Comparing the Neurophysiological Findings of 200 Cases with Boston Carpal Tunnel Syndrome Questionnare Scores and Job Exposure

Öz

Objective: Electrodiagnostic diagnostic tests are the most reliable method in the diagnosis of carpal tunnel syndrome (CTS). The rates of patients who were referred to the electrophysiology laboratory from outpatient clinics with a pre-diagnosis of CTS, the scores of the Turkish version of the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), one of the frequently used questionnaires to aid diagnosis, and their relationship with the job exposure were evaluated.

Material and Methods: 200 patients, who were referred to our electrophysiology laboratory due to initial diagnosis of CTS, were included. All the patients self recorded demographic findings, comorbid diseases, duration of complaints, daily working time, jobs and Turkish version of BCTSQ

Results: 94 of 200 patients who were referred to our electrophysiology laboratory with a pre-diagnosis of CTS were diagnosed with carpal tunnel syndrome according to their electrophysiological findings. 94 CTS patients; 53 (56.4%) were housewives, 31(33%) were blue collar and 10 (10.6%) were white collar. Statistically significant correlation was found between CTS and age, number of births, menopause, obesity (p <0.05). However, no statistically significant difference was found between gender, comorbid diseases, duration of complaints and daily working hours. There was a statistically significant difference between electrophysiological results and BCTSQ Symptom Severity Scale, but no significant difference was found between the Functional Status Scale.

Conclusion: This study confirms that age, number of births, menopause and obesity are important risk factors for CTS. The fact that the number of patients referred to our laboratory is higher than those with CTS detected electrophysiologically suggests that patient evaluation in outpatient clinics is not sufficient. In order to increase this rate, easier and more understandable questionnaire tests can be done. We believe that detailed clinical evaluation and examination (Tinel and Phalen test) will prevent unnecessary tests.

Anahtar Kelimeler

• Carpal Tunnel Syndrome
• Boston Questionnaire
• entrapment neuropathy

İKİ YÜZ HASTANIN ELEKTROFİZYOLOJİK BULGULARININ BOSTON KARPAL TÜNEL SENDROMU ANKETİ SKORLARI VE MESLEKLER İLE İLİŞKİSİNİN İNCELENMESİ

Öz

Amaç: Karpal tünel sendromu (KTS) tanısında en güvenilir yöntem elektrodiagnostik tanı testlerdir. KTS ön tanısı ile polikliniklerden, elektrofizyoloji laboratuvarına yönlendirilen hastalardan kesin tanı alanların oranları, tanıya yardımcı sık kullanılan anketlerden Boston Karpal Tünel Sendromu Anketi (BKTSA) Türkçe versiyonu skorları ve meslekler ile ilişkisi değerlendirildi.

Gereç ve Yöntemler: KTS ön tanısıyla elektrofizyoloji laboratuvarımıza sevk edilen 200 hasta çalışmaya dahil edildi. Tüm hastaların demografik bulguları, komorbid hastalıkları, şikayet süresi, günlük çalışma süresi, mesleği ve BKTSA Türkçe versiyonu skorları ve elektrofizyolojik bulguları kaydedildi.

Bulgular: Elektrofizyoloji laboratuvarımıza KTS ön tanısı ile yönlendirilen 200 hastanın 94' üne elektrofizyolojik bulgularına göre KTS tanısı konuldu. 94 KTS hastasının; 53'ü (%56.4) ev hanımı, 31'i (%33) mavi yakalı ve 10'u (%10.6) beyaz yakalıydı. KTS ile yaş, doğum sayısı, menopoz ve obezite arasında istatistiksel olarak anlamlı bir ilişki bulundu (p<0.05). Ancak cinsiyet, eşlik eden hastalıklar, şikayet süresi ve günlük çalışma süresi arasında anlamlı fark bulunamadı. Elektrofizyolojik sonuçlar ile BKTSA Semptom Şiddeti Skalası arasında istatistiksel olarak anlamlı fark bulunurken; Fonksiyonel Durum Skalası arasında bulunamadı.

Sonuç: Bu çalışma yaş, doğum sayısı, menopoz ve obezitenin KTS için önemli bir risk faktörü olduğunu doğrulamaktadır. Laboratuvarımıza yönlendirilen hasta sayısının, elektrofizyolojik olarak KTS tespit edilenlerden daha fazla olması, polikliniklerde hasta değerlendirilmesinin yeterli olmadığını düşündürmektedir. Bu oranı yükseltmek için daha kolay ve anlaşılır anket testleri yapılabilir. Ayrıntılı klinik değerlendirme ve muayene (Tinel ve Phalen testi) ile gereksiz tetkik istenmesini engelleyeceğine inanmaktayız.

Anahtar Kelimeler

• Karpal Tünel Sendromu
• Boston Anketi
• tuzak nöropati

Kaynakça

1. 1. Tunc A, Gungen BD. Carpal tunnel syndrome: Investigating the sensitivity of initial-diagnosis with electro-diagnostic tests in 600 cases and associated risk factors especially manual milking. J Back Musculoskelet Rehabil. 2017;30(2):333-8.
2. 2. Oktayoglu P, Nas K, Kilinc F, Tasdemir N, Bozkurt M, Yildiz I. Assessment of the presence of carpal tunnel syndrome in patients with diabetes mellitus, hypothyroidism and acromegaly. J Clin Diagn Res. 2015;9(6):OC14-8.
3. 3. Goodson JT, DeBerard MS, Wheeler AJ, Colledge AL. Occupational and biopsychosocial risk factors for carpal tunnel syndrome. J Occup Environ Med. 2014;56(9):965-72.
4. 4. Kozak A, Schedlbauer G, Wirth T, Euler U, Westermann C, Nienhaus A. Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a meta-analysis of current research. BMC Musculoskelet Disord. 2015;16:231.
5. 5. Franklin GM, Friedman AS. Work-related carpal tunnel syndrome: diagnosis and treatment guideline. Phys Med Rehabil Clin N Am. 2015;26(3):523-37.
6. 6. Evcili G, Gül H, Karadaş Ö, Börü Ü. Carpal tunnel syndrome: In which ratio does electroneuromyography confirm the diagnosis. J Clin Anal Med. 2012;3:412-4.
7. 7. de Jesus Filho AG, do Nascimento BF, Amorim Mde C, Naus RA, Loures Ede A, Moratelli L. Comparative study between physical examination, electroneuromyography and ultrasonography in diagnosing carpal tunnel syndrome. Rev Bras Ortop. 2014;49(5):446-51.
8. 8. 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.

9. 9. İlhan D, Toker S, Kılıncıoğlu V, Gülcan E. Assessment of the Boston questionnaire in diagnosis of idiopathic carpal tunnel syndrome: Comparing scores with clinical and neurophysiological findings. Düzce Tıp Fakültesi Dergisi. 2008;10(3):4-9.
10. 10. Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J. 2012;6:69-76.
11. 11. Werner RA, Albers JW, Franzblau A, Armstrong TJ. The relationship between body mass index and the diagnosis of carpal tunnel syndrome. Muscle & Nerve. 1994;17(6):632-6.
12. 12. Tanaka S, Wild DK, Seligman PJ, Halperin WE, Behrens VJ, Putz‐Anderson V. Prevalence and work‐relatedness of self‐reported carpal tunnel syndrome among US workers: Analysis of the Occupational Health Supplement data of 1988 National Health Interview Survey. American Journal of Industrial Medicine. 1995;27(4):451-70.
13. 13. Silverstein BA, Fine LJ, Armstrong TJ. Occupational factors and carpal tunnel syndrome. Am J Ind Med. 1987;11(3):343-58.
14. 14. Spahn G, Wollny J, Hartmann B, Schiele R, Hofmann G. Metaanalysis for the evaluation of risk factors for carpal tunnel syndrome (CTS) Part II. Occupational Risk Factors. 2012;150(5):516-24.
15. 15. You D, Smith AH, Rempel D. Meta-analysis: association between wrist posture and carpal tunnel syndrome among workers. Safety and Health at Work. 2014;5(1):27-31.
16. 16. Saint-Lary O, Rebois A, Mediouni Z, Descatha A. Carpal tunnel syndrome: primary care and occupational factors. Front Med (Lausanne). 2015;2:28.
17. 17. El-Helaly M, Balkhy HH, Vallenius L. Carpal tunnel syndrome among laboratory technicians in relation to personal and ergonomic factors at work. Journal of Occupational Health. 2017:16-0279-OA.
18. 18. Manktelow RT, Binhammer P, Tomat LR, Bril V, Szalai JP. Carpal tunnel syndrome: cross-sectional and outcome study in Ontario workers. J Hand Surg Am. 2004;29(2):307-17.
19. 19. Daniell WE, Fulton-Kehoe D, Franklin GM. Work-related carpal tunnel syndrome in Washington State workers' compensation: utilization of surgery and the duration of lost work. Am J Ind Med. 2009;52(12):931-42.
20. 20. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992;45(4):373-6.
21. 21. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153-8.
22. 22. Armstrong T, Dale AM, Franzblau A, Evanoff BA. Risk factors for carpal tunnel syndrome and median neuropathy in a working population. J Occup Environ Med. 2008;50(12):1355-64.
23. 23. Rosecrance JC, Cook TM, Anton DC, Merlino LA. Carpal tunnel syndrome among apprentice construction workers. Am J Ind Med. 2002;42(2):107-16.
24. 24. Kim JY, Kim JI, Son JE, Yun SK. Prevalence of carpal tunnel syndrome in meat and fish processing plants. J Occup Health. 2004;46(3):230-4.
25. 25. Roquelaure Y, Ha C, Pelier-Cady MC, Nicolas G, Descatha A, Leclerc A et al. Work increases the incidence of carpal tunnel syndrome in the general population. Muscle Nerve. 2008;37(4):477-82.
26. 26. Sambandam SN, Priyanka P, Gul A, Ilango B. Critical analysis of outcome measures used in the assessment of carpal tunnel syndrome. International Orthopaedics. 2008;32(4):497-504.
27. 27. Greenslade J, Mehta R, Belward P, Warwick D. Dash and Boston questionnaire assessment of carpal tunnel syndrome outcome: what is the responsiveness of an outcome questionnaire? Journal of Hand Surgery. 2004;29(2):159-64.