AB0337 IS THE RADIAL DEVIATION ASSOCIATED WITH MEDIAN NERVE SWELLING IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Abstract

Background Rheumatoid arthritis (RA) and carpal tunnel syndrome (CTS) are known to be associated and also RA may lead to swelling of the median nerve without the presence of CTS. Objectives This study was conducted to test the hypothesis that one of the causes of this median nerve swelling may be radial deviation developing after wrist involvement of RA. Methods Of a total of 138 cases, 51 that met the inclusion criteria were included in the study. Electroneuromyography (ENMG) was performed on each patient and those with a CTS diagnosis were excluded from the study. Duruoz hand index, visual analog scale and painDETECT questionnaire was performed in clinical assesment. Radiographic measurements including radial inclination angle were performed with radiography. Using ultrasonography, the median nerve cross-sectional areas (CSAs) of the patients were measured from the four levels of the distal 1/3 of the forearm, radioulnar joint, pisiform bone and hook of hamate, and the ulnar nerve CSAs were measured from the pisiform bone. Results The study completed with 102 hands of 51 patients. 27% of these RA patients without clinical and electrophysiological findings were diagnosed as CTS by ultrasonography. A negative correlation was found between the radial inclination (RI) and the median CSAs measured from the radioulnar joint (R: - 0.49; p: 0.00), the pisiform bone (R: - 0.45; p: 0.00), and hook of hamate (R: - 0.60, p: 0.00). When the hands were divided into three groups according to the ranges of RI specified in the literature, the median nerve CSA was found to be significantly higher in the group with a low RI at these levels (p Conclusion The median nerve CSAs increased as the radial deviation increased in RA patients. The prevention of disease progression may prevent the increase in median nerve CSA by preventing deviations in patients with RA. And the development of CTS may also be prevented.