Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi

Öz

Amaç: Çalışmamızın amacı karpal tünel sendromunda elektrodiyagnostik bulgular ile el fonksiyonları, semptomlar ve muayene bulguları arasındaki ilişkiyi değerlendirmektir. Ayrıca KTS tanısında kullanılan tinel, phalen ve ters phalen gibi provakatif testlerin tanısal değerini de saptamayı amaçladık. Gereç ve Yöntemler: Öykü, fi zik muayene ve median sinir duysal ve motor ileti hızlarının değerlendirilmesi sonucunda KTS tanısı konan 44 hastanın 79 eli ve 50 sağlıklı gönüllü değerlendirildi. Fizik muayenede tinel, phalen ve ters phalen testleri kullanıldı. Semptomların şiddeti “semptom şiddet skalası” ve el fonksiyonları ise “Boston karpal tünel anketi” ve “Duruöz el indeksi” ile değerlendirildi. Bulgular: Karpal tünel sendromunun elektrodiyagnostik şiddeti semptomların şiddeti, ağrı ve el kavrama güçleri ile korele bulunurken, el fonksiyonları ile korelasyon saptanmamıştır. Fonksiyonel durum, el ve başparmak kavrama gücünden etkilenmiştir. Tinel, phalen ve ters phalen testlerinin sensitiviteleri sırasıyla %62, %54.4 ve %57 bulunurken, spesifi teleri %92, %86 ve %88 olarak saptanmıştır. KTS’nin şiddeti ile provakatif testlerin pozitifl iği arasında ise korelasyon saptanmamıştır. Sonuç: KTS tanısında elektrofi zyolojik değerlendirmeler çok önemlidir. Ancak bu inceleme her yerde yapılamamakta ve değerlendirme için uzun hasta randevuları oluşmaktadır. Böyle durumlarda provakatif testler, semptomlar ve fonksiyonel düzeyin değerlendirilmesi KTS tanısı koymada oldukça değerlidir

Anahtar Kelimeler

• Karpal tünel sendromu, Hastalık şiddeti, El fonksiyonları, Provakatif testler

The Effect of Electrodiagnostic Findings on Clinical and The Effect of Electrodiagnostic Findings on Clinical and Functional Status in Carpal Tunnel Syndrome Functional Status in Carpal Tunnel Syndrome

Abstract

Objective: The purpose of this study was to assess the relationship between electrodiagnostic fi ndings and hand functions, clinical severity and examination fi ndings of carpal tunnel syndrome CTS . In addition, we aimed to determine the diagnostic value of provocative tests such as tinel, phalen and reverse phalen tests in the diagnosis of CTS. Material and Methods: We evaluated 79 wrists of 44 patients who were diagnosed as CTS on the basis of clinical history, physical examination and abnormalities of median nerve sensory and motor conduction velocities and 50 healthy volunteers. Physical evaluation included the tinel, phalen and reverse phalen tests. The clinical severity of CTS was scored in terms of a historic and objective scale and hand function was evaluated through the Boston carpal tunnel questionnaire and Duruoz Hand Index.Results: It was determined that the severity of CTS and the electrophysiological assessment was correlated with the severity of symptoms, pain and hand strength whereas it was not correlated with functional status. Functional status is affected by hand and pinch grip strength. Sensitivities of the tinel, phalen and reverse phalen tests were 62%, 54.4%, and 57% respectively, whereas their specifi cities were 92%, 86%, and 88% respectively in our study group. There was no association between CTS severity and the positivity of provocative tests.Conclusion: Electrophysiological evaluation is quite important for the diagnosis of CTS disease. However, this investigative method cannot be carried out everywhere and patient appointments to evaluate their condition are arranged for later times. In such situations, provocative tests, symptoms and functional status are important for the diagnosis

Keywords

• Carpal tunnel syndrome, Disease severity, Hand function, Provocative test

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