Kemal BARKUT, Münevver ÇELİK, Nevin Kuloğlu PAZARCI, Şule TAŞPINAR

Karpal tünel sendromu klinik tanılı diabetik hastalarda elektrofizyolojik bulgular

Amaç: Çalışmamızda, karpal tünel sendromu (KTS) klinik ön tanısı ile elektrofizyolojik inceleme istenen tip 2 diabetik hastalarda polinöropati (PNP) ve KTS görülme sıklığının araştırılması amaçlanmıştır. Gereç ve yöntem: KTS ön tanısıyla kliniğimiz Elektrofizyoloji Laboratuarına gönderilen, tip 2 diabet tanısıyla izlenen, ellerinde gece uyandıran uyuşma, yanma, ağrı, beceriksizlik yakınmalarından en az üçü olan hastalar çalışmaya alındı. Nörolojik muayenelerinde median sinir tutulumuna ait subjektif yakınma ve/veya objektif muayene bulgusu dışında bulgusu olanlar dışlandı. Hastalara konvansiyonel yöntemlerle duyusal ve motor ileti çalışmaları ile iğne elektromiyografisi uygulandı. Elektrofizyolojik inceleme sonuçlarına göre KTS ve PNP olguları belirlendi. Median sinir tutulumu hafif veya ağır olarak derecelendirildi. Karşılaştırmalarda “Fisher exact” ile, “student's ttest” kullanıldı.Bulgular: Çalışmaya katılan 56 olgunun 2'sinde elektrofizyolojik inceleme, 3'ünde median sinir ileti ölçümleri normaldi. Elektrofizyolojik incelemelerde 51 hastanın 33'ünde KTS, 18'inde PNP saptandı. KTS saptanan 33 olgunun 21'inde bilateral, 12'sinde unilateral median sinir tutulumu mevcuttu. Bilateral tutulum, median sinirin tutulum derecesi ve ileti ölçümlerinde saptanan median sinir duysal yanıt latansı, duyusal anksiyon potansiyeli amplitüdü ile motor distal latansı, motor ileti hızı ve bileşik kas aksiyon potansiyeli amplitüdü KTS ve PNP olguları arasında anlamlı farklılık göstermedi.Sonuç: Diabetik PNP sıklıkla klinik olarak ön planda KTS ile prezante olmakta, tuzaklanma bölgesinin mekanik etkileri ile diabetin metabolik etkileri birlikte tutulumun tuzaklanma bölgelerinden başlamasına neden olmaktadır. Median sinir ileti ölçümleri KTS ve PNP'de farklılık göstermemektedir. Diabetik hastanın yakınmaları KTS düşündürse bile, elektrofizyolojik inceleme KTS ile birlikte PNP de araştırılmak üzere istenmelidir.

Electrophysiological findings in diabetic patients with clinical diagnosis of carpal tunnel syndrome

Objective: The aim of this study was to evaluate the frequencies of carpal tunnel syndrome (CTS) and polyneuropathy (PNP) in type 2 diabetic patients referred to the electrophysiology section with the clinical diagnosis of CTS. Materials and Methods: Patients with type 2 diabetes, referred to our electrophysiology section with clinical CTS with a minimum of three of the four complaints of numbness, burning paresthesias, pain, and clumsiness in one or both hands, were included in this study. Patients with subjective complaints and/or objective findings of other involvement than median nerve in neurological examination were excluded. Conventional nerve conduction studies and needle electromyography were performed. Patients were diagnosed as having CTS or polyneuropathy (PNP) according to the electrophysiological examinations. Median nerve involvement was classified as mild or severe. Fisher exact test and student's t-test was used for statistical evaluation.Results: Of the total 56 patients, 2 had normal electrophysiological examinations and 3 had normal median nerve conduction studies. Electrophysiological examinations revealed CTS in 33 and PNP in 18 patients. CTS were detected bilaterally in 21 and unilaterally in 12 patients. Bilateral involvement, the severity of the median nerve involvement and the latencies and sensory action potential amplitudes of median nerve sensory conduction studies and the distal latencies, motor conduction velocities and compound muscle action potential amplitudes in median nerve motor conduction studies did not differ significantly.Conclusion: Diabetic polyneuropathy can present with clinical signs of CTS, because peripheral nerves become vulnerable due to the metabolic alterations during diabetes and can initially be affected at the entrapment sides due to the mechanical effects. Median nerve conduction studies did not significantly differ in CTS and PNP in this study. The clinical diagnosis of both CTS and PNP should be mentioned when requesting electrophysiological examination, even if the clinical signs indicate CTS.

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