Thoracic Outlet Syndrome "Recurrence"

Thoracic outlet syndrome encompasses a number of lesions which compress the neurovascular supply to the upper extremity. This bundle passes between the scalenus and medius muscles, the clavicle and first rib, and subsequently behind the pectoralis minor muscle. Abnormality of any of these structures, especially a rudimentary cervical rib (with a fibrous band to the first rib) may compress it. Most of the patients are female, often with droopy shoulders and swan necks. It has also been related to hypertension trauma, military backpacks, and abnormal posture with the chin protruded. It has been added by some to the group of "cumulative trauma disorders" (repetitive stress syndrome)exemplified by CTS.

CARPAL TUNNEL SYNDROME
Bilateral Lateral Hand Syndrome (Carpal Tunnel Syndrome) is common in adults, especially women, and is probably the most frequent problem referred for electrodiagnosis. This condition can be related to sustained positions of the upper extremity and is considered a prototype of a work-related condition caused by repetitive motion of the wrist - repetitive stress syndrome. On examination, there may be sensory loss over the lateral three fingers and the adjacent ring finger. Weakness and atrophy (wasting away, dimunition in size) of the muscle may be detectable of the lateral thenar muscles (palm and thumb) which are almost always affected by the median nerve (arm through shoulder). Carpal tunnel is a common yet serious condition which afflicts millions of Americans, many of whom are often untreated.

GUIDELINE FOR DIABETIC NEUROPATHY

Diabetic neuropathy, also called nerve pain, is a condition resulting from nerve damage caused by high blood sugar levels associated with diabetes. The American Academy of Neurology (AAN) has created a guideline for treatment and it has recently reviewed 79 available scientific studies on therapies for diabetic neuropathy over a four year period. While it is universally known that exercise is always considered a key step in the right direction in combating diabetes, the seizure medication pregabalin was found to have strong evidence of effectiveness in this study. Only one non-pharmaceutical therapy, transcutaneous electric nerve stimulation (TENS) – a portable device that sends an electric current to electrodes attached to the skin – was shown to have moderate evidence supporting its effectiveness.