User:Bruce Chen 0010334/CTMABRND

A Classic Tetris Monthly-associated brachioradialis and radial nerve degeneration (CTMABRND) is a very rare disease occurring in veteran or retired Classic Tetris Monthly players. Patients usually complain pain in the lateral aspect of forearm when typing arrow keys on a computer or numbness in C6 dermatome or radial nerve when stretching head after using computer.

Risk factors include frequent attendance of CTM or CTWC. It can often be diagnosed based on signs and symptoms. Occasionally medical imaging is used to confirm the diagnosis or rule out other possible causes.

Signs and symptoms
Patients usually complain pain in the lateral aspect of forearm when typing arrow keys on a computer. The pain only occurs when typing arrow keys, not when typing any other keys. Rarely do patients also complain numbness in C6 dermatome or radial nerve when stretching head after using computer. Pain in the tendons of other muscles of the hand and interphalyngeal joints is typical.

During the standard inquiry procedure in Taiwan (LQQOPERA), physicians may get the following:


 * Location：Lateral aspect of forearm
 * Quality：Stabbing pain (刺痛)
 * Quantity：Mild to severe
 * Onset：In the afternoon more frequently than in the morning. Most severe and frequent during 1st~4th every month (since CTM events are usually scheduled in 4th). No onset during 5th~20th. Sometimes in 21th~30th.
 * Precipitation factor：Pressing arrow keys on the computer with right hand. Sometime this is not necessary to induce pain when the date is 1st~4th.
 * Exaggeration factor：Prolonged practice of Classic Tetris
 * Relieving factor：Typing without pressing arrow keys or being away from computers
 * Accompany symptoms：When stretching head after being tired because of Tetris practicing, radiating numbness may occur in the yang aspect of arm and forearm, the back of hand, and the proximal part of the thumb, the index finger, the middle finger, and a half of the ring finger. (三指半的半截)

Pathophysiology
In order to hypertap, players have to make their hand vibrate at a frequency higher than 10Hz. This frequency is achieved by vibrating a muscle known as brachioradialis. Practicing hypertapping too much may cause injury to brachioradialis and its tendon, causing pain in the lateral aspect of forearm. This pain is sometimes radiated along the radial nerve, which innervates brachioradialis, causing numbness. The numbness can be induced by compressing the radial nerve or the root of C6. Pain may also arise in the tendons of other muscles of the hand and interphalyngeal joints due to inappropriate usage of other muscles.

The monthly cycle pain is sometimes psychogenic because the pain is conditioned in the players by paring the date of 1th~4th with pain that strikes them before each CTM competition. It is not found to be linked to menstruation.

Diagnosis
The disease can often be diagnosed based on signs and symptoms. Occasionally medical imaging, PE, and EMG/NCV test is used to confirm the diagnosis or rule out other possible causes.

Medical ultrasound imaging
Ultrasound may be able to find lesions and hypertrophy in the brachioradialis muscle.

Physical examination
Impaired brachioradialis reflex may be found. Radiated numbness in the C6 dermatome may be induced during Spurling's test. By flexing the forearm in the mid-pronated position, the pain in brachioradialis may be induced.

A positive Spurling's test may indicate anterograde or retrograde neuronal degeneration from the radial nerve. The degeneration is typically easily recovered by physical therapy and rehabilitation.

EMG/NCV
Increased conducting time in radial nerve may be found. However, the result of EMG is usually normal.

Conservative
The most recommended treatment for the players with this disease is to take a rest and stop attending global Classic Tetris events for a month or two. However, this is extremely difficult to the players addicted to the game. The players are sometimes ordered inpatient management just to monitor their lifestyle (not to play Tetris). The psychogenic monthly cycle pain can be treated by systematic desensitization.

Surgical
Traditional surgery or ultrasound-assisted interventional radiological surgery may be performed to remove the hypertrophic muscle that compresses radial nerve or to stimulate the recovery of brachioradialis and radial nerve. Treating muscles other than brachioradialis is usually unnecessary.

Epidemiology
CTMABRND is common in Classic Tetris players. If this factor is ignored, the disease is found to be clustered in male engineers such as PM or  RD, or males with no occupation.

Additional annotation
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