Assessment Of Frequency And Severity Of Clinical Findings Related To Carpal Tunnel Syndrome In Patients Undergoing Hemodialysis Therapy

Yıl 2014, Cilt: 3 Sayı: 3, 210 - 214, 01.09.2014

Mehmet Eroğlu Mehmet Serhan Er Levent Altınel Selma Eroğlu Güldane Cetinkaya

https://doi.org/10.5505/abantmedj.2014.14471

Öz

OBJECTIVE: To assess the frequency and severity of clinical findings related to carpal tunnel syndrome CTS in patients undergoing hemodialysis HD therapy.METHODS: The study included 95 patients who undergo HD at three centers in Afyonkarahisar, Turkey. All patients were asked if they had pain and/or numbness while asleep or in the morning. The ones with complaints 43 patients answered a scored questionnaire which was previously reported to be superior to electrophysiologic studies in normal population. Carpal tunnel compression test, which has higher sensitivity and specificity values when compared with other tests, was used to scan the patients for having CTS findings. Besides, data on the duration of HD, sides of the arteriovenous fistulas and additional accompanying diseases diabetes mellitus, tendinopathy were noted. Whether both of the tests could be used in decision for surgery was investigated.RESULTS: There was no relationship between the presence and severity of CTS symptoms and duration of HD. CTS symptoms and carpal tunnel compression test had a significant relationship. There was a significant correlation between scores obtained from the questionnaire and CTS symptoms but no relationship between scores and duration of HD. Three fourths of symptomatic patients had scores of 5 or more. No association between CTS symptoms and accompanying tendon problems, age, the sides of fistulas, diabetes mellitus or body mass index were detected.CONCLUSION: Patients on HD therapy are more prone to have CTS and even in more severe condition than in normal population. We found that 33,6% of patients on HD have CTS and that is consistent with the literature. Carpal tunnel compression test can reliably be used for diagnosing CTS in patients on HD. We believe that, unlike patients with CTS in normal population, the questionnaire cannot be solely used to replace nerve conduction studies to decide surgical intervention in patients with CTS on HD therapy. Not all patients need surgery but electrodiagnostic confirmation and close follow-up are necessary in HD patients.

Anahtar Kelimeler

Carpal tunnel syndrome, hemodialysis.

Hemodiyaliz Tedavisi Gören Hastalarda Karpal Tünel Sendromu Klinik Bulgularının Sıklık Ve Şiddetinin Değerlendirilmesi

Öz

AMAÇ: Hemodiyaliz HD tedavisi gören hastalarda karpal tünel sendromu KTS bulgularının sıklık ve şiddetini değerlendirmek.YÖNTEMLER: Çalışmaya Afyonkarahisar’daki üç merkezde HD tedavisi görmekte olan 95 hasta dahil edildi. Tüm hastalara gece yatarken veya sabah ellerinde ağrı veya uyuşma olup olmadığı soruldu, şikayeti olan hastalara 43 hasta daha önce normal populasyondaki hastalarda elektrofizyolojik çalışmalardan daha üstün olduğu bildirilmiş puanlı bir anket ve KTS bulgularının taranması amacıyla diğer testlerle kıyaslandığında daha yüksek duyarlılık ve özgünlüğe sahip olan karpal tünel kompresyon testi uygulandı. Ayrıca, HD süresi, arteriovenöz fistül tarafı ve eşlik eden diğer hastalıklar diabetes mellitus, tendinopati kaydedildi. Her iki testin cerrahiye karar vermede yol gösterici olup olamayacağı incelendi.BULGULAR: KTS semptomlarının varlığı ve şiddeti ile HD süresi arasında anlamlı bir ilişki tespit edilmedi. Karpal tünel kompresyon testi ile KTS klinik bulgularının ilişkili olduğu görüldü. Anketten elde edilen skorlar ile KTS semptomları arasında anlamlı ilişki bulunurken skorlar ile HD süresi arasında ilişki bulunamadı. Semptomatik hastaların 3/4’ünde 5 ve üzerinde skor değerleri elde edildi. Eşlik eden tendon problemleri, yaş, fistül tarafı, diabetes mellitus ve vücut kitle indeksi ile KTS semptomları arasında bir ilişki tespit edilmedi.SONUÇ: HD tedavisi gören hastalar, normal populasyonla kıyaslandığında KTS gelişmesine ve hatta daha şiddetli seyretmesine daha yatkındırlar. Literatürle uyumlu olarak, HD tedavisi gören hastaların %33,6’sında KTS olduğunu bulduk. Karpal tünel kompresyon testi, HD tedavisi gören hastalarda KTS tanısı koyarken güvenle kullanılabilir. Normal populasyondaki KTS’li hastalardan farklı olarak kullandığımız anketin HD tedavisi gören KTS’li hastalarda sinir iletim çalışmalarının yerini tek başına tutamayacağını düşünüyoruz. Tüm hastalar için cerrahi girişim gerekmemekte ancak HD tedavisi gören hastalarda elektrodiagnostik doğrulama ve yakın takip gerekmektedir.

Anahtar Kelimeler

Karpal tünel sendromu, hemodiyaliz.

Kaynakça

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