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.
Study Type
OBSERVATIONAL
Enrollment
84
Upper extremity nerve conduction studies including median-ulnar sensory and motor responses
Median nerve sonographic cross-sectional area and echogenicity measurements
tactile sensory tests
Sultan Abdülhamit Han Trainin and Educational Hospital
Üsküdar, İ̇stanbul, Turkey (Türkiye)
RECRUITINGmedian nerve ultrasound
Median nerve maximum cross-sectional area measurement at the level of the carpal tunnel (mm²)
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: 3 months
median nerve ultrasound
Median nerve echogenicity at the level of the carpal tunnel (%)
Time frame: 3 months
median nerve ultrasound
Median nerve cross-sectional area measurement at the level of the carpal tunnel inlet (mm²)
Time frame: 3 months
median nerve ultrasound
Median nerve cross-sectional area measurement at the level of the carpal tunnel outlet (mm²)
Time frame: 3 months
median nerve ultrasound
Median nerve cross-sectional area measurement at the level of the pronator quadratus (mm²)
Time frame: 3 months
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.
Time frame: 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.
Time frame: 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.
Time frame: 3 months
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