Selma EROĞLU, Lale AKTEKİN, HATİCE BODUR

İDİYOPATİK HAFİF KARPAL TÜNEL SENDROMLU HASTALARDA FARKLI ELEKTRODİAGNOSTİK ÇALIŞMALARIN DUYARLILIĞI

AMAÇ: Karpal Tünel Sendromu (KTS) en sık görülen tuzak nöropatisidir. Tanısı klinik bulgularla ile konulabilir, ancak tanıyı doğrulamak ve tedaviyi planlamak için elektrodiagnostik çalışmalara ihtiyaç vardır. Bu çalışmada, idiyopatik hafif KTS’li hastalarda klinik semptomlar ve provokatif testler ile elektrodiagnostik testlerin duyarlılığını değerlendirmek amaçlandı.GEREÇ VE YÖNTEM: Çalışmaya 75 idiyopatik hafif KTS tanılı hasta (90 el) ve 15 sağlıklı gönüllü (30 el) alındı. Hastalarda median sinir innervasyon alanında ağrı, parestezi, elde güçsüzlük, uyku sırasında artan ağrı ve uyuşma ile elleri silkeleme ile şikayetlerde rahatlama semptomları sorgulandı; Tinel ve Phalen testleri yapıldı. Elektrodiagnostik incelemede; median sinir motor, miks, 1-2-3-4. parmak ve avuç içi duyusal iletim çalışmaları, ulnar sinir motor, miks ve 5.parmak duyusal iletim çalışmaları, median ve ulnar F dalgası, radial sinir 1.parmak duyusal iletim çalışması yapıldı. Çalışılan tüm sinirler için distal latans ve sinir iletim hızı değerleri hesaplandı. Parmak (1, 2, 3, 4)ve avuç içi median duyusal distal latansları ve iletimhızlarının; karşılaştırmalı elektrodiagnostik testlerden 1.parmaktan median-radial duyusal distal latans farkının(DDLF), 4. parmaktan median-ulnar DDLF, 2-5, 3-5, 4-5.parmaklar arasında median-ulnar DDLF; median ve ulnarF dalgası latans farklarının duyarlılığı hesaplandı.BULGULAR: İdiyopatik hafif KTS’li hastalarda en sık rastlanan iki semptom parestezi (%95.6) ve gece uyuşması (%88.8) idi. Phalen testi ve Tinel testlerinin duyarlılığı sırasıyla %67.8 ve %56.7 olarak bulundu. Elektrodiagnostik testlerin sonuçları değerlendirildiğinde, 1.parmak-bilek ve avuç içi-bilek segmenti duyusal iletim hızı çalışmaları %98.9 ile duyarlılığı en yüksek testler olarak bulundu. Uygulanan karşılaştırmalı testlerden 4-5.parmak median-ulnar DDLF %93.3 ile en duyarlı karşılaştırmalı test olarak tespit edildi. Median-ulnar F latans farkı duyarlılığı en düşük test (%38.9) olarak saptandı.SONUÇ: En duyarlı elektrodiagnostik testler 1. parmak-bilek ve avuç içi-bilek segmenti duyusal iletim hızıydı. 4-5 parmak median-ulnar DDLF diğer karşılaştırmalı sinir iletim çalışmalarından daha duyarlı olarak bulundu. KTS elektrodiagnostik tanısında bu testlerin kullanılması ile duyarlılık arttırılabilir.

Anahtar Kelimeler:

Karpal tünel sendromu, elektrodiagnostik test, duyarlılık

SENSITIVITIES OF THE ELECTRODIAGNOSTIC TESTS IN IDIOPATHIC MILD CARPAL TUNNEL SYNDROME

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The diagnosis is based on the history, clinical signs and symptoms of the patient, but electrodiagnostic studies are done to confirm the diagnosis and to manage the treatment. This study aimed to assess sensitivities of clinical symptoms, provocative tests and electrodiagnostic studies (EDS) in patients with idiopathic mild CTS.MATERIAL AND METHODS:The study included 90 hands of 75 patients with idiopathic mild CTS and 30 hands of 15 healthy volunteers. The patients were questioned for symptoms in the innervation area of the median nerve such as pain, paresthesia, weakness in the hand and numbness and pain worsening at night, relief from the symptoms by shaking hands. Tinel and Phalen tests were done. The EDS included; motor, mixed and sensorial (digits 1-2-3-4 and palm) nerve conduction studies (NCS) for median nerve; motor, mixed and sensorial (fifth digit) NCS for ulnar nerve, sensorial NCS (first digit) for radial nerve, median and ulnar F waves. The values for distal latency and nerve conduction velocity (NCV) were calculated for all studied nerves. Sensitivities of median sensory distal latency and NCV to digits 1,2,3,4 and palm-wrist segments and sensitivities of the following comparative tests were detected; median-radial sensory distal latency difference (SDLD) to the first digit, median-ulnar SDLD to the fourth digit, median-ulnar SDLD to the digits 2-5, 3-5, 4-5 and median-ulnar F latency difference.RESULTS: The most common symptoms in patients with idiopathic mild CTS were paresthesia (95.6%) and nocturnal numbness (88.8%). The sensitivity of Phalen’s and Tinel’s tests were 67.8% and 56.7%, respectively. Among the EDS, first digit and palm-wrist sensorial NCV were the most sensitive tests (98.9%). Of the comparative tests, median-ulnar SDLD to digits 4-5 was the most sensitive one (93.3%). Median-ulnar F latency difference had the lowest sensitivity (38.9%).CONCLUSIONS: The most sensitive EDS were first digit and palm-wrist sensorial NCV. Median-ulnar SDLD to digits 4-5 was more sensitive than the other tests. With use of these tests, the diagnostic sensitivity of EDS may be increased in patients with mild CTS.

Keywords:

Carpal tunnel syndrome, electrodiagnostic test, sensitivity,

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