupture of the quadriceps tendon and infrapatellar tendon, peroneal nerve palsy, and patellofemoral pain syndrome. Disorders of the ankle and foot include Achilles tendinitis, retrocalcaneal and subcutaneous Achilles bursitis, plantar fasciitis, Achilles tendon rupture, tarsal tunnel syndrome, posterior tibial tendinitis, peroneal tendon dislocation and peroneal tendinitis, hallux valgus, bunionette, hammertoe, Morton's neuroma, metatarsalgia, pes planus, pes cavus, and posterior tibialis tendon rupture. Various disorders may affect the anterior chest wall, among them Tietze's syndrome, costochondritis, xiphoid cartilage syndrome, and conditions affecting the sternoclavicular joint. The chapter also identifies general causative factors and presents general management concepts, focusing on drug therapy, intralesional injections, and physical therapy. 3 figures and 26 references. •

New Diseases of Dialysis Patients: Amyloidosis Source: in Andreucci, V.E. International Yearbook of Nephrology 1990. Hingham, MA: Kluwer Academic Publishers. 1990. p. 217-233. Contact: Available from Kluwer Academic Publishers. P.O. Box 358, Accord Station, Hingham, MA 02018-0358. (617) 871-6600. Summary: This chapter summarizes and discusses recent findings concerning dialysis amyloidosis (DA), a well-defined clinical entity resulting from the accumulation of beta2-microglobulin (B2M) fibrils mainly along synovial membranes, which, in long-term dialysis patients, causes carpal tunnel syndrome, arthralgias and cystic bone lesions sometimes leading to pathological fractures. Specific attention is focused on: the extent of B2M amyloid deposits in dialysis patients; factors influencing the prevalence of DA; B2M chemistry in dialyzed patients; the metabolism of B2M; early markers of B2M DA; and the treatment of B2M DA. Two identified risk factors for DA are patient age at dialysis onset, and the characteristics of the dialysis membrane. The only efficient therapy currently is transplantation. 121 references.

•

Section Four: Hand and Wrist Source: in Greene, W.B., Ed. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons (AAOS). 2001. p. 198-291. Contact: Available from American Academy of Orthopaedic Surgeons (AAOS). 6300 North River Road, Rosemont, IL 60018-4262. (800) 626-6726 (toll-free) or (847) 823-7186. Fax (800) 823-8025 (toll-free) or (847) 823-8025. E-mail: [email protected]. Website: www.aaos.org. PRICE: $105.00 for nonmembers; $90.00 AAOS members; $80.00 for residents; plus shipping and handling. ISBN 0892032170. Summary: This section of a book on musculoskeletal care provides health professionals with information on common conditions affecting the hand and wrist, including acute and chronic or repetitive injuries and degenerative, inflammatory, or idiopathic conditions. The section begins with information on the principles of evaluating and examining a patient presenting with a hand or wrist complaint, focusing on inspection, palpation, range of motion, muscle testing, and special testing. This is followed by a description of animal and human bite injuries; arthritis of the hand, thumb carpometacarpal joint, and wrist; boutonniere deformity; carpal tunnel syndrome; de Quervain tenosynovitis; Dupuytren disease; fingertip infections, injuries, and amputations; flexor tendon injuries and infections; fracture of the distal radius, scaphoid, metacarpals, phalanges, and base of the thumb metacarpal; ganglia of the wrist and hand; Kienbock disease; mallet finger; nail injuries; sprains and dislocations of

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the hand; trigger finger; tumors of the hand and wrist; and ulnar nerve entrapment at the wrist. Information includes synonyms for and red flags associated with each condition; the definition, clinical symptoms, diagnosis, differential diagnosis, adverse outcomes, and treatment of the condition; diagnostic tests; and adverse treatment outcomes. Other topics include metacarpophalangeal or proximal interphalangeal joint, thumb, carpal tunnel, de Quervain, and trigger finger injection; wrist aspiration or injection; digital anesthetic block of the hand; ganglion aspiration; and fishhook removal. 108 figures and 3 tables.

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CHAPTER 8. SYNDROME

MULTIMEDIA

ON

CARPAL

TUNNEL

Overview In this chapter, we show you how to keep current on multimedia sources of information on carpal tunnel syndrome. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Bibliography: Multimedia on Carpal Tunnel Syndrome The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in carpal tunnel syndrome (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on carpal tunnel syndrome: •

A patient's guide to carpal tunnel syndrome [electronic resource]. Year: 1993; Format: Electronic resource; Libby, Mont.: Medical Multimedia Group, c1993

•

Carpal tunnel syndrome [electronic resource] Source: produced by Med.I.A. Inc., Medical Interactive Applications; Year: 1993; Format: Electronic resource; Milwaukee, WI: Med.I.A., c1993

•

Carpal tunnel syndrome [motion picture] Source: Ohio State University; Year: 1964; Format: Motion picture; [Columbus, Ohio]: The University, [1964]

•

Carpal tunnel syndrome [videorecording] Source: author, Alan K. Reeter; produced by Medfilms Inc; Year: 1994; Format: Videorecording; Tucson, Ariz.: Medfilms, c1994

•

Endoscopic carpal tunnel release [videorecording] Source: American Academy of Orthopaedic Surgeons; Year: 1995; Format: Videorecording; [Rosemont, Ill.: The Academy?, 1995]

160 Carpal Tunnel Syndrome

•

Endoscopic carpal tunnel release [videorecording] Source: [presented by] American College of Surgeons and Ciné-Med; Year: 1998; Format: Videorecording; Woodbury, Conn.: Ciné-Med, c1998

•

Endoscopic operative treatment of carpal tunnel syndrome [videorecording]. Year: 1991; Format: Videorecording; [United States?: s.n., 1991]

•

Prevention and relief of neck pain, headache, and carpal tunnel syndrome [videorecording] Source: Activator Methods, Inc; Year: 1998; Format: Videorecording; Phoenix, AZ: Activator Methods, c1998

•

Surgical anatomy for endoscopic carpal tunnel release [videorecording] Source: American Academy of Orthopaedic Surgeons; Year: 1994; Format: Videorecording; [Rosemont, Ill.]: AAOS, c1994

•

Two-portal endoscopic carpal tunnel release [videorecording] Source: the American Academy of Orthopaedic Surgeons, Mayo Clinic, Scottsdale; Year: 2000; Format: Videorecording; Rosemont, Ill.: The Academy, c2000

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CHAPTER 9. PERIODICALS AND NEWS ON CARPAL TUNNEL SYNDROME Overview In this chapter, we suggest a number of news sources and present various periodicals that cover carpal tunnel syndrome.

News Services and Press Releases One of the simplest ways of tracking press releases on carpal tunnel syndrome is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “carpal tunnel syndrome” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to carpal tunnel syndrome. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “carpal tunnel syndrome” (or synonyms). The following was recently listed in this archive for carpal tunnel syndrome: •

Computer use not linked to carpal tunnel syndrome Source: Reuters Medical News Date: June 10, 2003

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•

Short-term oral steroids effective for carpal tunnel syndrome Source: Reuters Industry Breifing Date: December 16, 2002

•

Surgery produces better outcomes for carpal tunnel syndrome than splinting Source: Reuters Medical News Date: September 10, 2002

•

Genes may play role in carpal tunnel syndrome Source: Reuters Health eLine Date: July 02, 2002

•

Electrodiagnostic testing best for diagnosing carpal tunnel syndrome Source: Reuters Medical News Date: June 10, 2002

•

Forearm nerve conduction velocity distinguishes carpal tunnel syndrome from neuropathy Source: Reuters Medical News Date: April 09, 2002

•

Tests miss carpal tunnel syndrome in diabetics Source: Reuters Medical News Date: April 01, 2002

•

Carpal tunnel syndrome may run in the family Source: Reuters Medical News Date: April 27, 2001

•

Conservative treatment favored for carpal tunnel syndrome in young patients Source: Reuters Medical News Date: March 06, 2001

•

Low-dose hydrocortisone effective in carpal tunnel syndrome Source: Reuters Industry Breifing Date: November 24, 2000

•

Neutral wrist splinting improves carpal tunnel syndrome Source: Reuters Medical News Date: April 28, 2000

•

Collagen may hold key to carpal tunnel syndrome Source: Reuters Health eLine Date: March 13, 2000

•

Carpal tunnel syndrome common in general population Source: Reuters Medical News Date: July 14, 1999

•

Carpal tunnel syndrome common Source: Reuters Health eLine Date: July 13, 1999

•

Oral corticosteroids effective in treatment of carpal tunnel syndrome Source: Reuters Medical News Date: August 20, 1998

•

Etiology of carpal tunnel syndrome not always work-related Source: Reuters Medical News Date: August 03, 1998

Periodicals and News

•

Vitamin B6 Supplements May Relieve Carpal Tunnel Syndrome Source: Reuters Medical News Date: October 16, 1997

•

Vitamins Linked to Carpal Tunnel Syndrome Source: Reuters Health eLine Date: October 15, 1997

•

Role Of Vitamin B6 In Carpal Tunnel Syndrome Questioned Source: Reuters Medical News Date: June 28, 1996

•

Vitamin B6 Deficiency Not A Cause Of Carpal Tunnel Syndrome Source: Reuters Medical News Date: May 10, 1996

•

Interleukin-2 Use May Cause Carpal Tunnel Syndrome Source: Reuters Medical News Date: March 18, 1996

•

Balloon Dilatation An Effective New Treatment For Carpal Tunnel Syndrome Source: Reuters Medical News Date: February 23, 1996

•

Carpal Tunnel Syndrome, Alcohol Use Among Teens Discussed At Public Health Meeting Source: Reuters Medical News Date: November 03, 1995

163

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “carpal tunnel syndrome” (or synonyms) into the search box, and click on “Search News.” As this service is

164 Carpal Tunnel Syndrome

technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “carpal tunnel syndrome” (or synonyms). If you know the name of a company that is relevant to carpal tunnel syndrome, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “carpal tunnel syndrome” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “carpal tunnel syndrome” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on carpal tunnel syndrome: •

Carpal Tunnel Syndrome: Make Way for Relief Source: Mayo Clinic Health Letter. 20(1):4-5. January 2002. Contact: Available from Mayo Clinic Health Letter. 200 First Street SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article presents an overview of the symptoms, risk factors, and treatment of patients with carpal tunnel syndrome. Carpal tunnel syndrome is caused by compression of the median nerve in the wrist. Carpal tunnel occurs most frequently in middle-aged women and is associated with work that requires repetitive grasping, wrist bending, or prolonged gripping. Patients with obesity, osteoarthritis, diabetes, rheumatoid arthritis, or thyroid disorders are at greater risk. People with previous wrist fractures, using oral contraceptives, experiencing hormonal changes due to pregnancy, or have hand or arm swelling after exercise are also at risk. Symptoms may include swelling, numbness, tingling, burning sensation, hand weakness, and muscle shrinkage. The doctor, after examination, may recommend conservative treatment options such as NSAIDs, night splints to immobilize the wrist, or corticosteroid injections to decrease inflammation. If the symptoms do not improve,

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165

then surgery may be performed. The surgical procedure is known as carpal tunnel release and is done on an outpatient basis. The transverse carpal is severed to relieve the pressure on the median nerve. Recovery usually takes 6 weeks, and 75 percent of those who have the surgery experience complete relief.

Academic Periodicals covering Carpal Tunnel Syndrome Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to carpal tunnel syndrome. In addition to these sources, you can search for articles covering carpal tunnel syndrome that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

167

CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for carpal tunnel syndrome. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with carpal tunnel syndrome. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks,

168 Carpal Tunnel Syndrome

etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to carpal tunnel syndrome: Corticosteroids •

Dental - U.S. Brands: Kenalog in Orabase; Orabase-HCA; Oracort; Oralone http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202010.html

•

Inhalation - U.S. Brands: AeroBid; AeroBid-M; Azmacort; Beclovent; Decadron Respihaler; Pulmicort Respules; Pulmicort Turbuhaler; Vanceril; Vanceril 84 mcg Double Strength http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202011.html

•

Nasal - U.S. Brands: Beconase; Beconase AQ; Dexacort Turbinaire; Flonase; Nasacort; Nasacort AQ; Nasalide; Nasarel; Nasonex; Rhinocort; Vancenase; Vancenase AQ 84 mcg; Vancenase pockethaler http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202012.html

•

Ophthalmic - U.S. Brands: AK-Dex; AK-Pred; AK-Tate; Baldex; Decadron; Dexair; Dexotic; Econopred; Econopred Plus; Eflone; Flarex; Fluor-Op; FML Forte; FML Liquifilm; FML S.O.P.; HMS Liquifilm; Inflamase Forte; Inflamase Mild; I-Pred; Lite Pred; Maxidex; Ocu-Dex; Ocu-Pred; Ocu-Pr http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202013.html

•

Otic - U.S. Brands: Decadron http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202014.html

•

Rectal - U.S. Brands: Anucort-HC; Anu-Med HC; Anuprep HC; Anusol-HC; Anutone-HC; Anuzone-HC; Cort-Dome; Cortenema; Cortifoam; Hemorrhoidal HC; Hemril-HC Uniserts; Proctocort; Proctosol-HC; Rectosol-HC http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203366.html

Lidocaine •

Topical - U.S. Brands: Lidoderm http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500058.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

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169

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

173

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

174 Carpal Tunnel Syndrome

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “carpal tunnel syndrome” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 5123 70 250 8 3 5454

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “carpal tunnel syndrome” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

15

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

16

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

The Genome Project and Carpal Tunnel Syndrome In the following section, we will discuss databases and references which relate to the Genome Project and carpal tunnel syndrome. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).23 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information.

20 Adapted 21

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 23 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

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To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “carpal tunnel syndrome” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for carpal tunnel syndrome: •

Carpal Tunnel Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?115430 Genes and Disease (NCBI - Map)

The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: •

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

•

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

•

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

•

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

•

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html

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•

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

•

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez

Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: •

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

•

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

•

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

•

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

•

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

•

PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

•

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

•

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

•

Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

•

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then

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select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “carpal tunnel syndrome” (or synonyms) into the search box and click “Go.” Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database24 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database25 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “carpal tunnel syndrome” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

24 Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 25 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on carpal tunnel syndrome can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to carpal tunnel syndrome. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to carpal tunnel syndrome. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “carpal tunnel syndrome”:

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•

Guides on carpal tunnel syndrome Carpal Tunnel Syndrome http://www.nlm.nih.gov/medlineplus/tutorials/carpaltunnelopenloader.html

•

Other guides Bell's Palsy http://www.nlm.nih.gov/medlineplus/bellspalsy.html Carpal Tunnel Syndrome http://www.nlm.nih.gov/medlineplus/carpaltunnelsyndrome.html Charcot-Marie-Tooth Disease http://www.nlm.nih.gov/medlineplus/charcotmarietoothdisease.html Diabetic Nerve Problems http://www.nlm.nih.gov/medlineplus/diabeticnerveproblems.html Dizziness and Vertigo http://www.nlm.nih.gov/medlineplus/dizzinessandvertigo.html Ergonomics http://www.nlm.nih.gov/medlineplus/ergonomics.html Foot Injuries and Disorders http://www.nlm.nih.gov/medlineplus/footinjuriesanddisorders.html Hand Injuries and Disorders http://www.nlm.nih.gov/medlineplus/handinjuriesanddisorders.html Multiple Sclerosis http://www.nlm.nih.gov/medlineplus/multiplesclerosis.html Neurologic Diseases http://www.nlm.nih.gov/medlineplus/neurologicdiseases.html Peripheral Nerve Disorders http://www.nlm.nih.gov/medlineplus/peripheralnervedisorders.html Tendinitis http://www.nlm.nih.gov/medlineplus/tendinitis.html

Within the health topic page dedicated to carpal tunnel syndrome, the following was listed: •

General/Overviews Carpal Tunnel Syndrome http://www.nlm.nih.gov/medlineplus/tutorials/carpaltunnelopenloader.html Carpal Tunnel Syndrome Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00326 JAMA Patient Page: Carpal Tunnel Syndrome Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZVK53OZ5D& sub_cat=181

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Diagnosis/Symptoms Arthroscopy Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=33&topcategory=A bout%2520Orthopaedics&searentry=arthroscopy Hand/Wrist/Arm Problems: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/526.html MR Imaging (MRI)-Musculoskeletal Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/mr_musculoskeletal.htm

•

Treatment Arthroscopy Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=33&topcategory=A bout%2520Orthopaedics&searentry=arthroscopy Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=PN00038

•

Children Carpal Tunnel Syndrome Source: Nemours Foundation http://kidshealth.org/kid/ill_injure/aches/carpal.html

•

From the National Institutes of Health Carpal Tunnel Syndrome Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/carpal_doc.htm Carpal Tunnel Syndrome Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/pubs/carpal_tunnel.htm

•

Organizations American Academy of Orthopaedic Surgeons http://www.aaos.org/ American Society for Surgery of the Hand http://www.hand-surg.org/ National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/

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•

Pictures/Diagrams Atlas of the Body: The Carpal Tunnel Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZDLCB46JC& sub_cat=181

•

Prevention/Screening Alternative Keyboards http://www.cdc.gov/niosh/pdfs/97-148.pdf Carpal Tunnel Syndrome: Preventing the Pain in Your Hands and Wrists Source: American Academy of Family Physicians http://familydoctor.org/healthfacts/023/

•

Statistics Repetitive Motion Leads to Longest Work Absences Source: Bureau of Labor Statistics http://www.bls.gov/opub/ted/2002/apr/wk5/art03.htm

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on carpal tunnel syndrome. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Carpal Tunnel Syndrome Source: Atlanta, GA: Arthritis Foundation. 1997. 10 p. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 300091616. (800) 207-8633. Fax (credit card orders only) (770) 442-9742. http://www.arthritis.org. PRICE: Single copy free from local Arthritis Foundation chapter (call 800-283-7800 for closest local chapter); bulk orders may be purchased from address above. Summary: This brochure for people with carpal tunnel syndrome (CTS) uses a question and answer format to provide information on this condition. It explains that CTS can affect one or both hands and can occur at any age, and describes the symptoms and possible causes. Also discussed are how a diagnosis is made and what treatments are

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available. The brochure also provides information on the Arthritis Foundation and its services. 2 figures. •

About Carpal Tunnel Syndrome Source: South Deerfield, MA: Channing L. Bete Company, Inc. 1997. 15 p. Contact: Available from Channing L. Bete Company, Inc., 200 State Road, South Deerfield, MA 01373. (800) 628-7733. Summary: This illustrated booklet for the general public discusses carpal tunnel syndrome (CTS). It describes the anatomical components of the carpal tunnel, defines CTS, and identifies individuals who are at risk for CTS. The booklet outlines the symptoms of CTS, explains how CTS is diagnosed and treated, and offers suggestions for preventing CTS. In addition, it answers common questions about CTS.

•

Carpal Tunnel Syndrome: Relieving the Pressure in Your Wrist Source: San Bruno, CA: StayWell Company. 1999. 8 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have carpal tunnel syndrome (CTS) with information on this common and troublesome condition that interferes with the use of the hand. The booklet describes the anatomy of the carpal tunnel, identifies some of the symptoms of CTS, and explains how CTS is diagnosed and treated. Diagnosis is based on a medical history, a physical examination, and x rays or other tests. Early treatments include taking medications such as aspirin or ibuprofen, receiving a cortisone injection, and wearing a splint. Surgery may be required if CTS symptoms become severe or if no other treatment relieves symptoms. The booklet then presents the steps involved in preparing for surgery, identifies goals and risks, describes the surgical procedures that can be used, and provides postoperative care guidelines. 17 figures.

•

Preventing Carpal Tunnel Syndrome: Reducing Your Risk Source: San Bruno, CA: StayWell Company. 1998. 8 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: $1.30 each; bulk discounts available. Item Number 11050LDFF. Summary: This illustrated booklet provides the general public with information on the prevention of carpal tunnel syndrome (CTS). This painful condition limits the use of the hands. Awkward and repeated hand and wrist movements may cause the sheaths of the flexor tendon to swell. The swollen sheaths have no room to expand because they are surrounded by bone and ligament, so they press against the median nerve, causing symptoms. Early symptoms include tiredness or tenderness in the hands or numbness of the hands at night. Ways to prevent CTS include using safe body posture, giving the hands and body a rest while performing various tasks during the day, and exercising. Tips for relieving minor symptoms include applying ice and heat, massaging the arm, and taking nonprescription analgesics. The booklet includes a list of questions readers can answer to determine whether they are at increased risk of CTS. 7 figures.

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The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “carpal tunnel syndrome” (or synonyms). The following was recently posted: •

Carpal tunnel syndrome Source: American Society of Plastic Surgeons - Medical Specialty Society; 1998 January 24; 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1572&nbr=798&am p;string=carpal+AND+tunnel+AND+syndrome

•

Practice parameter: electrodiagnostic studies in carpal tunnel syndrome Source: American Academy of Neurology - Medical Specialty Society; 1993 October (revised 2002); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3289&nbr=2515&a mp;string=carpal+AND+tunnel+AND+syndrome Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Carpal Tunnel Syndrome Fact Sheet Summary: This is a fact sheet describing the symptoms and causes of carpal tunnel syndrome. Source: National Institute of Neurological Disorders and Stroke, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7200

•

Carpal Tunnel Syndrome Question & Answers Summary: This patient education fact sheet describes the symptoms of carpal tunnel syndrome and discusses diagnosis, treatment, causes, and post-surgical recovery. Source: American Academy of Orthopaedic Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4847

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Understanding Carpal Tunnel Syndrome Summary: Carpal tunnel syndrome (CTS) is a term that refers to nerve compression in the wrist that results in pain, a burning sensation, numbness, and tingling in the wrist, hand, and/or fingers. Source: American Occupational Therapy Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7310 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to carpal tunnel syndrome. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to carpal tunnel syndrome. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with carpal tunnel syndrome. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about carpal tunnel syndrome. For more

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information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “carpal tunnel syndrome” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “carpal tunnel syndrome”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “carpal tunnel syndrome” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “carpal tunnel syndrome” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.26

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

26

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)27: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

27

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

191

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

192 Carpal Tunnel Syndrome

•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

193

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

194 Carpal Tunnel Syndrome

•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

195

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on carpal tunnel syndrome: •

Basic Guidelines for Carpal Tunnel Syndrome Carpal tunnel syndrome Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000433.htm Carpal tunnel syndrome Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002976.htm PMS Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001505.htm RA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000431.htm SLE Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000435.htm

196 Carpal Tunnel Syndrome

•

Signs & Symptoms for Carpal Tunnel Syndrome Decreased sensation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm High blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003082.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Obesity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Problems breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Sensory loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm

•

Diagnostics and Tests for Carpal Tunnel Syndrome Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm Electromyography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm Nerve conduction velocity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003927.htm Wrist X-rays Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003810.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm

Online Glossaries 197

•

Surgery and Procedures for Carpal Tunnel Syndrome Carpal tunnel release Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002976.htm

•

Background Topics for Carpal Tunnel Syndrome Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

199

CARPAL TUNNEL SYNDROME DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abduction: Forcible pulling of a limb away from its natural position, a risk in road accidents and disasters; move outwards away from middle line. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acupuncture Analgesia: Analgesia produced by the insertion of acupuncture needles at certain points in the body. These activate the small myelinated nerve fibers in the muscle which transmit impulses to the spinal cord and then activate three centers - the spinal cord, midbrain and pituitary hypothalamus - to produce analgesia. [NIH] Acupuncture Points: Designated locations along nerves or organ meridians for inserting acupuncture needles. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adduction: The rotation of an eye toward the midline (nasally). [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and

200 Carpal Tunnel Syndrome

dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Aeroembolism: Joint pains, respiratory distress, and central nervous system symptoms which may follow decompression after exposure to air or other gas mixture at a pressure greater than the normal atmospheric pressure. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amitriptyline: Tricyclic antidepressant with anticholinergic and sedative properties. It appears to prevent the re-uptake of norepinephrine and serotonin at nerve terminals, thus potentiating the action of these neurotransmitters. Amitriptyline also appears to antaganize cholinergic and alpha-1 adrenergic responses to bioactive amines. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular

Dictionary 201

fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anterior Cerebral Artery: Artery formed by the bifurcation of the internal carotid artery. Branches of the anterior cerebral artery supply the caudate nucleus, internal capsule, putamen, septal nuclei, gyrus cinguli, and surfaces of the frontal lobe and parietal lobe. [NIH]

202 Carpal Tunnel Syndrome

Anterograde: Moving or extending forward; called also antegrade. [EU] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH]

Dictionary 203

Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteritis: Inflammation of an artery. [NIH] Arthropathy: Any joint disease. [EU] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Arthroscopy: Endoscopic examination, therapy and surgery of the joint. [NIH] Arthrosis: A disease of a joint. [EU] Articular: Of or pertaining to a joint. [EU] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Axilla: The underarm or armpit. [NIH] Axonal: Condition associated with metabolic derangement of the entire neuron and is manifest by degeneration of the distal portion of the nerve fiber. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Injuries: General or unspecified injuries to the posterior part of the trunk. It includes injuries to the muscles of the back. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls,

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multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Bends: The form of aeroembolism that is marked by intense pain in muscles and joints due to formation of gas bubbles in the tissues. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Beta 2-Microglobulin: An 11 kDa protein associated with the outer membrane of many cells including lymphocytes. It is the small subunit of the MHC class I molecule. Association with beta 2-microglobulin is generally required for the transport of class I heavy chains from the endoplasmic reticulum to the cell surface. Beta 2-microglobulin is present in small amounts in serum, csf, and urine of normal people, and to a much greater degree in the urine and plasma of patients with tubular proteinemia, renal failure, or kidney transplants. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber.

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Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Boron: A trace element with the atomic symbol B, atomic number 5, and atomic weight 10.81. Boron-10, an isotope of boron, is used as a neutron absorber in boron neutron capture therapy. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Artery: The continuation of the axillary artery; it branches into the radial and ulnar arteries. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bunion: A swelling of the bursa mucosa of the ball of the great toe, with thickening of the overlying skin and forcing of the toe outward. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [EU] Calcinosis: Pathologic deposition of calcium salts in tissues. [NIH]

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Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Canthaxanthin: A trans-carotenoid pigment widely distributed in nature. The compound is used as an oral suntanning agent and as a food and drug coloring agent. It is believed that it inhibits development of tumor cells and neoplastic transformation through its antioxidant properties. Oral ingestion of the compound causes canthaxanthin retinopathy. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotenoids: Substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. May reduce the risk of developing cancer. [NIH] Carpal Bones: The eight bones of the wrist: capitate bone, hamate bone, lunate bone (semilunar bone), pisiform bone, scaphoid bone, trapezium bone, trapezoid bone and triquetral bone. [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship

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of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellar Diseases: Diseases that affect the structure or function of the cerebellum. Cardinal manifestations of cerebellar dysfunction include dysmetria, gait ataxia, and muscle hypotonia. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction).

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[NIH]

Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU]

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Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen, which is a component of the connective tissue. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the

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standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confined Spaces: A space which has limited openings for entry and exit combined with unfavorable natural ventilation such as caves, refrigerators, deep tunnels, pipelines, sewers, silos, tanks, vats, mines, deep trenches or pits, vaults, manholes, chimneys, etc. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

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Contusions: Injuries resulting in hemorrhage, usually manifested in the skin. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneal Opacity: Disorder occurring in the central or peripheral area of the cornea. The usual degree of transparency becomes relatively opaque. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Criterion: A standard by which something may be judged. [EU] CSF: Cerebrospinal fluid. The fluid flowing around the brain and spinal cord. CSF is produced in the ventricles of the brain. [NIH] Cubital Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Cumulative Trauma Disorders: Harmful and painful condition caused by overuse or overexertion of some part of the musculoskeletal system, often resulting from work-related physical activities. It is characterized by inflammation, pain, or dysfunction of the involved joints, bones, ligaments, and nerves. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S.

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crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curcumin: A dye obtained from tumeric, the powdered root of Curcuma longa Linn. It is used in the preparation of curcuma paper and the detection of boron. Curcumin appears to possess a spectrum of pharmacological properties, due primarily to its inhibitory effects on metabolic enzymes. [NIH] Cutaneous: Having to do with the skin. [NIH] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Hygienists: Persons trained in an accredited school or dental college and licensed by the state in which they reside to provide dental prophylaxis under the direction of a licensed dentist. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Dermal: Pertaining to or coming from the skin. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Dexterity: Ability to move the hands easily and skillfully. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnosis, Differential: Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH]

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Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duke: A lamp which produces ultraviolet radiations for certain ophthalmologic therapy. [NIH]

Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active

214 Carpal Tunnel Syndrome

second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrodiagnosis: Diagnosis of disease states by recording the spontaneous electrical activity of tissues or organs or by the response to stimulation of electrically excitable tissue. [NIH] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences,

Dictionary 215

or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophilia: Abnormal increase in eosinophils in the blood, tissues or organs. [NIH] Epicondylitis: Inflammation of the epicondyle or of the tissues adjoining the epicondyle of the humerus. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Ergonomics: Study of the relationships between man and machines; adjusting the design of machines to the need and capacities of man; study of the effect of machines on man's behavior. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fasciitis: Inflammation of the fascia. There are three major types: 1) Eosinophilic fasciitis, an inflammatory reaction with eosinophilia, producing hard thickened skin with an orangepeel configuration suggestive of scleroderma and considered by some a variant of

216 Carpal Tunnel Syndrome

scleroderma; 2) Necrotizing fasciitis, a serious fulminating infection (usually by a beta hemolytic Streptococcus) causing extensive necrosis of superficial fascia; 3) Nodular/Pseudosarcomatous/Proliferative fasciitis, characterized by a rapid growth of fibroblasts with mononuclear inflammatory cells and proliferating capillaries in soft tissue, often the forearm; it is not malignant but is sometimes mistaken for fibrosarcoma. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Febrile: Pertaining to or characterized by fever. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosarcoma: A type of soft tissue sarcoma that begins in fibrous tissue, which holds bones, muscles, and other organs in place. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Flexor: Muscles which flex a joint. [NIH] Follicular Phase: The period of the menstrual cycle that begins with menstruation and ends with ovulation. [NIH]

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Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Functional Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gait: Manner or style of walking. [NIH] Galactorrhoea: Excessive or spontaneous flow of milk; persistent secretion of milk irrespective of nursing. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH]

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Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genital: Pertaining to the genitalia. [EU] Gestures: Movement of a part of the body for the purpose of communication. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH]

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Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Haemodialysis: The removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a haemodialyzer. [EU] Hallux Valgus: Lateral displacement of the great toe, producing deformity of the first metatarsophalangeal joint with callous, bursa, or bunion formation over the bony prominence. [NIH] Hamartoma: A focal malformation resembling a neoplasm, composed of an overgrowth of mature cells and tissues that normally occur in the affected area. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematoxylin: A dye obtained from the heartwood of logwood (Haematoxylon campechianum Linn., Leguminosae) used as a stain in microscopy and in the manufacture of ink. [NIH] Hemiparesis: The weakness or paralysis affecting one side of the body. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH]

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Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humeral: 1. Of, relating to, or situated in the region of the humerus: brachial. 2. Of or belonging to the shoulder. 3. Of, relating to, or being any of several body parts that are analogous in structure, function, or location to the humerus or shoulder. [EU] Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic

Dictionary 221

acid can result in impaired hydroxyproline formation. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypodermic: Applied or administered beneath the skin. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH]

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Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the

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large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischial: A pointed projection on the posterior margin of the ischium. [NIH] Isotonic: A biological term denoting a solution in which body cells can be bathed without a net flow of water across the semipermeable cell membrane. Also, denoting a solution having the same tonicity as some other solution with which it is compared, such as physiologic salt solution and the blood serum. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Joint Capsule: The sac enclosing a joint. It is composed of an outer fibrous articular capsule and an inner synovial membrane. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH]

224 Carpal Tunnel Syndrome

Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipoma: A benign tumor composed of fat cells. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lunate: A curved sulcus of the lateral surface which forms the anterior limit of the visual cortex. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically

Dictionary 225

involves the nasal, buccal, and conjunctival mucosa. [NIH] Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphedema: Edema due to obstruction of lymph vessels or disorders of the lymph nodes. [NIH]

Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Median Neuropathy: Disease involving the median nerve, from its origin at the brachial plexus to its termination in the hand. Clinical features include weakness of wrist and finger flexion, forearm pronation, thenar abduction, and loss of sensation over the lateral palm, first three fingers, and radial half of the ring finger. Common sites of injury include the elbow, where the nerve passes through the two heads of the pronator teres muscle (pronator syndrome) and in the carpal tunnel (carpal tunnel syndrome). [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and

226 Carpal Tunnel Syndrome

intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meniscus: A fibro-cartilage within a joint, especially of the knee. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metacarpophalangeal Joint: The articulation between a metacarpal bone and a phalanx. [NIH]

Metatarsophalangeal Joint: The articulation between a metatarsal bone and a phalanx. [NIH] Mexiletine: Antiarrhythmic agent pharmacologically similar to lidocaine. It may have some anticonvulsant properties. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU]

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Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Mononeuropathies: Disease or trauma involving a single peripheral nerve in isolation, or out of proportion to evidence of diffuse peripheral nerve dysfunction. Mononeuropathy multiplex refers to a condition characterized by multiple isolated nerve injuries. Mononeuropathies may result from a wide variety of causes, includingischemia; traumatic injury; compression; connective tissue diseases; cumulative trauma disorders; and other conditions. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple Myeloma: A malignant tumor of plasma cells usually arising in the bone marrow; characterized by diffuse involvement of the skeletal system, hyperglobulinemia, Bence-Jones proteinuria, and anemia. [NIH] Muscle Fatigue: A state arrived at through prolonged and strong contraction of a muscle. Studies in athletes during prolonged submaximal exercise have shown that muscle fatigue increases in almost direct proportion to the rate of muscle glycogen depletion. Muscle fatigue in short-term maximal exercise is associated with oxygen lack and an increased level of blood and muscle lactic acid, and an accompanying increase in hydrogen-ion concentration in the exercised muscle. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting

228 Carpal Tunnel Syndrome

at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Myelography: X-ray visualization of the spinal cord following injection of contrast medium into the spinal arachnoid space. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Neck Muscles: The neck muscles consist of the platysma, splenius cervicis, sternocleidomastoid(eus), longus colli, the anterior, medius, and posterior scalenes, digastric(us), stylohyoid(eus), mylohyoid(eus), geniohyoid(eus), sternohyoid(eus), omohyoid(eus), sternothyroid(eus), and thyrohyoid(eus). [NIH] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis,

Dictionary 229

as the neutral arch. [EU] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Blockade: The intentional interruption of transmission at the neuromuscular junction by external agents, usually neuromuscular blocking agents. It is distinguished from nerve block in which nerve conduction is interrupted rather than neuromuscular transmission. Neuromuscular blockade is commonly used to produce muscle relaxation as an adjunct to anesthesia during surgery and other medical procedures. It is also often used as an experimental manipulation in basic research. It is not strictly speaking anesthesia but is grouped here with anesthetic techniques. The failure of neuromuscular transmission as a result of pathological processes is not included here. [NIH] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH]

230 Carpal Tunnel Syndrome

Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Occupational Exposure: The exposure to potentially harmful chemical, physical, or biological agents that occurs as a result of one's occupation. [NIH] Occupational Health: The promotion and maintenance of physical and mental health in the work environment. [NIH] Occupational Medicine: Medical specialty concerned with the promotion and maintenance of the physical and mental health of employees in occupational settings. [NIH] Onychomycosis: Mycosis of the nails, possibly due to some extent to humidity. [NIH] Ophthalmologic: Pertaining to ophthalmology (= the branch of medicine dealing with the eye). [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Orthostatic: Pertaining to or caused by standing erect. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the

Dictionary 231

outlines of organs. [NIH] Palsies: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paraesthesia: Morbid or perverted sensation; an abnormal sensation, as burning, prickling, formication, etc. [EU] Paralysis: Loss of ability to move all or part of the body. [NIH] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Paresthesia: Subjective cutaneous sensations (e.g., cold, warmth, tingling, pressure, etc.) that are experienced spontaneously in the absence of stimulation. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perineural: Around a nerve or group of nerves. [NIH]

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Peripheral Nerves: The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peroneal Nerve: The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected

Dictionary 233

to the hypothalamus by a short stalk. [NIH] Placebo Effect: An effect usually, but not necessarily, beneficial that is attributable to an expectation that the regimen will have an effect, i.e., the effect is due to the power of suggestion. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Popliteal Cyst: A synovial cyst in the popliteal space arising from the semimembranous bursa or the knee joint. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Postural: Pertaining to posture or position. [EU] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and

234 Carpal Tunnel Syndrome

costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Pronation: Applies to movements of the forearm in turning the palm backward or downward or when applied to the foot, a combination of eversion and abduction movements in the tarsal and metatarsal joints, (turning the foot up and in toward the

Dictionary 235

midline of the body). [NIH] Pronator: A muscle which turns a part into the prone position. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Putrefaction: The process of decomposition of animal and vegetable matter by living

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organisms. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radial Artery: The direct continuation of the brachial trunk, originating at the bifurcation of the brachial artery opposite the neck of the radius. Its branches may be divided into three groups corresponding to the three regions in which the vessel is situated, the forearm, wrist, and hand. [NIH] Radial Nerve: A major nerve of the upper extremity. In humans the fibers of the radial nerve originate in the lower cervical and upper thoracic spinal cord (usually C5 to T1), travel via the posterior cord of the brachial plexus, and supply motor innervation to extensor muscles of the arm and cutaneous sensory fibers to extensor regions of the arm and hand. [NIH]

Radial Neuropathy: Disease involving the radial nerve. Clinical features include weakness of elbow extension, elbow flexion, supination of the forearm, wrist and finger extension, and thumb abduction. Sensation may be impaired over regions of the dorsal forearm. Common sites of compression or traumatic injury include the axilla and radial groove of the humerus. [NIH]

Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radicular: Having the character of or relating to a radicle or root. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]

Radioactive: Giving off radiation. [NIH] Radius: The lateral bone of the forearm. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH]

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Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal Osteodystrophy: Decalcification of bone due to hyperparathyroidism secondary to chronic kidney disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Research Support: Financial support of research activities. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested

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as possible causes. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rotator: A muscle by which a part can be turned circularly. [NIH] Rotator Cuff: The musculotendinous sheath formed by the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. These help stabilize the head of the humerus in the glenoid fossa and allow for rotation of the shoulder joint about its longitudinal axis. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Scaphoid Bone: The bone which is located most lateral in the proximal row of carpal bones. [NIH]

Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the

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personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semilunar Bone: A carpal bone which is located between the scaphoid and triquelateral bones. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [NIH] Sensory Thresholds: The minimum amount of stimulus energy necessary to elicit a sensory response. [NIH]

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Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shoulder Pain: Unilateral or bilateral pain of the shoulder. It is often caused by physical activities such as work or sports participation, but may also be pathologic in origin. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Class: A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income. [NIH]

Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for

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oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH]

242 Carpal Tunnel Syndrome

Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Standardize: To compare with or conform to a standard; to establish standards. [EU] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclavian Artery: Artery arising from the brachiocephalic trunk on the right side and from the arch of the aorta on the left side. It distributes to the neck, thoracic wall, spinal cord, brain, meninges, and upper limb. [NIH] Subclavian Vein: The continuation of the axillary vein which follows the subclavian artery and then joins the internal jugular vein to form the brachiocephalic vein. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supination: Applies to the movements of the forearm in turning the palm forward or upward and when applied to the foot, a combination of adduction and inversion of the foot. [NIH]

Suppression: A conscious exclusion of disapproved desire contrary with repression, in

Dictionary 243

which the process of exclusion is not conscious. [NIH] Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathectomy: The removal or interruption of some part of the sympathetic nervous system for therapeutic or research purposes. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Cyst: A nodular, tumorlike lesion in or about a tendon sheath or joint capsule, especially of the hands, wrists, or feet. It is not a true cyst as it lacks an epithelial wall, and it does not communicate with the underlying synovial space. The lesion represents a focal accumulation of mucin in the dermis of the dorsal aspect of the distal phalanges or, less often, other portions of the extremities. [NIH] Synovial Fluid: The clear, viscous fluid secreted by the synovial membrane. It contains mucin, albumin, fat, and mineral salts and serves to lubricate joints. [NIH] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tarsal Tunnel Syndrome: A syndrome produced by entrapment neuropathy of posterior tibial nerve. [NIH] Technology Transfer: Spread and adoption of inventions and techniques from one geographic area to another, from one discipline to another, or from one sector of the economy to another. For example, improvements in medical equipment may be transferred from industrial countries to developing countries, advances arising from aerospace

244 Carpal Tunnel Syndrome

engineering may be applied to equipment for persons with disabilities, and innovations in science arising from government research are made available to private enterprise. [NIH] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Tendon Injuries: Injuries to the fibrous cords of connective tissue which attach muscles to bones or other structures. [NIH] Tendon Transfer: Surgical procedure by which a tendon is incised at its insertion and placed at an anatomical site distant from the original insertion. The tendon remains attached at the point of origin and takes over the function of a muscle inactivated by trauma or disease. [NIH] Tendonitis: Inflammation of tendons attached to the biceps muscle, i. e. the main flexor muscle of the upper arm. [NIH] Tennis Elbow: A condition characterized by pain in or near the lateral humeral epicondyle or in the forearm extensor muscle mass as a result of unusual strain. It occurs in tennis players as well as housewives, artisans, and violinists. [NIH] Tenosynovitis: Inflammation of a tendon sheath. [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermography: Measurement of the regional temperature of the body or an organ by infrared sensing devices, based on self-emanating infrared radiation. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thoracic Outlet Syndrome: A neurovascular syndrome associated with compression of the brachial plexus; subclavian artery; and subclavian vein at the superior thoracic outlet. This may result from a variety of anomalies such as a cervical rib (cervical rib syndrome), anomalous fascial bands, and abnormalities of the origin or insertion of the anterior or medial scalene muscles. Clinical features may include pain in the shoulder and neck region which radiates into the arm, paresis or paralysis of brachial plexus innervated muscles, paresthesia, loss of sensation, reduction of arterial pulses in the affected extremity, ischemia, and edema. (Adams et al., Principles of Neurology, 6th ed, pp214-5). [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Tibial Nerve: The medial terminal branch of the sciatic nerve. The tibial nerve fibers

Dictionary 245

originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tonicity: The normal state of muscular tension. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transcutaneous: Transdermal. [EU] Transcutaneous Electric Nerve Stimulation: Electrical stimulation of nerves and/or muscles to relieve pain; it is used less frequently to produce anesthesia. The optimal placements of electrodes or "trigger points" may correspond with acupuncture analgesia points. TENS is sometimes referred to as acupuncture-like when using a low frequency stimulus. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translation: The process whereby the genetic information present in the linear sequence of

246 Carpal Tunnel Syndrome

ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Truncal: The bilateral dissection of the abdominal branches of the vagus nerve. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulna: The long and medial bone of the forearm. [NIH] Ulnar Nerve: A major nerve of the upper extremity. In humans, the fibers of the ulnar nerve originate in the lower cervical and upper thoracic spinal cord (usually C7 to T1), travel via the medial cord of the brachial plexus, and supply sensory and motor innervation to parts of the hand and forearm. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of

Dictionary 247

urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visual Cortex: Area of the occipital lobe concerned with vision. [NIH] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the

248 Carpal Tunnel Syndrome

cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Word Processing: Automated production of typewritten documents with text editing and storage functions using computer software. [NIH] Wrist Injuries: Injuries to the wrist or the wrist joint. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

249

INDEX A Abdominal, 199, 223, 231, 232, 234, 246 Abduction, 6, 129, 199, 225, 234, 236 Acrylonitrile, 199, 238 Activities of Daily Living, 131, 133, 199 Acupuncture Analgesia, 199, 245 Acupuncture Points, 21, 90, 199 Adaptation, 17, 38, 199 Adduction, 129, 199, 242 Adenosine, 199, 232 Adjustment, 12, 97, 103, 107, 199 Adrenal Cortex, 199, 211, 220, 234 Adrenal Glands, 199, 201 Adrenergic, 199, 200 Adverse Effect, 199, 240 Aerobic, 35, 199 Aerobic Exercise, 35, 199 Aeroembolism, 200, 204 Afferent, 16, 200, 241 Age Groups, 139, 200 Aged, 80 and Over, 200 Algorithms, 200, 204 Alimentary, 200, 222, 231 Alkaline, 200, 206 Alkaloid, 200, 206, 227 Allergen, 200, 239 Alpha Particles, 200, 236 Alpha-1, 200 Alternative medicine, 163, 200 Ameliorating, 119, 200 Amino Acids, 200, 233, 235, 238, 246 Amitriptyline, 19, 90, 200 Ammonia, 200, 243, 246 Ampulla, 200, 214 Amputation, 152, 154, 200 Amyloid, 32, 38, 53, 58, 156, 200 Amyloidosis, 27, 53, 58, 82, 152, 155, 156, 201 Anal, 14, 29, 201, 216 Analgesic, 139, 201, 221, 227, 230 Anaphylatoxins, 201, 209 Anastomosis, 62, 201 Anatomical, 149, 185, 201, 221, 239, 244 Androgens, 199, 201, 211 Anemia, 74, 152, 201, 227 Anesthesia, 40, 138, 154, 201, 212, 214, 229, 234, 245 Anesthetics, 138, 201

Angioplasty, 13, 201 Animal model, 6, 11, 20, 201 Ankle, 16, 100, 153, 156, 201 Anomalies, 39, 201, 244 Anterior Cerebral Artery, 201, 207 Anterograde, 8, 202 Antiallergic, 202, 211 Antibacterial, 202, 241 Antibiotic, 202, 241 Antibodies, 202, 221, 233 Antibody, 202, 209, 220, 221, 222, 239, 241 Anticholinergic, 200, 202 Anticoagulant, 68, 202 Anticonvulsant, 202, 226 Antidepressant, 200, 202 Antigen, 202, 209, 220, 221, 222, 239 Antigen-Antibody Complex, 202, 209 Anti-inflammatory, 5, 97, 107, 128, 142, 202, 203, 211, 218, 221, 234 Anti-Inflammatory Agents, 5, 202, 203, 211 Antineoplastic, 202, 211 Antioxidant, 119, 202, 203, 206, 230 Anus, 201, 202, 205, 220, 222 Apathy, 152, 202 Aperture, 101, 202 Aponeurosis, 202, 217 Aqueous, 202, 204, 214 Arterial, 202, 207, 221, 235, 243, 244 Arteries, 202, 203, 205, 211, 226 Arterioles, 203, 205 Arteritis, 41, 203 Arthropathy, 76, 153, 203 Arthroplasty, 154, 203 Arthroscopy, 77, 78, 183, 203 Arthrosis, 128, 203 Articular, 203, 223, 230 Articulation, 128, 203, 226 Ascites, 152, 203 Ascorbic Acid, 68, 203, 221 Aspiration, 157, 203 Aspirin, 185, 203 Asymptomatic, 32, 203 Atrophy, 5, 6, 40, 110, 113, 140, 203 Autonomic, 29, 153, 154, 155, 203, 229, 232, 241, 243 Autonomic Nervous System, 203, 232, 243 Autonomic Neuropathy, 29, 153, 155, 203

250 Carpal Tunnel Syndrome

Axilla, 203, 205, 236 Axonal, 8, 27, 40, 203 Axons, 8, 25, 203, 228, 230, 232, 241 B Back Injuries, 12, 203 Back Pain, 14, 50, 111, 203 Bacteria, 202, 203, 204, 216, 217, 226, 241, 245, 247 Bacterial Physiology, 199, 204 Basal Ganglia, 204, 217 Base, 102, 104, 113, 115, 121, 127, 131, 134, 135, 137, 144, 156, 204, 212, 223 Bends, 129, 204 Benign, 204, 217, 219, 224, 228, 247 Benign tumor, 204, 224 Beta 2-Microglobulin, 32, 204 Beta-pleated, 201, 204 Bilateral, 5, 27, 28, 37, 39, 45, 51, 58, 129, 130, 204, 231, 240, 246 Bile, 204, 217, 224, 242 Biochemical, 7, 8, 28, 204, 224, 230, 240 Biological therapy, 204, 219 Biomechanics, 7, 57, 204 Biotechnology, 23, 151, 163, 175, 204 Bladder, 96, 115, 153, 154, 203, 204, 217, 237, 246, 247 Bloating, 204, 217, 223 Blood Coagulation, 204, 206 Blood Glucose, 153, 154, 204, 219, 222 Blood pressure, 15, 139, 152, 196, 204, 221, 227, 241 Blood transfusion, 152, 205 Blood vessel, 100, 121, 122, 204, 205, 206, 207, 220, 223, 224, 240, 241, 242, 244, 247 Body Mass Index, 38, 205 Bone Marrow, 205, 215, 221, 225, 227 Bone scan, 205, 238 Boron, 205, 212 Bowel, 201, 205, 213, 232 Bowel Movement, 205, 213 Brachial, 155, 205, 220, 225, 236, 244, 246 Brachial Artery, 205, 236 Brachial Plexus, 205, 225, 236, 244, 246 Branch, 20, 37, 120, 193, 205, 214, 230, 231, 241, 243, 244 Breakdown, 127, 205, 213, 217 Buccal, 205, 225 Bunion, 205, 219 Bupivacaine, 205, 224 Burns, 143, 205 Burns, Electric, 205 Bursitis, 138, 155, 205

C Calcinosis, 25, 154, 205 Calcium, 152, 205, 206, 209, 240 Calculi, 206, 218 Cannula, 113, 206 Canthaxanthin, 119, 206 Capsaicin, 153, 206 Carbohydrate, 206, 211, 218 Carbon Dioxide, 206, 216, 237, 247 Carcinogenic, 206, 222, 242 Cardiac, 206, 214, 217, 224, 228, 242 Cardiorespiratory, 200, 206 Cardiovascular, 153, 154, 203, 206, 240 Cardiovascular System, 203, 206 Carotene, 119, 206 Carotenoids, 119, 206 Carpal Bones, 97, 104, 106, 109, 116, 120, 128, 131, 139, 206, 238 Case report, 76, 206 Case-Control Studies, 77, 206 Catheterization, 201, 207 Catheters, 13, 207 Cathode, 207, 214 Cations, 9, 207, 223 Caudal, 207, 233 Causal, 15, 19, 207 Cell Differentiation, 207, 240 Cell Division, 204, 207, 219, 233 Cell membrane, 207, 212, 223 Cell proliferation, 207, 240 Cell Survival, 207, 219 Central Nervous System, 152, 154, 200, 203, 207, 217, 219, 227, 230, 240 Central Nervous System Infections, 207, 219 Cerebellar, 207, 246 Cerebellar Diseases, 207, 246 Cerebral, 68, 201, 204, 207, 208, 215, 217, 235 Cerebral Infarction, 68, 207 Cerebrum, 207, 208 Cervical, 14, 128, 205, 208, 225, 228, 236, 244, 246 Cervix, 208, 216 Character, 148, 208, 212, 236 Chemotactic Factors, 208, 209 Chemotherapy, 74, 208 Chest Pain, 73, 208 Chest wall, 156, 208 Chiropractic, 31, 76, 77, 82, 96, 208 Cholesterol, 204, 208, 211, 221, 242 Cholinergic, 200, 208

Index 251

Choroid, 208, 237 Chromosome, 34, 208, 224 Chronic Disease, 15, 208, 209 Circadian, 7, 208 Citrus, 203, 208 Clinical study, 208, 210 Clinical trial, 6, 14, 19, 24, 89, 91, 175, 208, 210, 227, 235, 236 Cloning, 204, 208 Coenzyme, 203, 208 Cofactor, 209, 235 Cohort Studies, 15, 209 Collagen, 7, 68, 162, 209, 216, 220, 234 Collagen disease, 209, 220 Collapse, 205, 209 Complement, 108, 201, 209, 239 Complementary and alternative medicine, 73, 74, 84, 209 Complementary medicine, 74, 209 Compress, 110, 137, 210 Computational Biology, 175, 210 Computed tomography, 210, 238 Computerized axial tomography, 210, 238 Concomitant, 37, 52, 61, 118, 210 Confined Spaces, 94, 210 Congestive heart failure, 152, 210 Connective Tissue, 20, 106, 155, 203, 205, 209, 210, 216, 217, 225, 227, 232, 237, 244 Connective Tissue Cells, 210 Consciousness, 201, 210 Constipation, 152, 210, 217, 223 Constriction, 210, 223 Contamination, 95, 210 Contracture, 105, 155, 210 Contraindications, ii, 210 Controlled clinical trial, 21, 210, 236 Controlled study, 75, 210 Contusions, 138, 211 Cornea, 211 Corneal Opacity, 68, 211 Coronary, 13, 15, 68, 152, 211, 226 Coronary heart disease, 15, 68, 211 Coronary Thrombosis, 211, 226 Corticosteroid, 49, 68, 69, 164, 211, 234 Cortisol, 15, 211 Cortisone, 94, 113, 185, 211, 234 Cranial, 153, 154, 211, 219, 230, 232, 247 Craniocerebral Trauma, 211, 219 Criterion, 4, 6, 211 CSF, 204, 211 Cubital Tunnel Syndrome, 30, 109, 211

Cumulative Trauma Disorders, 17, 89, 90, 109, 211, 227 Curare, 211, 228 Curative, 212, 244 Curcumin, 138, 212 Cutaneous, 37, 53, 212, 224, 231, 236 Cytotoxic, 206, 212, 240 D Data Collection, 21, 212 Databases, Bibliographic, 175, 212 Degenerative, 14, 156, 212, 220, 230, 237 Deletion, 38, 212 Density, 205, 212, 241 Dental Hygienists, 5, 56, 212 Dentists, 4, 212 Depolarization, 212, 240 Dermal, 139, 212 Developing Countries, 212, 243 Dexterity, 112, 212 Diabetes Mellitus, 26, 28, 139, 152, 212, 218, 219 Diagnosis, Differential, 157, 212 Diagnostic procedure, 93, 164, 212 Dialyzer, 212, 219 Diarrhea, 213, 217, 223 Diastolic, 213, 221 Diffusion, 213, 219, 222 Digestion, 200, 204, 205, 213, 217, 224, 231, 242 Digestive system, 91, 213 Digestive tract, 203, 213, 240 Dilatation, 163, 201, 213 Direct, iii, 22, 133, 167, 213, 227, 236, 237, 242 Discrimination, 22, 213 Disease Progression, 213, 237 Dislocation, 131, 156, 213, 241 Dissection, 213, 246 Distention, 61, 213 Dorsal, 96, 105, 109, 121, 129, 133, 141, 213, 233, 236, 241, 243 Dorsum, 213, 217 Drive, ii, vi, 8, 67, 115, 213 Drug Interactions, 168, 169, 213 Duct, 200, 206, 207, 213, 215, 238, 243 Duke, 90, 213 Duodenum, 204, 213, 214, 217, 242 Dyes, 201, 213 E Edema, 13, 98, 110, 113, 140, 152, 213, 225, 244 Effector, 209, 213, 229

252 Carpal Tunnel Syndrome

Efficacy, 14, 16, 17, 31, 74, 77, 95, 214, 246 Elasticity, 20, 129, 132, 214 Elastin, 209, 214 Electrode, 118, 207, 214 Electrodiagnosis, 5, 6, 36, 62, 214 Electrolysis, 207, 214 Electrolyte, 211, 214, 226, 241 Electromyography, 33, 48, 52, 69, 196, 214 Electrons, 202, 204, 207, 214, 223, 230, 236 Electrophysiological, 8, 26, 36, 43, 49, 52, 57, 58, 60, 214 Emulsion, 214, 216 Endarterectomy, 201, 214 Endocrine System, 214, 229 Endometrium, 214, 226 Endoscope, 113, 214 Endoscopic, 29, 31, 36, 37, 62, 77, 159, 160, 203, 214 Endotoxins, 209, 214 Environmental Health, 10, 12, 34, 65, 90, 174, 176, 214 Enzymatic, 206, 209, 215 Enzyme, 138, 208, 213, 215, 226, 231, 235, 240, 247 Eosinophilia, 215 Epicondylitis, 11, 155, 215 Epidemic, 13, 215 Epidemiological, 18, 29, 46, 215 Epidermal, 118, 215, 247 Epidermis, 215 Epigastric, 215, 231 Ergonomics, 5, 17, 22, 29, 40, 54, 57, 80, 141, 149, 150, 182, 215 Erythrocytes, 201, 205, 215, 239 Erythropoietin, 152, 215 Esophagus, 213, 215, 242 Evacuation, 210, 215, 217 Evoke, 215, 242 Exocrine, 215, 231 Extensor, 105, 121, 155, 215, 236, 244 Extracellular, 138, 200, 210, 215, 216, 241 Extracellular Matrix, 210, 215, 216 F Family Planning, 175, 215 Fasciitis, 156, 215 Fat, 205, 206, 211, 216, 224, 237, 241, 243 Fatigue, 11, 111, 124, 152, 216, 219, 227 Febrile, 152, 216 Feces, 210, 216 Femoral, 151, 216 Femur, 216 Fetus, 215, 216, 247

Fibroblasts, 6, 210, 216 Fibrosarcoma, 216 Fibrosis, 13, 20, 138, 210, 216, 239 Fibula, 216, 233 Filtration, 143, 216 Fixation, 121, 216, 239 Flexion, 5, 8, 98, 101, 107, 116, 120, 131, 136, 141, 142, 144, 216, 225, 236 Flexor, 28, 30, 39, 40, 43, 50, 65, 68, 96, 98, 105, 109, 115, 116, 120, 121, 128, 129, 131, 133, 136, 141, 154, 155, 156, 185, 215, 216, 244 Follicular Phase, 7, 216 Foot Ulcer, 153, 217 Foramen, 217, 220, 232 Fossa, 217, 238 Fovea, 216, 217 Friction, 110, 136, 140, 217 Frontal Lobe, 201, 207, 217 Functional Disorders, 133, 217 Fundus, 216, 217 G Gait, 16, 207, 217 Galactorrhoea, 27, 217 Gallbladder, 199, 213, 217 Ganglia, 156, 217, 228, 232, 241, 243 Ganglion, 41, 155, 157, 217, 230 Gangrene, 154, 217 Gas, 200, 204, 206, 213, 217, 220, 223, 229, 242, 247 Gastric, 217, 231 Gastric Emptying, 217 Gastric Juices, 217, 231 Gastric Mucosa, 217, 231 Gastrin, 217, 220 Gastrointestinal, 152, 153, 217, 240 Gastroparesis, 153, 217 Gene, 7, 151, 204, 218 Gene Expression, 7, 218 Genetic testing, 26, 218 Genital, 203, 218 Gestures, 134, 218 Gland, 199, 211, 218, 225, 231, 232, 239, 242, 243, 244 Glomerular, 218, 237 Glucocorticoid, 218, 220, 234 Glucose, 154, 155, 203, 204, 212, 218, 219, 222, 238 Glucose Intolerance, 212, 218 Glucose tolerance, 155, 218 Glucose Tolerance Test, 218 Glycogen, 218, 227

Index 253

Gonadal, 218, 242 Gout, 31, 155, 218 Governing Board, 218, 234 Government Agencies, 11, 218, 234 Graft, 218, 220 Granulocytes, 219, 240 Growth, 27, 68, 201, 202, 204, 207, 212, 216, 219, 225, 228, 233, 244, 246 Growth factors, 68, 219 H Habitual, 208, 219 Haemodialysis, 24, 219 Hallux Valgus, 156, 219 Hamartoma, 44, 219 Headache, 74, 152, 160, 219, 234 Headache Disorders, 219 Health Status, 15, 219 Heart attack, 154, 219 Heart failure, 219 Hematoxylin, 13, 219 Hemiparesis, 153, 219 Hemodialysis, 4, 27, 36, 42, 43, 58, 61, 69, 70, 152, 212, 219 Hemoglobin, 201, 215, 219 Hemolytic, 216, 220 Hemorrhage, 211, 219, 220, 242 Hemorrhoid, 220, 244 Hepatic, 218, 220 Hepatitis, 152, 220 Hepatocytes, 220 Heredity, 41, 218, 220 Herniated, 151, 220 Herpes, 74, 220 Herpes Zoster, 220 Histology, 20, 43, 220 Homologous, 220, 239, 243 Hormonal, 164, 203, 211, 220 Hormone, 7, 27, 74, 139, 211, 215, 217, 220, 222, 226, 234, 237, 240, 244 Hormone Replacement Therapy, 27, 220 Host, 139, 220, 221 Humeral, 220, 244 Hydrocortisone, 162, 220 Hydrogen, 204, 206, 220, 224, 227, 229, 230, 235 Hydroxylysine, 209, 220 Hydroxyproline, 209, 220 Hypercholesterolemia, 68, 221 Hyperglycemia, 153, 221 Hypersensitivity, 200, 221, 237, 239 Hypertension, 15, 152, 219, 221 Hyperthyroidism, 5, 221

Hypertrophy, 105, 221 Hyperuricemia, 218, 221 Hypodermic, 113, 221 Hypoglycemia, 154, 221 Hypotension, 152, 154, 221 Hypothyroidism, 70, 82, 139, 221 I Ibuprofen, 185, 221 Id, 71, 81, 182, 183, 186, 187, 192, 194, 221 Idiopathic, 25, 29, 36, 37, 42, 43, 45, 57, 62, 69, 156, 221 Immune response, 202, 211, 221, 239, 247 Immune system, 119, 204, 221, 247 Immunization, 221, 234, 239 Immunohistochemistry, 20, 221 Immunologic, 7, 208, 221 Impairment, 8, 221, 226 In vitro, 6, 221 In vivo, 11, 13, 221 Incision, 106, 113, 222, 223 Indicative, 148, 222, 231, 247 Infant, Newborn, 200, 222 Infarction, 207, 211, 222, 226 Infection, 25, 52, 132, 139, 204, 208, 216, 222, 224, 225, 229, 237, 242 Infiltration, 30, 31, 70, 222, 234 Inflammation, 5, 7, 22, 29, 45, 73, 97, 100, 116, 122, 123, 128, 130, 138, 154, 164, 202, 203, 205, 211, 215, 216, 217, 220, 222, 237, 244 Ingestion, 206, 218, 222, 233 Initiation, 11, 222 Innervation, 62, 109, 142, 205, 222, 225, 232, 236, 239, 245, 246 Insight, 11, 17, 113, 222 Insomnia, 152, 222, 234 Insulin, 49, 69, 218, 222 Insulin-dependent diabetes mellitus, 222 Intensive Care, 95, 222 Intermittent, 94, 96, 107, 222, 232 Interstitial, 222, 237 Intervertebral, 220, 222, 224, 236 Intervertebral Disk Displacement, 222, 224, 236 Intestinal, 206, 218, 222 Intestines, 199, 216, 217, 222, 239 Intoxication, 223, 248 Intracellular, 138, 222, 223, 226, 240 Intracellular Membranes, 223, 226 Intravenous, 153, 223 Invasive, 9, 15, 31, 37, 62, 130, 223, 225 Ions, 204, 214, 220, 223, 227

254 Carpal Tunnel Syndrome

Irrigation, 154, 223 Irritable Bowel Syndrome, 217, 223 Ischemia, 154, 203, 223, 244 Ischial, 155, 223 Isotonic, 121, 223 J Joint Capsule, 109, 223, 243 K Kb, 174, 223 Kidney Disease, 91, 154, 174, 223, 237 Kidney stone, 74, 223, 246 Kidney Transplantation, 43, 223 L Labile, 209, 223 Large Intestine, 213, 223, 236, 240 Latency, 4, 22, 35, 50, 63, 118, 223 Lectin, 224, 226 Leprosy, 217, 224 Lesion, 217, 224, 243, 246 Lethal, 114, 224 Lethargy, 221, 224 Library Services, 192, 224 Lidocaine, 138, 168, 224, 226 Linkage, 13, 41, 224 Lip, 112, 224 Lipid, 222, 224, 230 Lipid Peroxidation, 224, 230 Lipoma, 30, 41, 46, 224 Liver, 199, 201, 204, 213, 214, 215, 216, 217, 218, 220, 224, 234, 238, 246 Liver scan, 224, 238 Lobe, 201, 207, 224, 247 Localization, 221, 224 Localized, 11, 22, 116, 143, 201, 216, 222, 224, 228, 233, 239, 244, 246 Loop, 94, 100, 224 Low Back Pain, 8, 14, 15, 74, 224 Lumbar, 14, 151, 203, 222, 224, 239, 245 Lumen, 206, 224 Lunate, 9, 97, 206, 224 Lupus, 5, 209, 224 Luxation, 213, 225 Lymph, 208, 225 Lymph node, 208, 225 Lymphatic, 222, 225, 241 Lymphedema, 55, 225 M Magnetic Resonance Imaging, 13, 32, 33, 45, 78, 225, 238 Malformation, 219, 225 Malignant, 202, 216, 225, 227, 228 Malignant tumor, 225, 227

Malnutrition, 203, 225, 228 Manifest, 203, 225 Meat, 32, 34, 107, 225 Medial, 97, 115, 126, 144, 151, 155, 225, 244, 246 Median Nerve, 4, 5, 6, 13, 20, 21, 22, 27, 28, 35, 37, 41, 44, 46, 49, 62, 69, 70, 96, 97, 99, 100, 101, 104, 105, 106, 107, 109, 110, 113, 114, 117, 119, 120, 128, 130, 131, 133, 135, 136, 137, 138, 139, 140, 141, 142, 144, 147, 148, 151, 164, 185, 206, 211, 225 Median Neuropathy, 20, 148, 225 Medical Records, 12, 225 MEDLINE, 5, 175, 225 Membrane Proteins, 8, 225 Meninges, 207, 211, 226, 242 Meniscus, 151, 226 Menopause, 139, 226, 234 Menstrual Cycle, 7, 216, 226, 234 Menstruation, 216, 226, 234 Mental Disorders, 92, 226, 234, 235 Mental Health, iv, 6, 15, 92, 174, 176, 226, 230, 234 Meta-Analysis, 36, 55, 226 Metabolic disorder, 218, 226 Metacarpophalangeal Joint, 154, 226 Metatarsophalangeal Joint, 219, 226 Mexiletine, 153, 226 MI, 40, 59, 79, 110, 139, 140, 197, 226 Microbiology, 199, 226 Microorganism, 209, 226, 247 Microscopy, 13, 219, 226 Mineralocorticoids, 199, 211, 226 Mobility, 8, 226 Mobilization, 9, 226 Modeling, 11, 14, 227 Modification, 49, 101, 227 Molecular, 7, 68, 175, 177, 204, 210, 227, 238, 246 Molecular Structure, 227, 246 Molecule, 202, 204, 208, 209, 213, 224, 227, 230, 236, 240 Monitor, 95, 129, 227, 229 Mononeuropathies, 153, 155, 227 Mononuclear, 216, 227 Morphine, 70, 227, 228, 230 Morphological, 8, 227 Motility, 217, 227, 240 Motion Sickness, 227, 228 Motor nerve, 154, 227, 228 Mucinous, 217, 227

Index 255

Mucosa, 205, 217, 225, 227 Multicenter study, 62, 227 Multiple Myeloma, 139, 227 Muscle Fatigue, 115, 122, 227 Muscle Fibers, 227, 228 Muscle relaxant, 95, 227 Muscle Relaxation, 228, 229 Muscle tension, 227, 228 Muscular Atrophy, 98, 228 Musculoskeletal System, 211, 228, 230 Myelography, 14, 228 Myocardium, 226, 228 N Narcotic, 227, 228 Nausea, 74, 152, 217, 228, 234, 246 NCI, 1, 91, 173, 228 Neck Muscles, 115, 228 Neck Pain, 160, 228 Necrosis, 207, 216, 222, 226, 228 Need, 3, 63, 69, 102, 113, 136, 147, 151, 164, 188, 199, 215, 218, 228, 245 Neoplasm, 219, 228, 246 Neoplastic, 206, 220, 228 Nerve Fibers, 40, 78, 119, 154, 199, 205, 228, 241, 244 Nervous System, 200, 203, 207, 228, 229, 232, 243 Neural, 55, 151, 200, 201, 228 Neuroendocrine, 7, 229 Neurology, 22, 24, 25, 27, 30, 35, 38, 39, 42, 49, 50, 52, 55, 59, 62, 68, 69, 77, 186, 229, 244 Neuroma, 156, 229 Neuromuscular, 95, 229 Neuromuscular Blockade, 95, 229 Neuromuscular Junction, 229 Neuronal, 229, 232 Neurons, 217, 228, 229, 241, 243 Neuropathy, 3, 4, 8, 20, 37, 42, 43, 107, 109, 110, 120, 138, 152, 153, 154, 155, 162, 203, 229, 232, 243 Neurophysiology, 24, 26, 35, 36, 40, 43, 50, 53, 57, 60, 212, 229 Neurotransmitters, 200, 229 Neutrons, 200, 229, 236 Nitrogen, 200, 201, 216, 229, 246 Norepinephrine, 199, 200, 229 Nuclear, 204, 214, 217, 228, 229 Nuclei, 200, 201, 214, 225, 229, 230, 235 O Occupational Exposure, 15, 230

Occupational Health, 10, 12, 15, 16, 20, 65, 107, 230 Occupational Medicine, 22, 32, 46, 68, 230 Onychomycosis, 132, 230 Ophthalmologic, 213, 230 Ophthalmology, 216, 230 Opium, 227, 230 Optic Nerve, 230, 237 Orthopaedic, 6, 13, 36, 37, 44, 54, 56, 58, 61, 68, 69, 151, 156, 159, 160, 183, 186, 230 Orthostatic, 154, 230 Osteoarthritis, 61, 74, 164, 230 Outpatient, 165, 230 Ovulation, 216, 230 Oxidation, 202, 224, 230 Oxidative Stress, 153, 230 P Palliative, 230, 244 Palpation, 156, 230 Palsies, 42, 43, 153, 231 Palsy, 155, 182, 231 Pancreas, 43, 199, 213, 222, 231 Paraesthesia, 110, 140, 231 Paralysis, 78, 155, 212, 219, 231, 244 Paresis, 231, 244 Paresthesia, 131, 231, 244 Patch, 120, 138, 231, 245 Pathogenesis, 7, 153, 231 Pathologic, 148, 205, 211, 221, 231, 240 Pathologies, 95, 231 Pathophysiology, 8, 13, 98, 155, 231 Patient Education, 184, 186, 190, 192, 197, 231 Pepsin, 231 Pepsin A, 231 Peptic, 152, 231 Peptic Ulcer, 152, 231 Perception, 54, 73, 138, 231, 239 Perforation, 202, 217, 231 Perineural, 138, 231 Peripheral Nerves, 8, 95, 154, 224, 232, 241 Peripheral Nervous System, 154, 231, 232 Peripheral Neuropathy, 8, 16, 22, 105, 232 Peritoneal, 4, 152, 203, 232 Peritoneal Cavity, 152, 203, 232 Peritoneal Dialysis, 4, 232 Peritoneum, 232 Peroneal Nerve, 154, 156, 232, 239 Phallic, 216, 232 Pharmacologic, 14, 29, 201, 232, 245 Phospholipases, 232, 240

256 Carpal Tunnel Syndrome

Phosphorus, 152, 206, 232 Physical Examination, 5, 12, 44, 90, 185, 232 Physical Therapy, 22, 55, 156, 232 Physiologic, 7, 148, 223, 226, 232, 236, 246 Physiology, 68, 121, 214, 229, 232, 247 Pigment, 206, 232 Pilot study, 21, 60, 232 Pituitary Gland, 211, 232 Placebo Effect, 19, 90, 233 Plants, 200, 206, 208, 218, 224, 229, 233, 238, 245, 246 Plaque, 201, 233 Plasma, 202, 204, 207, 218, 219, 226, 227, 233 Plasma cells, 202, 227, 233 Platelet Activation, 233, 240 Platinum, 224, 233 Pleated, 107, 233 Poisoning, 223, 228, 233 Policy Making, 218, 233 Polypeptide, 209, 231, 233 Popliteal, 155, 233 Popliteal Cyst, 155, 233 Posterior, 155, 201, 203, 208, 213, 223, 228, 231, 233, 236, 243 Postoperative, 57, 74, 185, 233 Postsynaptic, 233, 240 Postural, 16, 17, 233 Potentiating, 200, 233 Potentiation, 233, 240 Practicability, 233, 246 Practice Guidelines, 150, 176, 186, 234 Prednisolone, 61, 234 Prednisone, 50, 234 Premenopausal, 7, 234 Premenstrual, 139, 234 Premenstrual Syndrome, 139, 234 Prevalence, 4, 8, 10, 34, 43, 56, 57, 60, 87, 152, 155, 156, 234 Primary Prevention, 46, 78, 234 Procaine, 224, 234 Progesterone, 234, 242 Prognostic factor, 234, 243 Progression, 11, 101, 201, 234 Progressive, 20, 99, 207, 219, 228, 230, 233, 234, 237, 246 Projection, 134, 223, 229, 230, 234 Proline, 209, 220, 234 Pronation, 225, 234 Pronator, 109, 155, 225, 235 Prone, 235

Prone Position, 235 Prophylaxis, 212, 235 Proportional, 12, 235 Prospective study, 9, 11, 12, 235 Protein S, 151, 204, 235, 238 Proteins, 200, 202, 207, 209, 225, 227, 229, 231, 233, 235, 240, 245 Proteinuria, 227, 235 Proteolytic, 200, 209, 235 Protocol, 11, 14, 56, 76, 235 Protons, 200, 220, 235, 236 Proximal, 95, 97, 100, 105, 109, 113, 117, 118, 120, 139, 148, 153, 154, 157, 213, 235, 238 Psychiatry, 14, 24, 27, 59, 216, 235, 247 Psychic, 235, 239 Psychomotor, 40, 235 Public Policy, 175, 235 Publishing, 4, 23, 235 Pulmonary, 52, 205, 235, 247 Pulmonary Artery, 205, 235 Pulse, 227, 235 Putrefaction, 217, 235 R Race, 7, 236 Radial Artery, 4, 236 Radial Nerve, 154, 155, 236 Radial Neuropathy, 155, 236 Radiation, 122, 236, 238, 244, 248 Radicular, 236 Radiculopathy, 153, 154, 236 Radioactive, 205, 220, 224, 229, 236, 238 Radius, 105, 109, 116, 156, 236 Randomized, 11, 14, 16, 18, 19, 21, 23, 24, 31, 70, 77, 81, 87, 89, 90, 214, 236 Randomized clinical trial, 31, 77, 236 Randomized Controlled Trials, 19, 236 Receptor, 138, 199, 202, 236, 240 Rectum, 202, 205, 213, 217, 220, 223, 236 Recur, 113, 237 Recurrence, 237 Refer, 1, 16, 205, 209, 216, 220, 224, 229, 237 Refraction, 237, 241 Regeneration, 49, 69, 237 Regimen, 17, 214, 233, 237 Registries, 14, 237 Relaxant, 237 Reliability, 12, 38, 237 Renal failure, 139, 204, 220, 237 Renal Osteodystrophy, 152, 237 Renal pelvis, 223, 237

Index 257

Reoperation, 14, 237 Research Support, 10, 237 Respiration, 206, 212, 227, 237 Restoration, 232, 237 Retina, 133, 208, 230, 237, 238, 247 Retinopathy, 206, 237 Retrograde, 8, 40, 237 Rheumatism, 34, 221, 237 Rheumatoid, 4, 5, 113, 139, 164, 209, 237 Rheumatoid arthritis, 4, 5, 113, 139, 164, 209, 237 Riboflavin, 72, 238 Ribosome, 238, 246 Rigidity, 107, 233, 238 Risk factor, 4, 11, 12, 15, 17, 18, 21, 26, 29, 38, 54, 152, 156, 164, 235, 238 Rod, 137, 238 Rotator, 8, 155, 238 Rotator Cuff, 8, 155, 238 Rubber, 116, 199, 238 S Saliva, 238 Salivary, 15, 213, 238 Salivary glands, 213, 238 Saphenous, 53, 238 Saphenous Vein, 53, 238 Saponins, 238, 242 Scans, 9, 14, 238 Scaphoid Bone, 206, 238 Schizoid, 238, 247 Schizophrenia, 238, 239, 247 Schizotypal Personality Disorder, 239, 247 Sciatic Nerve, 232, 239, 244 Scleroderma, 82, 215, 239 Sclerosis, 154, 182, 209, 239 Screening, 4, 57, 88, 208, 239 Secretion, 211, 217, 221, 222, 226, 239 Sedative, 200, 239 Segmental, 35, 62, 239, 241 Segmentation, 239 Seizures, 239 Self Care, 199, 239 Semilunar Bone, 206, 239 Sensibility, 38, 239 Sensitization, 22, 239 Sensor, 134, 239 Sensory loss, 196, 236, 239 Sensory Thresholds, 57, 239 Serotonin, 200, 240, 246 Serum, 28, 138, 201, 204, 209, 223, 226, 240 Shock, 140, 220, 240, 246 Shoulder Pain, 8, 240

Side effect, 167, 199, 204, 221, 240, 245 Signal Transduction, 138, 240 Skeletal, 35, 201, 212, 227, 240 Skeleton, 216, 223, 240 Skin graft, 154, 240 Small intestine, 213, 220, 223, 240 Smooth muscle, 201, 210, 227, 240 Social Class, 15, 240 Social Support, 7, 240 Sodium, 218, 226, 240, 243 Soft tissue, 18, 112, 116, 205, 216, 240, 241 Somatic, 232, 241, 247 Sound wave, 210, 241 Specialist, 188, 241 Species, 206, 211, 236, 241, 246, 248 Specificity, 12, 22, 241 Spectrum, 56, 122, 212, 241 Sperm, 201, 208, 241 Spinal cord, 199, 205, 207, 208, 211, 217, 225, 226, 228, 229, 232, 236, 239, 241, 242, 243, 246 Spinal Cord Injuries, 236, 241 Spinal Nerve Roots, 236, 241 Spinal Nerves, 232, 241 Spleen, 201, 225, 241 Splint, 13, 94, 96, 101, 107, 109, 130, 133, 142, 185, 241 Sprains and Strains, 224, 241 Stabilization, 133, 242 Staging, 32, 238, 242 Standardize, 21, 242 Stasis, 22, 242 Stem Cells, 215, 242 Steroid, 4, 35, 45, 49, 54, 55, 68, 69, 79, 96, 101, 142, 148, 211, 238, 242 Stimulus, 95, 118, 213, 214, 222, 223, 239, 242, 244, 245 Stomach, 74, 199, 213, 215, 217, 218, 220, 222, 228, 231, 232, 240, 241, 242 Stroke, 74, 78, 92, 152, 174, 183, 186, 242 Styrene, 238, 242 Subacute, 222, 242 Subarachnoid, 219, 242 Subclavian, 242, 244 Subclavian Artery, 242, 244 Subclavian Vein, 242, 244 Subclinical, 155, 222, 239, 242 Subcutaneous, 99, 106, 156, 213, 242 Suction, 216, 242 Supination, 236, 242 Suppression, 211, 242 Survival Analysis, 12, 243

258 Carpal Tunnel Syndrome

Sweat, 154, 243 Sweat Glands, 243 Sympathectomy, 154, 243 Sympathetic Nervous System, 203, 243 Symptomatic, 30, 49, 243 Symptomatology, 17, 35, 243 Synaptic, 240, 243 Synovial, 20, 156, 223, 233, 243 Synovial Cyst, 233, 243 Synovial Fluid, 243 Synovial Membrane, 156, 223, 243 Systemic, 27, 49, 58, 131, 154, 201, 205, 209, 222, 234, 239, 243 Systemic disease, 131, 243 Systolic, 221, 243 T Tarsal Tunnel Syndrome, 156, 243 Technology Transfer, 17, 151, 243 Tendinitis, 6, 15, 16, 22, 108, 115, 121, 122, 124, 155, 182, 244 Tendon Injuries, 156, 244 Tendon Transfer, 58, 244 Tendonitis, 11, 90, 102, 244 Tennis Elbow, 74, 244 Tenosynovitis, 42, 56, 109, 119, 138, 155, 156, 244 Therapeutics, 31, 75, 76, 77, 169, 244 Thermography, 148, 244 Thigh, 216, 244 Thoracic, 79, 155, 203, 205, 225, 236, 242, 244, 246, 247 Thoracic Outlet Syndrome, 79, 155, 244 Thorax, 224, 244, 247 Threshold, 12, 13, 22, 54, 221, 244 Thrombosed, 62, 244 Thrombosis, 235, 242, 244 Thyroid, 70, 136, 164, 221, 244 Thyroid Gland, 221, 244 Thyrotropin, 221, 244 Tibial Nerve, 239, 243, 244 Tin, 4, 5, 94, 96, 99, 100, 106, 109, 112, 113, 116, 119, 126, 131, 136, 137, 141, 142, 144, 164, 187, 196, 206, 211, 231, 232, 233, 245 Tolerance, 218, 245 Tonicity, 223, 245 Tooth Preparation, 199, 245 Topical, 22, 137, 138, 139, 153, 168, 245 Toxic, iv, 118, 212, 229, 242, 245 Toxicity, 213, 245 Toxicology, 176, 245 Toxins, 202, 214, 222, 245

Trace element, 205, 245 Trachea, 244, 245 Traction, 100, 104, 120, 127, 128, 140, 141, 245 Transcutaneous, 75, 76, 245 Transcutaneous Electric Nerve Stimulation, 75, 245 Transdermal, 138, 245 Transduction, 240, 245 Transfection, 204, 245 Transfusion, 245 Translation, 105, 245 Transplantation, 76, 156, 221, 246 Treatment Outcome, 157, 246 Trees, 238, 246 Tremor, 134, 246 Tricyclic, 153, 200, 246 Truncal, 153, 246 Tryptophan, 209, 240, 246 Tuberculosis, 52, 139, 224, 246 Tumour, 217, 246 U Ulcer, 231, 246 Ulceration, 29, 246 Ulna, 109, 116, 246 Ulnar Nerve, 154, 155, 157, 246 Unconscious, 201, 221, 246 Urea, 243, 246 Uremia, 237, 246 Ureters, 223, 246 Uric, 152, 218, 221, 246 Urinary, 74, 206, 246 Urine, 204, 223, 235, 237, 238, 246, 247 Uterus, 208, 214, 216, 217, 226, 234, 247 V Vaccine, 235, 247 Vagus Nerve, 246, 247 Vascular, 13, 22, 64, 153, 208, 219, 222, 244, 247 VE, 10, 47, 247 Vein, 223, 229, 238, 242, 244, 247 Venous, 98, 207, 235, 247 Venous blood, 207, 247 Ventilation, 210, 247 Venules, 205, 247 Veterinary Medicine, 175, 247 Viral, 155, 245, 247 Virus, 207, 233, 245, 247 Visceral, 203, 232, 247 Visual Cortex, 224, 247 Vitreous Body, 237, 247 Vitro, 7, 247

Index 259

Vivo, 247 W Warts, 132, 247 Windpipe, 244, 247 Withdrawal, 106, 247

Word Processing, 115, 122, 248 Wrist Injuries, 103, 115, 121, 248 X Xenograft, 201, 248 X-ray, 196, 207, 210, 228, 229, 238, 248

260 Carpal Tunnel Syndrome