Цитата:
Сообщение от Golosa
Вот мне повезло-то, что живу и работаю не в Америке. И штрафов платить не надо. Доктор, еще раз прошу прочитать тему "Синдром Рейно". Умоляю, просто. Ведь не читали!!! Там же все ясно написано: именно западные врачи, в частности, именно те же боязливые американцы заявляют, что необязательно и не во всех поголовно случаях надо выполнять электродиагностику, а лишь выборочно, когда есть сомнения. А как раз у наших врачей все наоборот: никто и слова не может или не хочет сказать против электродиагностики при СКЗ. Вот ведь в чем парадокс. Причин этого не знаю, но догадываюсь.
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над ней работали IIMAC Committee Members Gregory T. Carter MD MS Dianna Chamblin MD – Chair G.A. DeAndrea MD MBA Jordan Firestone, MD PhD MPH Andrew Friedman MD
Subcommittee Clinical Experts Christopher H. Allan MD Douglas P. Hanel MD Michel Kliot MD Lawrence R. Robinson MD Thomas E. Trumble MD Nicholas B. Vedder MD Michael D. Weiss MD
Consultation Provided by: Terrell Kjerulf MD, Qualis Health Ken O’Bara MD, Qualis Health Scott Carlson MD Jeffrey (Jerry) G. Jarvik MD.
Department staff who helped develop and prepare this guideline include: Gary M. Franklin MD MPH, Medical Director Simone P. Javaher BSN, MPA, Occupational Nurse Consultant Reshma N. Kearney MPH, Epidemiologist
Посмотрите список литературы.
А теперь выдержки оттуда:
Findings on physical examination, signs, are frequently absent or non-specific.
Hoffmann-Tinel’s sign (paresthesias radiating in a median nerve distribution with tapping on the wrist or over the median nerve)
and Phalen’s sign (paresthesias radiating in a median nerve distribution within 60 seconds of sustained flexion of the wrist) are frequently described, but by themselves
are not sensitive or specific for the diagnosis of CTS.
Every effort should be made to objectively verify the diagnosis of CTS before considering surgery.
ELECTRODIAGNOSTIC TESTING
NCVs are highly sensitive and specific for CTS. If the patient has a positive clinical picture of CTS but the NCV results are negative, the physician should investigate other competing clinical diagnoses such as pronator syndrome, cervical radiculopathy or tendonitis.
Less than 10% of patients with clinical CTS have normal NCV results.8 In these cases, the treating physician should be sure the most sensitive and specific NCVs are done. If not, a request for these tests should be made. In some cases of suspected CTS, the NCVs can be repeated. However, unless there is a significant intervening event or a substantial change in the clinical assessment, there should be a delay of at least one year before repeating the NCV test, as it is otherwise unlikely that a difference will be seen at a shorter time interval.
C. OTHER DIAGNOSTIC TESTS Some studies have demonstrated that Magnetic Resonance Imaging (MRI) neurography16 and ultrasound17 have promise in the diagnosis of CTS. However, the clinical utility of these tests has not yet been proven. While the panel recognizes that these tests may be useful in unusual circumstances where NCV results are normal but there are appropriate clinical symptoms, the panel believes that at this time the use of these tests is investigational and should be used only in a research setting.
The Department does not cover these services.
Table 1. Work Exposures and the Probability of Work-Relatedness
Exposure
Examples of types of jobs
Probability of work-relatedness
Combinations of high force with high repetition and awkward posture; regular strong vibrations
Seafood, fruit, or meat processing or canning, carpentry, roofing, dry-wall installation, boat building, book binding
High, Relative risk > 4
Medium-high force, high repetition or awkward posture alone, on a nearly continuous basis
Dental hygienists, wood products production
Medium, Relative risk 2-4
Low force or medium-low repetition alone, on an intermittent basis
Computer or keyboard use
Low, Relative risk < 2
По-моему, достаточно. Сколько еще можно доказательств? Статью про болезнь Рейно специально читать не стану, потому как не про СЗК, а про болезнь Рейно. Приведите мне хоть одну статью-опровержение именно неврологического профиля.