Karpal Tünel Sendromu Semptomları ile Başvuran Hastalarda Fibromiyalji Sıklığı

Yıl 2020, Cilt: 46 Sayı: 3, 271 - 275, 01.12.2020

Şüheda Özçakır

https://doi.org/10.32708/uutfd.775069

Cited By: 1

Öz

Karpal tünel sendromu (KTS), en sık görülen tuzak nöropatisidir. Ellerde ağrı, uyuşma ve kuvvetsizlik gibi yakınmalarla karakterizedir. Fibromiyalji (FM) ise yaygın ağrının eşlik ettiği kronik kas iskelet sistemi hastalığıdır. Geniş semptom yelpazesi içinde parestezi yakınması sık görülmekte olup KTS ile karışabilmektedir. FM’li hastalarda KTS sıklığını araştıran az sayıda çalışma olup sonuçlar çelişkili bulunmuş-tur. Bu çalışmada amaç, klinik olarak KTS ile uyumlu yakınmaları olup sinir ileti çalışmalarında KTS saptanan ve saptanmayan iki grup arasında FM açısından farlılık olup olmadığını araştırmaktır. Fiziksel Tıp ve Rehabilitasyon Polikliniği’ne başvuran ve KTS ön tanısı ile elektrofizyoloji laboratuvarına yönlendirilen kadın hastalar çalışmaya dahil edilmiştir. Tüm hastalara FM 2016 ACR tanı kriterleri uygulan-mış ve Yaygın Ağrı İndeksi (YAİ), Semptom Şiddet Skalası (SSS), Fibromiyalji Şiddet Skoru (FŞS) kaydedilmiştir. Hastalar elektrofizyolo-jik olarak KTS saptanan ve saptanmayan iki gruba ayrılarak sonuçlar karşılaştırılmıştır. Çalışmaya ellerde uyuşma yakınması olan ve sinir ileti çalışması sonucunda 30 KTS pozitif, 25 KTS negatif hasta alındı. İki grup arasında yaşa ve beden kitle indeksine göre farklılık saptan-madı. KTS saptananların %26,7’sinde, saptanmayanların %24’ünde ACR 2016 kriterlerine göre FM saptanmış olup, iki grup arasında istatis-tiksel olarak anlamlı fark bulunmamıştır. YAİ, SSS ve FŞS incelendiğinde de gruplar arasında istatistiksel fark saptanmamıştır. Diğer yandan FM saptanan ve saptanmayan iki grup karşılaştırıldığında FM saptanmayan grupta median sinir ileti hızları anlamlı olarak daha yavaş bulun-du. Sonuç olarak, KTS hastalarında FM prevalansı yüksek bulunmuştur. FM olan ve olmayan KTS hastalarının median sinir iletim hızların-da anlamlı farklılıklar olduğundan, FM hastalarında KTS tanısı için elektrofizyolojik doğrulama önerilebilir.

Anahtar Kelimeler

fibromiyalji, , karpal tünel sendromu, sinir ileti çalışması

Teşekkür

Dr.Cemre Güler, Dr.Burcu Sezer ve Dr.Gökhan Ocakoğlu'na veri toplama ve istatistiksel analizler konusundaki desteklerinden dolayı teşekkür ederim.

The Frequency of Fibromyalgia in Patients Presenting with Symptoms of Carpal Tunnel Syndrome

Öz

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It is characterized by complaints such as pain, numbness and weakness in the hands. Fibromyalgia (FM) is a chronic musculoskeletal disease accompanied by widespread pain. In a wide range of symp-toms, complaints of paresthesia are common and can be confused with CTS. There are few studies investigating the frequency of CTS in patients with FM, and the results have been contradictory. The aim of this study is to investigate whether there is a difference in terms of FM between the electrophysiologically confirmed and not confirmed CTS patients. Female patients who admitted to the Physical Medicine and Rehabilitation Outpatient Clinic and were referred to the electrophysiology laboratory with a preliminary diagnosis of CTS were included in the study. FM 2016 ACR diagnostic criteria were applied to all patients and the Widespread Pain Index (WPI), Symptom Severity Scale (SSS), Fibromyalgia Severity Score (FSS) were recorded.As a result of the nerve conduction study, 30 CTS positive and 25 CTS negative patients were included in the study. There was no difference between the two groups according to age and body mass index. FM was diag-nosed according to ACR 2016 criteria in 26.7% of those with CTS, and 24% of those without and there was no statistically significant differ-ence between the two groups. No statistical difference was found between the groups according to WPI, SSS and FSS. On the other hand, when the two groups with and without FM were compared, the median nerve conduction velocities were significantly slower in the group without FM. As a result, the prevalence of FM is high in CTS patients. Since there are significant differences in the median nerve conduction velocities of CTS patients with and without FM, electrophysiological confirmation may be recommended for CTS diagnosis in FM patients.

Anahtar Kelimeler

Fibromyalgia, Carpal tunnel syndrome, Nerve conduction study

Kaynakça

• Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. The Lancet Neurology. 2016;15(12):1273-84.
• Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle & nerve. 1997;20(12):1477-86.
• Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee. Muscle & nerve. 1993;16(12):1392-414.
• 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.
• Ozcakir S, Sigirli D, Avsaroglu H. High wrist ratio is a risk factor for carpal tunnel syndrome. Clinical anatomy. 2018;31(5):698-701.
• Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis care & research. 2010;62(5):600-10.
• Galvez-Sanchez CM, Reyes Del Paso GA. Diagnostic Criteria for Fibromyalgia: Critical Review and Future Perspectives. Journal of clinical medicine. 2020;9(4).
• Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis and rheumatism. 1990;33(2):160-72.
• Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RS, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. The Journal of rheumatology. 2011;38(6):1113-22.
• Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RL, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Seminars in arthritis and rheumatism. 2016;46(3):319-29.
• Okifuji A, Gao J, Bokat C, Hare BD. Management of fibromyalgia syndrome in 2016. Pain management. 2016;6(4):383-400.
• Nacir B, Genc H, Duyur Cakit B, Karagoz A, Erdem HR. Evaluation of upper extremity nerve conduction velocities and the relationship between fibromyalgia and carpal tunnel syndrome. Archives of medical research. 2012;43(5):369-74.
• Sarmer S, Yavuzer G, Kucukdeveci A, Ergin S. Prevalence of carpal tunnel syndrome in patients with fibromyalgia. Rheumatology international. 2002;22(2):68-70.
• Ersoz M. Nerve conduction tests in patients with fibromyalgia: comparison with normal controls. Rheumatology international. 2003;23(4):166-70.
• Yanmaz MN, Atar S, Bicer M. The reliability and validity of the Turkish version of fibromyalgia survey diagnostic criteria and symptom severity scale. Journal of back and musculoskeletal rehabilitation. 2016;29(2):287-93.
• Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis and rheumatism. 1995;38(1):19-28.
• de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. Journal of clinical epidemiology. 1992;45(4):373-6.
• Perez-Ruiz F, Calabozo M, Alonso-Ruiz A, Herrero A, Ruiz-Lucea E, Otermin I. High prevalence of undetected carpal tunnel syndrome in patients with fibromyalgia syndrome. The Journal of rheumatology. 1995;22(3):501-4.
• Silva FJ, Kanegusuku V, Bortoncello R, Skare T. Carpal tunnel syndrome and fibromyalgia. Acta reumatologica portuguesa. 2016;41(3):275-6.
• Caro XJ, Winter EF. The Role and Importance of Small Fiber Neuropathy in Fibromyalgia Pain. Current pain and headache reports. 2015;19(12):55.
• Hovaguimian A, Gibbons CH. Diagnosis and treatment of pain in small-fiber neuropathy. Current pain and headache reports. 2011;15(3):193-200.
• Caro XJ, Galbraith RG, Winter EF. Evidence of peripheral large nerve involvement in fibromyalgia: a retrospective review of EMG and nerve conduction findings in 55 FM subjects. European journal of rheumatology. 2018;5(2):104-10.