KARPAL TÜNEL SENDROMUNDA KLİNİK VE ELEKTROFİZYOLOJİK EVRELEMELERİN KARŞILAŞTIRILMASI

Year 2006, Volume: 7 Issue: 2, 23 - 26, 01.08.2006

Tuğba Tunç Gülnihal Kutlu Özlem Coşkun Emine Esra Okuyucu Leyla Çavdar Levent Ertuğrul İnan

Abstract

Amaçlar:Karpal tünel sendromu teşhis edilen hastalarda klinik ve elektrofizyolojik evrelemeler arasındakiilişkinin araştırılmasıdır.Gereç ve yöntemler:Karpal tünel sendromu saptanan 127 el (90 hasta) incelendi. Hastalar klinik olarak veelektrofizyolojik olarak evrelendi. Her iki evreleme arasındaki ilişki incelendi. Karpal tünel sendromu tanısı,medyan sinir trasesindeki, parestezi, ağrı, medyan sinir innervasyonlu alanlarda duyu kaybı, medyan sinirinnervasyonlu kaslarda motor güçsüzlük ve atrofi olması, Phalen testi ve Tinel testi pozitifliği ile konuldu.Bulgular:Hastaların klinik evrelemesi ile elektrofizyolojik evrelemesi arasında anlamlı bir ilişki saptandı(p=0.000). Hastaların klinik evreleri arttıkça elektrofizyolojik olarak da ağır derecelerde karpal tünel sendromuile uyumlu bulgular elde edilmekteydi.Sonuç:Pratikte klinik ve elektrofizyolojik olarak uyumsuz vakalara rastlansa da hastaların medyan sinirkompresyonunun derecesi klinik muayeneler ile tahmin edilebilir düşüncesindeyiz

Keywords

Karpal tünel sendromu, medyan nöropati, klinik evreleme, elektrofizyolojik evreleme

Comparision of Clinical and Electrophysiological Staging in Carpal Tunnel Syndrome

Abstract

Objectives: The aim of the study was to investigate the relationship between the clinical and electrophysiological stages in patients diagnosed with carpal tunnel syndrome. Material and methods: One hundered twentyeight hands (90 patients) with carpal tunnel syndrome were investigated. Patients were staged clinically and electrophysiologically. The relationship between these stages was investigated. Diagnosis of carpal tunnel syndrome was made according to the presence of paresthesia, pain in the innervation area of the median nerve, weakness and atrophy in the median nerve innervated muscles, positive Phalen and Tinnel tests. Results: A significant correlation was found between clinical and electrophysiological staging of patients. The electrophysiological findings were more severe as the clinical stage progressed. Conclusions: We suggest that although there may sometimes be a discordance between clinical and electrophysiological stages in clinical practice, the severity of the compression of the median nerve can usually be estimated by clinical examination.

Keywords

Carpal tunnel syndrome, median neuropathy, clinical scale, electrophysiologic scale

References

• 1- Sung-Bom P, Woohyun S, Seung-Don Y. Slowed conduction velocity of the median sensory nerve across the carpal tunnel in normal adults. Am J Phys Med Rehabil 2005; 84:598-603.
• 2- Bland JDP. Carpal tunnel syndrome. Curr Opin in Int Med 2005; 4:578-582.
• 3- Freimer M, Brushart TM, Cornblath JT. Entrapment neuropathies. In: Mendell RJ, Kissel TJ, Cornblath DR (eds): Diagnosis and Management of Peripheral Nerve Disorders, Oxford University Press, 2001, pp: 597- 601.
• 4- Oh SJ. Nerve conduction in focal neuropathies. In: Retford DC (ed). Clinical Electromyography: Nerve Conduction Studies, 2 ed. Baltimore: Williams and Wilkins, 1993, pp: 496-574.
• 5- Loong SC. The Carpal Tunnel Syndrome: A clinical and electrophysiological study of 250 patients. Proc AustAssoc Neurol 1977;14:51-65.
• 6- Katz JN, Larson MG, Sabra A. The Carpal Tunnel Syndrome: Diagnostic Utility of the History and Physical Findings.Ann Intern Med 1990;112:321-327.
• 7- Witt JC, Hentz JG, Stevens JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve 2004; 29:515-522.
• 8- Padua L, Padua R, Lo Monaco M,Aprile I, Tonali P, For the Italian CTS Study Group. Multiperspective assessment of carpal tunnel syndrome. A multicenter study. Neurology 1999; 53:1654-1659.
• 9- Padua L, Monaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal túnel síndrome hands. Acta Neurol Scand 1997; 96:211-217.
• 10- Padua L, Padua R, Tonali P. Postoperative outcome related to preoperative symptomatology. Clin Orthop 1998;346:284-285.
• 11- Freimer M, Brushat TM, Cornblath DR, Kissel JT. Entrapment neuropathies. In: Mendell JR, Kissel JT, Cornblath DR (eds). Diagnosis and Management of Peripheral Nerve Disorders, Oxford University Press, 2001, pp 592-638.
• 12- Dawson DM. Entrapment Neuropathies of the upper extremities. N Engl J Med 1993; 329:2013-2018.