P-PN025. Peculiarities of differential diagnosis and treatment of upper limb tunnel neuropathies

Abstract

Introduction . It is well-known that numbness in hands is associated with peripheral nerves compression or “tunnel neuropathies” (TN). According to numerous authors, TN account for up to 40% of all neurological diseases. However, TN diagnosing in outpatients is practically uncommon. Methods . 597 cases of hand numbness were selected on analysis of 2495 outpatient records in two remote ambulatories during 2016-2017, with the share of TN being 0.7% of all initial diagnoses. 92 patients with mild to moderate TN symptoms were included in the study, and divided into main (n=50) and control (n=42) groups. Both groups received B vitamins and thioctic acid as baseline medications. Ipidacrine (Ipigrix by Grindex, Latvia) was added in the main group: 15 mg I.M. q.d. for a week and 20 mg p.o. q.d. for 3 more weeks. Thorough clinical and ENMG examinations were carried out before and after treatment. Results . All initial diagnoses were associated with cervical osteochondrosis, including radiculopathy, lacking any signs of its objectification. The Kruskal-Wallis test revealed sample homogeneity regardless of the diagnoses, and no statistically significant inter-group differences by clinical or ENMG markers of TN were originally detected. A 4-week follow-up analysis compared with the baseline results demonstrated that the control group had a positive trend, but no significant differences before and after treatment. Meanwhile, in the main group, additionally receiving ipidacrine, there was a statistically confirmed improvement of hypoesthesia, paresthesia, provocative test results, SNAP amplitudes and conduction time within carpal and pronator TN, as well as CMAPs in the cubital TN (p<0.05). Conclusion . The study describes typical “diagnostic masks” of TN, traditionally associated with osteochondrosis, the role of which in the occurrence of hand numbness is greatly exaggerated. Furthermore, the results suggest the efficacy of a short course of ipidacrine in the complex treatment of patients with mild and moderate TN.