Abstract
Aims: To investigate the arm and hand function in hemodialysis patients.Methods: Upper limb function using validated questionnaires such as Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Cochin and Boston were applied to 57 chronic renal failure patients on hemodialysis and 60 healthy controls. Epidemiological data, data on pain and paresthesia in the upper limb and handgrip strength were obtained.Results: The three questionnaires showed worse performance of upper limb function in chronic renal failure patients than controls: DASH questionnaire with P = 0.05; Cochin questionnaire with P = 0.0004 and Boston questionnaire with P = 0.03. The questionnaire scores were affected by presence of pain (P = 0.05 for DASH and < 0.0001 for Boston questionnaires) and paresthesia (DASH with P = 0.003; Cochin with P = 0.01 and Boston questionnaire with P < 0.0001). Handgripstrength was lower in hemodialysis patients when compared with controls (P = 0.02) but did not affect the performance of any of the studied questionnaires.Conclusions: Upper limb function is impaired in hemodialysis patients and the main associations found were with pain and paresthesia.
Highlights
Good function of the arms and hands is essential to accomplish tasks that are necessary for daily living
Local factors, such as the arteriovenous (A-V) fistula required for the hemodialysis procedures, may cause musculoskeletal [6] and neuronal ischemia [7] by modifications in the local blood flow and promote limb edema favoring the appearance of carpal tunnel syndrome
6/17 (35.2%) of patients with paresthesia or 6/57 (1.0%) of the whole sample of patients in hemodialysis described the symptoms in the median nerve pathway
Summary
Good function of the arms and hands is essential to accomplish tasks that are necessary for daily living. Several factors may contribute to this loss of function. Sarcopenia with consequent muscle weakness [2,3,4], uremic polyneuropathy [5] and electrolyte imbalance [4] are common in patients with renal failure. Local factors, such as the arteriovenous (A-V) fistula required for the hemodialysis procedures, may cause musculoskeletal [6] and neuronal ischemia [7] by modifications in the local blood flow and promote limb edema favoring the appearance of carpal tunnel syndrome. Amyloidosis by ß-2 microglobulin deposition in tendons, carpal tunnel, bone and joints causes pain and inflammation leading to musculoskeletal dysfunction [8]
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