臺灣博碩士論文加值系統

研究背景與目的: 正中神經張力測試經常被用來檢查神經動力學表現或評估神經受到夾擠或壓迫產生的症狀，最常被用來評估頸椎神經根症狀的病人。在正中神經張力測試姿勢下測得的肘伸直角度通常被視為主要的測量結果。然而，對於腕隧道症候群病患的神經動力學表現仍未有清晰的輪廓。由於正中神經是在腕部受到壓迫，運用不同的神經張力測試順序在腕隧道症候群病人的身上是否會得到不同的反應亦屬未知。因此，本研究的主要目的是比較腕隧道症候群病人與沒有神經症狀之正常健康人的正中神經張力測試結果；進一步探討腕隧道症候群病人在正中神經張力測試姿勢下測得的關節角度，與臨床手部感覺運動功能或是日常功能評估結果是否具有相關性。並研究使用不同神經張力測試順序於腕隧道症候群病人時的神經動力學表現。
研究方法 : 本研究招募了39名(平均年齡59.4歲)的腕隧道症候群患者，以及25名(平均年齡22歲)的健康成年人。研究參與者皆接受一系列標準化症狀功能評估與上肢神經張力測試。症狀功能評估項目包含前三指的兩點覺、輕觸覺、最大握力 、捏力、腕隧道症候群症狀功能問卷、上肢功能問卷、與生活品質問卷。正中神經張力測試則使用兩種不同正中神經張力測試的順序，並以最後移動之腕或肘關節角度量化正中神經動力學表現。神經動力學表現與輕觸覺的測試結果的相關性分析採用斯皮爾曼等級相關係數；神經動力學表現與其他症狀功能評估結果的相關性分析則使用皮爾森相關係數。獨立t檢定則用來探討腕隧道症候群患者的神經動力學表現與健康成年人是否有所差異。顯著等級設定在p〈0.05。
結果: 神經動力學表現與腕隧道症候群的嚴重程度具有相關性，神經動力學表現愈差，則腕隧道症候群的感覺或日常功能表現愈差。使用不同的神經動力測試順序時，會產生不同的神經動力學表現結果。隧道症候群患者的神經動力學表現亦較健康成年人差。
結論: 腕隧道症候群患者之神經動力學表現愈差，則症狀與影響功能的程度愈嚴重。基於神經動力學表現與症狀的相關性，正中神經張力測試可應用在初步評估腕隧道症候群的嚴重程度。

Background and purpose: Upper limb neurodynamic test for median nerve bias (ULNT1) have been used to assess neurodynamics and evaluate nerve entrapments, particularly in patients with cervical radiculopathy. The measured angle of elbow extension during ULNT1 procedure is the commonly acceptable parameter representing the neurodynamics of the median nerve. However, the neurodynamic properties in patients with carpal tunnel syndrome (CTS) is still unclear, and whether dissimilar responses will be found while different sequences of ULNT1 are applied to those patients is unknown. Therefore, the main purpose of this study was to compare the neurodynamics of the median nerve between patients with patients with CTS and the healthy adults, and then further to investigate the associations between joint angles measured during the ULNT1 and clinical symptoms and functional measures in patients with CTS. The second purpose was to investigate the neurodynamics of median nerve in patients with CTS using different sequences of the ULNT1.
Methods: This study included 39 patients with CTS aged between 38 and 82 (mean 59.4) years, and 25 healthy adults aged 20-32 (mean 22) years. All participants received the standard ULNT1 testing and a series of measures of physical functions. Measures of physical functions included the two-point discrimination (2PD), Semmes-Weinstein monofilament (SWM) test, grip strength, pinch strength, and questionnaire surveys of CTS, DASH and SF36. The upper limb neurodynamic test 1 was performed using two different movement sequences to quantitatively assess the median nerve neurodynamics upon joint angles of wrist or elbow. Spearman's rank correlation coefficient was used to examine the correlations between the joint angle measured by ULNT1 and the results of SWM, while the correlations between the joint angles measured by ULNT1 and other physical function parameters were examined using the Pearson's correlation coefficient. The differences of neurodynamic properties between the patients with CTS and healthy adults were examined using the independent t-tests. The significant level was set at p〈0.05.
Results: There were mild to moderate correlations between the neurodynamics and the severity of CTS. The smaller angles measured during ULNT1, the poorer physical functions in patients with CTS. Different neurodynamic properties were observed while different sequences of ULNT1 were conducted in patients with CTS. Finally, the neurodynamics in patients with CTS was worse than that in the healthy adults.
Conclusion: Base on the correlation between the neurodynamics of patients with CTS and the severity of CTS, ULNT1 could be used to evaluate the severity of CTS.

中文摘要 I
Abstract II
致謝 IV
Contents V
List of Tables VIII
List of Figures IX
Chapter 1 Introduction 1
1.1 Background 1
1.2 Research purpose 2
1.3 Hypotheses 2
Chapter 2 Literature review 3
2.1 Neurodynamics 3
2.1.1 Anatomy of peripheral nerve 3
2.1.2 Concept of neurodynamics 4
2.1.3 Nerve entrapment 5
2.2 Carpal tunnel syndrome 6
2.2.1 Introduction of carpal tunnel syndrome 6
2.2.2 Changes due to CTS and following sensory response 7
2.3 Upper Limb Neurodynamic Test for Median nerve bias (ULNT1) 8
2.3.1 Introduction of ULNT1 8
2.3.2 Evidence of ULNT1 9
2.3.3 Sequences of UNLT1 10
Chapter 3 Materials and methods 12
3.1 Research design 12
3.2 Setting 12
3.3 Subjects 12
3.4 Experimental procedures 13
3.4.1 Two-Point Discrimination (2PD) test 15
3.4.2 Semmes-Weinstein Monofilament (SWM) Test 17
3.4.3 Grip strength measurement 20
3.4.4 Key pinch strength measurement 21
3.4.5 Palmar Pinch Strength Measurement 22
3.4.6 Upper Limb Neurodynamic Test 1 (ULNT1) 23
3.4.7 Boston Carpal Tunnel Questionnaire (BCTQ) survey 29
3.4.8 Disability of Arm, Shoulder and Hand Questionnaire 30
3.4.9 36-Item Short Form Healthy Survey (SF-36) 31
3.4.10 Data reduction 32
3.4.11 Statistical Analysis 38
Chapter 4 Results 39
4.1 Demographic data 39
4.2 ROM 39
4.3 Upper Limb Neurodynamic Test 1 (UNLT1) 40
4.4 The difference between ROM and neurodynamics. 41
4.5 The nurodynamic difference between sequences of ULNT1 42
4.6 Sensory response 43
4.7 Sensory tests 43
4.8 Motor tests 44
4.9 Questionnaire surveys 45
4.10 The correlation between neurodynamics with 2PD 46
4.11 The correlation between neurodynamics with SWM test 47
4.12 The correlation between neurodynamics with strength 47
4.13 The correlation between neurodynamics with BCTQ 50
4.14 The correlation between neurodynamics with DASH 53
4.15 The correlation between neurodynamics with SF-36 55
Chapter 5 Discussion 59
5.1 The characters of both groups 59
5.2 The difference between ROM and neurodynamics 59
5.3 The difference between sequences of ULNT1 60
5.4 Parts of body where sensory responses appear first 61
5.5 The correlation between neurodynamics with sensory tests 62
5.6 The correlation between neurodynamics with motor tests 62
5.7 The correlation between neurodynamics with questionnaires 62
5.8 Active movement during ULNT1 and sensory response 63
5.9 The inter-rater reliability 64
5.10 Limitation 65
Chapter 6 Conclusion 66
References 67
Appendix 76
Appendix 1 BCTQ 76
Appendix 2 DASH 78
Appendix 3 SF-36 81

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