Publication: Karpal Tünel Sendromunda Sinir İletim Çalışmaları ile Ultrasonografik Bulguların Karşılaştırılması
Abstract
Giriş ve amaç: Karpal Tünel Sendromu (KTS), üst ekstremitede en sık görülen tuzak nöropatidir. Median sinirin el bilek düzeyinde, karpal tünel içerisinde sıkışması sonucu meydana gelir. Ağrı, uyuşma, karıncalanma gibi şikayetlere neden olabilir. Tanısı klinik ve elektrofizyolojik yöntemlerle konulur. Tanısal zorluk yaşanan durumlarda ya da ek incelemeye ihtiyaç duyulduğunda radyolojik yöntemlere başvurulabilir. Tanıya katkı sağlamak ve altta yatan sekonder sebepleri saptayabilmek amacıyla en sık başvurulan radyolojik yöntemlerden birisi ultrasonografidir (USG). Ultrasonografi ile sinirlerin kesit alanı ölçülebilir ve el kaslarının kantitatif ölçümleri yapılabilir. Bu çalışmada KTS tanısında elektrofizyolojik çalışmalarla USG bulgularının karşılaştırılması amaçlanmıştır. Bu amaçla psiform kemik düzeyinde median sinir kesit alanı, tenar ve hipotenar kas kalınlığı ölçümleri yapılarak bu ölçümlerin KTS tanısındaki yeri ve elektrodiagnostik bulgularla korelasyonu gösterilmek istenilmiştir. Gereç ve yöntem: Bu çalışmaya Temmuz 2023 ile Aralık 2023 tarihleri arasında Samsun Ondokuz Mayıs Üniversitesi Nöroloji Bölümüne başvuran, Karpal Tünel Sendromunu düşündüren semptom ve bulguları olan ve tanıları elektronöromiyografi (ENMG) ile kesinleştirilen 76 hastanın 136 el bileği dahil edildi. Hasta grubuna ENMG çekimiyle aynı gün içerisinde tek bir araştırmacı tarafından USG çekildi. 81 sağlıklı gönüllünün 162 el bileğine ultrasonografik inceleme yapıldı. Verilerin istatistiksel analizinde GraphPad Prism 8 (Graphpad software, Inc, California) programı kullanıldı. Kolmogorov Smirnov normalite testi, Fisher Testi, bağımsız değişkenli t-testi (Unpaired t-testi), One-Way ANOVA, Tukey- Kramer Testi, Kruskal- Wallis Testi, Dunn Testi, ROC analizi ve Spearman korelasyon testi yapıldı. Bulgular: KTS kadın cinsiyette daha sık olarak saptandı. KTS'nin %76,3 oranında bilateral olduğu görüldü. Elektronöromiyografi sonucunda 42 minimal KTS, 32 hafif KTS, 49 orta KTS, 11 ağır KTS ve 2 ileri derecede ağır KTS tanıları koyuldu. Karpal Tünel Sendromu tanısında median sinir kesit alanı için kesim değeri 0,0905 cm2 saptandı. Sensitivite %90,3, spesifite ise %90,1 olarak bulundu. Median sinir kesit alanı için hasta grup ile kontrol grubu arasında anlamlı sonuç elde edildi. Tenar kas kalınlığında özellikle ağır ve ileri ağır KTS grubunda kontrol grubuna göre anlamlı düşüklük bulundu. Hipotenar kas grubunda kontrol grubu ile hasta grubu arasında anlamlı fark saptanmadı. Tenar kas kalınlığı ile median sinir kesit alanı arasında negatif yönde güçlü korelasyon saptandı. Ultrasonografi ile hasta grubunda %5,1 oranında, kontrol grubunda ise % 2,4 oranında bifid median sinir tanısı koyuldu. Sonuç: Ultrasonografik incelemeler ile minimal evre dahil olmak üzere tüm evrelerde median sinirdeki ödem başarılı bir şekilde gösterilmiş, özellikle orta, ağır ve ileri ağır KTS grubunda tenar atrofinin geliştiği saptanmıştır. Median sinir kesit alanı ölçümü, KTS tanısını koymada %90,3 sensitivite ve %90,1 spesifiteye sahiptir. El kaslarının kantitatif ölçümleri tanı için yardımcı parametrelerdir. Ultrasonografi kullanımı KTS tanısının koyulması, anatomik yapıların değerlendirilmesi ve etiyolojik bilgilere katkı sağlaması açısından ENMG incelemesine yardımcı bir tanı yöntemidir. Anahtar kelimeler: Karpal Tünel Sendromu, ultrasonografi, sinir iletim çalışması, median sinir kesit alanı, tenar kas kalınlığı, hipotenar kas kalınlığı
Introduction and Purpose: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. It occurs as a result of compression of the median nerve in the carpal tunnel at the wrist level. It may cause complaints such as pain, numbness and tingling. Diagnosis is made by clinical and electrophysiological methods. In cases of diagnostic difficulty or when additional examination is needed, radiological methods can be used. One of the most frequently used radiological methods to contribute to the diagnosis and detect underlying secondary causes is ultrasonography (USG). With ultrasonography, the cross-sectional area of the nerves can be measured and quantitative measurements of hand muscles can be made. This study aimed to compare electrophysiological studies and ultrasonographic findings in the diagnosis of CTS. For this purpose, median nerve cross-sectional area, thenar muscle thickness and hypothenar muscle thickness measurements were made at the pisiform bone level to show the contribution of these measurements to the diagnosis of CTS and their correlation with electrodiagnostic findings. Materials and methods: In this study, 136 wrists of 76 patients who had symptoms and findings suggestive of Carpal Tunnel Syndrome and whose diagnosis was confirmed by electromyography (EMG) who applied to Samsun Ondokuz Mayıs University Department of Neurology between July 2023 and December 2023 were included. 162 wrists of 81 healthy volunteers participated in the study. USG was performed on the patient group by a single researcher on the same day as EMG. GraphPad Prism 8 (Graphpad software, Inc, California) program was used for statistical analysis of the data. Kolmogorov Smirnov normality test, Fisher Test, independent variable t-test (Unpaired t-test), One-Way ANOVA, Tukey-Kramer Test, Kruskal-Wallis Test, Dunn Test, ROC analysis and Spearman correlation test were performed. Results: CTS was detected more frequently in female gender. It was observed that CTS was bilateral in 76.3% of cases. As a result of EMG, 42 minimal CTS, 32 mild CTS, 49 moderate CTS, 11 severe CTS and 2 extremely severe CTS were diagnosed. The cut-off value for median nerve cross-sectional area in the diagnosis of Carpal Tunnel Syndrome was determined as 0.0905 cm2. Sensitivity was found to be 90.3% and specificity was 90.1%. A significant difference was detected between the patient group and the control group in median nerve conduction studies. A significant result was obtained between the patient group and the control group for median nerve cross-sectional area. A significant decrease was found in thenar muscle thickness, especially in the severe + extremely severe CTS group compared to the control group. No significant difference was detected between any groups in the hypothenar muscle group. A strong negative correlation was detected between thenar muscle thickness and median nerve cross-sectional area. By ultrasonography, bifid median nerve was diagnosed in 5.1% of the patient group and 2.4% of the control group. Key words: Carpal Tunnel Syndrome, ultrasonography, nerve conduction study, median nerve cross-sectional area, thenar muscle thickness, hypothenar muscle thickness
Introduction and Purpose: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. It occurs as a result of compression of the median nerve in the carpal tunnel at the wrist level. It may cause complaints such as pain, numbness and tingling. Diagnosis is made by clinical and electrophysiological methods. In cases of diagnostic difficulty or when additional examination is needed, radiological methods can be used. One of the most frequently used radiological methods to contribute to the diagnosis and detect underlying secondary causes is ultrasonography (USG). With ultrasonography, the cross-sectional area of the nerves can be measured and quantitative measurements of hand muscles can be made. This study aimed to compare electrophysiological studies and ultrasonographic findings in the diagnosis of CTS. For this purpose, median nerve cross-sectional area, thenar muscle thickness and hypothenar muscle thickness measurements were made at the pisiform bone level to show the contribution of these measurements to the diagnosis of CTS and their correlation with electrodiagnostic findings. Materials and methods: In this study, 136 wrists of 76 patients who had symptoms and findings suggestive of Carpal Tunnel Syndrome and whose diagnosis was confirmed by electromyography (EMG) who applied to Samsun Ondokuz Mayıs University Department of Neurology between July 2023 and December 2023 were included. 162 wrists of 81 healthy volunteers participated in the study. USG was performed on the patient group by a single researcher on the same day as EMG. GraphPad Prism 8 (Graphpad software, Inc, California) program was used for statistical analysis of the data. Kolmogorov Smirnov normality test, Fisher Test, independent variable t-test (Unpaired t-test), One-Way ANOVA, Tukey-Kramer Test, Kruskal-Wallis Test, Dunn Test, ROC analysis and Spearman correlation test were performed. Results: CTS was detected more frequently in female gender. It was observed that CTS was bilateral in 76.3% of cases. As a result of EMG, 42 minimal CTS, 32 mild CTS, 49 moderate CTS, 11 severe CTS and 2 extremely severe CTS were diagnosed. The cut-off value for median nerve cross-sectional area in the diagnosis of Carpal Tunnel Syndrome was determined as 0.0905 cm2. Sensitivity was found to be 90.3% and specificity was 90.1%. A significant difference was detected between the patient group and the control group in median nerve conduction studies. A significant result was obtained between the patient group and the control group for median nerve cross-sectional area. A significant decrease was found in thenar muscle thickness, especially in the severe + extremely severe CTS group compared to the control group. No significant difference was detected between any groups in the hypothenar muscle group. A strong negative correlation was detected between thenar muscle thickness and median nerve cross-sectional area. By ultrasonography, bifid median nerve was diagnosed in 5.1% of the patient group and 2.4% of the control group. Key words: Carpal Tunnel Syndrome, ultrasonography, nerve conduction study, median nerve cross-sectional area, thenar muscle thickness, hypothenar muscle thickness
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