BANGALORE, KARNATAKA.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION1 / Name of the Candidate
and Address / BACHKANIWALA APARNA A. SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTER,
PANDESHWARA,
MANGALORE-575001
2 /
Name of the Institute
/ SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTER, MANGALORE.3 /
Course of Study and
Subject / Master of Physiotherapy (MPT)2 years Degree Course.
NEUROLOGY AND PSYCHOSOMATIC DISORDERS.
4 /
Date of Admission
To Course / 17/05/2010.5 /
Title of the Topic
/ “NERVE CONDUCTION VELOCITY STUDIES OF UPPER EXTREMITES IN ELITE BADMINTON PLAYERS.”Brief resume of the intended work:
6.1 Need for the study:Nerve conduction studies are an objective, quantitative and reproducible measure of peripheral nerve function and are widely used in diagnosis of neuropathies1.NCV have been used to monitor neuropathic disease progression2 and efficacy of interventions in clinical trials.3,4
Badminton is an individual non-contact sport requiring jumps, lunges, quick changes in direction and rapid
arm movements from a wide variety of postural positions and also rapid and repetitive wrist movements.5
Studies reporting epidemiological data of badminton injuries are sparse, but previous studies have shown that these injuries often are severe in character but of relatively low frequency.6,7
Peripheral nerves of upper extremity are exposed to acute and chronic mechanical injuries in the athlete because of excessive physiological demands. Various factors such as high repetition of motions, high muscular forces and extreme elbow positions affect the peripheral nervous system with or without signs and symptoms.8
Injuries about elbow are common in racquet sports and are most often related to overuse. It has been found that repetitive elbow motion may lead to cubital tunnel syndrome9, medial epicondylitis, ulnar nerve injury, medial collateral ligament injury, medial elbow intra-articular pathology or any combination of these causes, lateral epicondylitis.8
Repetitive stress on dominant extremity of badminton player is responsible for physiological and pathological changes. Also many neurological injuries remain subclinical and are not identified before damage is irreversible. However, the clinician can rehabilitate the patient, plan a preventive conditioning program, and modify biomechanics scientifically. Many of the asymptomatic players with abnormal nerve conduction tests may have pre-symptomatic or asymptomatic neuropathy similar to subclinical entrapment nerve neuropathy.8
So this study is an attempt to evaluate the influence of badminton practice in elite players on the radial, ulnar and median nerves crossing the elbow region.
6.2 Review of literature:
1. Mansour Azarbal et al (2004): Did a survey of elbow injuries in badminton players in Tehran. They found that 17.7% of badminton players had a history of medial elbow pain during training reflecting a history of medial elbow injury including medial epicondylitis, ulnar nerve injury, medial collateral ligament injury, medial elbow intra-articular pathology, or any combination of these causes However we could not define exactly the type of the injury. They also found that 9.7% of badminton players had a history of lateral elbow pain during training reflecting a history of lateral elbow injury including lateral epicondylitis, degenerative changes in radiocapitellar joint or radial tunnel syndrome.10
2. Dizon JMR et al (2007): Conducted a study to investigate the prevalence of upper extremity musculoskeletal injuries among recreational badminton players and to identify factors associated with the presence of injuries. They concluded that among recreational badminton players, the shoulder is the most commonly injured area and muscle strain is the most common type of injury. Risk factors associated with developing injuries are the use of one piece racquet, absence of protective equipment of any kind during play and absence of any previous injury.113. Hatta Arihiro et al (1995): They studied ulnar nerve conduction velocity in athletes and did comparison between kendo, badminton, soft tennis and non-athletes. They investigated effects of training on motor nerve conduction velocity (MCV) and distribution of motor nerve conduction velocity (DMCV) of athletes and nonathletes. They concluded that long-term training influences not only MCV but also DMCV.12
4. Bozentka DJ (1998): Stated that the unique anatomic relationships of ulnar nerve at the elbow place it at risk for injury. Normally with elbow range of motion, ulnar nerve is subjected to compression, traction and frictional forces. Cubital tunnel syndrome may develop because of various factors including repetitive elbow motion, prolonged elbow flexion or direct compression.9
5. David b. Waddell et al: They presented paper which reviewed biomechanical research carried out over the last thirty years on the execution of badminton power strokes, and to share with the coach important implications of that research. Emphasis is on the forehand and backhand clear and smash. Results emphasize the importance of the rotational movements at the shoulder and radio-ulnar joints.13
6. T Colak et al (2004): They studied nerve conduction velocities of upper extremities in tennis players. They found that there is a delay in sensory and motor conduction velocities of radial nerve and sensory conduction velocity of ulnar nerve in dominant arms of tennis players compared with there non-dominant arms and normal subjects.8
7. Diana S. Stetson et al (1992): Conducted a study to find the effects of age, sex and anthropometric factors on nerve conduction measures. In summary, in randomly selected adults without occupational exposure to high force or repetitive hand exertions, age, height, and index finger circumference were found to be important predictors of median, ulnar nerve conduction measures.14
8. L Meyer et al (2007): Did a survey to determine the prevalence of musculoskeletal injuries among adolescent squash players in the Western Cape. They concluded that there is relatively high prevalence of squash injuries was found.15
6.3 Objective of the study:
1. To examine the influence of regular and intense practice of badminton on nerves in the elbow region.
2. To compare the upper extremity nerve conduction velocity in badminton players with age matched asymptomatic individual.
6.4 Hypothesis:
Experimental hypothesis:
There will be an influence of regular and intense practice of badminton on upper extremity nerves.
Null hypothesis:
There will be no influence of regular and intense practice of badminton on upper extremity nerves.
Material and Methods:
7.1 Source of data:
30 male badminton players in the age range of 20 – 40 years, who match the inclusion criteria, will be selected in this study.
Control group: 30 male, age matched asymptomatic individuals.
Sampling : Purposive sampling
7.2 Method of collection of data:
Subjects preparation:
It is performed with the subject in a supine position in a warm room with the temperature maintained at 26–28˚C. The skin temperature of the upper limb was checked to eliminate the influence of temperature on the conduction parameters.
Technique:
Nerve conduction studies were performed using standard techniques of supramaximal percutaneus stimulation with a constant current stimulator and surface electrode recording on both extremities of each subject.
Radial Nerve:
Motor part:19
· Stimulating electrode: elbow (about 5 cm proximal to the lateral epicondyle of humerus) and in the dorsum of forearm (about 8 cm proximal to styloid process of ulna).8
· Recording electrode: over extensor pollicis longus and abductor pollicis longus.
· Reference electrode: over styloid process.
· Ground electrode: between stimulating and recording electrode.
Sensory part(Orthodromic study):19
· Stimulating electrode: ring electrode at the thumb.
· Recording electrode: at wrist and elbow.
· Reference electrode: 2 cm proximal to the recording electrode.
· Ground electrode: between stimulating and recording electrode.
Ulnar Nerve:
Motor part:19
· Stimulating electrode: at wrist and below elbow (about 4 cm below the medial epicondyle).
· Recording electrode: from abductor digiti minimi
· Reference electrode: little finger.
· Ground electrode: between stimulating and recording electrode.
Sensory part(Orthodromic study):19
· Stimulating electrode: ring electrode at interphalangeal joint of 5th digit.
· Recording electrode: along course of ulnar nerve.
· Reference electrode: 2 cm proximal to the recording electrode.
· Ground electrode: between stimulating and recording electrode.
Median Nerve:
Motor part: 19
· Stimulating electrode: at wrist- 3 cm proximal to distal wrist crease and at elbow-near volar crease of brachial pulse.
· Recording electrode: close to motor point of abductor pollicis brevis.
· Reference electrode: 3 cm distal at 1st meta-carpophalangeal joint.
· Ground electrode: between stimulating and recording electrode.
Sensory part(Orthodromic study):19
· Stimulating electrode: ring electrode at 2nd or 3rd digit.
· Recording electrode: 3 cm proximal to the distal crease of the wrist.
· Reference electrode: 3 cm proximally.
· Ground electrode: between stimulating and recording electrode.
Materials used:
· ENMG Instrument
· Electrodes
· Coupling gel
· Cotton
· Adhesive tape
· Pillows
· Thermometer
Inclusion criteria:
1. Subjects training for minimum of 1 hour per day, four days a week.
2. Gender: male badminton players with age group 20-40 years.
3. Control group: age matched asymptomatic individuals.
Exclusion criteria:
1. History, signs or symptoms of peripheral neuropathy.
2. Compression syndrome of upper extremities.
Statistical analysis
Study design: Cross-sectional study.TEST: Descriptive statistics. includes mean and standard deviation.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans
or animals? If so please describe briefly.
YES.
I intend to measure the nerve conduction velocity of upper limb nerves in elite badminton players.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
YES.
Consent has been taken from the Institute ethical committee.
8.List of references:
1. Kimura J. Facts, fallacies and fancies of nerve conduction studies: twenty-first annual Edward H. Lambert Lecture. Muscle Nerve 1997; 20(7):777-787.
2. Dyck PJ, Harper C, O’Brien P et al. Monotonicity of nerve tests in diabetes. Diabetes Care 2005, 28(9):2192-2200.
3. Bril V, Ellison R, NgO M et al. Electrophysiological monitoring in clinical trials. Muscle Nerve 1998; 21(11):1368-1373.
4. Bird SJ, Brown MJ, Spino C et al. Value of repeated measures of nerve conduction and quantitative sensory testing
In a diabetic neuropathy trial. Muscle Nerve 2006, 34:214-224.
5. Field LD, Altchek DW. Elbow injuries. Clinical Sports Med. 1995; 14(1):59-78.
6. Hensley L.D. and Paup D.C. A survey of badminton injuries.
Brit J Sports Med1979; 13:156-160.
7. Lorentzen R., Johansson, C. and Bjonstig, U. Fotbollen
orsaker flest skador men badmintonskadan ar dyrast LUkartidningen 1984;81: 340-343
8. T Colak, B Bamac, A Ozbek et al. Nerve conduction studies of upper extremities in tennis players. Br J Sports Med 2004; 38:632-635.
9. Bozentka DJ. Cubital tunnel syndrome pathophysiology. Clin Orthop Relat Res. 1998; 351:90-94.
10. Mansour Azarbal, Dariush Adybeik, Hossein Ettehad et al. A survey of elbow injuries in badminton players. The international Journal of Orthopedic Surgery 2004; 2(1).
11. Dizon JMR, Dayao R, Elazegui C et al. Prevalence of upper extremity musculoskeletal injuries among recreational badminton players. Philippine Journal of Allied Health Sciences 2007; 2:32-36.
12. Hatta Arihiro, Nishihira Yoshiaki, Takemiya Takashi et al. Ulnar nerve conduction velocity in athletes: comparison between kendo, badminton, soft tennis players and non athletes. Journal of exercise and Sports Physiology; 2(2):177-184.
13. David B. Waddell, Barbara A. Gowitzke1. Biomechanical principles applied to badminton power strokes.
14. Diana S. Stetson, James W. Albers, Barbara A. Silverstein et al. Effects of Age, Sex And Anthropometric factors on Nerve Conduction Measures. MUSCLE AND NERVE 1992; 15:1095-1104.
15. L Meyer, L van Niekerk, E Prinsloo et al. Prevalence of
musculoskeletal injuries among adolescent squash players in
the Western Cape. SAJSM 2007; 19(1).
16. K.Kroner, S.A.Schmidt, A.B.Nielson et al. Badminton injuries. Brit J Sports Med; 24:2-3.
17. Xuan Kong, Eugene A Lesser, Shai N Gozani. Repeatability methods of nerve conduction measurements derived entirely by computer. BioMedical Engineering Online 2009, 8:33.
18. Jorgensen U, Winge S. Epidemiology of badminton injuries.
Int Journal of Sports Medicine 1997; 8(6):379-382.
19. UK Misra, J Kalita. Clinical Neurophysiology. New Delhi: Elsevier; 1999.
20. Jun Kimura. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 2nd Edition. New York: Oxford University Press; 1989.
9 /
Signature of the Candidate
/10 /
Remarks of the Guide
/11 /
Name & Designation of:
11.1 Guide11.2 Signature / DR. PURUSOTHAM CHIPPALA.
Assistant Professor in
Physiotherapy.
11.3 Co-Guide (If Any)11.4 Signature / DR. RAMPRASAD M.
Professor and Principal in Physiotherapy
11.5 Head of the Department
11.6 Signature
/DR. T.JOSELEY SUNDERRAJ PANDIAN.
Associate Professor in
Physiotherapy and P.G.
Coordinator.
12 /12.1 Remarks of Chairman and Principal
12.2 Signature /DR. RAMPRASAD M.
Professor and Principal inPhysiotherapy.
6