Öz
Introduction: Carpal tunnel syndrome (CTS) is the most common mononeuropathy characterized by numbness, paresthesia, pain and weakness in the fingers, depending on the functions of the median nerve. The aim of this study is to investigate the relationship between the pain and electrophysiological findings in patients diagnosed with idiopathic CTS.
Materials and Methods: 106 patients diagnosed with idiopathic CTS were included in this cross-sectional observational study. Demographic data of the patients were recorded. Motor and sensory conduction velocities, amplitudes and latency of the median and ulnar nerves were evaluated. According to electrophysiological findings, staging of CTS was made as "Mild CTS", "Moderate CTS" and "Severe CTS". Visual Analogue Scale (VAS) was used for pain severity.
Results: 106 patients (90 females (84.9%), 16 males (15.1%), mean age 45.97 years ± 5.28 years) diagnosed with CTS were included in this study. Bilateral CTS symptoms were present in 63.2% of the patients. According to VAS, the mean pain intensity of the patients was 5.88 ± 2.29. The mean VAS score of the patients in the mild CTS group was 4.03±1.66, 6.85±1.67 in the moderate CTS group, and 8.83±1.60 in the severe CTS group (p=0.01 and p=0.02). While the mean VAS was 4.46±2.22 in those with unilateral CTS, it was 6.23±2.08 in those with bilateral CTS (p=0.01). Moderate CTS was detected in 61.2% of the patients with bilateral clinical findings (p=0.01). In addition, the VAS scores of those with both unilateral and bilateral CTS were found to be significantly higher in those with moderate than mild CTS (p= 0.01/ p=0.01).
Discussion: In this study, it was determined that the pain was more severe in patients with electrophysiologically more severe CTS and that pain was more in those with bilateral CTS. The increase in the severity of the pain that determined with VAS which can be applied easily and quickly in daily practice. and the increase in the stage of the disease may contribute to the early and effective initiation of the patient's treatment.
Anahtar Kelimeler
Kaynakça
- 1- İnanç, Y. , İnanç, Y. , Ay, H. , Arlier, Z. , Kocatürk, Ö. "Karpal Tünel Sendromu: 126 Olgunun Demoğrafik Açıdan Değerlendirilmesi". Harran Üniversitesi Tıp Fakültesi Dergisi 11 (2014 ): 242-246
- 2- Hegmann KT, Merryweather A, Thiese MS, Kendall R, Garg A, Kapellusch J, Foster J, Drury D, Wood EM, Melhorn JM. Median Nerve Symptoms, Signs, and Electrodiagnostic Abnormalities Among Working Adults. J Am Acad Orthop Surg. 2018;26(16):576-584.
- 3- Carlson H, Colbert A, Frydl J, Arnall E, Elliot M, Carlson N. Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol. 2010;5:129-42.
- 4- Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol. 2015;29(3):440-53.
- 5- Sevy JO, Varacallo M. Carpal Tunnel Syndrome. [Updated 2021 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/
- 6- Yang C, Chen HH, Lee MC, Kao HK, Lin YT, Chen CT, et al. Risk Factors of Carpal Tunnel Syndrome in Taiwan: A Population-Based Cohort Study. Ann Plast Surg. 2021 Jul 13. Online ahead of print.
- 7- Rosario NB, De Jesus O. Electrodiagnostic Evaluation Of Carpal Tunnel Syndrome. [Updated 2021 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562235/
- 8- Sucher BM. Grading severity of carpal tunnel syndrome in electrodiagnostic reports: why grading is recommended. Muscle Nerve. 2013; 48(3): 331-3.
- 9- Seror P. Electrodiagnosis, a real added value for the evaluation of upper limb paresthesiae and pains. Clin Neurophysiol Pract. 2018;3:89-90.
- 10- Ntani G, Palmer KT, Linaker C, Harris EC, Van der Star R, Cooper C, Coggon D. Symptoms, signs and nerve conduction velocities in patients with suspected carpal tunnel syndrome. BMC Musculoskelet Disord. 2013;14:242.
- 11- Stevens, J. C. (1997). AAEM minimonograph #26: The electrodiagnosis of carpal tunnel syndrome. Muscle & Nerve, 20(12), 1477–1486).
- 12- Güzeldemir ME. Ağrı değerlendirme yöntemleri. Sendrom. 1995;7:11-21.
- 13- Padua L, Padua R, Lo Monaco M, Aprile I, Tonali P. Multiperspective assessment of carpal tunnel syndrome: a multicenter study. Italian CTS Study Group. Neurology. 1999;53:1654–1659.
- 14- AN Alagöz, Y Aras, BA Acar, T Acar. Comparison of Severity of Pain and Electrophysiological Severity Degree in Patients with Carpal Tunnel Syndrome. Bosphorus Medical Journal. 2019; 6(1): 1-8
- 15- De Campos CC, Manzano GM, Leopoldino JF, Nobrega JA, Sanudo A, De Araujo Peres C. The relationship between symptoms and electrophysiological detected compression of the median nerve at wrist. Acta Neurol Scand 2004;110:398-402
- 16- CS Modi, K Ho, V Hegde, R Boer, SM Turner. Diagnosis of motor fascicle compression in carpal tunnel syndrome. Orthopaedics&Traumatology: Surgery&Research. 2010, 485-489
- 17- Ferry S, Silman AJ, Pritchard T, Kenan J, Croft P. The association between different patterns of hand symptoms and objective evidence of median nevre compression. Arthritis Rheum 1998;41(4):720-4
- 18- HD Keklikoğlu, Aİ Çolpak, EB Solak, TK Yoldaş Karpal Tünel Sendromunda Ağrı ve Elektrofizyolojik Bulgular. Turk Norol Derg 2009;15:188-193
Öz
Giriş: Karpal tünel sendromu (KTS) median sinirin işlevlerine bağlı olarak parmaklarda uyuşma, parestezi, ağrı ve güçsüzlükle karakterize en sık görülen mononöropatidir. Bu çalışmanın amacı idiyopatik KTS tanısı alan hastalarda hissedilen ağrı ile elektrofizyolojik bulgular arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntem: Bu kesitsel gözlemsel çalışmaya idiyopatik KTS tanısı alan 106 hasta alındı. Hastaların demografik verileri kaydedildi. Median ve ulnar sinirin motor ve duyu olarak iletim hızları, amplitüdleri, latansları değerlendirildi. Elektrofizyolojik bulgulara göre KTS evrelemesi ‘’Hafif KTS’’, ‘’Orta KTS’’ ve ‘’Şiddetli KTS’’ olarak yapıldı. Ağrı şiddeti için Görsel Analog Ölçeği (GAÖ) kullanıldı.
Bulgular: Bu çalışmaya KTS tanısı alan 106 hasta (90 kadın (%84,9), 16 erkek (%15,1), ortalama yaş 45,97 yıl ± 5,28) dahil edildi. Hastaların %63,2’sinde bilateral KTS semptomları vardı. GAÖ’ye göre, hastaların ortalama ağrı şiddeti 5,88 ± 2,29 idi. Hafif KTS grubunda olan hastaların ortalama GAÖ puanı 4,03±1,66, orta KTS grubundakilerin 6,85±1,67, şiddetli KTS grubundakilerin ise 8,83±1,60 idi (p=0,01 ve p=0,02). Tek taraflı KTS’si olanlarda VAS ortalaması 4,46±2,22 iken bilateral KTS’si olanlarda VAS ortalaması 6,23±2,08’di (p=0.01). Bilateral klinik bulgusu olan hastaların %61,2’sinde orta derecede KTS saptandı (p=0,01). Ayrıca hem unilateral hem de bilateral KTS’si olanlarda VAS puanları hafife göre orta evre KTS’si olanlarda anlamlı olarak yüksek bulunmuştur (p= 0,01/ p=0,01).
Tartışma: Bu çalışmada elektrofizyolojik olarak daha ağır olan KTS’de ağrının daha şiddetli olduğu ve bilateral KTS’si olanlarda da ağrının daha fazla olduğu saptanmıştır. Ağrının şiddetinin artması ile hastalığın evresinin artması, günlük pratikte kolay ve çabuk uygulanacak GAÖ’nün hastanın tedavisinin erken ve etkili bir şekilde başlatılabilmesine katkı sağlayabilir.
Anahtar Kelimeler
Kaynakça
- 1- İnanç, Y. , İnanç, Y. , Ay, H. , Arlier, Z. , Kocatürk, Ö. "Karpal Tünel Sendromu: 126 Olgunun Demoğrafik Açıdan Değerlendirilmesi". Harran Üniversitesi Tıp Fakültesi Dergisi 11 (2014 ): 242-246
- 2- Hegmann KT, Merryweather A, Thiese MS, Kendall R, Garg A, Kapellusch J, Foster J, Drury D, Wood EM, Melhorn JM. Median Nerve Symptoms, Signs, and Electrodiagnostic Abnormalities Among Working Adults. J Am Acad Orthop Surg. 2018;26(16):576-584.
- 3- Carlson H, Colbert A, Frydl J, Arnall E, Elliot M, Carlson N. Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol. 2010;5:129-42.
- 4- Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol. 2015;29(3):440-53.
- 5- Sevy JO, Varacallo M. Carpal Tunnel Syndrome. [Updated 2021 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/
- 6- Yang C, Chen HH, Lee MC, Kao HK, Lin YT, Chen CT, et al. Risk Factors of Carpal Tunnel Syndrome in Taiwan: A Population-Based Cohort Study. Ann Plast Surg. 2021 Jul 13. Online ahead of print.
- 7- Rosario NB, De Jesus O. Electrodiagnostic Evaluation Of Carpal Tunnel Syndrome. [Updated 2021 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562235/
- 8- Sucher BM. Grading severity of carpal tunnel syndrome in electrodiagnostic reports: why grading is recommended. Muscle Nerve. 2013; 48(3): 331-3.
- 9- Seror P. Electrodiagnosis, a real added value for the evaluation of upper limb paresthesiae and pains. Clin Neurophysiol Pract. 2018;3:89-90.
- 10- Ntani G, Palmer KT, Linaker C, Harris EC, Van der Star R, Cooper C, Coggon D. Symptoms, signs and nerve conduction velocities in patients with suspected carpal tunnel syndrome. BMC Musculoskelet Disord. 2013;14:242.
- 11- Stevens, J. C. (1997). AAEM minimonograph #26: The electrodiagnosis of carpal tunnel syndrome. Muscle & Nerve, 20(12), 1477–1486).
- 12- Güzeldemir ME. Ağrı değerlendirme yöntemleri. Sendrom. 1995;7:11-21.
- 13- Padua L, Padua R, Lo Monaco M, Aprile I, Tonali P. Multiperspective assessment of carpal tunnel syndrome: a multicenter study. Italian CTS Study Group. Neurology. 1999;53:1654–1659.
- 14- AN Alagöz, Y Aras, BA Acar, T Acar. Comparison of Severity of Pain and Electrophysiological Severity Degree in Patients with Carpal Tunnel Syndrome. Bosphorus Medical Journal. 2019; 6(1): 1-8
- 15- De Campos CC, Manzano GM, Leopoldino JF, Nobrega JA, Sanudo A, De Araujo Peres C. The relationship between symptoms and electrophysiological detected compression of the median nerve at wrist. Acta Neurol Scand 2004;110:398-402
- 16- CS Modi, K Ho, V Hegde, R Boer, SM Turner. Diagnosis of motor fascicle compression in carpal tunnel syndrome. Orthopaedics&Traumatology: Surgery&Research. 2010, 485-489
- 17- Ferry S, Silman AJ, Pritchard T, Kenan J, Croft P. The association between different patterns of hand symptoms and objective evidence of median nevre compression. Arthritis Rheum 1998;41(4):720-4
- 18- HD Keklikoğlu, Aİ Çolpak, EB Solak, TK Yoldaş Karpal Tünel Sendromunda Ağrı ve Elektrofizyolojik Bulgular. Turk Norol Derg 2009;15:188-193
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 21 Mart 2022 |
| Gönderilme Tarihi | 18 Kasım 2021 |
| Kabul Tarihi | 5 Ocak 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 17 Sayı: 1 |
