İdiyopatik Karpal Tünel Sendromlu Hastalarda Tedavi Öncesi ve Sonrası MRG Bulguları

Year 2019, Volume: 21 Issue: 3, 302 - 312, 31.12.2019

Şahika Burcu Karaca , Rula Şahin Leman Günbey Karabekmez , Tevfik Yetiş Nihal Duran

https://doi.org/10.24938/kutfd.545513

Abstract

Amaç: İdiyopatik
Karpal Tünel Sendromu (KTS) tanılı hastalarda splint, enjeksiyon, parafin ve
cerrahi tedavinin etkinliğini Manyetik Rezonans Görüntüleme (MRG) ile değerlendirirken,
farklı gözlemciler tarafından yapılan MRG ölçümleri arasındaki tutarlılığı
araştırdık.

Gereç ve Yöntemler: İdiyopatik KTS
tanılı 50 hastanın 50 eli Boston anketi ile değerlendirildi ve 2 farklı
gözlemci tarafından MRG’de median sinir kesitsel alanı ölçüldü.

Bulgular: Tedavi öncesi ve
tedaviden 3 ay sonra radiokarpal eklem düzeyi, hamat kemik düzeyine göre
istatistiksel anlamlı olarak daha yüksekti (Sırasıyla p<0.001; <0.001).
1. gözlemci tarafından yapılan gerek radiokarpal eklem düzey gerek hamat kemik
düzeyinde yapılan median sinir kesitsel alan ölçümünde tedavi öncesine göre
tedavi sonrasında istatistiksel olarak anlamlı azalma gözlendi (Sırasıyla p<0.001;
0.002). Gözlemcilerin tedavi öncesi ve sonrası yapmış olduğu radiokarpal eklem
düzey, hamat kemik düzey ölçümlerinin önemli derecede uyumlu olduğu görüldü.

Sonuç: KTS’de idyopatik KTS tanısı koyarken MRG
kıymetli bir tetkiktir. Tedavinin etkinliğini değerlendirirken özellikle kanal
proksimalinden yapılan median sinir kesitsel alan ölçümleri değerlidir. Farklı
gözlemciler arasındaki uyumluluk ölçümlerin objektif olduğunu düşündürmektedir.

Keywords

Karpal Tünel Sendromu, Magnetik Rezonans Görüntüleme, Sinir Kesitsel Alanı, El bileği

THE MRI FINDINGS IN PATIENTS WITH IDIOPATHIC CARPAL TUNNEL SYNDROME BEFORE AND AFTER TREATMENT

Abstract

Objective: In this study, while evaluating the effectiveness of splint, injection, paraffin and
surgical treatment with Magnetic Resonance Imaging (MRI) in patients with
idiopathic carpal tunnel syndrome (CTS), we investigated the consistency
between MRI measurements performed by different observers.

Material and Methods: Boston questionnaires were evaluated,
and the cross-sectional areas (CSA) of the median nerve were measured by two
different observers, in 50 hands of 50 patients with idiopathic CTS.

Results: The CSA of the median nerve at the
radiocarpal joint level of the canal were significantly larger than the values
at the hamate level of the canal when values before treatment and three months
after treatment were compared (p<0.001; <0.001 respectively). Measurements
of the CSA of the median nerve, taken by the first observer, were found to be
significantly lower in the post-treatment period at both the radiocarpal joint
and hamate level, compared with the pre-treatment period (p<0.001; 0.002
respectively). Measurements of CSA of the median nerve at the radiocarpal joint
and hamate level performed by the observers in the pre- and post-treatment
periods, were found to be highly compatible with one another.

Conclusion:
MRI is a valuable investigative technique for use
with CTS patients, for the diagnosis of idiopathic CTS. When evaluating the
efficacy of treatment, measurements of CSA of the median nerve are important,
particularly at the proximal regions of the canal. The compatibility between
the MRI measurements of the different observers, led us to consider that the
measurements were objective.

Keywords

Carpal Tunnel Syndrome, Magnetic Resonance Imaging, Cross-sectional Area, Wrist

References

• 1. Huisstede BM, Fridén J, Coert JH, Hoogvliet P. Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline-results from the European HANDGUIDE Study. Arch Phys Med Rehabil. 2014;95(12):2253-63.
• 2. Werner R, Andary M. Carpal tunnel syndrome: Pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002;113(9):1373-81.
• 3. Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G, Franzblau A et al. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Heal. 1998;88(10):1447-51.
• 4. Aroori S, Spence RAJ. Carpal tunnel syndrome. Ulster Med J. 2008;77(1):6-17.
• 5. Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J. 2012;6(1):69-76.
• 6. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome. Jama. 1999;282(2):153-8.
• 7. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology. 2002;58(2):289-94.
• 8. Rask MR. Anterior interosseous nerve entrapment: (Kiloh-Nevin syndrome) report of seven cases. Clin Orthop Relat Res. 1979;(142):176-81.
• 9. Ghasemi-Rad M, Nosair E, Vegh A, Mohammadi A, Akkad A, Lesha E et al. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World J Radiol. 2014;6(6):284-300.
• 10. Ashworth NL. Carpal tunnel syndrome. BMJ Clin Evid. 2010;2010. pii:1114.
• 11. Tascioglu F, Degirmenci NA, Ozkan S, Mehmetoglu O. Low-level laser in the treatment of carpal tunnel syndrome: Clinical, electrophysiological, and ultrasonographical evaluation. Rheumatol Int. 2012;32(2):409-15.
• 12. Soyupek F, Yesildag A, Kutluhan S, Askin A, Ozden A, Uslusoy GA et al. Determining the effectiveness of various treatment modalities in carpal tunnel syndrome by ultrasonography and comparing ultrasonographic findings with other outcomes. Rheumatol Int. 2012;32(10):3229-34. 13. Chang YW, Hsieh SF, Horng YS, Chen HL, Lee KC, Horng YS. Comparative effectiveness of ultrasound and paraffin therapy in patients with carpal tunnel syndrome: a randomized trial. BMC Musculoskelet Disord. 2014;15(1):399.
• 14. Jablecki C. Practice parameter for carpal tunnel syndrome. Neurology. 1993;43(11):2406-9.
• 15. Aulisa L, Tamburrelli F, Padua R, Romanini E, Lo Monaco M, Padua L. Carpal tunnel syndrome: indication for surgical treatment based on electrophysiologic study. J Hand Surg Am. 1998;23(4):687-91.
• 16. Dilek B, Gözüm M, Şahin E, Baydar M, Ergör G, El O et al. Efficacy of paraffin bath therapy in hand osteoarthritis: a single-blinded randomized controlled trial. Arch Phys Med Rehabil. 2013;94(4):642-9.
• 17. Jenkins PJ, Duckworth AD, Watts AC, McEachan JE. Corticosteroid injection for carpal tunnel syndrome: a 5-year survivorship analysis. Hand. 2012;7(2):151-6.
• 18. Smith J, Wisniewski SJ, Finnoff JT, Payne JM. Sonographically guided carpal tunnel injections: the ulnar approach. J Ultrasound Med. 2008;27(10):1485-90.
• 19. Mintalucci DJ, Leinberry CF. Open versus endoscopic carpal tunnel release. Orthop Clin North Am. 2012;43(4):431-7.
• 20. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75(11):1585-92.
• 21. Sezgin M, Incel NA, Serhan S, Camdeviren H, As I, Erdoğan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disabil Rehabil. 2006;28(20):1281-5.
• 22. Buchberger W. Radiologic imaging of the carpal tunnel. Eur J Radiol. 1997;25(12):112-7.
• 23. Mesgarzadeh M, Schneck CD, Bonakdarpour A, Mitra A, Conaway D. Carpal tunnel: MR imaging. Part II. Carpal tunnel syndrome. Radiology. 1989;171(3):749-54.
• 24. Pasternack II, Malmivaara A, Tervahartiala P, Forsberg H, Vehmas T. Magnetic resonance imaging findings in respect to carpal tunnel syndrome. Scand J Work Environ Health. 2003;29(3):189-96.
• 25. Jarvik JG, Yuen E, Haynor DR, Bradley CM, Fulton-Kehoe D, Smith-Weller T et al. MR nerve imaging in a prospective cohort of patients with suspected carpal tunnel syndrome. Neurology. 2002;58(11):1597-602.
• 26. Aoki T, Oshige T, Matsuyama A, Oki H, Kinoshita S, Yamashita Y et al. High-resolution MRI predicts steroid injection response in carpal tunnel syndrome patients. Eur Radiol. 2014;24(3):559-65.
• 27. Momose T, Uchiyama S, Kobayashi S, Nakagawa H, Kato H. Structural changes of the carpal tunnel, median nerve and flexor tendons in MRI before and after endoscopic carpal tunnel release. Hand Surg. 2014;19(2):193-8.
• 28. Schmid AB, Elliott JM, Strudwick MW, Little M, Coppieters MW. Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome-an MRI study to reveal therapeutic mechanisms. J Orthop Res. 2012;30(8):1343-50.
• 29. Wu H-TH, Schweitzer ME, Culp RW. Potential MR signs of recurrent carpal tunnel syndrome: initial experience. J Comput Assist Tomogr. 2004;28(6):860-4.