Carpal Tunnel Syndrome Group Research Articles

Comparison of Magnetic Resonance Imaging and Ultrasonography in Diagnosing and Grading Carpal Tunnel Syndrome: A Prospective Study

ObjectiveTo use anatomic measurements on magnetic resonance imaging (MRI) and ultrasonography (USG) in diagnosing and grading carpal tunnel syndrome (CTS) using nerve conduction studies (NCS) as the gold standard. Material and methodsIn this prospective study, 26 patients with CTS (45 wrists; 22 female and 4 male patients; mean ± SD age of 49.42 + 14.47 years) and 19 age and sex matched healthy volunteers (32 wrists; 15 female and 4 male volunteers, mean ± SD age of 42.52 + 10.85 years) underwent MRI and USG. Cross-sectional area (CA) of median nerve was measured using free hand ROI at four levels: hamate hook (H0), pisiform bone (PI0), 1 cm proximal (PI1) and 2 cm proximal to PI0 (PI2). Relative median nerve signal intensity (MNSI) was calculated as ratio of median nerve signal intensity with hypothenar muscle signal intensity. Flexor retinacular bowing was calculated at hamate hook level. Echogenicity and Power Doppler vascularity of median nerve were assessed on USG. Independent t-test, chi square test and receiver operating characteristic curve analysis were used as appropriate. ResultsOn USG, CA measured at PI0 (95% confidence interval of 0.872-0.987) and retinacular bowing (0.816-0.912), while, on MRI, CA at PI1 (0.874-0.997) were most useful in diagnosing CTS based on the ROC and Zombie plot analysis. Area under curves for CA measurements on USG and MRI were not significantly different. CA at PI1 on MRI (0.752-0.965) was significantly different between minimal to moderate CTS and severe to extreme CTS groups (on NCS). ConclusionCA of median nerve is the most useful parameter to diagnose and grade CTS and USG and MRI are comparable for measurements. Increased retinacular bowing on USG and hypoechogenicity of median nerve increase the diagnostic confidence while MRI helps in picking up important associated conditions.

Reliability of ultrasound speckle tracking with singular value decomposition for quantifying displacement in the carpal tunnel

Inhibited movement patterns of carpal tunnel structures have been found in carpal tunnel syndrome (CTS) patients. Motion analysis on ultrasound images allows us to non-invasively study the (relative) movement of carpal tunnel structures and recently a speckle tracking method using singular value decomposition (SVD) has been proposed to optimize this tracking. This study aims to assess the reliability of longitudinal speckle tracking with SVD in both healthy volunteers and patients with CTS.Images from sixteen healthy volunteers and twenty-two CTS patients were used. Ultrasound clips of the third superficial flexor tendon and surrounding subsynovial connective tissue (SSCT) were acquired during finger flexion-extension. A custom made tracking algorithm was used for the analysis. Intra-class correlation coefficients (ICCs) were calculated using a single measure, two-way random model with absolute agreement and Bland-Altman plots were added for graphical representation.ICC values varied between 0.73 and 0.95 in the control group and 0.66–0.98 in the CTS patients, with the majority of the results classified as good to excellent. Tendon tracking showed higher reliability values compared to the SSCT, but values between the control and CTS groups were comparable.Speckle tracking with SVD can reliably be used to analyze longitudinal movement of anatomical structures with different sizes and compositions within the context of the carpal tunnel in both a healthy as well as a pathological state. Based on these results, this technique also holds relevant potential for areas where ultrasound based dynamic imaging requires quantification of motion.

Study of Wrist Ratio and Wrist-to-Palm Index Radio in Individuals Suffering from Carpal Tunnel Syndrome.

Background:Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy, with preponderance in females.Aims and Objective:The aim of the present study was to find out wrist ratio (WR) and wrist/palm ratio (WPR) in clinically diagnosed patients of CTS.Methodology:One hundred individuals (fifty patients of CTS and fifty as control group) aged between 30 and 50 years were recruited for the study. Early confirmation of clinically suspected patients of CTS was done by performing electrodiagnostic tests of median and ulnar nerves. Motor and sensory conduction velocities, distal motor and sensory latencies, and F-wave latencies were performed in the recruited volunteers.Results:The values for mean wrist ratio in control groups were 0.694, 0.703 respectively, and in patients with carpal tunnel syndrome, it was 0.704 and 0.719 respectively in moderate and severe type. The mean wrist to palm ratio (WPR) in control group was 0.371, while in patients with CTS, it was 0.374, 0.382, 0.387, and 0.401 based on progression of severity. Both were statistically significant for the last two groups (wrist to index finger [WIF] >4.4 m/s, moderate, and WIF nonrecordable, severe). Statistically significant (P < 0.001) decrease of motor conduction velocities for median nerve was seen in the CTS group as compared to control group. Statistically significant (P < 0.001) increase in distal motor and sensory latencies was observed for both median and ulnar nerves in CTS group with more increase in distal motor latency than sensory latency. Increase in F-wave latencies of both nerves was seen in CTS group.Conclusion:The study results confirm selective slowing of sensory and motor conduction within wrist-to-palm segment in patients of CTS. Both WR and WPR have a progressive correlation with the severity of CTS, but statistically significant changes were seen in the groups with moderate and severe CTS. Thus, WR/WPR can act as one of the essential parameters in the diagnosis of CTS with moderate-to-severe CTS.

Terminal Latency Index, Residual Latency, and Median-Ulnar F-Wave Latency Difference in Carpal Tunnel Syndrome.

Introduction:Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, but no electrodiagnostic test alone shows sufficient sensitivity for CTS. We aimed to investigate the value of median motor terminal latency index (mTLI), median motor residual latency (mRL), and median-ulnar F-wave latency difference (FdifMU) as additional tests to nerve conduction studies which are performed traditionally in electromyography laboratories.Methods:This is a retrospective study. The results of electrodiagnostic studies performed on patients with CTS were examined. We divided the enrolled hands of the patients diagnosed with CTS into two groups: affected hands with abnormal electroneuromyographic parameters indicating CTS diagnosis (CTS group) and hands with normal electroneuromyographic parameters (control group). Then, we analyzed the results of these completed electrodiagnostic studies.Results:A total of 320 hands of 160 patients were studied. FdifMU and mRL were found to be significantly higher in CTS group compared with the control group (P < 0.001). mTLIs were found to be significantly higher in control group compared with the CTS group (P < 0.001). Given that, the area under the curve is more than 70% for mTLI and mRL, but not for FdifMU.Conclusion:When combined with mMDL, both mTLI and mRL have excellent specificity for the diagnosis of mild and moderate CTS. However, the sensitivities for both parameters were lower. In suspected patients, FdifMU can be an additional tool for the diagnosis of CTS also, but alone it is not valuable.

A new method of measuring the thumb pronation and palmar abduction angles during opposition movement using a three-axis gyroscope

BackgroundThumb opposition is vital for hand function and involves pronation and palmar abduction. The improvement of pronation is often used as one of the evaluation items of the opponensplasty method for severe carpal tunnel syndrome. However, most of the studies used substitution evaluation methods for measurement of the pronation angle. Thus, there is still no appropriate method for measuring thumb pronation angle accurately in carpal tunnel syndrome patients.In recent reports, a wearable gyroscope was used to evaluate upper extremity motions and it can be possibly used for accurate measurement of the thumb pronation angle along the three-dimensionally moving bone axis.Thus, we investigated the reliability of measuring thumb pronation using a gyroscope and evaluated whether this method can be used to detect opposition impairment.MethodsThe participants were volunteers with unaffected upper limbs (32 hands) and patients with carpal tunnel syndrome (27 hands). The pronation and palmar abduction angles during opposition movements were measured using a three-axis gyroscope that included a three-axis accelerometer. The gyroscope was fixed onto the first metacarpal bone and the thumb phalanx.ResultsThe pronation and palmar abduction angles of the metacarpal bone and the palmar abduction angles of the phalanx significantly decreased in the carpal tunnel syndrome group. The pronation angle of the metacarpal bone during opposition movement peaked later than the palmar abduction angle in all hands.ConclusionsWe were able to measure the thumb pronation and palmar abduction angles using the three-axis gyroscope, and this tool was able to detect impairments of thumb opposition due to carpal tunnel syndrome. This could be a tool for measuring thumb and finger angles and for detecting impairments caused by various diseases.

Correlation between serum 25-hydroxyvitamin D3 and carpal tunnel syndrome in type 2 diabetes

Objective To investigate the relationship between serum 25-OH vitamin D3(25-OHD3)levels and carpal tunnel syndrome(CTS)in type 2 diabetes. Methods Data from 102 patients with type 2 diabetes were collected, and patients were divided into a CTS group(n=29)and a non-CTS group(n=73)according to clinical symptoms, signs, and electrophysiological testing.Fasting venous blood was collected to assay serum 25-OHD3 levels that were compared between the two groups.The correlation between 25-OHD3 and clinical parameters for type 2 diabetes was analyzed. Results The incidence of vitamin D3 deficiency was 65.5%(n=19)in the CTS group and 46.6%(n=34)in the non-CTS group, and the difference was statistically significant(χ2=16.85, P<0.01). Levels of 25-OHD3 were lower in the CTS group(14.13±4.91)μg/L than in the non-CTS group(17.08±3.35)μg/L(t=4.067, P<0.01). Levels of 25-OHD3 were negatively correlated with those of glycosylated hemoglobin(HbA1c)(r=-0.176, P=0.041)and the duration of diabetes(r=-0.29, P=0.01). Conclusions Low 25-OHD3 is a risk factor for carpal tunnel syndrome in type 2 diabetes and is negatively associated with the duration of diabetes and HbA1c in patients with type 2 diabetes. Key words: Diabetes mellitus, type 2; Vitamin D; Carpal tunnel syndrome

Multicentre cross-sectional study for bone-articular lesions associated with dialysis related amyloidosis in Japan.

Dialysis-related amyloidosis (DRA) exhibits multiple bone-articular lesions, such as carpal tunnel syndrome (CTS), trigger finger (TF), spinal canal stenosis (SCS), destructive spondyloarthropathy (DSA), bone cysts, and joint pains. DRA leads to a decrease in activities of daily living (ADL). We investigated the initiation of CTS and TF, and evaluated the relationship between walking disturbances and bone-articular lesions or joint pains. A multicentre cross-sectional study was performed. Eighty-two patients with clinical DRA from 20 hospitals in Japan were evaluated. Of the 82 patients, the first symptom of DRA was CTS in 39 patients (47.6%) and TF in 21 (25.6%). The mean new-onset vintages of 21 earlier cases in the CTS and TF groups were 86.1 ± 36.3 and 133.2 ± 56.4 (mean ± SD) months, respectively (P = 0.0091). The development of SCS and DSA appeared to be later than CTS and TF. Multiple regression analysis revealed that knee joint pain was a significant contributor to walking disturbances. Carpal tunnel syndrome appeared significantly earlier than TF since the initiation of dialysis. In the advanced phase, knee joint pain was a major cause of decreased ADL in patients with clinical DRA.

High wrist ratio is a risk factor for carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common upper extremity entrapment neuropathy and various risk factors have been implicated in the etiology. In this study, we aimed to determine whether anthropometric measurements are independent risk factors for CTS. Patients with symptoms of CTS (n = 27) and asymptomatic controls (n = 27) were enrolled following electrophysiological confirmation. Body mass index (BMI) was recorded and anthropometric measurements of the hand were made by a digital caliper. BMI, wrist width, wrist depth, palm length, hand width, wrist ratio, wrist/palm ratio, and wrist/hand ratio were significantly higher in the CTS group. BMI, wrist ratio, wrist/palm ratio, and wrist/hand ratio were independent variables in the logistic regression analysis; wrist ratio was the only significant predictor of CTS. Patients with a wrist ratio higher than 0.69 were 8.2 times more likely to have CTS. This study suggests that wrist ratio may be considered as an independent risk factor for CTS. Clin. Anat. 31:698-701, 2018. © 2018 Wiley Periodicals, Inc.

Usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome

ObjectiveThe aim of the study was to assess the usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome (CTS) and to determine the relationships of ultrasonographic measurements with the clinical severity and the electrophysiological grading scale.Patients and methodsOne hundred CTS diseased hands and 100 nondiseased hands were assessed clinically and by nerve conduction studies. We measured ultrasonographic cross-sectional area (CSA) of the median nerve at various levels of the carpal canal (inlet and outlet), flattening ratio (FR), palmar bowing of the flexor retinaculum, wrist/ forearm ratio, as well as median nerve mobility and power doppler signals. Data from patients and controls were compared to determine the diagnostic relations and the grade of severity.ResultsMeasures of CSA of the median nerve at the inlet and at the outlet, palmer bowing and inlet/forearm ratio in the CTS group were significantly higher than the control group (P<0.05); 50% of diseased hands showed restriction of mobility of the median nerve, while 31% had doppler signals. Positive correlations of ultrasonographic measurements with patient-oriented measures, clinical severity scale and electrophysiological grade were observed.ConclusionUltrasonographic measurements of CSA at the inlet and flexor retinaculum have a relatively higher diagnostic accuracy than FR for CTS. The correlation between clinical scores, historical-objective-distribution scale, electrophysiological grade and ultrasonographic measurements reflects the usefulness of neuromuscular ultrasound in the diagnosis of idiopathic CTS.

Muscle echogenicity ratio can indicate severity of carpal tunnel syndrome.

The purpose of this study was to investigate the usefulness of the echogenicity (EI) ratio of the thenar to hypothenar muscle measured using ultrasonography in assessing the severity of carpal tunnel syndrome (CTS). Fifty-nine hands of 30 patients electrodiagnostically confirmed as having CTS were classified into 3 subgroups (mild, moderate, and severe). The EI of the thenar and hypothenar muscles was measured with ultrasonography, and the EI ratio was calculated in the patients and 13 normal participants (26 hands). The average EI ratio was higher in the CTS group than in the control group. We also found a positive correlation between the severity of CTS and a high EI ratio measured with ultrasonography. The EI ratio of the thenar to hypothenar muscle is a useful parameter that can indicate the severity of CTS. Muscle Nerve 58: 304-306, 2018.

Usefulness of ultrasound assessment of median nerve mobility in carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common peripheral compression neuropathy of the upper extremity. Recently, dynamic ultrasound (US) imaging has shown differences in median nerve mobility between the affected and unaffected sides in CTS. The present study was performed to compare the median nerve mobility between patients with CTS and healthy individuals, and to correlate median nerve mobility with the severity of CTS. A total of 101 patients (128 wrists) with CTS and 43 healthy individuals (70 wrists) were evaluated. Electrodiagnostic studies were initially conducted to determine the neurophysiological grading scale (NGS). The cross-sectional area (CSA) of the median nerve and the grade of median nerve mobility were measured using US. The mean grade of median nerve mobility in the CTS group (1.9) was significantly lower than that in the control group (2.6; P < 0.001). There were significant negative correlations between the grade of median nerve mobility and distal motor latency of the median nerve (r = -0.218, P = 0.015), NGS (r = -0.207, P = 0.020) and CSA of the median nerve (r = -0.196, P = 0.028). The grade of median nerve mobility was negatively correlated with the severity of CTS. US assessment of median nerve mobility may be useful in diagnosing and determining the severity of CTS.

Influence of the thickness of the transverse carpal ligament in carpal tunnel syndrome

ObjectiveTo determine if the thickness of the transverse carpal ligament measured by T2 axial magnetic resonance imaging actually influences the onset of carpal tunnel syndrome. Material and method94 patients between January 2015 and June 2016, of whom 28 had carpal tunnel syndrome, underwent magnetic resonance imaging, 37 with discomfort in different carpus regions without symptoms of carpal tunnel and 29 healthy subjects. Two observers performed 3 measurements in 3 different levels, and in the 3 groups of patients. ResultsNo statistically significant differences in transverse carpal ligament thickness measurements between the carpal tunnel syndrome group and the group without carpal tunnel involvement became apparent, but statistical differences between the control group and the carpal tunnel syndrome group, and between the control group and the group without involvement of the carpal tunnel were observed. In both these groups, the thickness of the transverse ligament was higher than in the control group. DiscussionAn increase in the thickness of the transverse ligament in was found in this study in subjects with involvement of carpal tunnel syndrome as evidenced by numerous studies in the literature. There is no certain causative factor, but rather a set of facts that make onset of the syndrome possible in a specific group of patients. ConclusionCarpal tunnel syndrome is multifactorial. The thickness of the transverse ligament does not directly affect the onset of symptoms.

The efficiency of acoustic radiation force impulse (ARFI) elastography in the diagnosis and staging of carpal tunnel syndrome.

The aim of the present study was to quantify the stiffness of the median nerve (MN) at the carpal tunnel inlet by acoustic radiation force impulse (ARFI) elastography and to evaluate whether ARFI can be used in diagnosis and staging of carpal tunnel syndrome (CTS). Sonographic examinations of 96 wrists in 50 patients were included in the study. The cross-sectional area and stiffness of the MN were quantitatively measured by B-mode ultrasonography (USG) and ARFI. The findings of CTS were assigned to four groups: (I) normal (n=21), (II) mild (n=39), (III) moderate (n=38), and (IV) severe (n=19). The differences between CTS patients and controls and the differences in electrodiagnostic tests among subgroups were statistically compared. ROC analysis was performed to determine the cut-off values between subgroups. Bilateral CTS was present in 46 patients (92 wrists) and unilateral CTS in four patients. Of the 96 nerves in the 50 symptomatic "idiopathic CTS" patients (48 women, 2 men; mean age 45.9years, range 23-73years), 39 (40.4%) were mild, 38 (39.8%) were moderate, and 19 (19.8%) were severely affected. When compared to controls, MN stiffness was significantly higher in the CTS group (P<0.001); furthermore, it was higher in the severe or extreme severity group than the mild or moderate severity group (P<0.001). A 3.250m/s cut-off value on ARFI revealed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81, 82, 95.1, 50, and 82%, respectively. The MN stiffness measured by ARFI elastography is significantly higher in patients with CTS then in controls. ARFI elastography appears to be a highly efficient imaging modality for the diagnosis and staging of these patients.

Can decrease in hand grip strength in carpal tunnel syndrome be explained by interosseous muscle and intermetacarpal space dimensions?

Objectives. To investigate the correlation of the grip strength with sonographic measurement of interosseous muscle (IOM) and intermetacarpal space (IMS) of the hands in carpal tunnel syndrome (CTS) patients. Methods. A total of 96 hands of 48 female patients constituted the study group. Of those, 36 hands of 18 patients (mean age: 50.2 ± 9 years) had CTS confirmed by electro-diagnostic tests. Sixty hands of 30 healthy volunteers (mean age: 45.2 ± 9.7 years) constituted the control group. Grip strength was assessed by Jamar hand dynamometer. IOM and IMS dimensions for all hands were measured sonographically at three levels (2 nd , 3 rd and 4 th intermetacarpal; palmar side for IMS, dorsal side for IOM) by the same radiologist. Spearman and Mann Whitney U tests were used for statistical analysis. Results. The median hand grip strength was determined as 11.3 kg (min-max = 7.2-18.1 kg) in the CTS group and 19.5 kg (min-max = 7.8-30.5 kg) in the control group, with a statistical difference between the two groups ( p < 0.03). In both groups, there was a positive correlation between the IOM-IMS dimensions and grip strength ( p < 0.05). Sonographically, IOM-IMS measurements in CTS group were significantly lower than control group ( p < 0.01). Conclusion. To our knowledge, this is the first study evaluating the correlation of grip strength and the sonographic IOM-IMS measurements in CTS patients. The muscular atrophy, which is generally a finding of advanced disease, may be revealed by sonographical measurements earlier than the physical examination findings.

Influencia del espesor del ligamento transverso del carpo en el síndrome del túnel carpiano

ObjectiveTo determine if the thickness of the transverse carpal ligament measured by T2 axial magnetic resonance imaging actually influences the onset of carpal tunnel syndrome. Material and method94 patients between January 2015 and June 2016, of whom 28 had carpal tunnel syndrome, underwent magnetic resonance imaging, 37 with discomfort in different carpus regions without symptoms of carpal tunnel and 29 healthy subjects. Two observers performed 3 measurements in 3 different levels, and in the 3 groups of patients. ResultsNo statistically significant differences in transverse carpal ligament thickness measurements between the carpal tunnel syndrome group and the group without carpal tunnel involvement became apparent, but statistical differences between the control group and the carpal tunnel syndrome group, and between the control group and the group without involvement of the carpal tunnel were observed. In both these groups, the thickness of the transverse ligament was higher than in the control group. DiscussionAn increase in the thickness of the transverse ligament in was found in this study in subjects with involvement of carpal tunnel syndrome as evidenced by numerous studies in the literature. There is no certain causative factor, but rather a set of facts that make onset of the syndrome possible in a specific group of patients. ConclusionCarpal tunnel syndrome is multifactorial. The thickness of the transverse ligament does not directly affect the onset of symptoms.

Increased stiffness of median nerve in systemic sclerosis

BackgroundSystemic sclerosis can affect peripheral nerves, but the extent and the nature of this involvement are not well defined. The aim of this study is to compare the sonoelastrographic measurements of median nerves in systemic sclerosis (SSC), idiopathic carpal tunnel syndrome (CTS) and healthy individuals.MethodsThe clinical, electrophysiological and ultrasonographic assessments were done. Patients with SSC and CTS were assessed with nerve conduction studies. The measurements of cross sectional areas (CSA) were performed at psiform and forearm level from axial US images. The elastic ratio is the ratio of strain distribution in two selected region of interests (ROI) done via comparing the median nerve to flexor digitorum superfcialis tendon. The ROIs were fixed to 2 mm.ResultsThe study was completed with 47 hands of 24 patients with SSC, 53 hands of 27 patients with CTS and 38 hands of health controls. The CSA of CTS group was significantly higher than systemic sclerosis and control groups. The elastic ratio at psiform level and forearm levels of systemic sclerosis group were significantly higher than the CTS and control groups.ConclusionMedian nerves lose the elasticity while the CSA’s are in the normal range in patients with SSC. These results suggested that the increased peripheral nerve involvement in SSC is about the increased stiffness of the nerves.

Can we use thermal imaging to evaluate the effects of carpal tunnel syndrome surgical decompression?

Research is intended to verify if thermal imaging can be used in diagnosing and monitoring the carpal tunnel syndrome (CTS).This disease is not easy to diagnose using traditional methods. Also, the difficulties in monitoring carpal tunnel surgery effects necessitate new, noninvasive method, which gives more information.The research group consists of 15 patients with CTS and control group of healthy people. All patients who were examined before surgery were also tested 4 weeks after surgery, to check the effects of treatment. In addition a lot of our patients had or will have open carpel tunnel release surgery. Diagnosis of CTS was performed by thermal imaging in both hands from phalanges to the area of the wrist on the external and palmar side of the palm.Using infrared (IR) camera one can observe high temperature gradient on hand-tested areas and these differences prove the diagnosis. Moreover patients after surgery have better temperature distribution and it was closer to control group. Results prove that surgery is the best, and currently, the only method to treat CTS.Thermal imaging may be helpful in diagnosing CTS.

Ultrasound carpal tunnel syndrome: additional criteria for diagnosis

To define the usefulness of the cross-sectional area (CSA) of the median nerve distal to the carpal tunnel in addition to other established common parameters in the diagnosis of carpal tunnel syndrome (CTS). Forty-four wrists from 24 symptomatic CTS patients and 32 wrists from 17 asymptomatic volunteers were evaluated by ultrasound. The CSA of the median nerve was measured at four pre-selected levels, i.e., proximal, inlet, outlet, and distal to the carpal tunnel. The flattening ratio, intraneural vascularity, neural fasciculation, and retinacular palmar bowing were also assessed. Significant differences were found between the CTS and control groups for median nerve CSA proximal and distal (p<0.001) to the tunnel as well as retinacular bowing (p<0.001). Using the receiver operating characteristic (ROC) curve, the sensitivity, specificity, and accuracy of using a cut-off of >14mm2 of CSA proximal and distal to the tunnel were 75%, 87.5%, 86.8% and 63.6%, 100%, 78.9%, respectively. Using either CSA proximal or distal to the tunnel or bowing retinaculum at the outlet >1mm yielded a sensitivity, specificity, and accuracy of 100%, 84.3% and 93.4%, respectively. The median nerve CSA proximal and distal to the carpal tunnel and bowing of the retinaculum at the outlet are helpful in diagnosis of CTS.

P335 Comparison of median nerve distal motor responses in patients with chronic inflammatory demyelinating polyneuropathy and carpal tunnel syndrome

Objective Dispersion of distal compound muscle action potential (CMAP) is a useful finding for showing demyelination. In this study, we aimed to compare the duration and area of CMAP of median nerve between cases with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and Carpal Tunnel Syndrome (CTS). Material and methods Ninety-two participants (thirty patients with CDIP, 32 patients with CTS and 30 participants of normal control group) who were evaluated. The CMAP duration was measured from the onset of the initial negative potential to the terminal negative deflection back to baseline. The CMAP area calculation was performed by computerized EMG machine. Results A significant difference was not found between groups as for mean age of the groups, and distribution of genders (CIDP: 52,73 ± 12,34 years, 18 (%40) women, 12 (%60) men; CTS: 52,38 ± 11,83 years, 25 (%78,1) women, 7 (%21,9) men; control: 48,5 ± 14,41 years,22 (%79,3) women, and 8 (%26,7) men). The mean CMAP duration of patients with CIDP was significantly higher than patients with CTS (p: 0.003) and control group (p: 0.001), however there was not any significant difference between the patients with CTS and control group (p > 0.05). The mean CMAP area of patients with CIDP was significantly lower than patients with CTS (p: 0.003) and control group (p: 0.001), however there was not any significant difference between the patients with CTS and control group (p > 0.05). Conclusion These findings suggest that the duration and area of distal CMAP is a useful parameter for the differentiation of patients with CIDPand CTS.

P349 Assessment of prevalence and risk factors for carpal tunnel syndrome in polio survivors

Objective Carpal tunnel syndrome (CTS) is a commonly reported nerve entrapment syndrome in patients with chronic physical disabilities. It causes disability independent of underlying disease. In this study, we aimed to identify prevalence and risk factors for CTS in polio survivors. Methods Based on clinical and electrophysiological findings, 46 patients with prior paralytic poliomyelitis were selected from patients referred to clinical neurophysiology laboratory. The CTS was classified according to the severity of nerve conduction (NC) changes. Demographic factors, medical history, crutch or cane use, post-polio syndrome,body mass index (BMI), wrist index and Barthel index were compared between the polio survivors with CTS (CTS group) and without CTS (non-CTS group). A logistic regression analysis was conducted to evaluate odds ratio of different risk factors. Results Prevalence of CTS confirmed by NC studies in polio survivors was 43.4% (20 patient). Eighteen (45%), 12 (30%) and 2 (%5) hands had mild, moderate and severe CTS, respectively. The age, BMI and wrist index were higher in the CTS group than in the non-CTS group (p Discussion Our study confirms a high occurrence of CTS in polio survivors. Conclusions Body mass index may be associated with prevalent CTS in polio survivors. Significance Prevention of weight gain in polio survivors may reduce the risk of CTS.