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DİABETİK GEBELERDE KARPAL TÜNELİN ULTRASONOGRAFİK DEĞERLENDİRİLMESİ

Year 2021, Volume: 18 Issue: 4, 1078 - 1082, 31.12.2021
https://doi.org/10.38136/jgon.982937

Abstract

Amaç: Diabetik gebelerde karpal tünel sendromu tanısı için median sinir alanının ultrasonografik olarak değerlendirilmesi.

Gereçler ve yöntem: Tip 1, tip 2 diabetes mellitus (DM) ve gestasyonel diabetes mellitus (GDM) tanısı olan gebeler prospektif olarak değerlendirildi. GDM tanısı için tek basamaklı 75 gr oral glukoz tolerans testi kullanıldı. Median sinir el bileğinin distal seviyesinde karpal tünel giriş seviyesinde USG kullanılarak tespit edildi ve en büyük sinir alanı ölçümü yapıldı. Ölçüm sonrası hastalara ellerinde ağrı, uyuşukluk ve parastezi olup olmadığı soruldu. Diabetik grup yaş, gebelik haftası, gebelikte alınan kilo, median sinir alanı ve şikayetler açısından kontrol grubu gebe hastalarla karşılaştırıldı.

Bulgular: DM grubunda 107 gebe hasta ve kontrol grubunda 113 gebe hasta bulunmakta idi. DM grupta median sinir alanı kontrol grubuna göre anlamlı olarak artmış bulundu (p< 0,001). Diabetik subgruplar ve insülin kullanımı açısından median sinir alanı alçümlerinde farklılık saptanmadı. Elde ağrı diabetik grupta anlamlı olarak daha sık idi ve median sinir alanı ile gebelikte alınan kilo arasında pozitif ilişki mevcuttu.

Sonuç: USG diabetik gebelerde genel popülasyonda olduğu gibi karpal tünel sendromu tanısında ilk tercih olarak kullanılabilecek bir yöntemdir. Hem gebelik hem de diabet karpal tünel sendromu için risk faktörü olduğu için bu hastalara özellikle şikayetleri mevcut ise rutin gebelik takipleri sırasında yapacakları basit bir median sinir alanı ölçümü ile güncel yaklaşım olan basit koruyucu tavsiyelerde bulunarak hayat kalitelerinde artış sağlayabilir.

References

  • 1. Meems M, Truijens S, Spek V, Visser LH, Pop VJ. Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study. BJOG. 2015 Jul;122(8):1112-8.
  • 2. Padua L, Di Pasquale A, Pazzaglia C, Liotta GA, Librante A, Mondelli M. Systematic review of pregnancy-related carpal tunnel syndrome. Muscle Nerve. 2010 Nov;42(5):697-702.
  • 3. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et. al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016 Nov;15(12):1273-1284.
  • 4. Gooding MS, Evangelista V, Pereira L. Carpal Tunnel Syndrome and Meralgia Paresthetica in Pregnancy. Obstet Gynecol Surv. 2020 Feb;75(2):121-126.
  • 5. Bahrami MH, Rayegani SM, Fereidouni M, Baghbani M. Prevalence and severity of carpal tunnel syndrome (CTS) during pregnancy. Electromyogr Clin Neurophysiol. 2005 Mar;45(2):123-5.
  • 6. Aboonq MS (2015) Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh, Saudi Arabia) 20:4-9.
  • 7. Pourmemari MH, Shiri R. Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis. Diabet Med. 2016 Jan;33(1):10-6.
  • 8. Ažman D, Hrabač P, Demarin V. Use of Multiple Ultrasonographic Parameters in Confirmation of Carpal Tunnel Syndrome. J Ultrasound Med. 2018 Apr;37(4):879-889.
  • 9. Chen YT, Williams L, Zak MJ, Fredericson M. Review of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome and a Proposed Scanning Protocol. J Ultrasound Med. 2016 Nov;35(11):2311-2324.
  • 10. Tulipan JE, Ilyas AM. Carpal Tunnel Syndrome Surgery: What You Should Know. Plast Reconstr Surg Glob Open. 2020 Mar 20;8(3):e2692.
  • 11. Cartwright MS, Hobson-Webb LD, Boon AJ, Alter KE, Hunt CH, Flores VH, et. al. American Association of Neuromuscular and Electrodiagnostic Medicine. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug;46(2):287-93.
  • 12. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care. (2014) 37(Suppl. 1):S81–90. 10.2337/dc14-S081
  • 13. Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry. 2008 Jan;79(1):63-7
  • 14. Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011 Apr;469(4):1089-94.
  • 15. Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol. 1999 Sep;173(3):681-4.
  • 16. Yesildag A, Kutluhan S, Sengul N, Koyuncuoglu HR, Oyar O, Guler K et. al. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol. 2004 Oct;59(10):910-5.
  • 17. Alemán L, Berná JD, Reus M, Martínez F, Doménech-Ratto G, Campos M. Reproducibility of sonographic measurements of the median nerve. J Ultrasound Med. 2008 Feb;27(2):193-7.
  • 18. Goswami RP, Sit H, Chatterjee M, Lahiri D, Sircar G, Ghosh P. High-resolution ultrasonography in carpal tunnel syndrome: role of ancillary criteria in diagnosis and response to steroid injection. Clin Rheumatol. 2021 Mar;40(3):1069-1076.
  • 19. Oliveira GAD, Bernardes JM, Santos ES, Dias A. Carpal tunnel syndrome during the third trimester of pregnancy: prevalence and risk factors. Arch Gynecol Obstet. 2019 Sep;300(3):623-631.
  • 20. Ng AWH, Griffith JF, Lee RKL, Tse WL, Wong CWY, Ho PC. Ultrasound carpal tunnel syndrome: additional criteria for diagnosis. Clin Radiol. 2018 Feb;73(2):214.e11-214.e18.
  • 21. Wright C, Smith B, Wright S, Weiner M, Wright K, Rubin D. Who develops carpal tunnel syndrome during pregnancy: An analysis of obesity, gestational weight gain, and parity. Obstet Med. 2014 Jun;7(2):90-4.
  • 22. Balık G, Sabri Balık M, Ustüner I, Kağıtcı M, Sahin FK, Güven ES. Hand and wrist complaints in pregnancy. Arch Gynecol Obstet. 2014 Sep;290(3):479-83.
  • 23. Sapuan J, Yam KF, Noorman MF, De Cruz PK, Abdul Razab WN, Rozali ZI, et al (2012) Carpal tunnel syndrome in pregnancy—you need to ask! Singap Med J 53:671-675.
  • 24. Tupković E, Nisić M, Kendić S, Salihović S, Balić A, Brigić K, et. al. Median nerve: neurophysiological parameters in third trimester of pregnancy. Bosn J Basic Med Sci. 2007 Feb;7(1):84-9.
  • 25. Osterman M, Ilyas AM, Matzon JL (2012) Carpal tunnel syndrome in pregnancy. Orthop Clin North Am 43:515-520.
  • 26. Turgut F, Cetinşahinahin M, Turgut M, Bölükbaşi O (2001) The management of carpal tunnel syndrome in pregnancy. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia 8:332-334.

ULTRASONOGRAPHIC EVALUATION OF CARPAL TUNNEL IN PREGNANT WOMEN WITH DIABETES MELLITUS

Year 2021, Volume: 18 Issue: 4, 1078 - 1082, 31.12.2021
https://doi.org/10.38136/jgon.982937

Abstract

Objective: To determine the ultrasonography (USG) values of median nerve cross-sectional area (MN-CSA) in pregnant women with and without diabetes mellitus (DM) to confirm carpal tunnel syndrome (CTS).
Methods: We prospectively studied pregnant women who have been diagnosed with pregestational type 1 and type 2 DM or gestational DM (GDM) due to positive GDM screening tests. One-step GDM screening (2 h - 75 g oral glucose tolerance test (OGTT)) was used at 24–28 weeks of gestation and diagnosis of GDM. MN was identified at the level of distal wrist crease in transverse sections with USG and maximal MN-CSA was calculated then, asked the patient complaints about her hand (paraesthesia, pain, numbness). The DM group was compared to the control group according to age, week of pregnancy, weight gain during pregnancy, MN-CSA, and presence of compliments.
Results: There were 107 DM pregnant women and 113 controls in the study group. The median value of MN-CSA was higher in the DM group than in the control group (p< 0,001). There was no difference between groups in terms of DM subgroups and insulin requirement. Hand pain is significantly frequent in the DM group than in controls. There has been a positive correlation between weight gain during pregnancy and MN-CSA (p =0,011; r=0,245).
Conclusion: USG can be a first-line diagnostic test for CTS in the diabetic pregnant population, as recommended for the general population before. Both pregnancy and DM are stated as risk factors for CTS, these patients must be evaluated more carefully about this issue and proper advices should be given to improve their life quality.

References

  • 1. Meems M, Truijens S, Spek V, Visser LH, Pop VJ. Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study. BJOG. 2015 Jul;122(8):1112-8.
  • 2. Padua L, Di Pasquale A, Pazzaglia C, Liotta GA, Librante A, Mondelli M. Systematic review of pregnancy-related carpal tunnel syndrome. Muscle Nerve. 2010 Nov;42(5):697-702.
  • 3. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et. al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016 Nov;15(12):1273-1284.
  • 4. Gooding MS, Evangelista V, Pereira L. Carpal Tunnel Syndrome and Meralgia Paresthetica in Pregnancy. Obstet Gynecol Surv. 2020 Feb;75(2):121-126.
  • 5. Bahrami MH, Rayegani SM, Fereidouni M, Baghbani M. Prevalence and severity of carpal tunnel syndrome (CTS) during pregnancy. Electromyogr Clin Neurophysiol. 2005 Mar;45(2):123-5.
  • 6. Aboonq MS (2015) Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh, Saudi Arabia) 20:4-9.
  • 7. Pourmemari MH, Shiri R. Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis. Diabet Med. 2016 Jan;33(1):10-6.
  • 8. Ažman D, Hrabač P, Demarin V. Use of Multiple Ultrasonographic Parameters in Confirmation of Carpal Tunnel Syndrome. J Ultrasound Med. 2018 Apr;37(4):879-889.
  • 9. Chen YT, Williams L, Zak MJ, Fredericson M. Review of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome and a Proposed Scanning Protocol. J Ultrasound Med. 2016 Nov;35(11):2311-2324.
  • 10. Tulipan JE, Ilyas AM. Carpal Tunnel Syndrome Surgery: What You Should Know. Plast Reconstr Surg Glob Open. 2020 Mar 20;8(3):e2692.
  • 11. Cartwright MS, Hobson-Webb LD, Boon AJ, Alter KE, Hunt CH, Flores VH, et. al. American Association of Neuromuscular and Electrodiagnostic Medicine. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug;46(2):287-93.
  • 12. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care. (2014) 37(Suppl. 1):S81–90. 10.2337/dc14-S081
  • 13. Visser LH, Smidt MH, Lee ML. High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry. 2008 Jan;79(1):63-7
  • 14. Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011 Apr;469(4):1089-94.
  • 15. Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol. 1999 Sep;173(3):681-4.
  • 16. Yesildag A, Kutluhan S, Sengul N, Koyuncuoglu HR, Oyar O, Guler K et. al. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol. 2004 Oct;59(10):910-5.
  • 17. Alemán L, Berná JD, Reus M, Martínez F, Doménech-Ratto G, Campos M. Reproducibility of sonographic measurements of the median nerve. J Ultrasound Med. 2008 Feb;27(2):193-7.
  • 18. Goswami RP, Sit H, Chatterjee M, Lahiri D, Sircar G, Ghosh P. High-resolution ultrasonography in carpal tunnel syndrome: role of ancillary criteria in diagnosis and response to steroid injection. Clin Rheumatol. 2021 Mar;40(3):1069-1076.
  • 19. Oliveira GAD, Bernardes JM, Santos ES, Dias A. Carpal tunnel syndrome during the third trimester of pregnancy: prevalence and risk factors. Arch Gynecol Obstet. 2019 Sep;300(3):623-631.
  • 20. Ng AWH, Griffith JF, Lee RKL, Tse WL, Wong CWY, Ho PC. Ultrasound carpal tunnel syndrome: additional criteria for diagnosis. Clin Radiol. 2018 Feb;73(2):214.e11-214.e18.
  • 21. Wright C, Smith B, Wright S, Weiner M, Wright K, Rubin D. Who develops carpal tunnel syndrome during pregnancy: An analysis of obesity, gestational weight gain, and parity. Obstet Med. 2014 Jun;7(2):90-4.
  • 22. Balık G, Sabri Balık M, Ustüner I, Kağıtcı M, Sahin FK, Güven ES. Hand and wrist complaints in pregnancy. Arch Gynecol Obstet. 2014 Sep;290(3):479-83.
  • 23. Sapuan J, Yam KF, Noorman MF, De Cruz PK, Abdul Razab WN, Rozali ZI, et al (2012) Carpal tunnel syndrome in pregnancy—you need to ask! Singap Med J 53:671-675.
  • 24. Tupković E, Nisić M, Kendić S, Salihović S, Balić A, Brigić K, et. al. Median nerve: neurophysiological parameters in third trimester of pregnancy. Bosn J Basic Med Sci. 2007 Feb;7(1):84-9.
  • 25. Osterman M, Ilyas AM, Matzon JL (2012) Carpal tunnel syndrome in pregnancy. Orthop Clin North Am 43:515-520.
  • 26. Turgut F, Cetinşahinahin M, Turgut M, Bölükbaşi O (2001) The management of carpal tunnel syndrome in pregnancy. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia 8:332-334.
There are 26 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Şule Göncü Ayhan 0000-0002-5770-7555

Dilek Sahin 0000-0001-8567-9048

Publication Date December 31, 2021
Submission Date August 14, 2021
Acceptance Date November 7, 2021
Published in Issue Year 2021 Volume: 18 Issue: 4

Cite

Vancouver Göncü Ayhan Ş, Sahin D. ULTRASONOGRAPHIC EVALUATION OF CARPAL TUNNEL IN PREGNANT WOMEN WITH DIABETES MELLITUS. JGON. 2021;18(4):1078-82.