Karpal tünel sendromlu hastalarda median ve ulnar sinirin ultrasonografik olarak değerlendirilmesi
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Dosyalar
Tarih
2013
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Karpal tünel sendromu, el bileğinde median sinirin kompresyonuna bağlı ortaya çıkan ve en sık görülen tuzak nöropatisidir. Tanı için hikaye, fizik muayene ve provakatif testler orta ve ağır dereceli vakalarda yeterli olabilmekle birlikte hafif dereceli vakalarda fizik muayene ve elektrodiagnostik testler normal iken hikaye ve semptomların yayılımı halen karpal tünel sendromunu düşündürmekte ise görüntüleme yöntemleri (ultrasonografi,manyetik rezonans görüntüleme) yardımcı tanı yöntemi olarak kullanılabilmektedir. Biz çalışmada sonografik olarak median sinir kesitsel alanı ile median ve ulnar sinir kesit alanı oranlarını değerlendirerek bulguları elektromiyografi sonuçları ile karşılaştırmayı amaçladık. Bu çalışmada, Ocak 2010 ile Ocak 2011 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Nöroloji polikliniğine başvuran ve elektromiyografi laboratuarında karpal tünel sendromu tanısı doğrulanan 41 hasta (36 kadın, 5 erkek) ile 26 kişiden (22 kadın,4 erkek) oluşan kontrol grubu değerlendirildi. Elektromiyografi ile karpal tünel tanısı doğrulanan hastalar ile sağlıklı gönüllülere median ve ulnar siniri görüntülemek amacıyla ultrasonografi tetkiki yapıldı. Hasta ve konrol grupları ekstremite bazında değerlendirildiğinde hasta grupta toplam 71 el bileği, kontrol grubunda toplam 52 el bileği değerlendirildi. Karpal tünel sendromulu olgularda median sinir kesit alanı ve median sinir kesit alanının ulnar sinir kesit alanına oranı, kontrol grubuna göre belirgin derecede artmış olarak tesbit edildi. Ancak bu değerlerde yaş ve cinsiyet bakımından belirgin fark saptanmadı. Elektrofizyolojik veriler değerlendirildiğinde ise median motor sinir ileti hızı açısından ağır grup ile hafif grup arasında istatistiksel yönden anlamlı fark varken (p=0.002); ağır grup ile orta gruplar arasında istatistiksel yönden anlamlı fark saptanmadı (p=0.034). Ayrıca ulnar motor sinir amplitüdü ve unlar duysal sinir amplitüdü açısından hafif, orta ile ağır gruplar arasında anlamlı fark saptanmaz (p>0.005) iken ulnar motor sinir ileti hızı, ulnar duysal sinir ileti hızı, median motor sinir distal latansı, median motor sinir amplitüdü, median duysal sinir ileti hızı ve median duysal sinir amplitüdü açısından hafif, orta ve ağır grup arasında istatistiksel yönden anlamlı fark saptandı (p<0,005) . Sonuç olarak ultrasonografi, elektrodiagnostik testlere alternatif bir tanı yöntemi olmamakla birlikte bu testler birbirinin tamamlayıcısıdır. Karpal tünel sendromu tanısında median sinir kesit alanı ölçümü ile birlikte median sinir kesit alanı ile ulnar sinir kesit alanı oranının da ultrasonografik incelemede değerlendirilmesi gereken bir parametre olabileceğini önermekteyiz.
Abstract
Carpal tunnel syndrome, is the most common entrapment neuropathy caused by compression of the median nerve at the wrist. History, physical examination and provocative tests may be enough in moderate ve severe cases. In mild cases if physical examination and electrodiagnostic tests are normal and history and symptoms still suggest carpal tunnel syndrome than imaging methods (ultrasonography, magnetic resonance imaging) may be helpful for the diagnosis. In our study, sonographic cross-sectional areas of the median nerve and the ratio of median and ulnar nerve cross-sectional area were compared with the results of electromyography findings. In this study, between January 2010 and January 2011, 41 patients (36 female, 5 male) who who confirmed the diagnosis of carpal tunnel syndrome at our outpatient clinic of Neurology of Trakya University Faculty of Medicine and electromygraphy lab and 26 subjects (22 female, 4 male) of healthy control were examined and ultrasonography was performed for these in order to evaluate median and ulnar nevre. 71 wrists in patient group and 52 wrists in control group were examined. In patients with carpal tunnel syndrome, median nerve cross-sectional area and the ratio of median nerve cross-sectional area to ulnar nerve cross-sectional area values were significantly higher than the control group. However, these values were not differ significantly in terms of age and gender. Electrophysiologically in median motor nerve conduction velocity, there is a and mild groups (p = 0.002) but there is no significant difference between severe and moderate group statistically (p = 0.034). In ulnar motor nerve amplitude and ulnar sensory nerve amplitude there was no significant difference (p>0.005) between mild, moderate and severe groups while in ulnar motor nerve conduction velocity, ulnar sensory nerve conduction velocity, median motor nerve distal latency, median motor nerve amplitude, median sensory nerve amplitude, median sensory nerve conduction velocity there was significant difference (p<0,005) between these groups was detected. Ultrasonography is not an alternative diagnostic method for electrodiagnostic tests. Both of these are complementary to each other. We recommend that measurement of cross-sectional area of the median nerve with the ratio of cross-sectional area of median nerve to the ulnar nerve should also be evaluated in ultrasonographic examination in the diagnosis of carpal tunnel syndrome.
Abstract
Carpal tunnel syndrome, is the most common entrapment neuropathy caused by compression of the median nerve at the wrist. History, physical examination and provocative tests may be enough in moderate ve severe cases. In mild cases if physical examination and electrodiagnostic tests are normal and history and symptoms still suggest carpal tunnel syndrome than imaging methods (ultrasonography, magnetic resonance imaging) may be helpful for the diagnosis. In our study, sonographic cross-sectional areas of the median nerve and the ratio of median and ulnar nerve cross-sectional area were compared with the results of electromyography findings. In this study, between January 2010 and January 2011, 41 patients (36 female, 5 male) who who confirmed the diagnosis of carpal tunnel syndrome at our outpatient clinic of Neurology of Trakya University Faculty of Medicine and electromygraphy lab and 26 subjects (22 female, 4 male) of healthy control were examined and ultrasonography was performed for these in order to evaluate median and ulnar nevre. 71 wrists in patient group and 52 wrists in control group were examined. In patients with carpal tunnel syndrome, median nerve cross-sectional area and the ratio of median nerve cross-sectional area to ulnar nerve cross-sectional area values were significantly higher than the control group. However, these values were not differ significantly in terms of age and gender. Electrophysiologically in median motor nerve conduction velocity, there is a and mild groups (p = 0.002) but there is no significant difference between severe and moderate group statistically (p = 0.034). In ulnar motor nerve amplitude and ulnar sensory nerve amplitude there was no significant difference (p>0.005) between mild, moderate and severe groups while in ulnar motor nerve conduction velocity, ulnar sensory nerve conduction velocity, median motor nerve distal latency, median motor nerve amplitude, median sensory nerve amplitude, median sensory nerve conduction velocity there was significant difference (p<0,005) between these groups was detected. Ultrasonography is not an alternative diagnostic method for electrodiagnostic tests. Both of these are complementary to each other. We recommend that measurement of cross-sectional area of the median nerve with the ratio of cross-sectional area of median nerve to the ulnar nerve should also be evaluated in ultrasonographic examination in the diagnosis of carpal tunnel syndrome.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Karpal Tünel Sendromu, Median Sinir Kesit Alanı, Ulnar Sinir Kesit Alanı, Ultrasonografi, Carpal Tunnel Syndrome, Median Nerve Cross-sectional Area, Ulnar Nerve Cross-sectional Area, Ultrasonography
