Publication: Hafif dereceli karpal tünel sendromunda farklı elektrofizyolojik metodların karşılaştırılması
Abstract
Amaç: Hafif düzeyde etkikenen karpal tünel sendromu (KTS) olan olgularda farklı elektrofizyolojik duysal metodları incelemektir. Gereç ve Yöntem: Marmara Üniversitesi Tıp Fakültesi Elektrofizyoloji Laboratuarı’na KTS ön tanısı ile müracaat eden median sinir dağılım alanında haftada 3 kez ve en az 3 hafta süre ile uyuşma, elektriklenme ve ağrı yakınması olan 47 hasta (45 kadın, 2 erkek) 65 el çalışmaya dahil edildi. Daha önce KTS operasyonu geçirmiş olma, azalmış ulnar duysal aksiyon potansiyeli amplitüdü (<12µV), uzamış ulnar duysal başlangıç latansı olanlar (>3.7 ms), uzamış median motor distal latansı olanlar (>4.2 ms), polinöropatisi ve / veya radikülopatisi olan hastalar, kalp pili olanlar, hamile olanlar çalışma dışında tutuldu. Elektrofizyolojik olarak median ve ulnar sinir motor ileti hızları (MİH), 5.parmak ulnar sinir antidromik duyu ileti hızları (DİH), 1, 2, 3.parmaklarda antidromik median sinir DİH, 1.parmak median-radial sinir duysal latans karşılaştırması (DLK), 4. parmak median-ulnar sinir DLK, median-ulnar sinir el bileği 8 cm segmentte ortodromik DLK, avuç içi-bilek median sinir DİH ölçüldü. Bulgular: Sırasıyla median sinir 1.parmak DİH çalışma grubunun tamamında, 1. parmak median-radial sinir DLK olguların %92,3’ünde, 4. parmak median-ulnar sinir DLK olguların % 92’sinde, 2. parmak median sinir DİH olguların % 81,5’unda, median-ulnar sinir ortodromik DLK %78.5’unda, avuç içi-bilek median sinir DİH ise % 55,62’sinde patolojik olarak bulundu. Yapılan değerlendirmede iki test birlikte kullanıldığında median 3. parmak DİH ile birlikte sırasıyla median 1.parmak DİH, 4.parmak median-ulnar sinir DLK veya 1.parmak median-radial sinir DLK %100, 98; 97 oranında hafif dereceli KTS’de tanı konulabilmektedir. Sonuç: Şüpheli KTS’li olgularda median 3. parmak DİH’e ilave olarak 1. parmak DİH, 1. parmak median-radial sinir DLK ve 4. parmak ulnar-median DLK en az birinin daha yapılması tanı koyduruculuğu arttırmak açısından önerilebilir. THE COMPARISON OF DIFFERENT ELECTRODIAGNOSTIC STUDIES IN MILD CARPAL TUNNEL SYNDROME
Objective: To evaluate different sensory electrodiagnostic tests in mild carpal tunnel syndrome (CTS). Material and Methods: 47 patients (45males, 2 females) 65 hands who applied to the electrodiagnosis laboratory of Marmara University School of Medicine with the complaints of paresthesia, tingling and pain in the median nerve distribution area for at least 3 months, 3 times per week were included in the study. Patients with a history of CTS surgery, decreased ulnar sensory nerve axion potential amplitude (<12µV), increased ulnar sensory nerve onset latency (>3.7 ms), increased median motor distal latency (>4.2 ms), polyneuropathy and/ or radiculopathy, pacemaker users and pregnant women were excluded from the study. Electrodiagnostic studies including median and ulnar motor nerve conduction velocities, 5th digit ulnar, 1st, 2nd, 3rd digits median sensory nerve conduction velocities (SNCV), 1st digit median-radial nerve sensory nerve latency difference (SNLD), 4th digit median ulnar nerve SNLD, median-ulnar SNLD across the wrist over a 8 cm segment, palm-wrist median SNCV were studied. Results: 1 st digit median SNCV was found pathologic in all patients, 1st digit median-radial SNLD in 92,3%, 4 th digit median-ulnar SNLD in 92%, 2nd digit SNCV in 81,5%, median-ulnar orthodromic SNLD in 78,5%, and palm-wrist median SNCV in 55,62% respectively. In the case where a second test including 1st digit median SNCV, 4th digit median-ulnar SNLD or 1st digit median-radial SNLD is conducted with 3rd digit median SNCV 100, 98, 97 % of patients having mild CTS could be diagnosed respectively . Conclusion: For the electrophysiologic diagnosis of patients with probable mild CTS adding 1st digit median SNCV, 4th digit median-ulnar SNLD or 1st digit median-radial SNLD to 3rd digit median SNCV study could be suggested in order to increase the accuracy of the diagnosis. Key words: Carpal tunnel syndrome, electrodiagnosis, nerve conduction studies, sensory median conduction studies, median sensory comparative tests.
Objective: To evaluate different sensory electrodiagnostic tests in mild carpal tunnel syndrome (CTS). Material and Methods: 47 patients (45males, 2 females) 65 hands who applied to the electrodiagnosis laboratory of Marmara University School of Medicine with the complaints of paresthesia, tingling and pain in the median nerve distribution area for at least 3 months, 3 times per week were included in the study. Patients with a history of CTS surgery, decreased ulnar sensory nerve axion potential amplitude (<12µV), increased ulnar sensory nerve onset latency (>3.7 ms), increased median motor distal latency (>4.2 ms), polyneuropathy and/ or radiculopathy, pacemaker users and pregnant women were excluded from the study. Electrodiagnostic studies including median and ulnar motor nerve conduction velocities, 5th digit ulnar, 1st, 2nd, 3rd digits median sensory nerve conduction velocities (SNCV), 1st digit median-radial nerve sensory nerve latency difference (SNLD), 4th digit median ulnar nerve SNLD, median-ulnar SNLD across the wrist over a 8 cm segment, palm-wrist median SNCV were studied. Results: 1 st digit median SNCV was found pathologic in all patients, 1st digit median-radial SNLD in 92,3%, 4 th digit median-ulnar SNLD in 92%, 2nd digit SNCV in 81,5%, median-ulnar orthodromic SNLD in 78,5%, and palm-wrist median SNCV in 55,62% respectively. In the case where a second test including 1st digit median SNCV, 4th digit median-ulnar SNLD or 1st digit median-radial SNLD is conducted with 3rd digit median SNCV 100, 98, 97 % of patients having mild CTS could be diagnosed respectively . Conclusion: For the electrophysiologic diagnosis of patients with probable mild CTS adding 1st digit median SNCV, 4th digit median-ulnar SNLD or 1st digit median-radial SNLD to 3rd digit median SNCV study could be suggested in order to increase the accuracy of the diagnosis. Key words: Carpal tunnel syndrome, electrodiagnosis, nerve conduction studies, sensory median conduction studies, median sensory comparative tests.