Karpal Tünel Sendromunun Tedavisinde Kullanılan Karpal Ligaman Traksiyon Aletinin Ultrasonografik Olarak Tedaviye Katkısının Ölçülmesi

Öz

Objective: The aim of this study is to figure out the wrist traction effectiveness of ultrasound which is used to treat the carpal tunnel syndrome (CTS), determine whether the ultrasound (US) applied in patients with a diagnosis of CTS can be used for follow up before and after the treatments. Material and Methods: 28 patients (45 hands) which has been diagnosed idiopathic CTS with the electrophysiological studies were included in the study. For treatment wrist traction device for the application of traction (C-TRACTM brand) was used on all patients. All the patients have been carried out with the US two times before and after the treatment.US examinations were performed with a 12-MHz linear probe (Toshiba, Aplio500, Tokyo, Japan) device. In all cases, the measured distance between the bones carpal tunnel at the level of the input and output measurements and the fact whether there is a difference between the median nerve cross-sectional area measurements, were assessed by the groups’t-test. Results: On the 45 wrists included in the study, two US measurements before and after the usage of wrist traction device, the carpal tunnel at the level of the input and output of measured between distances of bone were found statistically significant difference (p<0,001), while there wasn’t found statistically significant difference between the median nerve cross-sectional area measurements (p>0,05). Conclusion: Our study is the first study evaluating the effectiveness of US and CTS carpal ligament traction in the literature. Considered in patients with CTS and US measurements can be carried out in a short time and can be performed in a dynamic way without the exposure to radiation

Anahtar Kelimeler

• Carpal tunnel syndrome; ultrasonography; wrist traction

Karpal Tünel Sendromunun Tedavisinde Kullanılan Karpal Ligaman Traksiyon Aletinin Ultrasonografik Olarak Tedaviye Katkısının Ölçülmesi

Öz

Amaç: Çalışmanın amacı karpal tünel sendromu (KTS) tedavisinde kullanılan el bileği traksiyonunun sonografik olarak etkinliğini araştırmak, ultrasonografi (US)’nin KTS tanılı olgularda uygulanan tedavilerin öncesinde ve sonrasında takip amacıyla kullanılıp kullanılamayacağını belirlemektir. Gereç ve Yöntem: Çalışmaya daha önce yapılan elektrofizyolojik çalışmalarla idiopatik KTS tanısı almış 28 olgu (45 el) dahil edildi. Tüm olgulara tedavi amacıyla el bileği traksiyonu uygulanması için traksiyon cihazı (CTRACTM marka) kullanıldı. Tüm olgulara tedavi öncesi ve sonrasında iki kez US yapıldı. US incelemeleri 12-MHz lineer proba sahip (Toshiba, Aplio 500, Tokyo, Japan) cihaz kullanılarak yapıldı. Tüm olgularda karpal tünel giriş ve çıkış düzeyinde kemikler arasında ölçülen mesafe ile medyan sinir kesitsel alanının ölçümleri arasında fark olup olmadığı bağımlı grupların t testi ile değerlendirildi.Bulgular: Çalışmaya dahil edilen 45 el bileğinde, el bileği traksiyon cihaz kullanım öncesi ve sonrası iki US ölçümünde, karpal tünel giriş ve çıkış düzeyinde ölçülen kemik mesafeler arasında istatistiksel olarak anlamlı fark bulunurken (p < 0,001); medyan sinir kesitsel alan ölçümleri arasında istatistiksel olarak anlamlı fark bulunmadı (p > 0,05). Sonuç: Çalışmamız literatürde US ile KTS’de karpal ligaman traksiyonunun etkinliğini değerlendiren ilk çalışmadır. US ile KTS düşünülen olgularda ölçümler kısa sürede, radyasyona maruz kalmadan dinamik olarak gerçekleştirmek mümkündür

Anahtar Kelimeler

• Karpal tünel sendromu; ultrasonografi; el bileği traksiyonu

Kaynakça

1. Nakamichi K, Tachibana S. Restricted motion of the medyan nerve in carpal tunnel syndrome. J Hand Surg Br 1995;20(4):460-4.
2. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome 1999;282(2):153-8. general in a population. JAMA
3. Brown M. Carpal tunnel syndrome. Aust Fam Physician 2009;38(12):953.
4. Martinoli C, Bianchi S, Giovagnorio F, Pugliese F. Ultrasound 2001;30(11):605-14. elbow. Skeletal Radiol
5. Chan L, Turner JA, Comstock BA, et al. The relation- ship between electrodiagnostic findings and patient symptoms and function in carpal tunnel syndrome. Arch Phys Med Rehabil 2007;88(1):19-24.
6. Koenig RW, Pedro MT, Heinen CP, et al. High- resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neurosurg Focus 2009;26(2):E13.
7. Serarslan Y, Melek Mİ, Duman T. Karpal tünel sendromu. Pamukkale Tıp Dergisi 2008;1(2):45-9.
8. Viera AJ. Management of carpal tunnel syndrome. Am Fam Physician 2003;68(2):265-72.

9. Brunarski DJ, Kleinberg BA, Wilkins KR. Intermittent axial wrist traction as a conservative treatment for carpal tunnel syndrome: a case series. J Can Chiropr Assoc 2004;48(3):211-6.
10. Porrata H, Porrata A, Sosner J. New carpal liga- ment traction device for the treatment of carpal tun- nel syndrome unresponsive to conservative therapy. J Hand Ther 2007;20(1):20-7.
11. Phalen GS. The diagnosis of carpal tunnel syndrome. Cleve Clin Q 1968;35(1):1-6.
12. Kuschner SH, Ebramzadeh E, Johnson D, Brien WW, Sherman R. Tinel's sign and Phalen's test in carpal 1992;15(11):1297-302. syndrome. Orthopedics
13. Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997;96(4):211-7.
14. Feldman MK, Katyal S, Blackwood MS. US artifacts. Radiographics 2009;29(4):1179-89.
15. Kaymak B, Ozcakar L, Cetin A, Candan Cetin M, Akinci A, Hascelik Z. A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome. Arch Phys Med Rehabil 2008;89(4):743-8.
16. Buchberger W, Schon G, Strasser K, Jungwirth W. High-resolution ultrasonography of the carpal tunnel. J Ultrasound Med 1991;10(10):531-7.
17. Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol 1999;173(3):681-4.
18. Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 2002;46(7):1914-21.
19. Yesildag A, Kutluhan S, Sengul N, Koyuncuoglu HR, Oyar O, Guler K, et al. The role of ultrasonographic measurements of the medyan nerve in the diagnosis of 2004;59(10):910-5. syndrome. Clin Radiol
20. Wang LY, Leong CP, Huang YC, Hung JW, Cheung SM, Pong YP. Best diagnostic criterion in high- resolution ultrasonography for carpal tunnel syndrome. Chang Gung Med J 2008;31(5):469-76.
21. Saraçgil N, Karataş M, Yerli H, Işıklar İ, Karadeli E. Diagnostic significiance of ultrasonography in carpal tunnel electrodiagnostic tests. Turkish Journal of Physical and Medicine and Rehabilitation 2009;55(1):13-8. with
22. Aygul R, Ulvi H, Kotan D, Kuyucu M, Demir R. Sensitivities electrophysiological techniques in carpal tunnel syndrome and their relationship to body mass index. J Brachial Plex Peripher Nerve Inj 2009;4(3):12. new
23. Duymuş M, Ulaşlı AM, Yılmaz Ö, et al. İdiopatik karpal tünel sendromlu hastalarda ultrason ve man- yetik rezonans görüntüleme ile median sinir kesitsel alan ölçümleri. Journal of Neurological Sciences 2013;30(34):59-71.