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Ultrasonographic assessment of the shoulder in patients with carpal tunnel syndrome

Year 2016, , 102 - 109, 01.04.2016
https://doi.org/10.5472/MMJoa.2902.07

Abstract

Objectives: To detect the causes of shoulder pain with shoulder ultrasonography in patients with carpal tunnel syndrome (CTS)and compare the findings of the patients with CTS to healthy controls.Patients and Methods: Patients with CTS and healthy controls were evaluated clinically, electrophysiologically and ultrasonographically by three masked researchers.Electrophysiological assessment consisted median and ulnar nerve conduction studies (NCS). In ultrasonographic assessment, crosssectionalareas of the median nerve were measured at hamatum hook, psiform bone, radio-ulnar joint levels. Shoulder joint, axial and longitudinal biceps tendon, subscapularis tendon, supraspinatus tendon, infraspinatus tendon, rotator cuff, acromioclavicular joint were evaluated by a standardized protocol.Results: The study was completed with 30 patients with CTS and 30 healthy subjects. The presence of shoulder pain in the last week was 53.3% in the CTS group and 30% in the control group but there was no statistically significant difference between the groups (p=0.16; p>0.05). Subdeltoid bursitis was significantly more common in CTS group when compared to the control group (p=0.03) in ultrasonographic assessment, and there was no significant difference between the two groups for other parameters.Conclusion: Shoulder pain and subdeltoid bursitis were common in patients with CTS however, shoulder pain was not directly related to shoulder problems alone. Central sensitization may play a role for shoulder pain rather than shoulder problems.Keywords: Ultrasonography, Carpal tunnel syndrome, Shoulderpain, Central sensitization

References

  • Atroshi I, Gummesson C, Johnsson R, Ornstein E, Rantsam J, Rosen I. Prevelance of carpal tunnel syndrome in a general population. JAMA 1999;282:153-8. doi:10.1001/jama.282.2.153.
  • de-la-Llave-Rincón AI, Puentedura EJ, Fernández-de-las-Peñas C. New advances in the mechanisms and etiology of carpal tunnel syndrome. Discov Med 2012;13:343-8.
  • Nora DB, Becker J, Ehlers JA, Gomes I. What symptoms are truly caused by Median nerve compression in carpal tunnel syndrome? Clin Neurophysiol 2005; 116:275–83. doi:10.1016/j.clinph.2004.08.013
  • Zanette G, Marani S, Tamburin S. Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms. Pain 2006; 122:264-70.
  • Zanette G, Marani S, Tamburin S. Proximal pain in patients with carpal tunnel syndrome: a clinical neuro-physiological study. J Peripher Nerv Syst 7-91 :12 ;2007.
  • Zanette G, Cacciatori C, Tamburin S : Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms. Pain 2010; 148: 227-236 Doi: 10.1111/j.1529-8027.2007.00127.x
  • Stevens JC, Smith BE, Weaver AL, Bosch EP, Deen HG, Wilkens JA. Symptoms of 100 patients with electromyographically verified carpal tunnel syndrome. Muscle & Nerve 1999; 22(: 1448-56.
  • Titchener AG, White JJE, Hinchliffe SR, Tambe AA, Hubbard RB, Clark DI. Comorbidities in rotator cuff disease: a case-control study. J Shoulder Elbow Surg 2014 23: 1282-8. doi: 10.1016/j.jse.2013.12.019.
  • Katz JN, Stirrat CR, Larson MG, Fossel AH, Eaton HM, Liang MH. A self-administered hand symptom diagram for the diagnosis and epidemiologic study of carpal tunnel syndrome. J Rheumatol 1990;17:1495-8.
  • Oken O, Catal SA, Ceceli E. A useful and simple method in diagnosis of carpal tunnel syndrome: Hand diagram Rheumatism 2003; 18: 23-6.
  • Sezgin M, Incel NA, Serhan S, Camdevren 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;28:1281-5.
  • doi:10.1080/09638280600621469
  • Levine DW, Simmons BP, Koris MJ, et al. A selfadministered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone and Joint Surg 1993;75:1585-92.
  • Randall L. Braddom. Physical Medicine & Rehabilitation. O’Dell MW, Lin D, Panagos A. The physiatric history and examination. Fourth edition, 2011; 3-39.
  • Werner RA, Andrary M. Electrodiagnostic evaluation of carpal tunnel syndrome. AANEM Monograph. Muscle & Nerve 2011; 44:597-607. doi: 10.1002/mus.22208
  • Bianchi S, Martinoli C. Ultrasound of the musculoskeletal system. New York: Springer, 2007.
  • Van Holsbeeck M, Strouse PJ. Sonography of the shoulder: evaluation of the subacromial-subdeltoid bursa. Am JRoentgenol 1993;160: 561-4. doi:10.2214/ajr.160.3.8430553
  • Cholewinski JJ, Kusz DJ, Wojciechowski P, Cielinski LS, Zoladz MP. Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder. Knee Surg Sports Traumatol Arthrosc 2008;16:408-14.
  • doi:10.1007/s00167-007-0443-4
  • Singh JP. Shoulder ultrasound: What you need to know. Indian J Radiol Imaging 2012;22:284-92. doi:10.4103/0971-3026.111481
  • Nirschl RP. Mesenchymal syndrome. Va Med Mon;1969;96: 659-62.
  • Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron 2006;52:77–92. doi:10.1016/j.neuron.2006.09.021
  • Fernández-de-las-Peñas C, De-la-Llave-Rincón AI, Fernández-Carnero J, Cuadrado M, Arendt-Nielsen L, Pareja J. Bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome: Evidence of central processing in unilateral neuropathy. Brain 2009;132:1472-9. doi:10.1093/brain/awp050
  • Tecchio F, Padua L, Aprile I, Rossini PM. Carpal tunnel syndrome modifies sensory hand cortical somatotopy: a MEG study. Hum Brain Mapp 2002; 17:28-36. doi: 10.1002/hbm.10049

Ultrasonographic assessment of the shoulder in patients with carpal tunnel syndrome

Year 2016, , 102 - 109, 01.04.2016
https://doi.org/10.5472/MMJoa.2902.07

Abstract

Objectives: To detect the causes of shoulder pain with shoulder ultrasonography in patients with carpal tunnel syndrome (CTS)and compare the findings of the patients with CTS to healthy controls.Patients and Methods: Patients with CTS and healthy controls were evaluated clinically, electrophysiologically and ultrasonographically by three masked researchers.Electrophysiological assessment consisted median and ulnar nerve conduction studies (NCS). In ultrasonographic assessment, crosssectionalareas of the median nerve were measured at hamatum hook, psiform bone, radio-ulnar joint levels. Shoulder joint, axial and longitudinal biceps tendon, subscapularis tendon, supraspinatus tendon, infraspinatus tendon, rotator cuff, acromioclavicular joint were evaluated by a standardized protocol.Results: The study was completed with 30 patients with CTS and 30 healthy subjects. The presence of shoulder pain in the last week was 53.3% in the CTS group and 30% in the control group but there was no statistically significant difference between the groups (p=0.16; p>0.05). Subdeltoid bursitis was significantly more common in CTS group when compared to the control group (p=0.03) in ultrasonographic assessment, and there was no significant difference between the two groups for other parameters.Conclusion: Shoulder pain and subdeltoid bursitis were common in patients with CTS however, shoulder pain was not directly related to shoulder problems alone. Central sensitization may play a role for shoulder pain rather than shoulder problems.Keywords: Ultrasonography, Carpal tunnel syndrome, Shoulderpain, Central sensitization

References

  • Atroshi I, Gummesson C, Johnsson R, Ornstein E, Rantsam J, Rosen I. Prevelance of carpal tunnel syndrome in a general population. JAMA 1999;282:153-8. doi:10.1001/jama.282.2.153.
  • de-la-Llave-Rincón AI, Puentedura EJ, Fernández-de-las-Peñas C. New advances in the mechanisms and etiology of carpal tunnel syndrome. Discov Med 2012;13:343-8.
  • Nora DB, Becker J, Ehlers JA, Gomes I. What symptoms are truly caused by Median nerve compression in carpal tunnel syndrome? Clin Neurophysiol 2005; 116:275–83. doi:10.1016/j.clinph.2004.08.013
  • Zanette G, Marani S, Tamburin S. Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms. Pain 2006; 122:264-70.
  • Zanette G, Marani S, Tamburin S. Proximal pain in patients with carpal tunnel syndrome: a clinical neuro-physiological study. J Peripher Nerv Syst 7-91 :12 ;2007.
  • Zanette G, Cacciatori C, Tamburin S : Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms. Pain 2010; 148: 227-236 Doi: 10.1111/j.1529-8027.2007.00127.x
  • Stevens JC, Smith BE, Weaver AL, Bosch EP, Deen HG, Wilkens JA. Symptoms of 100 patients with electromyographically verified carpal tunnel syndrome. Muscle & Nerve 1999; 22(: 1448-56.
  • Titchener AG, White JJE, Hinchliffe SR, Tambe AA, Hubbard RB, Clark DI. Comorbidities in rotator cuff disease: a case-control study. J Shoulder Elbow Surg 2014 23: 1282-8. doi: 10.1016/j.jse.2013.12.019.
  • Katz JN, Stirrat CR, Larson MG, Fossel AH, Eaton HM, Liang MH. A self-administered hand symptom diagram for the diagnosis and epidemiologic study of carpal tunnel syndrome. J Rheumatol 1990;17:1495-8.
  • Oken O, Catal SA, Ceceli E. A useful and simple method in diagnosis of carpal tunnel syndrome: Hand diagram Rheumatism 2003; 18: 23-6.
  • Sezgin M, Incel NA, Serhan S, Camdevren 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;28:1281-5.
  • doi:10.1080/09638280600621469
  • Levine DW, Simmons BP, Koris MJ, et al. A selfadministered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone and Joint Surg 1993;75:1585-92.
  • Randall L. Braddom. Physical Medicine & Rehabilitation. O’Dell MW, Lin D, Panagos A. The physiatric history and examination. Fourth edition, 2011; 3-39.
  • Werner RA, Andrary M. Electrodiagnostic evaluation of carpal tunnel syndrome. AANEM Monograph. Muscle & Nerve 2011; 44:597-607. doi: 10.1002/mus.22208
  • Bianchi S, Martinoli C. Ultrasound of the musculoskeletal system. New York: Springer, 2007.
  • Van Holsbeeck M, Strouse PJ. Sonography of the shoulder: evaluation of the subacromial-subdeltoid bursa. Am JRoentgenol 1993;160: 561-4. doi:10.2214/ajr.160.3.8430553
  • Cholewinski JJ, Kusz DJ, Wojciechowski P, Cielinski LS, Zoladz MP. Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder. Knee Surg Sports Traumatol Arthrosc 2008;16:408-14.
  • doi:10.1007/s00167-007-0443-4
  • Singh JP. Shoulder ultrasound: What you need to know. Indian J Radiol Imaging 2012;22:284-92. doi:10.4103/0971-3026.111481
  • Nirschl RP. Mesenchymal syndrome. Va Med Mon;1969;96: 659-62.
  • Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron 2006;52:77–92. doi:10.1016/j.neuron.2006.09.021
  • Fernández-de-las-Peñas C, De-la-Llave-Rincón AI, Fernández-Carnero J, Cuadrado M, Arendt-Nielsen L, Pareja J. Bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome: Evidence of central processing in unilateral neuropathy. Brain 2009;132:1472-9. doi:10.1093/brain/awp050
  • Tecchio F, Padua L, Aprile I, Rossini PM. Carpal tunnel syndrome modifies sensory hand cortical somatotopy: a MEG study. Hum Brain Mapp 2002; 17:28-36. doi: 10.1002/hbm.10049
There are 24 citations in total.

Details

Subjects Clinical Sciences
Other ID JA43DZ43MR
Journal Section Review Makaleler
Authors

Başak Mansız Kaplan This is me

İlker Yağcı This is me

Merve Akdeniz Leblebiciler This is me

Publication Date April 1, 2016
Published in Issue Year 2016

Cite

APA Kaplan, B. M., Yağcı, İ., & Leblebiciler, M. A. (2016). Ultrasonographic assessment of the shoulder in patients with carpal tunnel syndrome. Marmara Medical Journal, 29(2), 102-109. https://doi.org/10.5472/MMJoa.2902.07
AMA Kaplan BM, Yağcı İ, Leblebiciler MA. Ultrasonographic assessment of the shoulder in patients with carpal tunnel syndrome. Marmara Med J. April 2016;29(2):102-109. doi:10.5472/MMJoa.2902.07
Chicago Kaplan, Başak Mansız, İlker Yağcı, and Merve Akdeniz Leblebiciler. “Ultrasonographic Assessment of the Shoulder in Patients With Carpal Tunnel Syndrome”. Marmara Medical Journal 29, no. 2 (April 2016): 102-9. https://doi.org/10.5472/MMJoa.2902.07.
EndNote Kaplan BM, Yağcı İ, Leblebiciler MA (April 1, 2016) Ultrasonographic assessment of the shoulder in patients with carpal tunnel syndrome. Marmara Medical Journal 29 2 102–109.
IEEE B. M. Kaplan, İ. Yağcı, and M. A. Leblebiciler, “Ultrasonographic assessment of the shoulder in patients with carpal tunnel syndrome”, Marmara Med J, vol. 29, no. 2, pp. 102–109, 2016, doi: 10.5472/MMJoa.2902.07.
ISNAD Kaplan, Başak Mansız et al. “Ultrasonographic Assessment of the Shoulder in Patients With Carpal Tunnel Syndrome”. Marmara Medical Journal 29/2 (April 2016), 102-109. https://doi.org/10.5472/MMJoa.2902.07.
JAMA Kaplan BM, Yağcı İ, Leblebiciler MA. Ultrasonographic assessment of the shoulder in patients with carpal tunnel syndrome. Marmara Med J. 2016;29:102–109.
MLA Kaplan, Başak Mansız et al. “Ultrasonographic Assessment of the Shoulder in Patients With Carpal Tunnel Syndrome”. Marmara Medical Journal, vol. 29, no. 2, 2016, pp. 102-9, doi:10.5472/MMJoa.2902.07.
Vancouver Kaplan BM, Yağcı İ, Leblebiciler MA. Ultrasonographic assessment of the shoulder in patients with carpal tunnel syndrome. Marmara Med J. 2016;29(2):102-9.