Nurten UZUN, Derya ULUDÜZ, Azar RAHİMPANAH, Şafak Sahir KARAMEHMETOĞLU

Omurilik yaralanmalarında üst ekstremite tuzak nöropatileri

Omurilik yaralanmalı hastalarda üst ekstremitelerde tuzak nöropatileri normal popülasyondan daha sık gözlenmektedir. Çalışmamızın amacı, omurilik yaralanmalı hastalarımızda üst ekstremite tuzak nöropati varlığı ve sıklığını araştırmaktır. Bu çalışmaya, 4 aydan uzun süre önce travmatik omurilik yaralanması geçirmiş yaşları 11 ila 56 arasında değişen 31 hasta dahil edildi. Tüm hastaların hastalık öyküsü, hastalık süresi, yaş, cinsiyet, lezyon seviyesi, lezyon tipi (tam/kısmi) kaydedildi. Hastalar klinik ve elektrofizyolojik açıdan değerlendirildi. Tuzak nöropatisi saptanan ve saptanmayan hastalar bu parametreler açısından karşılaştırıldı. Hastalık süreleri ortalama 22.8 ay (SD=19.5) olan 31 hastanın 9’unda (% 29) tuzak nöropatisi saptandı. Tuzak nöropatisi olan hastalarda hastalık süresi anlamlı olarak daha uzundu (p=0.045). Tuzak nöropatisi, hastaların 5’inde median, 5’inde ise ulnar sinirde el bileği seviyesinde saptandı. Median sinir lezyonları hastaların 3’ünde sağ, 1’inde sol, 1’inde ise bilateral Karpal Tünel Sendromu idi. Ulnar sinirin el bileği düzeyinde etkilendiği hastaların 2’sinde sağ (Tip IV), 1’inde sol (Tip IV), 2’sinde bilateral (birinde Tip I, ikincisinde sol ağırlıklı Tip IV) tuzaklanma saptandı. Semptomatik olan tek hastamız, bilek seviyesinde hem median hem de ulnar sinirde tuzaklanmanın olduğu hasta idi. Günlük aktivitelerinde ileri derecede ellerine bağlı olarak yaşayan paraplejik hastaların üst ektremite tuzak nöropatileri açısından elektrofizyolojik testlerle araştırılması, oluşabilecek tuzak nöropatilerine ait klinik sendromların önlenmesi ve erken tedavi edilmesi açısından önemlidir.

Upper extremity entrapment neuropathies in patients with spinal cord injury

Upper extremity entrapment neuropathies are more common in patients with spinal cord injury. The purpose of this study is to determine the presence and the prevalence of upper extremity entrapment neuropathies in patients with spinal cord injury. 31 patients (22 male, 9 female), who have spinal cord injury for more than 4 months, between the ages of 11 and 56 years (me-an 32.8 ± 11.1) were enrolled. The patients were evaluated in regards to demographic, clinical and electrophysiological data. The parameters in patients with entrapment neuropathies were compared with the patients without entrapment neuropathy. Out of 31 patients studied, 9 had electrophysiologically Carpal Tunnel Syndrome (29 %). Disease duration was significantly longer in CTS patients (p=0.045). 5 patients showed median and 5 showed ulnar nerve pathology. Median nerve pathologies were Carpal Tunnel Syndrome in all patients. 3 had right (one in moderate sensorial fibers, one had severe sensorial and moderate motor nerve, last had moderate motor and sensorial nerve fiber pathologies), 1 had left (with severe motor and sensorial nerve fiber involvement) and 1 had bilateral (severe motor and sensorial nerve fibers involvement in right and moderate involvement in left side) Carpal Tunnel Syndrome findings. Among patients with ulnar nerve neuropathy, 2 had right (Type IV), 1 had left (Type IV) and 2 had bilateral pathologies. It is our belief that the high prevalence of Carpal Tunnel Syndrome in patients with spinal cord injury is the result of excessive use of their hands. This study documents the prevalence of entrapment neuropathies and emphasizes the need for early and periodic electrophysiological evaluations for prevention and early treatment for these syndromes.

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