Biomedical subjects

Cynthia Garvan

Publications and source records attributed to Cynthia Garvan.

3 recordsLinked to original sources

PubMed2005

The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy.

BACKGROUND: Distal ulnar neuropathies have been identified in cyclists because of prolonged grip pressures on handlebars. The so-called cyclist palsy has been postulated to be an entrapment neuropathy of the ulnar nerve in the Guyon canal of the wrist. Previous studies utilizing nerve conduction studies have typically been either case reports or small case series. HYPOTHESIS: Electrophysiologic changes will be present in the ulnar and median nerves after a long-distance multiday cycling event. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 28 adult hands from 14 subjects underwent median and ulnar motor and sensory nerve conductions, which were performed on both hands before and after a 6-day, 420-mile bike tour. A ride questionnaire was also administered after the ride, evaluating the experience level of the cyclist, equipment issues, hand position, and symptoms during the ride. RESULTS: Distal motor latencies of the deep branch of the ulnar nerve to the first dorsal interosseous were significantly prolonged after the long-distance cycling event. The median motor and sensory studies as well as the ulnar sensory and motor studies of the abductor digiti minimi did not change significantly. Electrophysiologic and symptomatic worsening of carpal tunnel syndrome was observed in 3 hands, with the onset of carpal tunnel syndrome in 1 hand after the ride. CONCLUSION: Long-distance cycling may promote physiologic changes in the deep branch of the ulnar nerve and exacerbate symptoms of carpal tunnel syndrome.

Adult↗

PubMed2003

Epidemiology of spine tumors presenting to musculoskeletal physiatrists.

OBJECTIVE: To report the incidence and epidemiologic formation of previously undetected primary and secondary spine tumors presenting as spinal and/or extremity pain to a physiatrist practicing in an academic or private practice multidisciplinary spine center. DESIGN: Multicenter retrospective chart review. SETTING: Three multidisciplinary spine settings (1 academic, 2 private). PARTICIPANTS: Charts of patients from 33 academic and 18 private practice settings. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Epidemiologic data collected included incidence, age, gender, race, and duration of symptoms before initial presentation. Symptom presentation data collected included intensity of pain when supine, sitting, standing, or walking; character of the pain; pain intensity as measured on the visual analog scale (VAS); spontaneous versus traumatic etiology; unexplained weight loss; presence of night pain; and fever. In addition, the results of radiographic studies including plain films, imaging, bone scan, and magnetic resonance imaging were recorded. The type of neoplastic disease was also assessed, primary versus metastatic, as well as the metastatic source. RESULTS: The incidence of spine tumors was.69% in academic multidisciplinary spine centers and.12% in private practice multidisciplinary spine centers. Patients with spinal pain because of neoplastic disease who presented to musculoskeletal physiatrists were an average age of 65.3 years and reported a relatively high likelihood of night pain, aching character of symptom manifestation, spontaneous onset of symptoms, history of cancer, standing and walking provoking symptoms, and unexplained weight loss. In addition, the pain intensity level ranged widely, with an average VAS score of 6.8. CONCLUSIONS: There are many similarities and differences in the clinical presentation of patients with spinal pain from spine tumors who present to musculoskeletal physiatrists practicing in multidisciplinary spine centers when compared with those presenting to a primary care setting.

Adult↗

PubMedDate not supplied

Provocative cervical discography symptom mapping.

BACKGROUND CONTEXT: In a small prospective study assessing 10 symptomatic and 10 asymptomatic subjects, Schellhas et al. compared cervical discography to magnetic resonance imaging. Within that study he reported on the distribution of pain for the C3-C4 to C6-C7 levels. Four years later, Grubb and Ellis reported retrospective data from his 12-year experience using cervical discography from C2-C3 to C7-T1 in 173 patients. To date, no large prospective study defining pain referral patterns for each cervical disc has been performed. PURPOSE: To conduct a prospective visual and statistical descriptive study of pain provocation of a cohort of subjects undergoing cervical discography. STUDY DESIGN/SETTING: Prospective multicenter descriptive study. METHODS: Pain referral maps were generated for each disc level from patients undergoing cervical discography with at least two levels assessed. If concordant pain was reproduced in a morphologically abnormal disc, the subject immediately completed a pain diagram. An independent observer interviewed the subject and recorded the location of provoked symptoms. Visual data were compiled using a body sector bit map, which consisted of 48 clinically relevant body regions. Visual maps with graduated color codes and frequencies of symptom location at each cervical disc level were generated. RESULTS: A total of 101 symptom provocation maps were recorded during cervical discography on 41 subjects. There were 10 at C2-C3, 19 at C3-C4, 27 at C4-C5, 27 at C5-C6, 16 at C6-C7 and 2 at C7-T1. Predominantly unilateral symptoms were provoked just as often as bilateral symptoms. The C2-C3 disc referred pain to the neck, subocciput and face. The C3-C4 disc referred pain to the neck, subocciput, trapezius, anterior neck, face, shoulder, interscapular and limb. The C4-C5 disc referred pain to the neck, shoulder, interscapular, trapezius, extremity, face, chest and subocciput. The C5-C6 disc referred pain to the neck, trapezius, interscapular, suboccipital, anterior neck, chest and face. The C6-C7 disc referred pain to the neck, interscapular, trapezius, shoulder, extremity and subocciput. At C7-T1 we produced neck and interscapular pain. Visual maps with graduated color codes and frequencies of symptom location at each cervical disc level were generated. CONCLUSIONS: In conclusion, these results confirm the observations of prior investigators that cervical internal disc disruption can elicit axial and peripheral symptoms. The particular patterns of pain generation allow the discographer to preprocedurally anticipate disc levels to assess. With these data, the number of disc punctures that are required can be limited rather than routinely assessing all cervical discs.

Cervical Vertebrae↗