Karpal Tünel Sendromu Hastalarında Elektrodiagnostik Evreleme ile Klinik Evre, Semptom Süresi ve Vücut Kitle İndeksi Arasındaki İlişkinin Değerlendirilmesi

Amaç: Karpal tünel sendromu (KTS) tanısı klinik bulgular, fizik muayene ve elektromiyografi (EMG) ile konur. Vücut kitle indeksi (VKI) KTS gelişiminde önemli bir risk faktörüdür. Bu çalışmanın amacı KTS hastalarında demografik verilerin değerlendirilmesi, klinik evreleme, VKI ve semptom süresi ile elektrofizyolojik KTS grupları arasındaki ilişkinin incelenmesidir. Yöntemler: Çalışmaya EMG laboratuvarımıza KTS ön tanısı ile gönderilen ve elektrofizyolojik olarak KTS tanısı alan 270 olgu alındı. Bu hastaların dosyaları retrospektif olarak incelendi. Tüm hastaların yaş, cinsiyet, dominant ve etkilenen el, boy, kilo ve semptom süreleri kaydedildi. Elektrofizyolojik değerlendirmeye göre hafif, orta ve ağır olarak gruplandırılan hastalar klinik evre, VKİ ve semptom süreleri ile karşılaştırıldı. Bulgular: Çalışmaya alınan hastaların yaş ortalaması 44,35±12,38 yıl olup 237' si ( %87,8) kadın idi. Tüm hastaların VKI ortalaması 27,85±2,93 olup erkeklerde 26,68±2,74, kadınlarda ise 28,02±2,92 kg/m2 saptandı. 50 (%18,3) hastada sadece sağ KTS, 32 (%11,85) hastada sadece sol KTS, 188 hastada (%69,62) ise bilateral KTS saptandı. EMG sonuçlarına göre sağ KTS ve sol KTS saptanan hastalarda elektrofizyolojik evreler ile semptom süresi, VKI ve klinik evre arasındaki ilişki istatistiksel olarak anlamlı bulundu. Bilateral KTS varlığı ile klinik evre, semptom süresi ve VKI değerleri arasında da anlamlı ilişki saptandı (p

Evaluation of the Relationship Between Electrodiagnostic Staging and Clinical Stage, Symptom Duration and Body Mass Index in Carpal Tunnel Syndrome Patients

Objectives: Carpal tunnel syndrome (CTS) is diagnosed with clinical symptoms, physical examination and electromyography (EMG). Body mass index (BMI) is an important risk factor in the development of CTS . The aim of this study was to evaluate the demographic data in CTS patients and to investigate the relationship between patients grouped with electrodiagnostic staging and BMI, symptom duration and clinical staging. Methods: 270 cases who were sent to our EMG laboratory with initial diagnosis of CTS and electrophysiologically diagnosed with CTS were included in this study. Files of these patients were examined retrospectively. Age, gender, dominant and affected hand, height and weight, symptom durations of all patients were recorded. Patients grouped as mild, moderate and severe according to electrophysiological evaluation were compared in terms of clinical stage, BMI and symptom duration. Results: The patients had an average age of 44.35 ± 12.38 years and 237 of them were female (87.8%). The average BMI of patients was 27.85 ± 2.93 and detected as 26.68±2.74 for men, 28.02±2.92 kg/m2 for women. It was found that 50 of them (18.3%) had only right CTS, 32 (11.85%) had only left CTS and 188 had bilateral CTS (69.62%). According to EMG results, the relationship between electrophysiological stages, symptom duration, BMI and clinical stage was statistically significant in patients with right CTS and left CTS. Significant correlations were also found between bilateral CTS presence and clinical stage, duration of symptoms and BMI (p <0.001). Conclusion: Long duration of symptoms and high BMI were considered as risk factors for the presence and severity of CTS in our study. In addition, the observation that electrophysiological findings have progressed in a similar way with the clinical findings reiterates the fact that nerve conduction studies provide additional, independent, and unbiased evidence for CTS and assessment of severity

PDF

___

Katz JN, Simmons BP. Carpal tunnel syndrome. N Eng J Med 2002; 346:1807-12.
D'Arcy CA, McGee S. The rational clinical examination. Does this patient have carpal tunnel syndrome? JAMA 2000; 283:3110-7.
Uchiyama S, Itsubo T, Nakamura K, Kato H, Yasutomi T, Momose T. Current concepts of carpal tunnel syndrome. Pathophysiology, treatment and evaluation. J Orthop Sci 2010; 15:1-13.
Karpitskaya Y, Novak CB, Mackinnon SE. Prevalence of smoking, obesity, diabetes mellitus, and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg 2002; 48:269-73.
Bland JD. Carpal tunnel syndrome. Curr Opin Neurol 2005; 18:581-5.
Alemdar M. Carpal Tunnel syndrome: Anatomy, symptoms, diagnostic tools and treatment: Review. Turkiye Klinikleri J Neur 2009; 4(1):19-32.,
Ogura T, Akiyo N, Kubo T, et al. The relationship between nerve conduction study and clinical grading of carpal tunnel syndrome. J Orthop Surg Res 2003;11(2): 190-3.
Srikanteswara PK, Cheluvaiah JD, Agadi JB, Nagaraj K. The relationship between nerve conduction study and clinical grading of carpal tunnel syndrome. BMJ Open 2016; 6(9): e012053.
Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011; 44(4): 597-607.
American Academy of Orthopaedic Surgeons. Clinical practice guideline on the treatment of carpal tunnel syndrome. Muscle Nerve 2011; 44: 597-607.
Padua L, Padua R, Lo Monaco M, Romanini E, Tonali P. For the Italian CTS Study Group. Multiperspective assessment of carpal tunnel syndrome. A multicenter study. Neurology 1999; 53: 1654-9.
Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee. Muscle Nerve 1993; 16: 1392-414.
Stevens JC. AAEM minimonograph #26: The electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve 1997; 20: 1477-86.
Chan L, Turner JA, Comstock BA, et al. The relationship between electrodiagnostic findings and patient symptoms and function in carpal tunnel syndrome. Arch Phys Med Rehabil 2007; 88: 19-24.
Kasundra GM, Sood I, Bhargava AN, et al. Carpal tunnel syndrome: Analyzing efficacy and utility of clinical tests and various diagnostic modalities. J Neurosci Rural Pract 2015; 6:504-10.
Ali Z, Khan A, Shah SMA, Zafar A. Clinical and electro- diagnostic quantification of the severity of carpal tunnel syndrome. Ann Pak Inst Med Sci 2012; 8(4): 207-12.
Bland JD. Do nerve conduction studies predict the outcome of carpal tunnel decompression? Muscle Nerve 2001; 24:935-40.
Leventoglu A, Kuruoglu R. Do electrophysiological findings differ according to the clinical severity of carpal tunnel syndrome? J Neurol Sci 2006; 23:272-8.
Moghtaderi A, Izadi S, Sharafadinzadeh N. An evaluation of gender, body mass index, wrist circumference and wrist ratio as independent risk factors for carpal tunnel syndrome. Acta Neurol Scand 2005; 112:375-9.
Şahin N, Albayrak İ, Uğurlu H. Obez hastalarda karpal tünel sendromunun şiddeti ve vücut kitle indeks değerleri arasındaki ilişki. TUBAV Bilim Dergisi 2009; 2(4): 484-8.
Sungpet A, Suphachatwong C, Kawinwonggowit V. The relationship between body mass index and the number of sides of carpal tunnel syndrome. J Med Assoc Thai 1999; 82:182-5.
Kouyoumdjian JA, Zanetta DMT, Morita MP. Evaluation of age, body mass index, and wrist index as risk factors for carpal tunnel syndrome severity. Muscle Nerve 2002; 25:93-7.
Werner RA, Albers JW, Franzblau A, Armstrong TJ. The relationship between body mass index and the diagnosis of carpal tunnel syndrome. Muscle Nerve 1994;17:632-6.
Kurt S, Karaer H, Kaplan Y, Etikan İ. The relationship between carpal tunnel syndrome and body mass index, age and gender. Turk J Phys Med Rehab 2006; 52:154-7.
Hlebs S, Majhenic K, Vidmar G. Body mass index and anthropometric characteristics of the hand as risk factors for carpal tunnel syndrome. Coll Antropol 2014; 38: 219-26.
Satman I, Yilmaz T, Sengül A, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP) Diabetes Care 2002; 25: 1551-6.
Kouyoumdjian JA. Duration of symptomatology and median segmental sensory latency in 993 carpal tunnel syndrome hands (668 cases). Arq Neuropsiquiatr 1999; 57(2A): 198-201.
Kouyoumdjian JA. Carpal tunnel syndrome: age, nerve conduction severity and duration of symptomatology. Arq. NeuroPsiquiatr 1999; 57(2B): 382-6.