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Assessment Of Frequency And Severity Of Clinical Findings Related To Carpal Tunnel Syndrome In Patients Undergoing Hemodialysis Therapy

Year 2014, Volume: 3 Issue: 3, 210 - 214, 01.09.2014
https://doi.org/10.5505/abantmedj.2014.14471

Abstract

OBJECTIVE: To assess the frequency and severity of clinical findings related to carpal tunnel syndrome CTS in patients undergoing hemodialysis HD therapy.METHODS: The study included 95 patients who undergo HD at three centers in Afyonkarahisar, Turkey. All patients were asked if they had pain and/or numbness while asleep or in the morning. The ones with complaints 43 patients answered a scored questionnaire which was previously reported to be superior to electrophysiologic studies in normal population. Carpal tunnel compression test, which has higher sensitivity and specificity values when compared with other tests, was used to scan the patients for having CTS findings. Besides, data on the duration of HD, sides of the arteriovenous fistulas and additional accompanying diseases diabetes mellitus, tendinopathy were noted. Whether both of the tests could be used in decision for surgery was investigated.RESULTS: There was no relationship between the presence and severity of CTS symptoms and duration of HD. CTS symptoms and carpal tunnel compression test had a significant relationship. There was a significant correlation between scores obtained from the questionnaire and CTS symptoms but no relationship between scores and duration of HD. Three fourths of symptomatic patients had scores of 5 or more. No association between CTS symptoms and accompanying tendon problems, age, the sides of fistulas, diabetes mellitus or body mass index were detected.CONCLUSION: Patients on HD therapy are more prone to have CTS and even in more severe condition than in normal population. We found that 33,6% of patients on HD have CTS and that is consistent with the literature. Carpal tunnel compression test can reliably be used for diagnosing CTS in patients on HD. We believe that, unlike patients with CTS in normal population, the questionnaire cannot be solely used to replace nerve conduction studies to decide surgical intervention in patients with CTS on HD therapy. Not all patients need surgery but electrodiagnostic confirmation and close follow-up are necessary in HD patients.

References

  • Kwon, H.K., et al., Carpal tunnel syndrome and peripheral polyneuropathy in patients with end stage kidney disease. J Korean Med Sci, 2011. 26(9): p. 1227-30.
  • Kang, H.J., et al., Does carpal tunnel release pro- vide long-term relief in patients with hemodialysis- associated carpal tunnel syndrome? Clin Orthop Relat Res, 2012. 470(9): p. 2561-5.
  • Sekiya, H., et al., Carpal tunnel pressure in pati- ents with carpal tunnel syndrome due to long-term hemodialysis. Int Orthop, 2002. 26(5): p. 274-7.
  • Padberg, F.T., Jr., K.D. Calligaro, and A.N. Sidawy, Complications of arteriovenous hemodialysis ac- cess: recognition and management. J Vasc Surg, 2008. 48(5 Suppl): p. 55S-80S.
  • Wilson, S.W., R.E. Pollard, and V.C. Lees, Mana- gement of carpal tunnel syndrome in renal dialysis patients using an extended carpal tunnel release procedure. J Plast Reconstr Aesthet Surg, 2008. 61(9): p. 1090-4.
  • Cocito, D., et al., A further critical evaluation of requests for electrodiagnostic examinations. Neurol Sci, 2006. 26(6): p. 419-22.
  • Podnar, S., Critical reappraisal of referrals to electromyography and nerve conduction studies. Eur J Neurol, 2005. 12(2): p. 150-5.
  • Kamath, V. and J. Stothard, A clinical questionnai- re for the diagnosis of carpal tunnel syndrome. J Hand Surg Br, 2003. 28(5): p. 455-9.
  • Uchiyama, S., et al., Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. J Orthop Sci, 2010. 15(1): p. 1-13.
  • Levine, D.W., et al., A self-administered questi- onnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am, 1993. 75(11): p. 1585-92.
  • Yamamoto, S. and F. Gejyo, Historical backgro- und and clinical treatment of dialysis-related amylo- idosis. Biochim Biophys Acta, 2005. 1753(1): p. 4-10.
  • El Miedany, Y., et al., Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts. Joint Bone Spine, 2008. 75(4): p. 451-7.
  • Hirasawa, Y. and T. Ogura, Carpal tunnel synd- rome in patients on long-term haemodialysis. Scand J Plast Reconstr Surg Hand Surg, 2000. 34(4): p. 373- 81.

Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi

Year 2014, Volume: 3 Issue: 3, 210 - 214, 01.09.2014
https://doi.org/10.5505/abantmedj.2014.14471

Abstract

AMAÇ: Hemodiyaliz HD tedavisi gören hastalarda karpal tünel sendromu KTS bulgularının sıklık ve şiddetini değerlendirmek.YÖNTEMLER: Çalışmaya Afyonkarahisar’daki üç merkezde HD tedavisi görmekte olan 95 hasta dahil edildi. Tüm hastalara gece yatarken veya sabah ellerinde ağrı veya uyuşma olup olmadığı soruldu, şikayeti olan hastalara 43 hasta daha önce normal populasyondaki hastalarda elektrofizyolojik çalışmalardan daha üstün olduğu bildirilmiş puanlı bir anket ve KTS bulgularının taranması amacıyla diğer testlerle kıyaslandığında daha yüksek duyarlılık ve özgünlüğe sahip olan karpal tünel kompresyon testi uygulandı. Ayrıca, HD süresi, arteriovenöz fistül tarafı ve eşlik eden diğer hastalıklar diabetes mellitus, tendinopati kaydedildi. Her iki testin cerrahiye karar vermede yol gösterici olup olamayacağı incelendi.BULGULAR: KTS semptomlarının varlığı ve şiddeti ile HD süresi arasında anlamlı bir ilişki tespit edilmedi. Karpal tünel kompresyon testi ile KTS klinik bulgularının ilişkili olduğu görüldü. Anketten elde edilen skorlar ile KTS semptomları arasında anlamlı ilişki bulunurken skorlar ile HD süresi arasında ilişki bulunamadı. Semptomatik hastaların 3/4’ünde 5 ve üzerinde skor değerleri elde edildi. Eşlik eden tendon problemleri, yaş, fistül tarafı, diabetes mellitus ve vücut kitle indeksi ile KTS semptomları arasında bir ilişki tespit edilmedi.SONUÇ: HD tedavisi gören hastalar, normal populasyonla kıyaslandığında KTS gelişmesine ve hatta daha şiddetli seyretmesine daha yatkındırlar. Literatürle uyumlu olarak, HD tedavisi gören hastaların %33,6’sında KTS olduğunu bulduk. Karpal tünel kompresyon testi, HD tedavisi gören hastalarda KTS tanısı koyarken güvenle kullanılabilir. Normal populasyondaki KTS’li hastalardan farklı olarak kullandığımız anketin HD tedavisi gören KTS’li hastalarda sinir iletim çalışmalarının yerini tek başına tutamayacağını düşünüyoruz. Tüm hastalar için cerrahi girişim gerekmemekte ancak HD tedavisi gören hastalarda elektrodiagnostik doğrulama ve yakın takip gerekmektedir.

References

  • Kwon, H.K., et al., Carpal tunnel syndrome and peripheral polyneuropathy in patients with end stage kidney disease. J Korean Med Sci, 2011. 26(9): p. 1227-30.
  • Kang, H.J., et al., Does carpal tunnel release pro- vide long-term relief in patients with hemodialysis- associated carpal tunnel syndrome? Clin Orthop Relat Res, 2012. 470(9): p. 2561-5.
  • Sekiya, H., et al., Carpal tunnel pressure in pati- ents with carpal tunnel syndrome due to long-term hemodialysis. Int Orthop, 2002. 26(5): p. 274-7.
  • Padberg, F.T., Jr., K.D. Calligaro, and A.N. Sidawy, Complications of arteriovenous hemodialysis ac- cess: recognition and management. J Vasc Surg, 2008. 48(5 Suppl): p. 55S-80S.
  • Wilson, S.W., R.E. Pollard, and V.C. Lees, Mana- gement of carpal tunnel syndrome in renal dialysis patients using an extended carpal tunnel release procedure. J Plast Reconstr Aesthet Surg, 2008. 61(9): p. 1090-4.
  • Cocito, D., et al., A further critical evaluation of requests for electrodiagnostic examinations. Neurol Sci, 2006. 26(6): p. 419-22.
  • Podnar, S., Critical reappraisal of referrals to electromyography and nerve conduction studies. Eur J Neurol, 2005. 12(2): p. 150-5.
  • Kamath, V. and J. Stothard, A clinical questionnai- re for the diagnosis of carpal tunnel syndrome. J Hand Surg Br, 2003. 28(5): p. 455-9.
  • Uchiyama, S., et al., Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. J Orthop Sci, 2010. 15(1): p. 1-13.
  • Levine, D.W., et al., A self-administered questi- onnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am, 1993. 75(11): p. 1585-92.
  • Yamamoto, S. and F. Gejyo, Historical backgro- und and clinical treatment of dialysis-related amylo- idosis. Biochim Biophys Acta, 2005. 1753(1): p. 4-10.
  • El Miedany, Y., et al., Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts. Joint Bone Spine, 2008. 75(4): p. 451-7.
  • Hirasawa, Y. and T. Ogura, Carpal tunnel synd- rome in patients on long-term haemodialysis. Scand J Plast Reconstr Surg Hand Surg, 2000. 34(4): p. 373- 81.
There are 13 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Mehmet Eroğlu This is me

Mehmet Serhan Er This is me

Levent Altınel This is me

Selma Eroğlu This is me

Güldane Cetinkaya This is me

Publication Date September 1, 2014
Published in Issue Year 2014 Volume: 3 Issue: 3

Cite

APA Eroğlu, M., Er, M. S., Altınel, L., Eroğlu, S., et al. (2014). Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi. Abant Medical Journal, 3(3), 210-214. https://doi.org/10.5505/abantmedj.2014.14471
AMA Eroğlu M, Er MS, Altınel L, Eroğlu S, Cetinkaya G. Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi. Abant Med J. September 2014;3(3):210-214. doi:10.5505/abantmedj.2014.14471
Chicago Eroğlu, Mehmet, Mehmet Serhan Er, Levent Altınel, Selma Eroğlu, and Güldane Cetinkaya. “Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi”. Abant Medical Journal 3, no. 3 (September 2014): 210-14. https://doi.org/10.5505/abantmedj.2014.14471.
EndNote Eroğlu M, Er MS, Altınel L, Eroğlu S, Cetinkaya G (September 1, 2014) Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi. Abant Medical Journal 3 3 210–214.
IEEE M. Eroğlu, M. S. Er, L. Altınel, S. Eroğlu, and G. Cetinkaya, “Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi”, Abant Med J, vol. 3, no. 3, pp. 210–214, 2014, doi: 10.5505/abantmedj.2014.14471.
ISNAD Eroğlu, Mehmet et al. “Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi”. Abant Medical Journal 3/3 (September 2014), 210-214. https://doi.org/10.5505/abantmedj.2014.14471.
JAMA Eroğlu M, Er MS, Altınel L, Eroğlu S, Cetinkaya G. Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi. Abant Med J. 2014;3:210–214.
MLA Eroğlu, Mehmet et al. “Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi”. Abant Medical Journal, vol. 3, no. 3, 2014, pp. 210-4, doi:10.5505/abantmedj.2014.14471.
Vancouver Eroğlu M, Er MS, Altınel L, Eroğlu S, Cetinkaya G. Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi. Abant Med J. 2014;3(3):210-4.