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The aim of this study was to investigate the relationship between different ultrasonographic indices used in patients with carpal tunnel syndrome and the level of tactile sensation.
The primary questions the study aimed to answer are:
• To what extent are the ultrasonographic parameters used in the diagnosis of carpal tunnel syndrome related to the level of sensory complaints in the patient?
Carpal tunnel syndrome (CTS) is the most common compression neuropathy. The etiology of CTS can be related to work, lifestyle, injury, or genetic predisposition. Exposure to vibrations or repetitive forceful angular movements is among the most common causes of CTS. Certain diseases, such as diabetes, pregnancy, and morbidity, are also thought to be associated with an increased risk of developing CTS. It accounts for 90% of all entrapment neuropathies. Its prevalence in the population is between 1% and 5%, and it is three times more common in women. In CTS, complaints related to motor and sensory deficits are observed in the first three fingers innervated by the median nerve and the radial aspect of the fourth finger. Diagnosis is made by corroborating clinical signs and symptoms with electrophysiological findings. However, recently, ultrasound (US) is frequently preferred for the diagnosis of CTS to evaluate the morphological and mechanical properties of the median nerve. US is considered a highly accurate, effective, and cost-effective diagnostic method for the diagnosis of CTS, with a short evaluation time . Sonographic measurements related to CTS can yield values such as the diameter of the nerve at the entrance and exit of the tunnel. CTS presents with a disturbance in tactile input, such as numbness and loss of sensation in the median nerve dermatom. This sensory loss can cause difficulty in using the patient's hand in activities of daily living. Sonography has recently become widely used in CTS patients. The fact that values measured by sonography can provide information about the clinical status of patients can be considered important data for healthcare professionals. Therefore, our study was designed to examine the relationship between sonographic measurements and tactile sensory levels in patients diagnosed with mild to moderate CTS based on electrodiagnostic tests.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patient group | Patients with carpal tunnel syndrome |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nerve conduction studies | Diagnostic Test | Upper extremity nerve conduction studies including median-ulnar sensory and motor responses |
|
| Measure | Description | Time Frame |
|---|---|---|
| median nerve ultrasound | Median nerve maximum cross-sectional area measurement at the level of the carpal tunnel (mm²) | 3 Months |
| Pointed - blunt discrimination test | The patient is asked to distinguish between a pointed and a blunt tip by touching the median nerve dermatome. | 3 Months |
| Moved two point discrimination | The patient's finger is touched, starting from the distal tip and moving proximally, and the patient is asked to distinguish between one and two dots. The distance between the last pair of dots the patient can distinguish is noted in mm. | 3 months |
| Fixed Two Point Discrimination Test | The patient's finger is touched starting from the distal tip and working proximally, and the patient is asked to distinguish between one and two dots. The distance between the last pair of dots the patient can distinguish is noted in millimeters. | 3 months |
| Semmes Weinstein Test | With the patient's eyes closed, monofilament is applied perpendicularly in a steady manner until the filament bends. Use a smooth motion to touch the skin with the filament, bend the filament for a full second, than lift from the skin. Patient raises hand to indicate that the monofilament touch sensation is perceived. | 3 months |
| median nerve ultrasound | Median nerve echogenicity at the level of the carpal tunnel (%) | 3 months |
| median nerve ultrasound |
| Measure | Description | Time Frame |
|---|---|---|
| Boston Carpal Tunnel Syndrome Questionnaire | The scale consists of an 11-question Likert-style symptom severity scale and an 8-question functional status scale. The total score is divided by the number of questions to calculate the score. Higher scores are associated with increased symptom severity and poorer functional status. | 3 Months |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with diagnosed CTS
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Müyesser Cavlak, PhD | Contact | +905426406118 | muyessercavlak@hotmail.com | |
| Feyza Nur Yücel, Specialist | Contact | 5385577059 ext +90 | dr.fny28@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Müyesser Cavlak, PhD | Sultan Abdülhamit Han Trainin and Educatioal Hospital | Principal Investigator |
| Emre Ata, Assoc Prof | Sultan Abdülhamit Han Trainin and Educatioal Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sultan Abdülhamit Han Trainin and Educational Hospital | Recruiting | Üsküdar | İ̇stanbul | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15772908 | Background | Bennett MI, Smith BH, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005 Mar;6(3):149-58. doi: 10.1016/j.jpain.2004.11.007. | |
| 17083175 | Background | Sezgin M, Incel NA, Serhan S, Camdeviren H, As I, Erdogan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disabil Rehabil. 2006 Oct 30;28(20):1281-5. doi: 10.1080/09638280600621469. |
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| Median nerve ultrasonography | Diagnostic Test | Median nerve sonographic cross-sectional area and echogenicity measurements |
|
| Sensory testing | Diagnostic Test | tactile sensory tests |
|
Median nerve cross-sectional area measurement at the level of the carpal tunnel inlet (mm²) |
| 3 months |
| median nerve ultrasound | Median nerve cross-sectional area measurement at the level of the carpal tunnel outlet (mm²) | 3 months |
| median nerve ultrasound | Median nerve cross-sectional area measurement at the level of the pronator quadratus (mm²) | 3 months |
| S-LANSS |
A score of 12 or more out of 24 on a 7-question scale is considered in favor of neuropathic pain. |
| 3 Months |
| SF-12 (Short Form-12) | The SF-12 is a practical test consisting of seven questions that examine the life limits of the patient. The questionnaire includes questions aimed at understanding the physical and psychiatric effects. The results of the survey are calculated using two score calculation tools: physical (PCS-12) and mental (MCS-12). The highest score for the PCS-12 is 56.6, while the highest score for the MCS-12 is 60.7. Higher scores are comparable to a state of resilience and recovery, which can be compared to quality of life. | 3 months |
| 32919457 | Background | Multanen J, Ylinen J, Karjalainen T, Ikonen J, Hakkinen A, Repo JP. Structural validity of the Boston Carpal Tunnel Questionnaire and its short version, the 6-Item CTS symptoms scale: a Rasch analysis one year after surgery. BMC Musculoskelet Disord. 2020 Sep 12;21(1):609. doi: 10.1186/s12891-020-03626-2. |
| 3821791 | Background | Stevens JC. AAEE minimonograph #26: The electrodiagnosis of carpal tunnel syndrome. Muscle Nerve. 1987 Feb;10(2):99-113. doi: 10.1002/mus.880100202. |
| 30554264 | Background | Fisse AL, Pitarokoili K, Motte J, Gamber D, Kerasnoudis A, Gold R, Yoon MS. Nerve echogenicity and intranerve CSA variability in high-resolution nerve ultrasound (HRUS) in chronic inflammatory demyelinating polyneuropathy (CIDP). J Neurol. 2019 Feb;266(2):468-475. doi: 10.1007/s00415-018-9158-3. Epub 2018 Dec 15. |
| 29482409 | Background | Wolny T, Linek P. Reliability of two-point discrimination test in carpal tunnel syndrome patients. Physiother Theory Pract. 2019 Apr;35(4):348-354. doi: 10.1080/09593985.2018.1443358. Epub 2018 Feb 26. |
| 23512486 | Background | Kim JM, Kim MW, Ko YJ. Correlating ultrasound findings of carpal tunnel syndrome with nerve conduction studies. Muscle Nerve. 2013 Dec;48(6):905-10. doi: 10.1002/mus.23841. Epub 2013 Sep 11. |
| 25630774 | Background | Aboonq MS. Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh). 2015 Jan;20(1):4-9. |
| 25995565 | Background | Yucel H. Factors affecting symptoms and functionality of patients with carpal tunnel syndrome: a retrospective study. J Phys Ther Sci. 2015 Apr;27(4):1097-101. doi: 10.1589/jpts.27.1097. Epub 2015 Apr 30. |
| ID | Term |
|---|---|
| D002349 | Carpal Tunnel Syndrome |
| ID | Term |
|---|---|
| D020423 | Median Neuropathy |
| D020422 | Mononeuropathies |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
| D009408 | Nerve Compression Syndromes |
| D012090 | Cumulative Trauma Disorders |
| D013180 | Sprains and Strains |
| D014947 | Wounds and Injuries |
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| ID | Term |
|---|---|
| D000092184 | Nerve Conduction Studies |
| ID | Term |
|---|---|
| D003943 | Diagnostic Techniques, Neurological |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D004568 | Electrodiagnosis |
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