Diabetic Carpal Tunnel Syndrome Research Articles

Electrophysiologic pattern of carpal tunnel syndrome among patients with and without diabetes mellitus

Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper limb in general population. Female gender, obesity, increase of age, diabetes mellitus (DM), hypothyroidism, pregnancy, rheumatoid arthritis, osteoarthritis and occupational factors like repetitive work are the main risk factors for CTS. The objective of this study was to determine whether the nerve conduction study measurement of the median nerve (MN) at the wrist differ between diabetic and non-diabetic CTS patients. Methods: This cross-sectional study was conducted at Electrodiagnostic Lab of BIRDEM General Hospital and Popular Medical College Hospital, Dhaka during the period of October 2017 to August 2019. Five hundred and seventeen hands from 377 patients were sampled according to inclusion criteria. Participants were assigned to two groups: Group 1 (CTS with DM) and Group 2 (CTS without DM). NCS study were performed using Nihon Kohden electrodiagnostic machine. Measurements at the MN was taken under consideration for study. Severity of CTS was graded according to Canterbury electrophysiologic grading scale and parameters were compared among diabetic and non-diabetic participants. Data were analyzed using Statistical Package for the Social Sciences SPSS version 23 (SPSS Inc., Chicago, IL, USA). Results: The 377 participants comprised 144 and 233 in Group 1 and Group 2, respectively. Out of 377 patients, 334 (88.59%) were females and there was no statistically significant difference between two groups. The average age was 50.66±10.2 years in diabetic participants and 43.34±10.7 years in non- diabetic participants. In the study population moderate CTS (Grade 3) was the most frequent (46.4%) followed by very severe (Grade 5) CTS. There was no statistically significant difference in incidence between diabetic and non-diabetic patients. Analysis of electrophysologic parameters of MN showed statistically significant difference in mean MN sensory nerve action potential (SNAP) amplitude (P 0.003), compound muscle action potential (CMAP) amplitude (p 0.05, right) and CMAP latency (p 0.02, right and 0.05, left) between diabetic and non –diabetic patients. Inter-group comparison revealed that impaired glycaemic status and duration of diabetes in diabetic population had a minimal influence in the electrophysiological severity of CTS in either hands. Conclusion: Some nerve conduction study parameters of the MN differ significantly between diabetic and non-diabetic patients with CTS and may provide both diagnostic and predictive results across the entire spectrum of CTS. BIRDEM Med J 2023; 13(3): 136-142

Characteristics of diabetic and non-diabetic carpal tunnel syndrome in terms of clinical, electrophysiological, and Sonographic features: a cross-sectional study

BackgroundAlthough diabetes is considered a major risk factor for carpal tunnel syndrome (CTS), the characteristics of diabetic CTS have not been fully understood.ObjectiveThis study is aimed at evaluation of the clinical, electrophysiological, and ultrasonographic findings of non-diabetic and diabetic CTS.MethodsThis retrospective, cross-sectional study included patients diagnosed with CTS. Patient age, sex, involved side, body mass index, clinical and electrophysiological findings, and median nerve cross-sectional area (CSA) were identified. Diabetes was identified through patient or guardian interviews, medical records, and medication history. Linear and binary logistic regression models were established to confirm the associations between the electrophysiological findings, median nerve CSA, and clinical outcomes. Covariates, such as age, sex, body mass index, diabetes, symptom duration, and thenar muscle weakness were adjusted.ResultsOut of the 920 hands, 126 and 794 belonged to the diabetic and non-diabetic CTS groups, respectively. The patients were significantly older in the diabetic CTS group (P < 0.001). The rate of thenar weakness in the diabetic CTS group was also significantly higher than that in the non-diabetic CTS group (P = 0.009). The diabetic CTS group had a more severe electrodiagnostic grade (P = 0.001). The prolonged onset latency of the compound motor nerve action potential (CMAP) and median nerve CSA were well associated with the degree of clinical symptoms. Increased median nerve CSA was significantly associated with prolonged CMAP onset latency (β = 0.64; P = 0.012), prolonged transcarpal latency (β = 0.95; P = 0.044), and decreased CMAP amplitude (β = -0.17; P = 0.002) in the non-diabetic CTS group.ConclusionDiabetic CTS had more profound electrophysiological abnormalities. Distal motor latency and median nerve CSA were not only associated with each other, but also with clinical symptoms. Further studies are needed to investigate the pathophysiological mechanisms underlying diabetic CTS.

Ultrasonic and Electrophysiological Evaluation of Carpal Tunnel Syndrome in Diabetic and Non-diabetic Subjects

Background: Carpal tunnel syndrome (CTS) is the most prevalent upper-limb entrapped neuropathy. A nerve conduction study (NCS) is the simplest method for identifying CTS when combined with a satisfactory clinical assessment and physical assessment. Ultrasound is a beneficial non-traumatic screening approach for CTS and there is a relationship between the NCS tests and the measures of CSA by ultrasound. Objective: to assess whether or not sonographic observations of the median nerve seems to be varied amongst DM and non-DM CTS individual. Patients and methods: The total of 50 non-DM Individuals with CTS and 50 DM individuals with CTS have been included in this study. All individuals were submitted to full medical assessment NCS testing the hands and sonogram US for assessment of cross-sectional area CSA and wrist forearm ratio (WFR). Results: Total 100 affected wrists with CTS are classified as 30 (60.0%) wrists with mild disease, 11 (22.0%) wrists that demonstrated moderate disease and 9 (18.0%) wrists had a severe disease in diabetic CTS patients and 23 (46.0%) wrist mild disease, 20 (40.0%)wrist show moderate disease, 7 (14.0%) wrist had a severe disease in non-diabetic CTS patient. The mean of the median nerve CSA was (0.14+0.03), (0.15+0.04) in diabetic and non-diabetic CTS individuals, respectively with no significant difference between the two groups. In contrast, the wrist-forearm ratio demonstrates a significant difference between the two groups. Conclusion: The CSA of the median nerve is greater in CTS wrists through both DM and non-DM individuals with no significant difference. The mean wrist-forearm ratio was less in diabetic patients than in non-diabetic with a significant difference. Pairing NCS with US imaging gives effective assessment methods for the CTS hands in individuals with and without diabetes.

Carpal Tunnel Decompression Surgery Outcome and Effect of Diabetes

Objective: The benefits of carpal tunnel decompressive surgery (CTDS) among diabetic patients with carpal tunnel syndrome (CTS) were previously investigated through comparing the outcome before and after CTDS, and in comparison to nondiabetic CTS. We sought to investigate if diabetes mitigates the benefits of CTDS compared to not receiving CTDS. Methods: In this retrospective study, we compared the risk of reporting any unfavorable outcomes among CTS patients (diabetic and nondiabetic) who underwent CTDS versus no CTDS after controlling for diabetes. We also compared the risk of reporting any unfavorable outcomes (waking up at night, pain during the day or during daily activities, or hand weakness) among diabetic CTS patients who underwent CTDS versus no CTDS after controlling for severity. Results: We included 207 patients; of these, 105 patients had CTDS and 102 did not. There were 60 diabetic and 147 nondiabetic patients. The risk of any unfavorable outcomes was reduced by CTDS from 83.3 to 66.6%, with an odds ratio (OR), after controlling for diabetes, of 0.39 (95% confidence interval [CI] 0.20–0.78). Among diabetic patients, there was no difference between the CTDS and non-CTDS groups in the risk of reporting any unfavorable outcomes; however, after adjustment for severity, the risk of hand weakness was less with CTDS, with an OR of 0.13 (95% CI 0.02–0.86). Conclusion: Diabetes did not mitigate the benefits of CTDS. CTDS may prevent hand weakness among diabetic CTS patients.

Elevated basal cytosolic calcium of endothelial cells influences the post-surgical outcome in diabetic CTS.

Background Type 2 diabetes mellitus (T2DM)-induced neuropathy and ischemia-reperfusion post-surgery prolong carpal tunnel syndrome (CTS) pathology, but the effect of T2DM on the prognostic outcome of carpal tunnel (CT) release surgery needs to be investigated. Materials and methods A total of 64 individuals with CTS underwent CT release surgery. HbA1c levels identified their diabetic status. The individual prognostic outcomes were measured by nerve conduction velocity (NCV), amplitude, and latency. Measurement of [Ca2+]c and reactive oxygen species (ROS) from isolated endothelial cells (ECs) revealed the oxidative burden of the normal and diabetic CTS phenotypes. Results CTS individuals with HbA1c > 7 showed decreased NCV (≈22m/s) and amplitude (≈4.2mV) with increased latency (≈6ms), compared to groups with HbA1c ≤ 7. Further to CT release surgery, the reversal of the nerve conduction to normalcy was greatly influenced by the diabetic profile of the individuals. Our results showed elevated basal [Ca2+]c and corresponding high cytosolic ROS in the ECs isolated from individuals with HbA1c > 7 compared to the diabetic and healthy control groups. Conclusion The individuals with diabetic index showed suboptimal neuronal performance pre- and post-CT release surgery. Oxidative stress mediated by high [Ca2+]c and ROS of ECs dissipates to adjoining cells worsening the pathology of the untreated CTS.

Electrophysiological Grading to Assess the Severity of Carpal Tunnel Syndrome in Symptomatic Diabetic Patients

Background: Carpal tunnel syndrome (CTS) is the most frequent compressive focal mononeuropathy found in clinical practice. Patients mostly experience pain, paresthesia, and less commonly, weakness in the median nerve distribution which badly affects dexterity and grip. Common risk factors include repetitive wrist movements, metabolic and degenerative diseases, connective tissue disease and pregnancy. Nerve conduction study is one of the most sensitive and specific tools to diagnose CTS. This study was aimed to grade the CTS cases according to the severity based on electrophysiological findings and explore its association with clinical presentation of diabetic patients had nerve conduction study at BIRDEM General Hospital. Materials and Methods: This observational study was done in the electro diagnostic clinic of Neurology department, BIRDEM during the period Sept 2015 to Feb 2016. The study included 100 hands of 84 patients suffering from CTS consecutively attending the clinic. All the patients were interviewed and clinically examined. Demographic data including age, gender, occupation, affected hand and hand dominance along with duration of disease were recorded. Patients were graded according to clinical history and objective findings and again based on the Canterbury NCS Severity Scale.&#x0D; Results: Of these 84 diabetic patients presenting with impression of CTS 96% were females. Mean age of the study subjects was 49.6±10.1 (28-85). Most of the female patients were housewives. Clinical grading of CTS was as follows: mild symptoms in 54.76%, moderate symptoms in 23.8% and severe symptoms in 28.58% patients. According to The Canterbury NCS Severity Scale out of total 100 hands,3.5% had Grade 2 (Mild ) 30.5%had Grade 3 (Moderate) ,29.4 % had Grade 4 (Severe), 34.1% had Grade 5 (Very severe) disease. Only 2 patients had Grade 6 (extremely severe) lesion. Of the study subjects 22 (26.19%) had bilateral and rest (73.81%) had unilateral disease.&#x0D; Conclusion: Data demonstrated female preponderance of the diabetic CTS cases of middle age. Proportional graded deterioration of electrophysiological parameters along with the clinical severity grades highlights the fact that NCS provide additional and independent objective evidence in the diagnosis and severity assessment of CTS and plausibly has important role in prioritizing treatment plan.&#x0D; Bangladesh Journal of Neuroscience 2016; Vol. 32 (2): 98-105

Outcome after carpal tunnel release: impact of factors related to metabolic syndrome

Objective: The standard surgical treatment of carpal tunnel syndrome (CTS), with an open carpal tunnel release, is reported to relieve symptoms in most patients. In a retrospective observational study, outcome after open carpal tunnel release was evaluated, focusing on factors related to the metabolic syndrome: diabetes, hypertension, obesity (BMI ≥30) and statin treatment.Methods: Results from 493 out of 962 patients (531/1044 hands) operated for CTS during 18 months that had filled in QuickDASH questionnaires before and 1-year after surgery were included in the study.Results: Patients with diabetes (n = 76) had higher QuickDASH scores pre- (56 [36–77]; i.e. median [interquartile range]) and postoperatively (31 [9–61]) compared to patients without diabetes (48 [32–66]; p < 0.05 and 16 [5–43]; p < 0.001), but the change in total score was equal. A higher proportion of patients with diabetes had a postoperative score of >10 (74% vs 61%; p < 0.05). The odds of having a change in QuickDASH score <8 was 2.6-times higher in patients with polyneuropathy than in patients without polyneuropathy. Patients with hypertension, obesity, or statin treatment had a similar improvement after surgery as patients without these factors.Conclusions: Patients with diabetes without neuropathy, as well as patients with hypertension, obesity or statin treatment, and CTS can expect the same effects of open carpal tunnel release as otherwise healthy patients. Patients with diabetic neuropathy and CTS did not experience the same improvement as otherwise healthy patients and should be informed about the risk of an unsatisfactory outcome.

Comparison of the histopathological findings of patients with diabetic and idiopathic carpal tunnel syndrome

This study is aimed to investigate whether there are any histopathological differences between diabetic and idiopathic carpal tunnel syndromes. The biopsy specimens were taken from transverse carpal ligament (TCL), tenosynovium adjacent to median nerve and epineurium of median nerve and evaluated in 47 patients (21 diabetic and 26 idiopathic) who were diagnosed with carpal tunnel syndrome (CTS) and treated surgically with open carpal tunnel release. Fibroblast proliferation, fibrosis, perivascular inflammation, oedema, vascular proliferation and vascular wall thickness were determined and scored in all specimens. There weren't any histopathological abnormalities in TCL specimens of both groups. Synovial hyperplasia, fibrosis and perivascular inflammation were not observed in tenosynovial analysis of both groups. Diabetic CTS patients, when compared with idiopathic CTS patients, had higher rates of synovial edema (idiopathic CTS 57 %, diabetic CTS 87 %), vascular proliferation (idiopathic CTS 30.8 %, diabetic CTS 90.5 %) and increased vascular wall thickness (idiopathic CTS 11.5 %, diabetic CTS 90.5 %). There was no oedema, fibrosis and perivascular inflammation of the epineurium in specimens of either group. But increases in vascular proliferation (idiopathic CTS 7.7 %, diabetic CTS 71.4 %) and vascular wall thickness (idiopathic CTS 3.8 %, diabetic CTS 71.4 %) was seen in the epineurium of diabetic patients and these differences were statistically significant (p < 0.05). Because of the severe synovial and epineurial histopathological abnormalities and inadequate neural regeneration capacity, surgical open carpal tunnel decompression should be planned earlier in diabetic CTS patients. Further studies should be considered to evaluate the histopathological features of diabetic CTS patients early in the course of the disease.

Can Palm Stimulation Differentiate Diabetic Polyneuropathy From Carpal Tunnel Syndrome?

Diabetic patients without symptoms of carpal tunnel syndrome (CTS) may frequently show a prolongation of their median distal latency. Previous authors have reported that diabetic polyneuropathy (DPN) and CTS were differentiated by evaluating the sensory conduction velocity (SCV) distal to the palm. This study aimed to clarify this issue. The subjects consisted of 30 DPN patients without clinical CTS and 50 CTS patients without diabetes mellitus. An antidromic sensory conduction study stimulating the median nerve at the wrist and palm was performed. The SCV distal to the palm (SCVpf) and across the carpal tunnel (SCVwp) and the sensory nerve action potential amplitude following palmar stimulation (AMP-p) were evaluated. The SCVwp was significantly lower than the SCVpf in DPN patients, implying the frequent presence of subclinical lesion at the carpal tunnel. The SCVpf was similar for both groups. The AMP-p was disproportionately low in relation to SCVwp in DPN patients, as compared with CTS patients. The polyneuropathic feature of DPN is primarily expressed as axonal loss. The diabetic axonal loss index has been introduced, which enabled to determine the co-presence, isolated presence, or absence of DPN/CTS in the electrophysiological sense.

152. The useful of US in diagnosis of carpal tunnel syndrome in diabetics: A proposal for new reference values

Increased median nerve Cross-section Area (CSA) is considered suggestive for Carpal Tunnel Syndrome (CTS). Increased peripheral nerves CSA was observed in diabetic polyneuropathy (DP). Our aim was to assess median nerve CSA cut-off values for the diagnosis of CTS in diabetic patients, with or without polyneuropathy. We enrolled consecutive diabetic patients with or without CTS symptoms who reached the hospital Diabetology Clinic in November 2012. Patients underwent median nerve EMG of the symptomatic or the dominant hand for diagnosis of CTS and ultrasonographic measure of CSA at the tunnel inlet. Tibial, peroneal and sural nerve EMG was performed to diagnose DP. Using ROC curves we determined the optimal cut-off values for ultrasonographic CSA in all patients and in subgroups with or without DP. 39 patients (mean age 64 yo, mean disease duration 18,6 y) were enrolled. Mean values of nerve CSA in the cohort and in patients with and without DP were respectively 11,23 mm2, 12,4 mm2 and 10,5. CSA best values for sensitivity and specificity were determined: in total cohort 11,5 mm2 (61,5%, 85%; AUC 0,796), in patients with DP 12 mm2 (69%, 100%; AUC 0,846), 10,5 mm2 in patients without DP (61%, 64%; AUC 0,734). We propose reference values for ultrasonographic diagnosis of CTS in diabetics: for patients with diagnosed or uncertain DP cut-off values of the general population should be raised.

SAT0530 The Useful of us in Diagnosis of Carpal Tunnel Syndrome in Diabetics: a Proposal for New Reference Values.

BackgroundCarpal Tunnel Syndrome (CTS) is a neural affection that in diabetic patients can be associated with polyneuropathy (DP). In rheumatologists’s practice, ultrasonography represents a useful tool in the study of...

Ultrasonographic assessment of carpal tunnel syndrome of mild and moderate severity in diabetic patients by using an 8-point measurement of median nerve cross-sectional areas

BackgroundUsing high-resolution ultrasonography (US) to measure the median nerve cross-sectional areas (CSAs) such as in the “inching test” conducted in nerve conduction studies is a valuable tool to assess carpal tunnel syndrome (CTS). However, using this US measurement method to assess the median nerve CSA in diabetic patients with CTS has rarely been reported. Therefore, we used this US measurement method in this study to measure median nerve CSAs and to compare the CSAs of idiopathic, diabetic and diabetic polyneuropathy (DPN) patients with CTS.Methods124 hands belonging to 89 participants were included and assigned into four groups: control (32), idiopathic (38), diabetic (38) and DPN (16) CTS. In the latter two groups, only patients with mild and moderately severe CTS were included. The median nerve CSAs were measured at 8 points marked as i4, i3, i2, i1, w, o1, o2, and o3 in the inching test. The measured CSAs in each group of participants were compared.ResultsCompared with the CSAs of the control group, enlarged CSAs were found in the idiopathic, diabetic and DPN CTS groups. The CSAs were larger at i4, i3 and i2 in the diabetic CTS group compared to the idiopathic CTS group. The CSAs measured at the i1 and w levels of the DPN CTS group were smaller than those of the diabetic CTS group. In the diabetic CTS group, the cut-off values of CSAs measured at the inlet, wrist crease, and outlet were 15.3 mm2, 13.4 mm2 and 10.0 mm2, respectively, and 14.0 mm2, 12.5 mm2 and 10.5 mm2, respectively, in the DPN CTS group.ConclusionsCompared with the median nerve CSAs of the control and idiopathic CTS groups, the median nerve CSAs of the diabetic patients with CTS were significantly enlarged. However, compared with the diabetic CTS group, the CSAs were significantly smaller in the DPN CTS group. This US 8-point measurement method can be of value as an important complementary tool for CTS studies and diagnosis among diabetic patients.

Carpal Tunnel Syndrome and Ulnar Neuropathy at the Wrist

The aim of this study was to elucidate the possible association between carpal tunnel syndrome (CTS) and ulnar neuropathy at the wrist because of the contradictory results of previous studies. Thus, a retrospective case-control study was arranged with an electromyographic database including patients between 2003 and 2009. Patients were selected according to initial diagnosis and the examiner's criteria, and data were plotted by computer. One thousand nine hundred twenty-four patients were evaluated for CTS and 1,024 patients for diabetic CTS or diabetic polyneuropathy. CTS and ulnar neuropathy co-occurrence and CTS alone at the wrist was found in 54/404, 19/50, 20/27 patients, respectively. Logistic regression analysis revealed that having CTS was associated with a doubled risk of ulnar neuropathy at the wrist in both idiopathic CTS and diabetic CTS groups but not in diabetic polyneuropathy. Being male and of advanced age were other risk factors for ulnar neuropathy at the wrist. Correlation analysis (age and sex were controlled) revealed decreased but significant correlations between median and ulnar sensory amplitudes in CTS cases in all groups.

Natural Course and Treatment Efficacy: One-Year Observation in Diabetic and Idiopathic Carpal Tunnel Syndrome

Our aims were to observe the effects of rehabilitation and surgery on idiopathic and diabetic carpal tunnel syndrome (CTS) and compare them with the natural course of the disease. Forty-two patients aged 33 to 74 years with clinically diagnosed, electrophysiologically confirmed, and laboratory screened hands with CTS (46 idiopathic and 34 diabetic) were enrolled in the study. Improvement of symptom severity and functional status after treatment using the Boston questionnaire (scales), changes of nerve conduction parameters (NCPs), and correlations between NCP and Boston questionnaires were outcome measures. Follow-up periods were 3 to 5 months and 6 to 12 months. In idiopathic CTS, surgery was effective according to scales and NCP. Rehabilitation was also effective according to scales but only in the late period. Nontreatment did not improve scales at a later period. In diabetic CTS, rehabilitation was not effective according to scales. Baseline and follow-up correlations between scales and NCP were weak and limited to sensory amplitudes (baseline), sensory amplitudes-velocity, and median motor distal latency (follow-up). Regression analysis also did not reveal any associations between scales and NCP. A repeated nerve conduction study was not meaningful if the diagnosis was definite. Treatment of CTS was definitely superior to spontaneous improvements. Rehabilitation was ineffective in diabetic CTS.

Ulnar Neuropathy at the Elbow in Diabetes

To compare the prevalence of diabetes in a consecutive sample of patients with ulnar neuropathy at the elbow (UNE) with that in patients with carpal tunnel syndrome (CTS) and to assess differences in demographic, clinical, and electrophysiologic findings between diabetic, idiopathic, and posttraumatic UNE. Six thousand eight hundred seventy-one and 434 consecutive patients diagnosed with CTS and UNE, respectively, were admitted to an outpatient electromyography service between 1995 and 2006. Twenty-six UNE and 452 CTS patients also had diabetes. Prevalence of diabetes in UNE was 6.0% and did not differ from that in CTS (6.6%); there were more male diabetic UNE patients (61.5%) than diabetic CTS patients (35.8%). There was no difference in occupation, duration of symptoms, association with CTS, polyneuropathy, and many neurographic findings of the ulnar, median, and radial nerves between diabetic and idiopathic or posttraumatic UNE patients when UNE groups were matched by sex and age, except for differences in sensory action potential amplitudes of diabetics vs. the other two groups. The prevalence of diabetes is the same in UNE and CTS patients. The patients with UNE and diabetes are clinically and electrophysiologically indistinguishable from other groups of UNE patients, except for a reduction in sensory action potential amplitudes in the diabetic UNE group, presumably owing to diabetic polyneuropathy. Subjects with UNE and diabetes could therefore be treated in the same way as patients with idiopathic forms.

Sympathetic skin response in idiopathic and diabetic carpal tunnel syndrome

Background In carpal tunnel syndrome (CTS), certain changes were expected in sympathetic skin response (SSR) because median nerve carries postganglionic unmyelinated fibres. Purpose To investigate the median and ulnar SSR in idiopathic and diabetic CTS without autonomic dysfunction in hands and to find possible relations with electrophysiological features of these diseases. Patients and methods SSRs were elicited by electrical stimulation on the supraorbital nerve and recorded from the median and ulnar territories in the hand from 20 diabetic patients with only CTS (29 hands), 24 idiopathic CTS patients (42 hands) and 13 normal subjects (26 hands). Hands with ulnar neuropathy at the wrist without symptoms and normal hands of unilateral CTS were excluded. In addition to classical parameters and comparative methods, SSR waveform changes and percentile method was used in finding abnormality. Results Median SSRs had significant delayed latency compared to ulnar latency in both CTS patients but this was not important clinically (1.38/1.37 s for idiopatic CTS; 1.43/1.36 s for diabetic CTS). Median and ulnar SSR amplitude, area, median/ulnar latency difference, amplitude and area ratio were compared and only median/ulnar latency difference and median/ulnar latency ratio were found different between the three groups. Four idiopathic CTS hands were outside of the limits or absent (9.5%). SSR waveforms were significantly different from normal subjects in CTS patients. P type SSR replaced M type in idiopathic CTS and N type in diabetic CTS. Conclusions Findings regarding SSR parameters suggest that unmyelinated C fibers were affected in CTS. These values were not useful because they were too small. Data on SSR were not normally distributed and the percentile method seems to be more convenient for finding any abnormality in clinical practice. Also, SSR waveform analysis could give us valuable data and should add to the SSR examination parameters.

One Year Follow‐Up In Diabetic Patients After Surgical Treatment Of Carpal Tunnel Syndrome

The aim of the study was to evaluate clinical and neurophysiological changes in diabetic patients who had the surgery of carpal tunnel syndrome (CTS). The group consisted of 61 diabetic patients with the clinical and neurophysiological signs of CTS, with mean age 50.3 (± 27.3) and diabetes duration 13.5 years (± 8.9). The response to treatment was evaluated using visual analogue scale (VAS) for pain and for paresthesias prior to surgery, as well as 3 and 12 months after. At the same time we compared the median motor distal latency, amplitude of motor nerve action potentials, sensory conduction velocity and amplitude of sensory nerve action potentials in distal segment of median nerve as well as vibration perception threshold. The improvement was found for pain (baseline VAS 4.5 cm vs. follow‐up VAS 1.5 cm; Wilcoxon p = 0.00365) and for paresthesias (baseline VAS 5.4 cm vs. follow‐up VAS 0.8 cm; Wilcoxon p = 0.00000) after 3 months. Subjective pain and paresthesias assessment remained at the improved level after 12 months of follow‐up. Neurophysiological parameters measured were shown to improve after 3 and 12 months of follow‐up period: median motor distal latency (baseline 5.9 ms/6 cm, 3 months 4.8 ms/6 cm, 12 months 4.1 ms/6 cm; ANOVA p &lt; 0.00000), amplitude of median motor action potential (baseline 4.8 mV, 3 months 5.6 mV, 12 months 6.6 mV., ANOVA p &lt; 0.01040), median sensory conduction velocity in distal segment (baseline 37.9 m/s, 3 months 43.0 m/s, 12 months 47.3 m/s, ANOVA p &lt; 0.00464), vibration perception threshold (baseline 9.8 V, 3 months 7.6 V, 12 months 6.8 V; ANOVA p &lt; 0.00006). Concerning our results, the clinical and neurophysiological parameters supported surgery as the effective treatment for CTS in diabetics.

Asymptomatic electrophysiologic carpal tunnel syndrome in diabetics: entrapment or polyneuropathy.

Electrophysiologic carpal tunnel syndrome (CTS) is common and is frequently asymptomatic in diabetics. In order to evaluate the clinical significance of asymptomatic electrophysiologic CTS, the nerve conduction studies (NCS) of 48 diabetics with asymptomatic electrophysiologic CTS were compared with those of 56 age and gender-matched controls, as well as 50 patients with symptomatic CTS without diabetes. Nerve conduction velocities of the ulnar, peroneal, and posterior tibial nerves were significantly slower in diabetics with asymptomatic electrophysiologic CTS than in normal controls. Compared to symptomatic non-diabetic CTS, there was also significant slowing of the median and ulnar nerve conduction velocities in asymptomatic diabetic CTS. However, in diabetics with asymptomatic CTS, abnormalities of the distal segment of the median NCS were more prominent compared with those of all the other tested nerves. These findings suggested that asymptomatic electrophysiologic CTS in diabetics is a manifestation of increased vulnerability to the entrapment of the peripheral nerve.

Hand Abnormalities Associated with Non-Insulin-Dependent Diabetes Mellitus in Japan

We carried out a survey of hand abnormalities in 65 Japanese adult diabetics (non-insulin-dependent diabetes mellitus) and compared the result with that of 65 non-diabetic adults as controls. A significantly higher incidence of Dupuytren's contracture, limited joint mobility, carpal tunnel syndrome, and flexor tenosynovitis was found in the diabetic group. In the diabetic group, Dupuytren's contracture was noted in 10 patients (15%), limited joint mobility in 34 patients (52%), carpal tunnel syndrome in 21 patients (32%), and flexor tenosynovitis in 10 patients (15%). Dupuytren's contracture in the diabetic patients involved the fourth and fifth rays. In diabetic carpal tunnel syndrome, as compared to the idiopathic form, men were more frequently affected than women. Carpal tunnel syndrome showed a positive correlation with duration of the diabetes and use of insulin during the last twelve months prior to the examination. All of 10 diabetic patients with flexor tenosynovitis also had limited joint mobility. Six of these 10 patients also had carpal tunnel syndrome.

3-48-03 Asymptomatic electrophysiologic carpal tunnel syndrome in diabetics: Entrapment or polyneuropathy

3-48-03 Asymptomatic electrophysiologic carpal tunnel syndrome in diabetics: Entrapment or polyneuropathy