F28. Carpal tunnel syndrome in patients with and without diabetes mellitus in upper Egypt: The impact of electrophysiological and ultrasonographical studies

Abstract

Carpal tunnel syndrome (CTS) is the most common form of entrapment neuropathies. In addition, previous studies stated that diabetes mellitus (DM) is also considered as a risk factor with a higher incidence of CTS in patients with pre-diabetes. Nerve conduction studies alone do not provide spatial information regarding the nerve or its attendant abnormalities. US can detect the median nerve compression characteristics; provide anatomical images of the median nerve, neighboring structures and space occupying lesions as ganglia neural tumors. US has been used in clinical evaluation of CTS in diabetic neuropathy. The purpose of this study is to evaluate whether or not ultrasonographic findings of the median nerve is different between DM and non- DM-CTS patients. To correlate the diagnostic results in both DM and non-DM-CTS patients. Thirty-six non-diabetic patients and twenty-five diabetic patients with CTS were assessed. their ages ranged 23–82 years old (mean ± SD 35.01 ± 3.17 years. Pregnant women, those diabetic patients with clinical and electrophysiologic diagnosis of diabetic polyneuropathy, those with history of underlying disorders associated with CTS such as renal and hepatic diseases, patients with gout, rheumatoid arthritis or thyroid disease, patients with previous wrist surgery (including carpal tunnel injection), and those with clinical or electrophysiological evidence of accompanying condition that mimics CTS as cervical radiculopathy. A written consent was obtained from all participants and approval from the local ethics committee of Faculty of Medicine, Aswan and Assuit Universities was obtained All patients were subjected to thorough history taking, full clinical examination, electrophysiological assessment of wrists and gray scale ultrasonography. The diagnostic criteria of electrodiagnostic tests for CTS were according to Delisa et al. (1994). The median nerve was examined in the transverse and longitudinal planes along the carpal tunnel by gray scale US to investigate the presence of median nerve compression criteria, including the measurement of cross sectional area (CSA) and flattening ratio of median nerve. High mean cross sectional area of median nerve (CSA) on ultrasonographical studies was detected with non-significant difference between both groups. Additionally, a non-significant difference for flattening ratio was found between two groups.Moreover, there was a highly significant positive correlation between electro diagnostic and ultrasonographic results in diabetic patients. The CSA of median nerve is larger in CTS hands in both DM and non-DM patients. The electrodiagnostic parameters are not predictors of CTS in patients with diabetes.The combination of electrophysiological and ultrasonography provides diagnostic effective tools across the entire spectrum of CTS in diabetic and non-diabetic patients. Nevertheless, screening for DM in patients with CTS is not recommended.