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KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR

Year 2006, Volume: 69 Issue: 3, 70 - 74, 15.11.2011

Abstract

Amaç: Çalışmamızda, karpal tünel sendromu (KTS) klinik ön tanısı ile elektrofizyolojik inceleme istenen tip 2 diabetik hastalarda polinöropati (PNP) ve KTS görülme sıklığının araştırılması amaçlanmıştır. Gereç ve yöntem: KTS ön tanısıyla kliniğimiz Elektrofizyoloji Laboratuarına gönderilen, tip 2 diabet tanısıyla izlenen, ellerinde gece uyandıran uyuşma, yanma, ağrı, beceriksizlik yakınmalarından en az üçü olan hastalar çalışmaya alındı. Nörolojik muayenelerinde median sinir tutulumuna ait subjektif yakınma ve/veya objektif muayene bulgusu dışında bulgusu olanlar dışlandı. Hastalara konvansiyonel yöntemlerle duyusal ve motor ileti çalışmaları ile iğne elektromiyografisi uygulandı. Elektrofizyolojik inceleme sonuçlarına göre KTS ve PNP olguları belirlendi. Median sinir tutulumu hafif veya ağır olarak derecelendirildi. Karşılaştırmalarda “Fisher exact” ile, “student’s ttest” kullanıldı. Bulgular: Çalışmaya katılan 56 olgunun 2’sinde elektrofizyolojik inceleme, 3’ünde median sinir ileti ölçümleri normaldi. Elektrofizyolojik incelemelerde 51 hastanın 33’ünde KTS, 18’inde PNP saptandı. KTS saptanan 33 olgunun 21’inde bilateral, 12’sinde unilateral median sinir tutulumu mevcuttu. Bilateral tutulum, median sinirin tutulum derecesi ve ileti ölçümlerinde saptanan median sinir duysal yanıt latansı, duyusal anksiyon potansiyeli amplitüdü ile motor distal latansı, motor ileti hızı ve bileşik kas aksiyon potansiyeli amplitüdü KTS ve PNP olguları arasında anlamlı farklılık göstermedi. Sonuç: Diabetik PNP sıklıkla klinik olarak ön planda KTS ile prezante olmakta, tuzaklanma bölgesinin mekanik etkileri ile diabetin metabolik etkileri birlikte tutulumun tuzaklanma bölgelerinden başlamasına neden olmaktadır. Median sinir ileti ölçümleri KTS ve PNP’de farklılık göstermemektedir. Diabetik hastanın yakınmaları KTS düşündürse bile, elektrofizyolojik inceleme KTS ile birlikte PNP de araştırılmak üzere istenmelidir.

References

  • Albers JW, Brown MB, Sima AAF, Greene DA. Frequency of median mononeuropathy in patients with mild diabetik neuro- pathy in the early diabetes intervention trial (EDIT). Muscle Nerve 1996; 19:140-146.
  • Boulton AJM, Arezzo JC, Malik RA, Sosenko JM. Diabetic so- matic neuropathies. Diabetes Care 2004; 27:1458-1486.
  • Boulton AJM, Gries FA, Jervell JA. Guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy. Diabet Med 1998; 15:508-514.
  • Campbell WW. Diagnosis and management of common compression and entrapment neuropathies. Neurol Clin 1997; 15:549-567.
  • Casey EB, Le Quesne PM. Digital nerve action potentials in he- althy subjects, and in carpal tunnel and diabetic patients. J Ne- urol Neurosurg Psychiatry 1972; 35:612-623.
  • Dellon AL. Treatment of symptomatic diabetic neuropathy by surgical decompression of multipl peripheral nerves. Plastic and reconstructive surgery 1992; 89:689-697.
  • Dyck PJ. Severity and staging of diabetic polyneuropathy. In “Textbook of Diabetic Neuropathy”. Gries FA, Cameron NE, Low PA, Ziegler D. (Eds.) Thieme, Stutgart, Germany, 2003, pp. 170-175.
  • Eisen A, Schulzer M, Pant B, MacNeil M, Stewart H, Trueman S, Mak E. Receiver operating characteristic curve analysis in the prediction of carpal tunnel syndrome: a model for reporting electrophysiological data. Muscle Nerve 1993; 16:787-796.
  • Fraser DM, Campbell D, Ewing DJ, Clarke BF. Mononeuro- pathy in diabetes mellitus. Diabetes 1979; 28:96-101.
  • Hamilton ML, Santos-Anzorandia C, Viera C, Coutin G, Cordi- es L. Motor and sensory nerve conduction in patients with car- pal tunnel syndrome and diabetic polyneuropathy. Rev Neurol 1999; 28:1147-1452.
  • Hansson S. Segmental median nerve conduction measurements discriminate carpal tunnel syndrome from diabetic polyneuro- pathy. Muscle Nerve 1995; 18:445-453.
  • Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. Li- terature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tun- nel syndrome. AAEM Quality Assurance Committee. Muscle Nerve 1993; 16:1392-1414.
  • Johnson EW. Sixteenth annual AAEM Edward H. Lambert Lec- ture. Electrodiagnostic aspects of diabetic neuropathies: Entrap- ments. Muscle Nerve 1993; 16:127-134.
  • Kapritskaya Y, Novak C, Mackinnon S. Prevalence of smoking, obesity, diabetes mellitus and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg 2002; 48:269–279.
  • Lindström P, Lindblom U, Brismar T. Delayed recovery of ner- ve conduction and vibratory sensibility after ischaemic block in patients with diabetes mellitus. J Neurol Neurosurg Psychiatry 1997; 63:346-350.
  • Mondelli M, Padula L, Reale F. Outcome of surgical release among diabetics with CTS Arch Phys Med Rehabil 2004; 85:7- 13.
  • Özkul Y, Sabuncu T, Kocabey Y. Outcomes of carpal tunnel re- lease in diabetic and non- diabetic patients. Acta Neurol Scand 2002; 106:168-172.
  • Perkins B, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care 2002; 25:565–569.
  • Pourmand R. Diabetic neuropathy. Neurol Clin 1997; 15:569- 576.
  • Steward JD. Pathological processes producing focal peripheral neuropathies in: Focal peripheral neuropathies. Steward JD (ed.), Elsevier, New York, USA, 1987; pp. 8-29.
  • Stevens JC. The electrodiagnosis of carpal tunnel syndrome, Muscle Nerve 1997; 20:1477-1487.
  • Thomas PK. Diabetic neuropathy: mechanisms and future treat- ment options. J Neurol Neurosurg Psychiatry 1999; 67:277-281.
  • Vinik AI. Diabetic Neuropathy: Pathogenesis and therapy. J Med 1999; 107:17-26.
Year 2006, Volume: 69 Issue: 3, 70 - 74, 15.11.2011

Abstract

References

  • Albers JW, Brown MB, Sima AAF, Greene DA. Frequency of median mononeuropathy in patients with mild diabetik neuro- pathy in the early diabetes intervention trial (EDIT). Muscle Nerve 1996; 19:140-146.
  • Boulton AJM, Arezzo JC, Malik RA, Sosenko JM. Diabetic so- matic neuropathies. Diabetes Care 2004; 27:1458-1486.
  • Boulton AJM, Gries FA, Jervell JA. Guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy. Diabet Med 1998; 15:508-514.
  • Campbell WW. Diagnosis and management of common compression and entrapment neuropathies. Neurol Clin 1997; 15:549-567.
  • Casey EB, Le Quesne PM. Digital nerve action potentials in he- althy subjects, and in carpal tunnel and diabetic patients. J Ne- urol Neurosurg Psychiatry 1972; 35:612-623.
  • Dellon AL. Treatment of symptomatic diabetic neuropathy by surgical decompression of multipl peripheral nerves. Plastic and reconstructive surgery 1992; 89:689-697.
  • Dyck PJ. Severity and staging of diabetic polyneuropathy. In “Textbook of Diabetic Neuropathy”. Gries FA, Cameron NE, Low PA, Ziegler D. (Eds.) Thieme, Stutgart, Germany, 2003, pp. 170-175.
  • Eisen A, Schulzer M, Pant B, MacNeil M, Stewart H, Trueman S, Mak E. Receiver operating characteristic curve analysis in the prediction of carpal tunnel syndrome: a model for reporting electrophysiological data. Muscle Nerve 1993; 16:787-796.
  • Fraser DM, Campbell D, Ewing DJ, Clarke BF. Mononeuro- pathy in diabetes mellitus. Diabetes 1979; 28:96-101.
  • Hamilton ML, Santos-Anzorandia C, Viera C, Coutin G, Cordi- es L. Motor and sensory nerve conduction in patients with car- pal tunnel syndrome and diabetic polyneuropathy. Rev Neurol 1999; 28:1147-1452.
  • Hansson S. Segmental median nerve conduction measurements discriminate carpal tunnel syndrome from diabetic polyneuro- pathy. Muscle Nerve 1995; 18:445-453.
  • Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. Li- terature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tun- nel syndrome. AAEM Quality Assurance Committee. Muscle Nerve 1993; 16:1392-1414.
  • Johnson EW. Sixteenth annual AAEM Edward H. Lambert Lec- ture. Electrodiagnostic aspects of diabetic neuropathies: Entrap- ments. Muscle Nerve 1993; 16:127-134.
  • Kapritskaya Y, Novak C, Mackinnon S. Prevalence of smoking, obesity, diabetes mellitus and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg 2002; 48:269–279.
  • Lindström P, Lindblom U, Brismar T. Delayed recovery of ner- ve conduction and vibratory sensibility after ischaemic block in patients with diabetes mellitus. J Neurol Neurosurg Psychiatry 1997; 63:346-350.
  • Mondelli M, Padula L, Reale F. Outcome of surgical release among diabetics with CTS Arch Phys Med Rehabil 2004; 85:7- 13.
  • Özkul Y, Sabuncu T, Kocabey Y. Outcomes of carpal tunnel re- lease in diabetic and non- diabetic patients. Acta Neurol Scand 2002; 106:168-172.
  • Perkins B, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care 2002; 25:565–569.
  • Pourmand R. Diabetic neuropathy. Neurol Clin 1997; 15:569- 576.
  • Steward JD. Pathological processes producing focal peripheral neuropathies in: Focal peripheral neuropathies. Steward JD (ed.), Elsevier, New York, USA, 1987; pp. 8-29.
  • Stevens JC. The electrodiagnosis of carpal tunnel syndrome, Muscle Nerve 1997; 20:1477-1487.
  • Thomas PK. Diabetic neuropathy: mechanisms and future treat- ment options. J Neurol Neurosurg Psychiatry 1999; 67:277-281.
  • Vinik AI. Diabetic Neuropathy: Pathogenesis and therapy. J Med 1999; 107:17-26.
There are 23 citations in total.

Details

Primary Language Turkish
Journal Section Clinical Research
Authors

Kemal Barkut This is me

Nevin Kuloğlu Pazarcı This is me

Şule Taşpınar This is me

Münevver Çelik This is me

At All. This is me

Publication Date November 15, 2011
Submission Date November 15, 2011
Published in Issue Year 2006 Volume: 69 Issue: 3

Cite

APA Barkut, K., Kuloğlu Pazarcı, N., Taşpınar, Ş., Çelik, M., et al. (2011). KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR. Journal of Istanbul Faculty of Medicine, 69(3), 70-74.
AMA Barkut K, Kuloğlu Pazarcı N, Taşpınar Ş, Çelik M, All. A. KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR. İst Tıp Fak Derg. November 2011;69(3):70-74.
Chicago Barkut, Kemal, Nevin Kuloğlu Pazarcı, Şule Taşpınar, Münevver Çelik, and At All. “KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR”. Journal of Istanbul Faculty of Medicine 69, no. 3 (November 2011): 70-74.
EndNote Barkut K, Kuloğlu Pazarcı N, Taşpınar Ş, Çelik M, All. A (November 1, 2011) KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR. Journal of Istanbul Faculty of Medicine 69 3 70–74.
IEEE K. Barkut, N. Kuloğlu Pazarcı, Ş. Taşpınar, M. Çelik, and A. All., “KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR”, İst Tıp Fak Derg, vol. 69, no. 3, pp. 70–74, 2011.
ISNAD Barkut, Kemal et al. “KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR”. Journal of Istanbul Faculty of Medicine 69/3 (November 2011), 70-74.
JAMA Barkut K, Kuloğlu Pazarcı N, Taşpınar Ş, Çelik M, All. A. KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR. İst Tıp Fak Derg. 2011;69:70–74.
MLA Barkut, Kemal et al. “KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR”. Journal of Istanbul Faculty of Medicine, vol. 69, no. 3, 2011, pp. 70-74.
Vancouver Barkut K, Kuloğlu Pazarcı N, Taşpınar Ş, Çelik M, All. A. KARPALTÜNEL SENDROMU KLİNİK TANILI DİABETİK HASTALARDA ELEKTROFİZYOLOJİK BULGULAR. İst Tıp Fak Derg. 2011;69(3):70-4.

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