The Now Popular and ‘Fashionable’ Carpal Tunnel Syndrome – Revisited
Notice bibliographique
Résumé
During my residency and first years of practice in the late 60s and early 70s, it was not unusual to see patients with neglected hands with obvious wasting of the abductor polli-cus brevis muscle, clumsiness, weakness and loss of sensation in the median nerve distribution. It was common practice to add some type of opponens tendon transfer to the carpal tunnel release procedure – frequently the Camitz procedure. During the past two decades the situation has changed drastically. The condition has now become ‘popular’ with family doctors, patients, coworkers, lawyers and others. Previously, we had to educate the public in early recognition of this condition. Now our problem is to make the correct diagnosis! Since my ‘semiretirement’ and since becoming a ‘hand physician’ (a plastic surgeon who does not operate but sees only hand patients), almost every patient with some type of tingling and pain in any finger is referred with the diagnosis of ‘carpal tunnel syndrome’! So, why this change? I would like to offer some suggestions. The family physicians in our area (Toronto, Ontario) are generally very busy and often do not have the time to go into the details of the history, order an electromyogram and nerve conduction study, which most of the time are positive, and refer the patient. And, while I am on this subject, I have never had much use for these tests – with some exceptions. I used to operate on patients with definite positive provocative tests and failure of conservative management. I have been known to state that, “I do not operate on x-rays or EMGs, only on hands!” However, they are helpful in the diabetic patient with peripheral neuropathy and, in some individuals, with the ‘double crush’ syndrome (ie, carpal tunnel syndrome and cervical radiculopathy). The tests may also be required by some third parties such as the Workplace Safety & Insurance Board of Ontario or insurance companies. There are several problems with these studies: They quite often do not correlate with the physical findings. They are highly subjective and the results can differ among laboratories (even the normal values). Most of the symptoms happen during the night but the tests are performed during the day when the patient may be symptomless. My biggest objection, however, deals with the report, which is quite often shown to the patient and states that the patient requires an operation! What can we do about it? We should present our thoughts and opinions in postgraduate presentations, rounds and talks to the medical students.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,003 | 0,009 |
| Communication savante | 0,004 | 0,010 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,012 | 0,013 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».