Karpal Tünel Sendromu Olan 45 Vakanın Değerlendirilmesi

Özet

Amaç: Karpal tünel sendromu (KTS), median sinirin el bileğinde karpal tünelde kompresyonu ile oluşan en sık görülen periferik mononöropatidir. Tanısı anamnez ve fizik muayene ile konur ve el bileğinde median sinir disfonksiyonunu değerlendiren objektif bir metod olan elektrodiagnostik test ile doğrulanır. Tedavi edilmezse el fonksiyonlarında kalıcı hasara neden olabilir. Bu çalışmada daha önce tanı konup tedavi edilmemiş ve sekonder neden saptanmayan KTS vakalarını değerlendirdik. Gereç ve Yöntem: Ardı ardına ellerde uyuşma, karıncalanma, ağrı ve güç kaybı ile başvuran hastaların Etik Kurul onayı alınarak demografik özellikleri, Phalen-Tinel provokasyon testleri, pamuk ve iğne ucu ile duyu testleri değerlendirildi. Kas kuvveti 1 ile 5. parmak oppozisyon gücü ile değerlendirildi ve tenar atrofi varlığı araştırıldı. İlk değerlendirmeden sonra elektromiyografi (EMG) uygulanarak tanı doğrulandı. Ayrıca vakalar KTSye yol açabilecek herhangi bir hastalığı olup olmadığı (metabolik, romatizmal, travma öyküsü vb.) açısından da değerlendirildiler. Vakaların ağrı, uyuşma ve güçsüzlüğü fonksiyonel durum skalası (FDS), semptom şiddet skalası (SŞS), görsel değerlendirme skalası (VAS) ile değerlendirildi. Verilerin karşılaştırılmasında Mann Whitney U testi, independent t testi; parametreler arası ilişkilerin değerlendirmesinde Spearman korelasyon analizi kullanıldı (anlamlılık p 0.05). Sonuç: Vakalarımızın çoğunda uyuşma şikayeti mevcuttu. Fizik muayenede önemli sayıda vakada tenar atrofi olması dikkati çekici idi. Ev temizliği vakalarımızda önemli bir risk faktörü olarak dikkati çekmektedir.

Abstract

Objective: Carpal tunnel syndrome (CTS) is the most common peripheral mononeuropathy developed by compression of the median nerve within the Carpal tunnel at the wrist. Diagnosis is made by history and physical examination, and confirmed objectively by electrodiagnostic study evaluating median nerve dysfunction. If untreated CTS can cause permanent damage. In this study, we have reviewed the patients diagnosed CTS without any secondary causes and untreated. Material and Methods: The patients who presented to the outpatient clinic consecutively with complaints of numbness, tingling, pain and weakness in their hands were evaluated for their demographic features and done Phalen-Tinel provocation tests, sensory testing with cotton and needle tip after obtaining the Ethics Committee approval. Muscle strength was assessed by first and fifth finger opposition, and presence of thenar atrophy was investigated. After the initial evaluation, the diagnosis of CTS was confirmed by electromyography (EMG). Cases were evaluated for the presence of any disease that may lead to for CTS (metabolic, rheumatic, trauma, etc.). The severity of pain, numbness and weakness were evaluated by functional status scale (FSS), symptom severity score (SSS), and by visual assessment scale (VAS). Mann-Whitney U test, independent t test were used to compare the data; Spearman correlation analysis was used for the relationship between parameters (significance p<0.05). Results: All 45 cases with mild-to-moderate CTS by EMG were women; The mean age was 47.86±9.74 years (29-66 years). Mean height was 159.16±5.16 cm (148-170 cm) and mean weight was 76.31±12.67 kg (53-115 kg). All cases were housewifes, and 32 cases had bilateral while 13 cases had unilateral CTS (total 77 hands). The mean of weekly cleaning frequency was 4.16±2.3 days (1-7 days). At the evaluation of 77 hands, 56 (72.7%) had numbness, 2 (2.6%) had pain, 15 (19.5%) had numbness and pain, and 4 (5.2%) had numbness and weakness. Thenar atrophy were detected at 23/77 (70.1%) hands. At 45/77 hands (58.4%), we were detected hypoesthesia. Muscle strength was 5/5 at 58/77 (75.3%) hands and 4/5 at 19/77 (24.6%) hands. In all hands (n=77), Phalen and Tinel signs were present. Fifty-two of seventy-seven EMG (67.5%) showed sensory CTS, and 25 of 77 EMG (32.5%) showed sensory and motor CTS. Mean FDS was 24.1±5.6 (10 to 33); mean SSS was 31±9.3 (14 to 52), and mean VAS was 6.66±1.99 (2 to 10). There were significant correlation with the number of weekly cleaning days and FDS (r=0.376, p=0.011) and SSS (0.341, p=0.022). There were no difference between EMG groups (sensory vs sensory and motor) for the number of weekly cleaning days, for VAS, FSS and SSS (p>0.05). Conclusions: Most of our cases presented with complaints of numbness in their affected hands. Thenar atrophy was present in important number of patients. Doing house work is noted as an important risk factor for CTS in our cases.