Roberto Padua

Incidence of Bilateral Symptoms in Carpal Tunnel Syndrome

We prospectively studied 266 hands in 133 patients with carpal tunnel syndrome (CTS) in order to evaluate: the incidence of bilateral CTS symptoms; correlation between severity, duration of symptoms and bilateral occurrence of CTS; agreement of clinical and neurophysiological findings; and the neurophysiological findings in asymptomatic hands in unilateral CTS, The incidence of bilateral clinical CTS in our population was 87%. Neurophysiological impairment of median nerve was observed in about half of the asymptomatic hands. Follow-up of patients with unilateral CTS showed that contralateral symptoms developed in most cases. We found a significant positive correlation of bilateral CTS with the duration of symptoms, whereas there was no correlation with the severity of symptoms. Our data suggest that bilateral impairment of median nerve is the rule in patients with CTS and probably it has been underestimated in previous studies.

Patient outcomes after Harrington instrumentation for idiopathic scoliosis : A 15- to 28-year evaluation

Study Design. A retrospective study was performed, using the Short Form-36 Health Survey and the Roland and Morris Disability Questionnaire, to investigate patient outcomes after fusion for adolescent idiopathic scoliosis using Harrington rod instrumentation. Objective. To evaluate health-related quality of life and low back pain in a long-term follow-up study of surgery for adolescent idiopathic scoliosis. Summary of Background Data. The commonly accepted surgical treatment for idiopathic evolutive scoliosis is vertebral fusion. It has been suggested that this procedure may cause low back pain and a poor quality of life over the long term. Outcome measures after surgery for adolescent idiopathic scoliosis have focused mainly on objective parameters such as radiographic measures. However, this information has proved to be correlated only weakly with outcomes that are more relevant to patients, such as functional status and symptoms. Until recently, only a few long-term outcome studies have used standardized and validated patient-oriented tools to evaluate surgically treated patients with scoliosis. Methods. In this study, 70 patients treated with a standard Harrington technique were recontacted and evaluated by means of self-administered questionnaires (Short Form-36 Health Survey and Roland and Morris Disability, clinical examination, and radiographic analysis. Preoperative and follow-up radiographic findings were registered. Relations between radiographic and patient-oriented data were evaluated. Results. A comparison between the current sample and the Italian age-matched normative data for the Short Form-36 Health Survey showed them to have a similar pattern. Findings showed the patient-oriented outcome to be correlated inversely with the extension of vertebral fusion and the preoperative Cobb angle. Conclusion. Long-term follow-up evaluation of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life, as measured by patient-oriented evaluation.

Carpal tunnel syndrome : Indication for surgical treatment based on electrophysiologic study

A prospective study of 50 hands from 45 consecutive patients surgically treated for idiopathic carpal tunnel syndrome was conducted to determinate the recovery capacity of the median nerve after open surgical release. Subjects were evaluated by clinical history, physical examination, and electrophysiologic testing. Motor and sensory terminal latencies and motor and sensory conduction velocities were examined before surgery and 2 weeks, 2 months, and 6 months after surgical decompression. All patients showed improvement of postoperative electrophysiologic values; the amount of improvement was dependent on the degree of preoperative impairment. Complete restoration of clinical and electrophysiologic nerve function was observed only in patients with mild carpal tunnel syndrome.

Cross-cultural Adaptation of the Lumbar North American Spine Society Questionnaire for Italian-speaking Patients With Lumbar Spinal Disease

Study Design. A cross-cultural adaptation and cross-sectional study of a sample of lumbar spine patients, with a subsample followed prospectively for retest reliability. Objectives. To assess the Italian version instrument reliability and validity. Summary of Background Data. The orthopaedic outcome measurements have been usually focused on objective parameters as radiograph measures or other technical aspects. However, these parameters are weakly related with outcomes that are more relevant to patients as functional status and symptoms. In the last ten years, the patient-oriented measures have become an important aspect of spinal clinical outcome evaluation. The most common instruments to assess patient perspective are self-administered questionnaires that must be validated by a widely accepted process to evaluate reliability and validity, which are fundamental for every instrumental measure. Methods. The North American Spine Society (NASS) questionnaire was culturally adapted for Italian-speaking people following the Guillemin criteria. The Italian version was tested on 74 consecutive patients who were referred to the authors’ department and suffered from low back pain with leg irradiation. The results were compared with other validated patient-oriented measures. Forty-eight-hour retests were performed on a subsample of 45 patients. Results. The questionnaire was favorably accepted by patients. The lumbar spine pain and disability and neurogenic symptoms subscales showed a high correlation with other patient-oriented measures, as hypothesized, and it also showed good values on test-retest. Conclusions. The questionnaire should be considered for patient health status monitoring and for clinical trials.

Carpal tunnel syndrome: relationship between clinical and patient-oriented assessment.

Clinical diagnosis of carpal tunnel syndrome usually is easy and sensitive, but frequently, it is based on history and referred symptoms when no motor or sensory deficits are observed during examination. In patients with carpal tunnel syndrome, a dissociation between the severity of the disease reported by the patient and the deficits clinically evaluated by the physician often are observed. The Italian Carpal Tunnel Syndrome Study Group did a multicenter study on 740 patients (1123 hands) with carpal tunnel syndrome to assess the aspects of dissociation between the patient’s and the physician’s quantification of the disease severity and the ability of the patients with carpal tunnel syndrome to do daily activities. Validated patient-oriented parameters assessing symptoms and hand functional status were used. The relationship between the physician’s and the patient’s measurements is strong with a linear significant correlation when analyzing the functional status of the hand but not so clear and simple when analyzing the symptoms. Patients with mild-to-moderate carpal tunnel syndrome seemed to function well, although severe symptoms may be reported by the patient; however, when nerve impairment becomes severe, the patient’s hand function is extremely impaired although symptoms may be milder. The data show that the patient’s point of view is reliable. Carpal tunnel syndrome seems to be an ideal model to evaluate the importance of patient-oriented measurements.

Cross-cultural Adaptation and Measurement Properties of an Italian Version of the Western Ontario Shoulder Instability Index (WOSI)

STUDY DESIGN Clinical measurement study. OBJECTIVES To translate and cross-culturally adapt the Western Ontario Shoulder Instability Index (WOSI) into Italian, and to evaluate its measurement properties in patients with shoulder instability secondary to a first-time traumatic anterior dislocation. BACKGROUND The WOSI was developed for English-speaking patients. To date, no Italian version of the WOSI exists. METHODS The WOSI was cross-culturally adapted to Italian according to established guidelines. Sixty-four (16 women, 48 men) patients with unilateral shoulder anterior instability were prospectively recruited for the purposes of this study. Internal consistency, test-retest reliability, construct validity, and responsiveness of the WOSI were evaluated. RESULTS The Italian version of the WOSI showed a high degree of internal consistency, with a Cronbach alpha of .93 (95% confidence interval [CI]: 0.91, 0.96). The test-retest reliability was high for both short-term (3 days, 64 patients) and medium-term (14 weeks, 20 patients) test-retest, with intraclass correlation coefficients of 0.95 (95% CI: 0.90, 0.97) and 0.92 (95% CI: 0.89, 0.95), respectively. The WOSI was more closely correlated to the Disabilities of the Arm, Shoulder and Hand questionnaire than to the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.794 and 0.113, respectively). The receiver-operating-characteristic curve analysis revealed that the WOSI was more responsive than the Disabilities of the Arm, Shoulder and Hand questionnaire (P = .03), with an area under the curve of 0.90 (95% CI: 0.78, 0.97) for the WOSI and 0.76 (95% CI: 0.61, 0.88) for the Disabilities of the Arm, Shoulder and Hand questionnaire. CONCLUSION The Italian version of the WOSI is a valid, reliable, and responsive tool that can be used to measure function in Italian-speaking patients with shoulder instability due to a first-time traumatic anterior dislocation.

Health-related quality of life and subjective outcome after shoulder replacement for proximal humeral fractures

Shoulder replacement has increased exponentially in recent decades, and previous studies have documented the effectiveness of this procedure. Pain relief, physical functional level, and health-related quality of life, however, were often not assessed. To our knowledge, no published articles have assessed quality of life in shoulder replacement for fracture. The main purpose of this study was to assess the patient-relevant outcomes in patients who underwent shoulder replacement for proximal humeral fractures. Standardized quality of life and shoulder-specific, self-administered questionnaires were used. On the Medical Outcomes Study Short Form 36 Health Survey, as expected, we observed a lower score in the domain compared with healthy Italian subjects. A surprising finding was that in the General Health and Role-Emotional domains, our sample had a better picture than the healthy one, probably because patients had experienced severe trauma and major surgery previously. These data represent the first step toward the definition of outcome for this procedure. This study does not address the necessity of therapy, but if this were included in future publications, it might provide useful data for therapeutic recommendations.

Intraneural cyst of the peroneal nerve

Abstract A 15-year-old girl was referred to us because of foot drop. The motor deficit was characterized by a peculiar fluctuating course related to sporting activity: improvement of symptoms during no-sport periods and worsening during sport training. Neurophysiological examination revealed marked global impairment of muscles innervated by the peroneal nerve. Ultrasound and MRI showed a mass in close proximity to the neck of the fibula extending in a tubular fashion. At operation an intraneural lesion was found and was totally removed. Histology revealed that it was an intraneural cyst. A hypothesis on the pathogenesis was drawn up. One year after the operation a clinical and neurophysiological follow-up was performed.

Suprascapular nerve entrapment Neurophysiological localization in 6 cases

We report 6 cases of a suprascapular nerve lesion: 3 of them presented a nerve entrapment at the suprascapular notch and 3 at the spinoglenoid notch. Electrophysiological investigation localized the site of entrapment in all cases.

Italian Multicentre Study of Carpal Tunnel Syndrome

The Italian Carpal Tunnel Syndrome Study Group has carried out a multicentre study on 1123 hands with idiopathic carpal tunnel syndrome. We have compared the findings on clinical examination, the neurophysiological data and a patient-oriented assessment in men and women. The patient-oriented assessment showed that men complain of less discomfort than women; clinical examination was similar in the two populations and neurophysiological investigations showed greater changes in men.