Publication: Karpal tünel sendromlu hastalarda el bilek boyutları, klinik ve elektrodiagnostik özellikler
Abstract
Karpal tünel sendromu klinikte en sık karşılaşılan tuzak nöropatisidir. Son yıllarda tanı yöntemlerindeki gelişmeler ve hastalığın daha yaygın olarak bilinmesi nedeniyle prevalans ve insidansı giderek artmaktadır. Dolayısıyla klinisyenlerin diagnostik ve prognostik yaklaşımını geliştirmek oldukça önemlidir. Biz bu çalışmada ilk defa tanı konulan karpal tünel sendromlu hastalarda semptom özellikleri ve şiddeti, provokatif testler ve el bilek boyutlarının ölçüleri (genişlik ve kalınlık) ile bunların elektrodiagnostik bulgularla ilişkisini araştırdık. Çalışmaya elektronöromiyografik incelemelerle ilk kez tanı konan ve yaş ortalaması 49,5+10,8 yıl olan 4 (%6,6) erkek, 57 (%93,4) kadın toplam 61 karpal tünel sendromlu hasta alındı. Hastalara semptomlar ve fonksiyonel duruma yönelik sorgulama yapıldı, bilateral Tinel ve Phalen testleri uygulandı, her iki el bileğinin boyutları ölçüldü. En sık karşılaşılan yakınmalar geceleri artan el ve el bileği ağrısı, uyuşukluk ve el bileği proksimaline yansıyan ağrı idi. Klinik semptomlar ile elektronöromiyografik bulguların şiddeti arasında anlamlı ilişki bulunamadı. Tek başlarına Tinel, Phalen testleri ve el bilek ölçülerinin duyarlılığının yüksek olmadığı görüldü. Yalnızca sağ tarafta, el bilek kalınlığı ile median sinir motor distal latansı arasında anlamlı ilişki saptandı. Bunun dışındaki parametrelerle el bilek ölçümleri arasında belirgin bir ilişki bulunamadı. Sonuç olarak karpal tünel sendromlu hastalarda provokatif testlerin ve el bilek boyutlarının duyarlılık ve özgünlüğünün tek başlarına yüksek olmadığı belirlendi. Hastaların yakınmaları ile elektrodiagnostik parametreler arasında belirgin bir korelasyon bulunamadı.
Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy observed in clinical practice. With the increasing prevalence and incidence of the condition in the recent years due to better diagnostic tests and widespread public awareness of the condition, improving the diagnostic and prognostic approach of the clinician is of broad importance. In this study we investigated the symptom patterns, diagnostic tests, wrist dimensions and their relations to the electrodiagnostic findings. Newly diagnosed 4 (%6.6) male, 57 (%93.4) female, a total of 61 carpal tunnel syndrome patients with a mean age of 49.5+10.8 years were included in the study. After completion of a questionnaire including symptoms and functional status, Tinel and Phalen tests were performed, and wrist dimensions were measured bilaterally.The most commonly encountered symptoms were nocturnally exaggerated hand and wrist pain, numbness, and pain proximal to the wrist. There were no relation between symptom patterns and electroneuromyographic findings. Sensitivities of Tinel, Phalen tests and wrist dimension meaurements were not high, solely. The only correlation found was between the dimensions of the right wrist and mean right median nerve motor distal latency. No other significant relation between wrist dimensions and the severity of carpal tunnel syndrome was observed. In conclusion, the sensitivity and specificity of the provocative tests and measurement of wrist dimensions were found to be low. There were no significant correlations between symptoms of the patients, and electrodiagnostic parameters in CTS.
Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy observed in clinical practice. With the increasing prevalence and incidence of the condition in the recent years due to better diagnostic tests and widespread public awareness of the condition, improving the diagnostic and prognostic approach of the clinician is of broad importance. In this study we investigated the symptom patterns, diagnostic tests, wrist dimensions and their relations to the electrodiagnostic findings. Newly diagnosed 4 (%6.6) male, 57 (%93.4) female, a total of 61 carpal tunnel syndrome patients with a mean age of 49.5+10.8 years were included in the study. After completion of a questionnaire including symptoms and functional status, Tinel and Phalen tests were performed, and wrist dimensions were measured bilaterally.The most commonly encountered symptoms were nocturnally exaggerated hand and wrist pain, numbness, and pain proximal to the wrist. There were no relation between symptom patterns and electroneuromyographic findings. Sensitivities of Tinel, Phalen tests and wrist dimension meaurements were not high, solely. The only correlation found was between the dimensions of the right wrist and mean right median nerve motor distal latency. No other significant relation between wrist dimensions and the severity of carpal tunnel syndrome was observed. In conclusion, the sensitivity and specificity of the provocative tests and measurement of wrist dimensions were found to be low. There were no significant correlations between symptoms of the patients, and electrodiagnostic parameters in CTS.