Yıl: 2018 Cilt: 4 Sayı: 1 Sayfa Aralığı: 35 - 41 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi

Öz:
Amaç: Çalışmamızın amacı karpal tünel sendromunda elektrodiyagnostik bulgular ile el fonksiyonları, semptomlar ve muayene bulguları arasındaki ilişkiyi değerlendirmektir. Ayrıca KTS tanısında kullanılan tinel, phalen ve ters phalen gibi provakatif testlerin tanısal değerini de saptamayı amaçladık. Gereç ve Yöntemler: Öykü, fi zik muayene ve median sinir duysal ve motor ileti hızlarının değerlendirilmesi sonucunda KTS tanısı konan 44 hastanın 79 eli ve 50 sağlıklı gönüllü değerlendirildi. Fizik muayenede tinel, phalen ve ters phalen testleri kullanıldı. Semptomların şiddeti "semptom şiddet skalası" ve el fonksiyonları ise "Boston karpal tünel anketi" ve "Duruöz el indeksi" ile değerlendirildi. Bulgular: Karpal tünel sendromunun elektrodiyagnostik şiddeti semptomların şiddeti, ağrı ve el kavrama güçleri ile korele bulunurken, el fonksiyonları ile korelasyon saptanmamıştır. Fonksiyonel durum, el ve başparmak kavrama gücünden etkilenmiştir. Tinel, phalen ve ters phalen testlerinin sensitiviteleri sırasıyla %62, %54.4 ve %57 bulunurken, spesifi teleri %92, %86 ve %88 olarak saptanmıştır. KTS'nin şiddeti ile provakatif testlerin pozitifl iği arasında ise korelasyon saptanmamıştır. Sonuç: KTS tanısında elektrofi zyolojik değerlendirmeler çok önemlidir. Ancak bu inceleme her yerde yapılamamakta ve değerlendirme için uzun hasta randevuları oluşmaktadır. Böyle durumlarda provakatif testler, semptomlar ve fonksiyonel düzeyin değerlendirilmesi KTS tanısı koymada oldukça değerlidir.
Anahtar Kelime:

Konular: Genel ve Dahili Tıp

The Effect of Electrodiagnostic Findings on Clinical and The Effect of Electrodiagnostic Findings on Clinical and Functional Status in Carpal Tunnel Syndrome Functional Status in Carpal Tunnel Syndrome

Öz:
Objective: The purpose of this study was to assess the relationship between electrodiagnostic fi ndings and hand functions, clinical severity and examination fi ndings of carpal tunnel syndrome (CTS). In addition, we aimed to determine the diagnostic value of provocative tests such as tinel, phalen and reverse phalen tests in the diagnosis of CTS. Material and Methods: We evaluated 79 wrists of 44 patients who were diagnosed as CTS on the basis of clinical history, physical examination and abnormalities of median nerve sensory and motor conduction velocities and 50 healthy volunteers. Physical evaluation included the tinel, phalen and reverse phalen tests. The clinical severity of CTS was scored in terms of a historic and objective scale and hand function was evaluated through the Boston carpal tunnel questionnaire and Duruoz Hand Index.Results: It was determined that the severity of CTS and the electrophysiological assessment was correlated with the severity of symptoms, pain and hand strength whereas it was not correlated with functional status. Functional status is affected by hand and pinch grip strength. Sensitivities of the tinel, phalen and reverse phalen tests were 62%, 54.4%, and 57% respectively, whereas their specifi cities were 92%, 86%, and 88% respectively in our study group. There was no association between CTS severity and the positivity of provocative tests.Conclusion: Electrophysiological evaluation is quite important for the diagnosis of CTS disease. However, this investigative method cannot be carried out everywhere and patient appointments to evaluate their condition are arranged for later times. In such situations, provocative tests, symptoms and functional status are important for the diagnosis.
Anahtar Kelime:

Konular: Genel ve Dahili Tıp
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Chang MH, Liu L, Lee YC, Wei SJ, Chiang HL, Hsieh PF. Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electrodiagnosis of carpal tunnel syndrome. Clin Neurophysiol 2006;117:984-91.
  • Padua L, Pazzaglia C, Caliandro P, Granata G, Foschini M, Briani C, et al. Carpal tunnel syndrome: Ultrasound, neurophysiology, clinical and patient-oriented assessment. Clin Neurophysiol 2008;119:2064-9.
  • Nora DB, Becker J, Ehlers JA, Gomes I. Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg 2004;107:64-9
  • Priganc VW, Henry SM. The relationship among fi ve common Carpal Tunnel Syndrome Tests and the Severity of Carpal Tunnel Syndrome. J Hand Ther 2003;16:225- 36.
  • Szabo RM, Slater RR Jr, Farver TB, Stanton DB, Sharman WK. The value of diagnostic testing in carpal tunnel syndrome. J Hand Surg Am 1999;24:704-14.
  • Makanji HS, Zhao M, Mudgal CS, Jupiter JB, Ring D. Correspondence between clinical presentation and electrophysiological testing for potential carpal tunnel syndrome. J Hand Surg Eur 2013;38:489-5.
  • Cevik DM. Karpal Tünel Sendromunda Klinik, Elektrodiagnostik ve Manyetik Rezonans Görüntüleme Bulgularının Karşılaştırılması. Thesis. Istanbul: 2006.
  • Gupta AD, Mahalanabis D . Study of hand function in a group of shoe factory workers engaged in repetitive work. J Occup Rehabil 2006;16:675-84.
  • Giannini F, Cioni R, Mondelli M, Padua R, Gregori B, D'Amico P, Padua L. A new clinical scale of carpal tunnel syndrome: Validation of the measurement and clinical- neurophysiological assessment. Clin Neurophysiol 2002;113:71-7.
  • Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993;75:1585-92.
  • Sezgin M, Incel NA, Serhan S, Camdeviren H, As I, Erdoğan 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;28:1281-5.
  • Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. Review BMC Musculoskelet Disord 2006;20:7-8.
  • Sambandam SN, Priyanka P, Gul A, Ilango B. Critical analysis of outcome measures used in the assessment of carpal tunnel syndrome. Int Orthop 2008;32:497-504.
  • Duruöz MT, Poiraudeau S, Fermanian J, Menkes CJ, Amor B, Dougados M, Revel M. Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol 1996;23:1167-72.
  • Sezer N, Yavuzer G, Sivrioglu K, Basaran P, Koseoglu BF. Clinimetric properties of the Duruoz hand index in patients with stroke. Arch Phys Med Rehabil 2007;88:309- 14.
  • Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter for carpal tunnel syndrome. Neurology 1993;43:2406-9.
  • Mondelli M, Passero S, Giannini F. Provocative tests in different stages of carpal tunnel syndrome. Clin Neurol Neurosurg 2001;103:178-83.
  • MacDermid JC, Doherty T. Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A narrative Review. J Orthop Sports Phys Ther 2004;34:565-88.
  • Jordan R, Carter T, Cummins C. A systematic review of the utility of electrodiagnostic testing in carpal tunnel syndrome. Br J Gen Pract 2002;52: 670-3.
  • You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity scales and nerve conduction measures in carpal tunnel syndrome. Muscle Nerve 1999;22:497501.
  • Katz JN, Larson MG, Sabra A, Krarup C, Stirrat CR, Sethi R, Eaton EM, Fossel AH, Liang MH. The carpal tunnel syndrome: diagnostic utility of the history and physical examination fi ndings. Ann Int Med 1990;112:321-7.
  • Mondelli M, Reale F, Sicurelli F, Padua L. Relationship between the self administrated Boston questionnaire and electrophysiological fi ndings in follow up of surgically treated carpal tunnel syndrome. J Hand Surg Br 2000;25:128-34.
  • Jarvik JG, Deyo RA. Imaging of lumbar intervertebral disk degeneration and aging, excluding disk herniations. Radiol Clin N Am 2000;8:1255-66.
  • Ortiz-Corredor F, Calambas N, Mendoza-Pulido C, Galeano J, Díaz-Ruíz J, Delgado O. Factor analysis of carpal tunnel syndrome questionnaire in relation to nerve conduction studies. Clin Neurophysiol 2011;122:2067-70.
  • de la Llave-Rincón AI, Fernández-de-Las-Peñas C, Pérez-de-Heredia-Torres M, Martínez-Perez A, Valenza MC, Pareja JA. Bilateral defi cits in fi ne motor control and pinch grip force are not associated with electrodiagnostic fi ndings in women with carpal tunnel syndrome. Am J Phys Med Rehabil 2011;90:443-51.
  • Itsubo T, Uchiyama S, Momose T, Yasutomi T, Imaeda T, Kato H. Electrophysiological responsiveness and quality of life (QuickDASH, CTSI) evaluation of surgically treated carpal tunnel syndrome. J Orthop Sci 2009;14:17- 23.
  • Lang E, Claus D, Neundörfer B, Handwerker HO. Parameters of thick and thin nerve-fi ber functions as predictors of pain in carpal tunnel syndrome. Pain 1995;60:295-302.
  • Wiesman IM, Novak CB, Mackinnon SE, Winograd JM. Sensitivity and specifi city of clinical testing for carpal tunnel syndrome. Can J Plast Surg 2003;11(2):70-2.
  • Ghavanini MR, Haghighat M. Carpal tunnel syndrome: Reappraisal of fi ve clinical tests. Electromyogr Clin Neurophysiol 1998;38:437-4.
  • Homan MM, Franzblau A, Werner RA, Albers JW, Armstrong TJ, Bromberg MB. Agreement between symptom surveys, physical examination procedures and electrodiagnostic fi ndings for the carpal tunnel syndrome. Scand J Work Environ Health 1999;25:115-24.
  • Novak CB, Mackinnon SE, Brownlee R, Kelly L. Provocative sensory testing in carpal tunnel syndrome. J Hand Surg Br 1992;17:204-8.
  • Buchberger W, Schon G, Strasser K, Jungwirth W. High- resolution ultrasonography of carpal tunnel. J Ultrasound 1991;10:531-7.
  • Deryani E, Aki S, Muslumanoglu L, Rozanes I. MR imaging and electrophysiological evaluation in carpal tunnel syndrome. Yonsei Med J 2003;44:27-32.
APA TAŞÇI BOZBAŞ G, UNUBOL İYİYAPICI A, ŞENDUR Ö, gurer g (2018). Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. , 35 - 41.
Chicago TAŞÇI BOZBAŞ GÜLNUR,UNUBOL İYİYAPICI Ayşe,ŞENDUR Ömer Faruk,gurer gülcan Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. (2018): 35 - 41.
MLA TAŞÇI BOZBAŞ GÜLNUR,UNUBOL İYİYAPICI Ayşe,ŞENDUR Ömer Faruk,gurer gülcan Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. , 2018, ss.35 - 41.
AMA TAŞÇI BOZBAŞ G,UNUBOL İYİYAPICI A,ŞENDUR Ö,gurer g Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. . 2018; 35 - 41.
Vancouver TAŞÇI BOZBAŞ G,UNUBOL İYİYAPICI A,ŞENDUR Ö,gurer g Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. . 2018; 35 - 41.
IEEE TAŞÇI BOZBAŞ G,UNUBOL İYİYAPICI A,ŞENDUR Ö,gurer g "Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi." , ss.35 - 41, 2018.
ISNAD TAŞÇI BOZBAŞ, GÜLNUR vd. "Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi". (2018), 35-41.
APA TAŞÇI BOZBAŞ G, UNUBOL İYİYAPICI A, ŞENDUR Ö, gurer g (2018). Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. Akdeniz Tıp Dergisi, 4(1), 35 - 41.
Chicago TAŞÇI BOZBAŞ GÜLNUR,UNUBOL İYİYAPICI Ayşe,ŞENDUR Ömer Faruk,gurer gülcan Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. Akdeniz Tıp Dergisi 4, no.1 (2018): 35 - 41.
MLA TAŞÇI BOZBAŞ GÜLNUR,UNUBOL İYİYAPICI Ayşe,ŞENDUR Ömer Faruk,gurer gülcan Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. Akdeniz Tıp Dergisi, vol.4, no.1, 2018, ss.35 - 41.
AMA TAŞÇI BOZBAŞ G,UNUBOL İYİYAPICI A,ŞENDUR Ö,gurer g Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. Akdeniz Tıp Dergisi. 2018; 4(1): 35 - 41.
Vancouver TAŞÇI BOZBAŞ G,UNUBOL İYİYAPICI A,ŞENDUR Ö,gurer g Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi. Akdeniz Tıp Dergisi. 2018; 4(1): 35 - 41.
IEEE TAŞÇI BOZBAŞ G,UNUBOL İYİYAPICI A,ŞENDUR Ö,gurer g "Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi." Akdeniz Tıp Dergisi, 4, ss.35 - 41, 2018.
ISNAD TAŞÇI BOZBAŞ, GÜLNUR vd. "Karpal Tünel Sendromunda Elektrodiagnostik Bulguların Klinik ve Fonksiyonel Durum Üzerine Etkisi". Akdeniz Tıp Dergisi 4/1 (2018), 35-41.