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Background: Carpal tunnel syndrome (CTS) is the most frequent mononeuropathy of upper extremities. From the early 1990's it has been suggested that intensive work with computers can result in CTS development, however, this relationship has not as yet been proved. The aim of the study was to evaluate occupational and non-occupational risk factors for developing CTS in the population of computer-users., Material and Methods: The study group comprised 60 patients (58 women and 2 men; mean age: 53.8 +/- 6.35 years) working with computers and suspected of occupational CTS. A survey as well as both median and ulnar nerve conduction examination (NCS) were performed in all the subjects., Results: The patients worked with use of computer for 6.43 +/- 1.71 h per day. The mean latency between the beginning of employment and the occurrence of first CTS symptoms was 12.09 +/- 5.94 years. All patients met the clinical and electrophysiological diagnostic criteria of CTS. In the majority of patients etiological factors for developing CTS were non-occupational: obesity, hypothyroidism, oophorectomy, past hysterectomy, hormonal replacement therapy or oral contraceptives, recent menopause, diabetes, tendovaginitis. In 7 computer-users etiological factors were not identified., Conclusion: The results of our study show that CTS is usually generated by different causes not related with using computers at work.

Unlabelled: The objective of this study was an assessment of sympathetic activity within the hand in patients with traumatic, incomplete nerve lacerations. In 12 patients, 1 female and 11 male in the mean age of 30 years with injuries of these nerves within forearm, the sympathetic skin response was obtained with index fingers of the affected and unaffected hand. Capillaroscopy examination of nail folds of the middle fingers was performed in affected and unaffected hand. Over and above, symptoms and signs attributed to the sympathetic function were registered., Results: Mean values of the sympathetic skin response parameters: amplitude and area were statistically significantly reduced in the affected hand, comparing to the unaffected: amplitude 0.5 vs 1.0 mV, area 0.6 vs 1.2 mVms, respectively. Latency was not different between the hands; 1.4 vs. 1.5 ms. Qualitative analysis of the SSR graphs revealed no response in two patients, reduced SSR in 7 and normal SSR in 3 patients. Wide individual variability of the parameters of the sympathetic skin response was observed. Capillaroscopy. Mean diameters of afferent capillary vessels were greater in the affected (11.7 pm) than in the unaffected (10.7 microm) hand, but the difference was not significant. Mean diameters of efferent capillary vessels were statistically significantly greater in the affected (15.2 microm) than in the unaffected (14.2 microm) hand, what may be attributed to reduced sympathetic activity in the distribution of the examined nerve. All patients reported symptoms and signs attributed to sympathetic dysfunction, which majority of them were considered troublesome in their daily life. Results obtained in our study does not allow for a definitive conclusion regarding the severity of sympathetic dysfunction due to partial laceration of the median or median and ulnar nerves. The results indicate on limited ability of employed diagnostic techniques in detection of factual effect of the loss of sympathetic fibres in the median nerve on the activity of sympathetic system in the distribution of this nerve.

A series of 52 patients with peripheral nerve injury, treated operatively is presented. Motor function has been assessed according to Highet (MO-M5). Sensory function has been evaluated according to Nicholson and Seddon (S0-S4). An attempt to show decisive factors for successful peripheral nerve reconstruction. Clinical analysis proved surgical technique, modified with experience gained influences the final result remarkably. Imposition of microsurgical techniques and instrumentation as well as operative microscopy improved efficacy of the treatment. Delay of final reconstruction worsens ultimate outcome. Age of the patient and coexisting injury of the skin, tendons and bone that change conditions of nerve regeneration are also important. The longer the skin nerve graft is the worse motor and sensory recovery.

The authors present the microsurgical technique of grafting thin cutaneous nerves at the site of peripheral nerve defect. The application of grafts in place of end-to-end suture makes possible elimination of nerve stretching at the time of suturing and at the time of rehabilitation. The use of cutaneous nerves makes possible good revascularization of grafts and their correct regeneration. The use of the microsurgical technique makes possible a good evaluation of the fascicular structure of nerve trunks, their adequate resection, and good adaptation of nerve stumps and grafts connecting the corresponding nerve fascicles. The use of the technique of nerve gluing with autologous plasma enables a stable connection of grafts and stumps to be obtained, with simultaneous elimination of foreign material (threads) from the area of connection.