Publication: Tek taraflı ekstremite ağrılı olgularda nörojenik etkilenme sıklığının araştırılması
Abstract
Çeşitli nedenlerle meydana gelen üst ekstremite ağrısı çok sık karşılaşılan bir problemdir. Etyolojide muskuloskeletal, nörolojik, vasküler, romatolojik kaynaklı pekçok hastalık ve başka bölgeden yansıyan ağrılar vardır. Kas iskelet sistemi ile ilgili hastalıklar daha sıklıkla görülmektedir. Nörolojik kaynaklı üst ekstremite ağrıları ise zaman zaman gözden kaçabilmekte ve teşhisinde güçlükler çekilmektedir. Elektrofizyolojik inceleme üst ekstremite ağrılarının ayırıcı tanısında önemli bir yere sahiptir. Bu çalışmada tek taraflı kas iskelet sistemi kaynaklı üst ekstremite ağrısı olan hastalarda elektrofizyolojik yöntemler kullanılarak nörojenik etkilenme sıklığının araştırılması amaçlanmıştır. Bu amaçla 50 subakromial sıkışma sendromu tanısı konmuş omuz ağrılı olgu ve16 lateral epikodilit tanısı konmuş dirsek ağrılı olgu çalışmaya alındı. Tüm vakalarda median ve ulnar sinir motor iletim çalışmaları, median, ulnar, radial sinir duyu iletim çalışmaları, iğne elektromiyografi (EMG) çalışması; omuz vakalarında Erb noktasından uyarımla supraskapular, aksiller, muskulokutanöz ve radial sinir motor distal latans ve birleşik kas aksiyon potansiyel (BKAP) amplitüd ölçümleri, dirsek vakalarında medial antebrakial sinir duyu iletim çalışmaları yapıldı. Hem omuz hem de dirsek vakalarında hasta taraf ve sağlam tarafta incelenen sinirlerin motor distal latans ve iletim hızı, duyusal amplitüd ve iletim hızı değerleri karşılaştırıldığında anlamlı fark saptanmadı (p>0,05). Omuz vakalarında hasta tarafta 19 radikülopati teşhis edilirken, sağlam tarafta bu sayı yalnızca 4 idi (p>0,05). Vakaların tümü değerlendirildiğinde hasta tarafta vakaların 43’ünde nörojenik etkilenme gözlenirken, sağlam tarafta bu sayı 29 olarak bulundu. Sonuç olarak tek taraflı üst ekstremite ağrılı vakalarda nörojenik etkilenme sıklığının ağrılı tarafta sağlam taraftan fazla olduğu söylenebilir, ama omuz çevresi sinirlerde herhangi bir nörojenik etkilenme bulgusuna rastlanmamıştır.
Upper extremity pain is a very common problem with various clinical presentations. There are multiple etiologies for upper extremity pain, including musculoskeletal, neurologic, vascular and rheumatic disorders, as well as referred pain from distant sites. Musculoskeletal disorders are more common than others. Neurologic sources upper extremity pain sometimes can be overlooked and there are some difficulties in their diagnosis. Electrophysiological investigation has a very important place in the differential diagnosis of upper extremity pain. In this study, the aim was to investigate the frequency of neurogenic involvement in cases with unilateral upper extremity pain of musculoskeletal origin by using electrophysiological techniques. Fifty patients with shoulder pain with subacromial impingment sendrome and 16 patients with elbow pain with lateral epicodilitis were included in the study. Median and ulnar nerve motor conduction studies, median, ulnar and radial sensory nerve conduction studies and needle electromiyography (EMG) were studied in all cases. Suprascapular, axillary, musculocutanous and radial nerve motor distal latency and compound muscle action potantial amplitude measurements in shoulder pain cases, and medial antebrachial nerve sensory conduction studies in elbow pain cases were performed. There was no significant difference between affected and non-affected sides in terms of motor distal latencies, motor nerve conduction velocities and sensory amplitudes and nerve conduction velocities (p>0,05). In shoulder cases 19 cases had radiculopathy in the affected side while only 4 in the non-affected side. Forty-three of all cases have neurological involvement in their affected sides while 29 patients have neurological involvement in their non –affected sides according to electrophysiological findings. As a result, neurological involvement can be more promeinent in the affected side than in the nonaffected side. However, there was no sign of neurological involvement in the shoulder girdle nerves.
Upper extremity pain is a very common problem with various clinical presentations. There are multiple etiologies for upper extremity pain, including musculoskeletal, neurologic, vascular and rheumatic disorders, as well as referred pain from distant sites. Musculoskeletal disorders are more common than others. Neurologic sources upper extremity pain sometimes can be overlooked and there are some difficulties in their diagnosis. Electrophysiological investigation has a very important place in the differential diagnosis of upper extremity pain. In this study, the aim was to investigate the frequency of neurogenic involvement in cases with unilateral upper extremity pain of musculoskeletal origin by using electrophysiological techniques. Fifty patients with shoulder pain with subacromial impingment sendrome and 16 patients with elbow pain with lateral epicodilitis were included in the study. Median and ulnar nerve motor conduction studies, median, ulnar and radial sensory nerve conduction studies and needle electromiyography (EMG) were studied in all cases. Suprascapular, axillary, musculocutanous and radial nerve motor distal latency and compound muscle action potantial amplitude measurements in shoulder pain cases, and medial antebrachial nerve sensory conduction studies in elbow pain cases were performed. There was no significant difference between affected and non-affected sides in terms of motor distal latencies, motor nerve conduction velocities and sensory amplitudes and nerve conduction velocities (p>0,05). In shoulder cases 19 cases had radiculopathy in the affected side while only 4 in the non-affected side. Forty-three of all cases have neurological involvement in their affected sides while 29 patients have neurological involvement in their non –affected sides according to electrophysiological findings. As a result, neurological involvement can be more promeinent in the affected side than in the nonaffected side. However, there was no sign of neurological involvement in the shoulder girdle nerves.