Document Type : Original Article
Authors
Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: Since diabetic generalized neuropathy affects peripheral nerves, the diagnosis of carpal tunnel syndrome (CTS) with conventional electrodiagnostic techniques (EDX) [onset latency of median sensory nerve action potential (SNAP) or distal latency of median compound muscle action potential (CMAP)] is controversial. The aim of this study is to investigate the diagnostic values of two other techniques including inching method and second lumbrical-interossei test in patients with diabetic polyneuropathy (DPN) as well as signs or symptoms of CTS.
Methods: Fifteen patients (30 hands) with definite diagnosis of generalized peripheral neuropathy secondary to diabetes who developed signs and symptoms of CTS were participated. For diagnosis of CTS, sensory and motor median distal latencies were considered by nerve conduction study. In the next step, inching method and second lumbrical-interossei test were performed for all hands. Finally, sensitivity and specificity of two tests were calculated.
Results: Mean age of participants was 53.87 ± 11.53 years. The sensitivity and specificity of inching method in this study were 95.65% and 85.71%, respectively, and for the second lumbrical-interossei test, they were 73.91% and 71.42%, respectively.
Conclusion: Inching method was more sensitive and specific than second lumbrical-interossei test in diagnosis of CTS among patients with diabetic peripheral neuropathy. Moreover, the sensitivity of inching method was greater than specificity.
Keywords
- Amato AA, Dumitru D. Acquired neuropathies. In: Dumitru D, Amato AA, Zwarts M, editors. Elextrodiagnostic medicine. 2nd Boston: Hanley & Belfus; 2002. p. 937-1041.
- Bahrmann A, Zieschang T, Neumann T, Hein G, Oster P. Carpal tunnel syndrome in diabetes mellitus. Med Klin (Munich) 2010; 105(3): 150-4. [In Germany].
- Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: A review of the recent literature. Open Orthop J 2012; 6: 69-76.
- Craig A, Richardson JK, Ayyangar R. Rehabilitation of patients with neuropathies. In: Cifu DX, editor. Braddom's physical medicine and rehabilitation. 5th Philadelphia, PA: Elsevier/Saunders; 2015. p. 930-1.
- Nathan PA, Keniston RC, Meadows KD, Lockwood RS. Predictive value of nerve conduction measurements at the carpal tunnel. Muscle Nerve 1993; 16(12): 1377-82.
- Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997; 96(4): 211-7.
- Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011; 44(4): 597-607.
- 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.
- Zhao M, Burke D. Median neuropathy (Carpal tunnel syndrome). In: Frontra WR, Silver JK, Rizzo T. Essentials of physical medicine and Rehabilitation. 3rd. Philadelphia: Elsevier/Saunders; 2015. p. 174-9.
- England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, et al. Distal symmetric polyneuropathy: a definition for clinical research: Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005; 64(2): 199-207.
- Kimura J. The carpal tunnel syndrome: localization of conduction abnormalities within the distal segment of the median nerve. Brain 1979; 102(3): 619-35.
- Kimura J. Polyneuropatheis and mononeuropathies multiplex. In: Kimura J, editor. Electrodiagnosis in disease of nerve and muscle. 4th Oxford, UK: Oxford University Press; 2013. p. 662-4.
- Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am 1981; 63(3): 380-3.
- Werner RA. Evaluation of work-related carpal tunnel syndrome. J Occup Rehabil 2006; 16(2): 207-22.
- Cartwright MS, Walker FO, Blocker JN, Schulz MR, Arcury TA, Grzywacz JG, et al. The prevalence of carpal tunnel syndrome in Latino poultry-processing workers and other Latino manual workers. J Occup Environ Med 2012; 54(2): 198-201.
- Seror P. Comparative diagnostic sensitivities of orthodromic or antidromic sensory inching test in mild carpal tunnel syndrome. Arch Phys Med Rehabil 2000; 81(4): 442-6.
- Vogt T, Mika A, Thomke F, Hopf HC. Evaluation of carpal tunnel syndrome in patients with polyneuropathy. Muscle Nerve 1997; 20(2): 153-7.
- Ubogu EE, Benatar M. Electrodiagnostic criteria for carpal tunnel syndrome in axonal polyneuropathy. Muscle Nerve 2006; 33(6): 747-52.
- Yagci I, Gunduz OH, Sancak S, Agirman M, Mesci E, Akyuz G. Comparative electrophysiological techniques in the diagnosis of carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Res Clin Pract 2010; 88(2): 157-63.
- Ozben S, Acar H, Gunaydin S, Genc F, Ozer F, Ozben H. The second lumbrical-interosseous latency comparison in carpal tunnel syndrome. J Clin Neurophysiol 2012; 29(3): 263-7.