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1
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Provocative tests used in the diagnosis of carpal tunnel syndrome

100%
Georgiew F.
Medical Rehabilitation
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2007
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vol. 11(4)
15-25
EN
The carpal tunnel syndrome (CTS) is the most often diagnosed compressive neuropathy of the upper limb. As a result of the changes within the tunnel of the median nerve, the disease is associated with hypersensitivity to some external factors such as: an increase in pressure within the carpal tunnel, direct or indirect pressure on the wrist level, hypoxia. These factors are used in provocative tests. The aim of this article is to make a distinction between functional test’s classifications used in the CTS diagnosis, depending on the method of ailment provocation. Different modifications used in common tests and their average sensitivity and specificity are also presented. Carpal tunnel syndrome should be diagnosed clinically; although electro-diagnostic studies are a standard method of establishing the diagnosis, they do have limitations. Clinical diagnostic skill must be reinforced by a valuable provocative test: the Provocative Test, the Phalen test + mCCT, Tinel’s sign, Phalen’s and reverse Phalen’s test, Durkan Carpal Compression Test (mCCT). There are also tests, which, due to their low sensitivity and specificity, be not applied in the CTS diagnostics. Provocative tests are more easily performed than electro-diagnostic studies and are the most appropriate diagnostic tools in the ambulatory setting. Provocative tests are commonly needed for establishing the diagnosis for treatment, screening and determining aetiology. To improve the efficiency of provocative tests, we should apply univocal standards for their performance and interpretation. A combination of tests might be more powerful than a single test in establishing the diagnosis. Taking medical history and performing physical examination should be the primary methods of diagnosing CTS. The combination of hand diagram, questionnaires, abnormal sensibility and positive provocative tests will provide a diagnostic tool for CTS with high sensitivity and specificity. The addition of nerve conduction studies is unnecessary in most cases.
2
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Diagnostic tests used in diagnosis of carpal tunnel syndrome

51%
Georgiew F., Otfinowska E., Adamczyk T.
Medical Rehabilitation
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2008
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vol. 12(3)
24-35
EN
In 1854 Paget described for the first time that carpal tunnel syndrome (CTS) results from compression of the median nerve within the carpal tunnel. CTS predominantly involves tingling and numbness in the typical median nerve distribution. Pain, described as deep, aching, or throbbing, occurs diffusely in the hand and radiates up the forearm. Atrophy of the muscles of the thenar is usually seen later in the course of the nerve compression. CTS is most frequent among persons between the ages of 30 to 60 and is two to three times more common in women than in men (peak prevalence in women older than 55 years). Carpal tunnel syndrome may affect 1% to 10% of the population. Incorrect diagnosis of CTS has been identified as one of the most common causes of CTS treatment failure. CTS should be diagnosed clinically. Electro-diagnostic studies are a standard method of establishing the diagnosis. Electrodiagnostic studies are performed to confirm the clinical diagnosis, to assess the severity of median nerve compression and to rule out more proximal compression sites. Abnormalities in nerve conduction study results can be the only objective evidence of carpal tunnel syndrome. Lack of objective data, such as ENG can lead to incorrect diagnosis and inappropriate treatment. Clinical diagnosis should be reinforced by valuable diagnostic tests: the Semmes–Weinstein monofilaments test – performed in neutral and Phalen’s positions, vibration threshold measured by means of tuning forks or a vibrometer, by observation of thenar atrophy and using provocative tests. The use of common, sensitive and specific diagnostic tests should improve decision making about patients referral for specific therapies, facilitate the performance of epidemiologic studies, increase the accuracy of diagnosis. The combination of a results obtained using various methods might be more powerful than a single test in establishing the diagnosis of CTS. The combination of hand diagram, questionnaires, abnormal sensibility, thenar weakness or thenar atrophy and positive provocative tests constitutes a sensitive and specific diagnostic tool to establish the diagnosis of CTS. Standardized clinical criteria for CTS would be an important step in reducing inconsistencies and misdiagnoses.
3
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Analiza porównawcza czynnościowych wyników leczenia operacyjnego pacjentów ze złamaniem końca dalszego kości promieniowej

51%
Florek J., Georgiew F., Kotela I.
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vol. 23(6)
401-410
EN
Background. Unstable and comminuted distal radial fractures require surgical treatment by percutaneous insertion of Kirschner wires, open reduction and fixation with a non-locking or locking plate or with an external device. The aim of this paper was to try to answer the following question: are there differences in functional treatment outcomes in patients after surgery with the use of Kirschner wires vs LCP plate fixation? Material and methods. The study group included 100 patients after surgical treatment by closed reduction and simple fixation with Kirschner wires (50 patients) and by open reduction and LCP locking plate fixation (50 patients). The study assessed the following parameters: global grip strength, pain severity in a VAS scale, range of motion, functional status of the wrist based on the Fernandez classification, quality of life according to the QuickDASH score, and the frequency of complications. These parameters were assessed at 6 and 12 months after surgery. Results. An assessment of the treatment outcomes at 6 and 12 months after surgery showed statistically significant differences between the treatment methods in the following parameters: pain severity, global grip strength and range of motion in the sagittal plane. A comparison of the functional status of the wrist at 6 and 12 months between the groups showed considerably worse results in the Kirschner wire fixation group. The frequency of postoperative complications at 12 months was 6% in the Kirschner wire fixation group and 2% in the LCP plate fixation group. Conclusions. 1. Treatment outcomes were better in patients with distal radial fractures managed with LCP plate fixation. 2. The use of LCP plate fixation predisposes patients to better ranges of mobility in the sagittal plane in the radiocarpal joint. 3. The values of global grip strength were higher in the group treated with LCP plate fixation. 4. Patients treated with LCP plates have better limb function and quality of life and lower pain intensity after treatment completion. 5. The number of complications was higher in patients treated with Kirschner wire fixation.
PL
Wstęp. Niestabilne i wieloodłamowe złamania końca dalszego kości promieniowej wymagają leczenia operacyjnego poprzez przezskórne wprowadzenie grotów Kirschnera, otwartą repozycję i zespolenie płytką nieblokowaną, blokowaną lub założeniem stabilizatora zewnętrznego. Celem pracy była próba odpowiedzi na pytanie: czy istnieją różnice w czynnościowych wynikach leczenia u pacjentów operowanych z wykorzystaniem stabilizacji grotami Kirschnera i płytką LCP? Materiał i Metody. Materiał badany obejmował 100 chorych leczonych operacyjnie metodą zamkniętej repozycji i prostej stabilizacji grotami Kirschnera (50 pacjentów) oraz metodą repozycji krwawej i stabilizacji płytką blokowaną LCP (50 pacjentów). W pracy dokonano oceny następujących parametrów: siły chwytu globalnego, natężenia bólu w skali VAS, zakresów ruchów, stanu czynnościowego nadgarstka w oparciu o klasyfikację Fernandeza, jakości życia w oparciu o  kwestionariusz Quick DASH, częstości powikłań. Oceny opisanych parametrów dokonano po 6 i 12 miesiącach od operacji. Wyniki. Ocena wyników leczenia po 6 i 12 miesiącach od operacji pokazała obecność istotnych statystycznie różnic między obiema metodami leczenia w zakresie następujących parametrów: natężenia bólu, siły chwytu globalnego, zakresu ruchu w płaszczyźnie strzałkowej. Porównanie stanu funkcjonalnego nadgarstka po 6 i 12 miesiącach w obu grupach pokazało, że w grupie leczonej metodą stabilizacji grotami Kirschnera uzyskano zdecydowanie gorsze wyniki. Częstotliwość powikłań pooperacyjnych w grupie pacjentów po stabilizacji drutami Kirschnera po 12 miesiącach uzyskała wartości 6%. W grupie pacjentów po stabilizacji płytką LCP po 12 miesiącach wyniosła 2%. Wnioski. 1. Lepsze wyniki leczenia pacjentów ze złamaniem końca dalszego kości promieniowej uzyskano w metodzie stabilizacji płytką LCP. 2. Zastosowanie stabilizacji płytką LCP predysponuje do uzyskania lepszego zakresu ruchomości w płaszczyźnie strzałkowej w obrębie stawu promieniowo-nadgarstkowego. 3. Stwierdzono wyższe wartości siły chwytu globalnego w grupie leczonej metodą stabilizacji płytką LCP. 4. Pacjenci leczeni z użyciem płytki LCP uzyskują lepszą sprawność kończyny, wyższą jakość życia oraz mniejsze natężenie bólu po zakończonym leczeniu. 5. Większą liczbę powikłań zarejestrowano u pacjentów leczonych metodą stabilizacji drutami Kirschnera.
4
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Evaluation of the degree of subjective pain intensification accompanying carpal tunnel syndrome in relation to the intensification of changes confirmed by electroneurographic (ENG) testing

51%
Georgiew F., Maciejczak A., Otfinowska E.
Medical Rehabilitation
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2010
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vol. 14(2)
17-22
PL
Wprowadzenia: Zespól kanału nadgarstka (ZKN) jest coraz częściej rozpoznawaną patologia występującą najczęściej u pacjentów pomiędzy 30-60 rokiem życia. Schorzenie to 2 do 3 razy częściej dotyczy kobiet. Cel: Sprawdzenie czy istnieje zaleSność pomiędzy stopniem nasilenia ZKN ocenianym na podstawie wyniku badania ENG a ich stanem klinicznym ocenianym jako nasilenie dolegliwości subiektywnych i sprawność funkcjonalna. Materiał i metoda: Zbadano 161 chorych (12S kobiet i 33 mężczyzn) leczonych z powodu ZKN w poradni przyszpitalnej i na oddziale neurochirurgicznym. U 49 chorych występujące objaw}' miały charakter obustronny, tak więc łączna ilość wszystkich zbadanych przypadków wyniosła 210. Wiek chorych w chwili badania wynosił od 25 do 81 lat, średnio 55,2 lat. Ciężkość ZKN oceniono przy pomocy badania ENG a nasilenie objawów klinicznych określono jako ilość punktów uzyskaną przy pomocy kwestionariusza Levina (skala nasilenia objawów SSS + skala stanu funkcjonalnego FSS) oraz przy pomocy skali VAS. Wyniki: Pacjenci z ciężkim ZKN uzyskują średnio wyższe wyniki w pełnym kwestionariuszu Levina w porównaniu z grupa chorych z łagodnym ZKN. Przy pomocy skali SSS wskazano istotne statystycznie różnice nasilenia objawów subiektywnych pomiędzy umiarkowanym i ciężkim stopniem ZKN. Badanie nasilenia objawów bólu i/lub zdrętwienia przy pomocy skali VAS wykazało istotne różnice pomiędzy grupami o lekkim i ciężkim oraz grupami o umiarkowanym i ciężkim stopniu ZKN. Wnioski: Wynik uzyskany przy pomocy kwestionariusza według Levina (BQ) oraz wynik samooceny bólu i/lub zdrętwienia przy pomocy skali VAS może odzwierciedlać stopień uszkodzenia nerwu pośrodkowego jedynie w odniesieniu do chorych z ZKN z ciężkimi zaburzeniami w badaniu ENG.
EN
Introduction: Carpal tunnel syndrome (CTS) is an increasingly widespread pathology occurring in patients from the age of 30 to 60. This illness is 2 to 3 times more common in women.Aim of the study: verification of whether there exists a dependence between the degree of CTS intensification evaluated on the basis of ENG testing and the patients’ clinical state evaluated as an intensification of subjective discomfort and functional ability.Materials and methods: 161 patients were tested (128 women and 33 men) who were being treated for CTS at a hospital clinic and a neurosurgical ward. In 49 patients the symptoms were bilateral in nature hence the combined number of all the tested cases was 210. The age of the patients at the moment of testing was from 25 to 81, the average being 55,2. The severity of CTS was evaluated by means of ENG testing while the intensification of the clinical symptoms was defined as the number of points obtained via the Levin questionnaire (the scale of symptoms SSS (Severity Status Scale) + the functional state scale FSS) as well by means of the VAS scale. Results: Patients with severe CTS obtained on average higher results in the full Levin questionnaire when compared to the group of patients with mild CTS. Through the aid of SSS significant statistical differences were shown in the intensification of subjective symptoms between a moderate and severe degree of CTS. The testing of symptom intensification of pain and/or numbness through the help of the VAS scale showed significant differences between the groups with mild and severe degrees of CTS as well as between the groups with moderate and severe.Conclusions: The result obtained through the help of the Levin questionnaire (BQ) as well as the result of self evaluation of pain and/or numbness through the VAS scale can reflect the degree of damage to the median nerve only in relation to CTS patients with severe disturbances in the ENG test.
5
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Ocena jakości życia pacjentek leczonych onkologicznie z powodu raka piersi

51%
Trybulec A., Georgiew F., Borowiec-Trybulec A.
Health Promotion & Physical Activity
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2019
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vol. 9
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issue 4
14-20
EN
Introduction: Currently, in the world, breast cancer is recognized as one in four malignant neoplasms in women. It is the second most common cause of death in cancer patients. The disease, which is a threat to women’s lives, leads to the loss of personal control, during its duration it becomes everyday life with negative emotions such as uncertainty, anxiety and anxiety. Women have contact with a range of negative effects that the disease provides, causing them to resign and destructive to the psychophysical sphere. Disorders in the physical and mental aspect of body image, side effects of therapy, sexual relations with a partner and anxiety about health in the future are factors that have a huge impact on the quality of life of patients. The aim of the study was to assess the quality of life of women with breast cancer. Materials and methods: The quality of life of 40 women with breast cancer who underwent oncological treatment was assessed using the author’s questionnaire with 12 questions and QLQ-BR23 questionnaire with 23 questions.. Results and conclusions: Studies have shown that the biggest problem for women was the side effects of the treatment and the most common discomfort during radiation therapy. They are characterized by redness of the skin, general weakness and fatigue, which in turn later translated into, a change in the perception of their body image, a decrease in their attractiveness, a sense of comfort and confidence. The obtained results showed that the lowest quality of life of the respondents was registered in the domain determining future perspectives. The best result was recorded in the domain of sexual pleasure and sexual functioning. When assessing the quality of life of the respondents, it follows that patients with vocational education have a worse quality of life within the domain of breast symptoms. Employed persons surveyed obtained worse quality of life results in terms of sexual functioning and sexual pleasure. Considering the duration of illness of the respondents, there were no statistically significant differences affecting the quality of life.
PL
Wstęp: Obecnie na świecie rak piersi rozpoznawany jest jako co czwarty złośliwy nowotwór u kobiet. Jest on drugą pod względem częstości przyczyną zgonu kobiet chorujących na nowotwór. Choroba często prowadzi do utraty osobistej kontroli. Codziennością staje się obcowanie z negatywnymi emocjami, takimi jak niepewność, niepokój oraz lęk. Kobiety borykają się z całym wachlarzem negatywnych konsekwencji choroby, które są przyczyną rezygnacji oraz działają destrukcyjnie na sferę psychofizyczną. Celem pracy była ocena jakości życia kobiet z rakiem piersi poddanych leczeniu onkologicznemu. Materiał i metody: Ocenie poddano 40 kobiet z rozpoznanym rakiem piersi poddanych leczeniu onkologicznemu w oddziale radioterapii. Do oceny jakości życia zastosowano autorską ankietę oraz kwestionariusz QLQ-BR23. Wyniki i wnioski: Uzyskane wyniki pokazały, że najniższą jakość życia respondentek zarejestrowano w domenie określającej perspektywy na przyszłość. Najlepszy wynik zaobserwowano w zakresie domeny odnoszącej się do przyjemności seksualnej i funkcjonowania seksualnego. Badaniami potwierdzono, że pacjentki z wykształceniem zawodowym wskazały na gorszą jakość życia w obrębie domeny obrazującej objawy ze strony piersi. Pacjentki pracujące zawodowo uzyskały gorsze wyniki jakości życia w zakresie funkcji seksualnych i przyjemności z seksu. Nie zaobserwowano istotnych statystycznie różnic pomiędzy czasem trwania choroby respondentek, a jakością życia.
6
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An evaluation of sensitivity of provocative tests used in the carpal tunnel syndrome diagnosis depending on clinical severity of the syndrome

51%
Georgiew F., Otfinowska E., Adamczyk T.
Medical Rehabilitation
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2009
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vol. 13(2)
17-22
EN
Background: Using popular provocative tests to diagnose the carpal tunnel syndrome (CTS) facilitates referring patients for specialist treatment and is indispensable to the performance of epidemiologic studies. Patients with severe carpal tunnel syndrome (CTS) are frequently referred for surgery, whereas people with mild CTS are commonly referred for conservative therapy. Finding out which provocative tests are most effective in diagnosing mild cases can aid clinicians in making decisions about further treatment.Objectives: The purpose of this study was to evaluate the sensitivity of provocative tests used for diagnosis of CTS such as Phalen’s, Durkan’s and Tinel’s sign and to find out if the time of paresthesia occurrence during the tests depended on the severity of the syndrome assessed using Levine’s Questionnaire.Material and methods: The study involved 130 women and 33 men with carpal tunnel syndrome confirmed by ENG. 52 patients had bilateral symptoms so a total number of cases examined was 215. Subjects were tested using four CTS provocative tests in random order: Phalen’s, Durkan’s, Provocative and Tinel’s sign. The examiner waited 2 – 3 minutes between each provocative test to ensure that any nerve irritation caused by previous test had abated. Severity level of CTS was assessed using Levine’s Questionnaire .Results: Sensitivity values were: for Phalen’s Test – 85.6%, Durkan’s Test – 86.5%, Provocative Test 84.6%, and Tinel’s sign – 46%. Sensitivity values for Phalen’s, Durkan’s and Provocative tests are higher than 93,1% for moderate, severe and extreme CTS. There is a relationship between testing positive on CTS provocative tests and severity of clinical symptoms. As the severity of CTS increases, the average time of paresthesia occurrence in median nerve distribution decreases. Conclusions: (1) Tinel’s sign should not be recommended as a CTS diagnostic tool because of its low sensitivity. (2) If Levine’s Questionnaire reveals small progression of CTS the sensitivity of the tests is insufficient to confirm CTS. (3) In the case of patients with moderate, severe or extreme CTS according to Levine’s Questionnaire, the diagnosis can be confirmed using valid provocative tests such as Phalen’s, Durkan’s and Provocative.
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