Laursen Lise H, Jepsen Jørgen R, Sjøgaard Gisela
Research Unit of Maritime Medicine, University of Southern Denmark, Oestergade 81-83, 6700, Esbjerg, Denmark.
Int Arch Occup Environ Health. 2006 Aug;79(7):593-601. doi: 10.1007/s00420-006-0094-7. Epub 2006 Mar 17.
Upper limb disorders (ULDs) are common, and so are the difficulties with regard to their specific diagnoses. According to diagnostic consensus criteria, specific diagnoses include neuropathy and muscular- and connective-tissue disorders (MCDs). There is a need for valid objective diagnostic tools to reveal underlying mechanisms for specific diagnoses.
To investigate the possible differences in vibration perception threshold (VPT) and tolerance to suprathreshold stimulation (STS) between controls and specific diagnostic ULD patient groups with uni- and bilateral neuropathy and/or MCD.
In 161 ULD patients and 40 controls, the VPT of the median, ulnar, and radial nerves innervating the hand was examined by vibrometry using the "method of limits". The tolerance to STS of the anterior forearm was tested in 128 of the patients and all controls.
The ULD patients in all diagnostic groups had significantly higher VPT (P<0.05) in all the nerves in limbs, with and without diagnoses compared with controls. Only patient groups defined with neuropathy demonstrated significantly higher VPT in the limb with diagnoses compared with the contralateral limb without diagnoses. The highest VPTs were found in the patient group with unilateral neuropathy and MCD, and for the radial nerve, VPT was significantly higher than that for patients with unilateral MCD alone. These findings were confirmed by almost similar findings in STS responses.
The ULD patients generally demonstrated increased VPT compared with controls, indicating a neurogenous component independent of specific ULD diagnosis. Contralateral significant findings in limbs without diagnoses compared with controls indicate central neurogenous affection and/or the possibility of certain exposures elevating VPT before a positive status of a limb diagnosis is attained. Significantly higher VPT values in limbs with neuropathy diagnoses compared with limbs without and not in MCD alone, may indicate peripheral sensibilization or nerve affection only in the group with a specific diagnosis of neuropathy. These findings underline the importance of specific diagnoses among ULD patients.
上肢疾病（ULDs）很常见，其具体诊断也存在困难。根据诊断共识标准，具体诊断包括神经病变以及肌肉和结缔组织疾病（MCDs）。需要有效的客观诊断工具来揭示具体诊断的潜在机制。
研究对照组与患有单侧和双侧神经病变及/或MCD的特定诊断ULD患者组之间在振动觉阈值（VPT）和对阈上刺激（STS）的耐受性方面的可能差异。
对161例ULD患者和40名对照组进行研究，使用“极限法”通过振动测量法检查支配手部的正中神经、尺神经和桡神经的VPT。对128例患者和所有对照组测试前臂对STS的耐受性。
与对照组相比，所有诊断组的ULD患者无论肢体有无诊断，其所有神经的VPT均显著更高（P<0.05）。只有诊断为神经病变的患者组，患侧肢体的VPT显著高于对侧未诊断的肢体。VPT最高的是单侧神经病变和MCD患者组，对于桡神经，其VPT显著高于仅患有单侧MCD的患者。STS反应的几乎相似结果证实了这些发现。
与对照组相比，ULD患者总体上表现出VPT升高，表明存在独立于特定ULD诊断的神经源性成分。与对照组相比，未诊断肢体的对侧显著结果表明存在中枢神经源性影响和/或在肢体诊断呈阳性之前某些暴露导致VPT升高的可能性。与未诊断且非仅患有MCD的肢体相比，诊断为神经病变的肢体VPT值显著更高，可能仅在特定诊断为神经病变的组中表明存在外周敏化或神经损伤。这些发现强调了ULD患者中进行具体诊断的重要性。
