PROFIL PASIEN SINDROM TEROWONGAN KARPAL DI POLIKLINIK SARAF RSUP SANGLAH DENPASAR

PROFILE OF PATIENT CARPAL TUNNEL SYNDROME IN THE NEUROLOGY CLINIC SANGLAH GENERAL HOSPITAL IN DENPASARABSTRACTIntroduction: Carpal tunnel syndrome (CTS) is the entrapment of the median nerve at the carpal tunnel.Aims: To determine the profile of patients with carpal tunnel syndrome in the Neurology Clinic Sanglah GeneralHospital in Denpasar.Methods: This is a descriptive, cross sectional study. Data was collected during a6-month period from April 2016 to September 2016.Results: Among 25 subjects, 76% were female with mean age 48+10,133 years old, housewives (40%), with working hours of more than 8 hours per day. Most subjects had symptoms on the right hand 68% in the form of tingling sensation (96%), pain (36%), numbness (48%), and hand weakness (24%). Most subject has positive Phalen test (80%), Tinnel (80%), and Flick (76%) and small number had tenar muscle atrophy (28%), impaired sensibility (32%), and decrease in muscle strength (24%). As many as 68% of subjects had distal sensoric latency of median nerve recorded on the 4th digit>3.5msec, while 72% showed ≥0.5 difference of distal sensoric latency between the median nerve and ulnar nerve, while8% showed no response.Discussion: Most patients were female, with dominant complaint was tingling, positive Phalen and Tinnel test, and68% ENMG result shown CTS.Keywords: Carpal tunnel syndrome, electroneuromyography, patient profileABSTRAKPendahuluan: Sindrom terowongan karpal (STK) adalah penjepitan N. Medianus saat melewati terowongan karpal. Tujuan: Untuk mengetahui profil pasien sindrom terowongan karpal di poliklinik saraf RSUP Sanglah, Denpasar. Metode: Penelitian potong lintang terhadap pasien dengan STK yang berobat ke poliklinik saraf RSUP Sanglah,Denpasar secara konsekutif pada bulan April-September 2016.Hasil: Dari 25 subjek, 76% adalah perempuan dengan rerata usia 48+10,133 tahun, ibu rumah tangga (40%) dengan durasi kerja lebih dari 8 jam perhari. Mayoritas keluhan terjadi pada tangan kanan (68%), berupa kesemutan (96%), nyeri (36%), rasa tebal (48%), dan kelemahan otot tangan (24%). Sebagian besar hasil positif pada tes Phalen (80%), Tinnel (80%), dan Flick (76%), serta sebagian kecil mengalami atrofi otot tenar (28%), gangguan sensibilitas (32%), dan kelemahan otot tangan (24%). Latensi distal sensorik N. Medianus pada perekaman jari IV terutama >3,5ms (68%), perbedaan latensi distal sensorik N. Medianus dan Ulnaris ≥0,5ms (72%), dan tidak ada respons 8%.Diskusi: Sebagian besar sampel adalah perempuan, gejala yang dominan berupa kesemutan, tes Phalen dan Tinnel yang positif, serta hasil ENMG 68% menderita STK.Kata kunci: Elektroneuromiografi, profil pasien, sindrom terowongan karpal

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The value of sonographic quantitative parameters in the diagnosis of carpal tunnel syndrome in the Vietnamese population

Journal of International Medical Research ◽

10.1177/03000605211064408 ◽

2021 ◽

Vol 49 (12) ◽

pp. 030006052110644

Author(s):

Nhu Quynh Vo ◽

Thi Hieu Dung Nguyen ◽

Duy Duan Nguyen ◽

Trong Binh Le ◽

Nghi Thanh Nhan Le ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Sensitivity And Specificity ◽

Carpal Tunnel ◽

Area Under The Curve ◽

Cross Sectional Study ◽

Control Group ◽

Cross Sectional ◽

Vietnamese Population ◽

Tunnel Syndrome

Objective To examine the value of ultrasound (US) in the diagnosis of carpal tunnel syndrome (CTS) in the Vietnamese population. Methods This prospective cross-sectional study involved 42 wrists of 25 patients with idiopathic CTS evaluated by US. In addition, 38 wrists of 22 healthy volunteers were included as the control group. Results Significant differences in the median nerve cross-sectional area (CSA) at different levels were found between patients with CTS and controls. Using a cut-off value of 9.5 mm2 for the median nerve CSA at the pisiform (p-CSA), US had a sensitivity and specificity of 95.2% and 97.4%, respectively, for the diagnosis of CTS. Area under the curve analysis revealed a sensitivity and specificity of 100% and 95.4%, respectively, for the prediction of severe CTS using a p-CSA of >15.5 mm2. Conclusions The median nerve CSA is a highly accurate parameter in the diagnosis of CTS. We recommend using a p-CSA of >9.5 mm2 as a diagnostic criterion for CTS and a p-CSA of >15.5 mm2 as a marker for severe CTS in the Vietnamese population. Research Registry number: 7261

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POS0584 ULTRASONOGRAPHY OF THE MEDIAN NERVE IN PATIENTS WITH RHEUMATOID ARTHRITIS UNDER SUSPICION OF CARPAL TUNNEL SYNDROME

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3994 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 525.1-525

Author(s):

S. Tsiami ◽

E. Ntasiou ◽

C. Krogias ◽

R. Gold ◽

J. Braun ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Nerve Conduction Velocity ◽

Sectional Area ◽

Cross Sectional ◽

Spearman's Rho ◽

Spearman’S Rho ◽

Tunnel Syndrome

Background:Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome and a common extra-articular manifestation of rheumatoid arthritis (RA). Different causes of CTS are known, among them inflammatory and non-inflammatory pathologies. Electroneurography (ENG) of the median nerve, the method of choice to diagnose CTS, measures impairment of nerve conduction velocity without explaining its underlying cause. However, because the electrical stimulation is often not well tolerated, ENG results may come out inconclusive. Using greyscale ultrasonography (GS-US) provides anatomic information including a structural representation of the carpal tunnel.Objectives:To investigate the performance of nerve GS-US in the diagnosis of CTS in patients with RA.Methods:Consecutive patients with active RA under suspicion of CTS presenting to a large rheumatologic center were included. Both hands were examined by an experienced neurologist including ENG and a GS-US (ML linear probe with 6-15 Hz) of the median nerve. An established grading system for ENG (1), and an established system for GS-US based on cut-offs for the nerve cross sectional area (CSA) [mild: 0,11-0,13cm2, moderate: 0,14-0,15 cm2, severe: > 0,15 cm2 CTS (2)] were used. In addition, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) was used to assess CTS symptoms (3).Results:Both hands of 58 patients with active RA (n=116) and clinical suspicion of CTS (in 38 cases bilaterally) were included. After clinical examination, CTS was suspicious in 96 hands (82.8%), and 59 of all hands had a final diagnosis of CTS (50.9%). Of the latter, 43 hands (72.9%) had a positive ENG and 16 (27.1%) a positive GS-US finding only, while 30 hands (50.8%) were positive in both examinations.There was a good correlation of the cross-sectional area (CSA) as well as the CSA-ratio to the ENG findings: the larger the CSA, the more severe was the CTS as assessed by ENG (Spearman’s rho=0.554; p<0.001). The more severe the GS-US findings of CTS were, the more definite were the distal motor latency (Spearman’s rho=0.554; p<0.001) and sensible nerve conduction velocity of the median nerve (Spearman’s rho=-0.5411; p<0.001).In the 46 hands positive in GS-US, tenosynovial hypertrophy of the flexor tendons was detected in 19 hands (41.3%), 7 of which (36.8%) also showed an additional cystic mass. In these 19 patients, clinical complains were more severely present than in patients with non-inflammatory CTS, as assessed by the BCTSQ with a total score of 68.8±13.4 vs. 59.3±13.7, respectively (p=0.007).Conclusion:In patients with active RA and clinical complains of CTS, ultrasound examinations provide additional information about inflammation which is helpful for a diagnosis of CTS. Thus, ENG and nerve GS-US should be used complementary for a diagnostic workup of CTS in RA patients with a suspicion of CTS. Power-Doppler may further improve the diagnostic performance of GS-US.References:[1]Padua L et al. Acta Neurol Scand 1997; 96:211–217[2]El Miedany et al., Rheumatology (Oxford). 2004 Jul; 43(7):887-895[3]Levine DW et al. J Bone Joint Surg Am 1993; 75: 1585-1592Figure 1.BCTSQ scores in patients with diagnosis of CTS and absence or presence of RA-related tenosynovial hypertrophyDisclosure of Interests:None declared

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Reduction in median nerve cross-sectional area at the forearm correlates with axon loss in carpal tunnel syndrome

Clinical Neurophysiology Practice ◽

10.1016/j.cnp.2021.06.001 ◽

2021 ◽

Author(s):

Lauri Martikkala ◽

Katri Mäkelä ◽

Sari-Leena Himanen

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Axon Loss ◽

Tunnel Syndrome

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Cross-Sectional Area of the Median Nerve Characterized by Ultrasound in Patients With Carpal Tunnel Syndrome Before and After the Release of the Transverse Carpal Ligament

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479313477731 ◽

2013 ◽

Vol 29 (3) ◽

pp. 116-121 ◽

Cited By ~ 2

Author(s):

Benedito F. Pimentel ◽

Claudia A. Abicalaf ◽

Larissa Braga ◽

Walter M. Albertoni ◽

Carlos H. Fernandes ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Sectional Area ◽

Transverse Carpal Ligament ◽

Cross Sectional ◽

Before And After ◽

Tunnel Syndrome

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Ultrasound Assessment of the Median Nerve Does Not Adequately Discriminate the Carpal Tunnel Syndrome among Patients Diagnosed with Diabetes

Diabetology ◽

10.3390/diabetology2040020 ◽

2021 ◽

Vol 2 (4) ◽

pp. 226-231

Author(s):

Carlos Antonio Guillen-Astete ◽

Monica Luque-Alarcon ◽

Nuria Garcia-Montes

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Diabetic Patients ◽

Sectional Area ◽

Cross Sectional ◽

Patients With Diabetes ◽

Ultrasound Assessment ◽

Tunnel Syndrome

Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11.7 years old, 57.89% female, mean of time of evolution 13.6 ± 8.3 months) from 2012 to 2020. The cross-sectional area of the median nerve was 10.46 ± 1.44 mm2 in non-diabetic patients and 8.92 ± 0.9 mm2 in diabetic patients (p < 0.001). Additionally, diabetic patients had a shorter time of evolution (7.91 ± 8.28 months vs. 14.36 ± 0.526 months, p < 0.001). In the multivariate analysis, the resultant model (fixed R-square = 0.659, p = 0.003) included a constant of the following four variables: the evolution time (Beta coeff. = 0.108, p < 0.001 95% CI 0.091 to 0.126, standardized coeff. = 0.611), the condition of diabetes (Beta coeff. = −0.623, p < 0.001 95% CI −0.907 to −0.339, standardized coeff. = −0.152), the severity (Beta coeff. = 0.359, p = 0.001 95% CI 0.147 to 0.571, standardized coeff. = 0.169), and the masculine sex (Beta coeff. = 0.309, p = 0.003, 95% CI 0.109 to 0.509, standardized coeff. = 0.103). Conclusions: Ultrasound assessment of the median nerve in patients with diabetes is not a useful tool to confirm whether carpal tunnel syndrome should be diagnosed or not diagnosed.

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Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

Neural Regeneration Research ◽

10.4103/1673-5374.160117 ◽

2015 ◽

Vol 10 (7) ◽

pp. 1172 ◽

Cited By ~ 6

Author(s):

Feng Peng ◽

Li Zhang ◽

Aierken Rehemutula ◽

Cong Yu ◽

Tian-bin Wang ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional ◽

Tunnel Syndrome

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Bifid Median Nerve in Carpal Tunnel Syndrome: Assessment with US Cross-sectional Area Measurement

Radiology ◽

10.1148/radiol.11101644 ◽

2011 ◽

Vol 259 (3) ◽

pp. 808-815 ◽

Cited By ~ 40

Author(s):

Andrea S. Klauser ◽

Ethan J. Halpern ◽

Ralph Faschingbauer ◽

Florian Guerra ◽

Carlo Martinoli ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Area Measurement ◽

Sectional Area ◽

Cross Sectional ◽

Tunnel Syndrome

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Ultrasonography Findings in Severe Carpal Tunnel Syndrome

Hand ◽

10.1177/1558944718788642 ◽

2018 ◽

Vol 15 (1) ◽

pp. 64-68

Author(s):

Gideon Nkrumah ◽

Alan R. Blackburn ◽

Robert J. Goitz ◽

John R. Fowler

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Nerve Conduction Studies ◽

Cross Sectional ◽

Younger Patients ◽

Tunnel Syndrome ◽

Sensory Latency ◽

Pisiform Bone

Background: Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of recovery after carpal tunnel release (CTR). The purpose of this study is to compare the cross-sectional area (CSA) of the median nerve in patients with severe and nonsevere CTS as defined by NCS. Methods: Ultrasound CSA measurements were taken at the carpal tunnel inlet at the level of the pisiform bone by a hand fellowship–trained orthopedic surgeon. Severe CTS on NCS was defined as no response for the distal motor latency (DML) and/or distal sensory latency (DSL). Results: A total of 274 wrists were enrolled in the study. The median age was 51 years (range: 18-90 years), and 72.6% of wrists were from female patients. CSA of median nerve and age were comparatively the best predictors of severity using a linear regression model and receiver operator curves. Using cutoff of 12 mm2 for severe CTS, the sensitivity and specificity are 37.5% and 81.9%, respectively. Conclusions: Ultrasound can be used to grade severity in younger patients (<65 years) with a CTS-6 score of >12.

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