Tunnel Syndrome In Diabetic Patients Research Articles

The Accuracy of Provocative Tests on Diabetic Patients with Suspected Carpal Tunnel Syndome and Comparison with Nondiabetics

Objective: Carpal tunnel syndrome in diabetic patients differ in some aspects from those in the nondiabetic population. The study was designed to evaluate the diagnostic accuracy of widely used provocative tests in the diabetic population in comparison to nondiabetic population. Materials and Methods: 87 nondiabetic and 25 diabetic hands suspicious of carpal tunnel syndrome were included in this retrospective study. The presence of carpal tunnel syndrome is confirmed by nerve conduction studies. The hands were divided into DM- and DM+ groups based on patients’ diabetes mellitus history. From patient records, results of Tinel’s, Phalen’s, Durkan’s, median nerve compression, and scratch collapse tests were obtained. Sensitivity, specificity, positive predictive value, and negative predictive values of tests are calculated for each population and then compared with each other. Results: Tinel’s test had a higher sensitivity in the diabetic population. Accuracies of Phalen’s, Durkan’s, median nerve compression, and scratch collapse tests in diabetic patients were similar to those in diabetic patients. None of the tests had a high enough sensitivity to be used alone in either group. Scratch collapse test had very high specificity in both groups but very low sensitivity. Conclusion: The studied provocative tests have comparable accuracy for carpal tunnel syndrome in diabetic patients to those in nondiabetic patients, with Tinel even having higher sensitivity. But excluding scratch collapse test, none of the tests is strong enough to achieve a diagnosis and none is sensitive enough to rule out a disease.

Management of carpal tunnel syndrome in diabetic patients

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Can ultrasound imaging be used for the diagnosis of carpal tunnel syndrome in diabetic patients? A systemic review and network meta-analysis.

High-resolution ultrasound (US) becomes a reliable tool for diagnosing carpal tunnel syndrome (CTS), but whether it can be applied to patients with preexisting diabetes mellitus (DM) remains unclear. We searched PubMed and Embase and systemically reviewed studies exploring the median nerve CSAs at the wrist level by US imaging. Nine studies enrolling at least one subgroup comprising patients with both DM and CTS were included for network meta-analysis. The primary outcome was the inter-group difference of the wrist-level median nerve CSA. The median nerve size at the wrist level was larger in patients with only CTS than in patients with only DM [CSA difference = 3.14 mm2, 95% confidence interval (CI) 1.92-4.35]. Patients with DM and CTS had a slightly enlarged median nerve CSA than did patients with only CTS, but the difference was not statistically significant (0.52 mm2, 95% CI - 0.54 to 1.59). According to rank probabilities, median nerve CSAs in patients with DM and CTS were likely to be ranked as the largest, followed by patients with only CTS, patients with only DM, and healthy controls. Furthermore, median nerve CSAs seemed smaller in patients with than without diabetic polyneuropathy. Although DM causes swelling of the median nerve at the wrist level, patients with CTS have a larger CSA regardless of preexisting DM. The add-on effect of DM on median nerve CSAs in patients with CTS is limited. Diabetic polyneuropathy tends to result in less swollen median nerves in the CTS population.

Electrophysiologic severity of carpal tunnel syndrome in diabetic patients of the Saudi population.

Objectives:To study the frequency of multiple vascular risk factors and electrophysiological severity of carpal tunnel syndrome (CTS) in Saudi diabetic patients.Methods:This retrospective cross-sectional study was conducted in Neurology Department, King Fahd Hospital of University, Al-Khobar, Kingdom of Saudi Arabia from April 2017 to March 2018 and included 200 patients with CTS. Body parameters, such as blood pressure (BP), weight, height, and body mass index (BMI), along with laboratory and median nerve electrophysiological parameters, of diabetic and non-diabetic patients were compared, and a p-value<0.05 was considered significant.Results:Frequency of hypertension (HTN) and obesity was significantly higher in diabetic patients (p<0.05). Mean median nerve sensory amplitude (MNSA) was lower in diabetic patients (p<0.05).Non-recordable nerves, as well as bilateral and extremely severe CTS (p<0.05), were more frequently seen in diabetic patients. Age, BMI, systolic BP, low serum high density lipoprotein (HDL), high triglycerides, high fasting blood sugar, and high glycated hemoglobin (Hba1c) levels, known to affect the electrophysiological severity of CTS, had a statistically significant association with diabetes.Conclusion:Diabetes mellitus (DM) and obesity are the most commonly identified risk factors of CTS. Dyslipidemia, HTN and obesity are more frequently seen in diabetic patients with CTS. These concurrent risk factors are confounding the electrophysiological severity of CTS in these patients. Further larger-scale studies with the control of confounding factors are recommended.

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Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome in Diabetic Patients: Missing the Mark?

Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome in Diabetic Patients: Missing the Mark?

Diabetes mellitus (DM) and carpal tunnel syndrome (CTS) are common pathologies. The diagnosis of CTS can be facilitated by the use of an ultrasound-based wrist-to-forearm ratio (WFR) of the nerve diameter. However, the applicability of WFR in DM-patients is not yet clear. 233 wrists of 153 patients were examined. Cross-sectional areas (CSA) of the median nerve were obtained using a linear array probe. The WFR was calculated. Diabetics with CTS had significantly lower WFR values than non-diabetics with CTS (p = 0.002). There was no difference between the WFR of diabetics with and without CTS (p = 0.06). The diagnostic accuracy between diabetics with and without CTS was low for measurements of WFR (ROC AUC = 0.630, 95 % CI 0.541 - 0.715, p = 0.011). Our findings suggest that the WFR has a low diagnostic accuracy in diabetic patients with CTS and should be used with caution in those patients. · The diagnostic accuracy of WFR is low in patients with DM. · WFR should not be used in patients with DM. · The sonographic evaluation of the median nerve in patients with DM should focus on morphological changes. · Steinkohl F, Loizides A, Gruber L et al. Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome in Diabetic Patients: Missing the Mark?. Fortschr Röntgenstr 2019; 191: 117 - 121.

Sonographic assessment of carpal tunnel syndrome in diabetic patients with and without polyneuropathy.

The objective of this study is to determine whether the cross sectional area (CSA) measurement of the median nerve at the wrist differ between carpal tunnel syndrome (CTS) in diabetic patients with and without diabetic polyneuropathy (DPN).This study included 44 patients with type II diabete millitus (DM) with CTS, 32 patients with CTS and DPN, 46 patients with idiopathic CTS, and 42 healthy subjects. Ultrasonographic measurement of the CSA of the median nerve was made at the level of the wrist, together with nerve conduction studies.The median CSA at the wrist was significantly larger in all patient groups compared with healthy subjects. The median nerve CSA was significantly larger in diabetic patients with CTS than patients with idiopathic CTS. The median nerve CSA at wrist was significantly smaller in patients with CTS and DPN compared with diabetic patients with CTS only.The median nerve CSA at the wrist was larger in diabetic patients with CTS than patients with idiopathic CTS and CTS with DPN. Median nerve CSA can help to differentiate between diabetic patients with CTS with and without DPN.

Manual therapy in the treatment of carpal tunnel syndrome in diabetic patients: A randomized clinical trial.

Background:Generally, conservative interventions including physiotherapy modalities and manual therapy have been recommended in the management of carpal tunnel syndrome (CTS), but this subject has not been studied in diabetic patients with CTS. Therefore the aim of this study was to investigate the effects of manual therapy on diabetic patients with CTS.Methods:Thirty diabetic patients with CTS were randomly divided into two equal groups: modality group and manual therapy group. Participants in the modality group received transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) and patients in the manual therapy group received manual techniques for the median nerve and its surrounding structures. Interventions were applied 3 times weekly for 4 weeks in both groups. Visual analogue scale (VAS), symptom severity scale (SSS), functional status scale (FSS) and median neurodynamic test (MNT) were evaluated before and after the interventions in both groups. Paired t-test and independent t-test were used for statistical analysis.Results:Paired t-test revealed that all of the outcome measures had a significant change in the manual therapy group, whereas only the VAS and SSS changed significantly in the modality group at the end of 4 weeks. Independent t-test showed that the variables of SSS, FSS and MNT in the manual therapy group improved significantly greater than the modality group.Conclusions:Manual therapy techniques applied to mechanical interface of the median nerve and nerve mobilization possess more appropriate and valuable effects on hand difficulties than modalities in diabetic patients with CTS.

Role of ultrasound in diagnosis of Carpal Tunnel Syndrome in diabetic patients

Objective: To detect the musculoskeletal disorders of diabetes affecting the hand by ultrasonography (US) and to study the relationship of these changes with the arterial Doppler blood flow pattern. Materials & Methods: Both hands of 23 diabetic patients (age 53 ± 11.3 years) (10 female, 13 male) were examined by US and compared to age and sex matched control group (age 53 ± 11.1 years). Median nerve diameters, area and circumference measurements, flexor retinaculum thickness and tendinopathic changes as decrease in echogenicity, peritendinous fluid collection were studied. Arterial Doppler echo pattern of radial, ulnar and palmar arch arteries have also been studied. Clinical findings as arthralgia, numbness and limited joint mobility were recorded. Results: Patients group showed a significant increase (P

Prevalence of Carpal Tunnel Syndrome in Diabetic Patients with and without Metabolic Syndrome

Background and Objectives : Carpal tunnel syndrome (CTS) is defined as the impaction of the median nerve in the carpal tunnel of the wrist. Metabolic disorders are closely associated with CTS; and metabolic syndrome (MS) is found to be more in patients with CTS. Metabolic syndrome is highly prevalent in patients with type 2 diabetes. This study was conducted to determine the prevalence of CTS in diabetic patients with and without metabolic syndrome. Material and Methods : In this cross-sectional study, 439 diabetic patients that participated in the study of risk factors for coronary artery disease in Kerman (KERCADRS) were enrolled. People with positive clinical symptoms for CTS and a positive Boston questionnaire, were referred to a neurologist for further diagnosis. For the diagnosis of metabolic syndrome, three criteria (ATPIII, IDF and new criteria in Kerman) were used. Also, electro-diagnostic tests were used for the diagnosis of CTS. Data were analyzed by independent t-test and chi square test in SPSS20. Results : The prevalence of CTS in diabetic patients was 24.23%. The prevalence of the disorder in male and female patients was 16.21% and 30.65%, respectively. The results showed that there is no significant difference in the prevalence of CTS in diabetic people with and without metabolic syndrome, in overall as well as sex subgroups. Discussion and Conclusion : The higher prevalence of CTS in diabetic patients in this study compared to other studies shows the lack of prevention and case finding in diabetic patients. Therefore, screening, educating and informing at risk people about the disease is necessary.

Carpal tunnel syndrome in diabetic patients: Clinical, electrophysiological and sonographic study

Carpal tunnel syndrome in diabetic patients: Clinical, electrophysiological and sonographic study

The outcome of carpal tunnel decompression in patients with diabetes mellitus

Diabetes mellitus is recognised as a risk factor for carpal tunnel syndrome. The response to treatment is unclear, and may be poorer than in non-diabetic patients. Previous randomised studies of interventions for carpal tunnel syndrome have specifically excluded diabetic patients. The aim of this study was to investigate the epidemiology of carpal tunnel syndrome in diabetic patients, and compare the outcome of carpal tunnel decompression with non-diabetic patients. The primary endpoint was improvement in the QuickDASH score. The prevalence of diabetes mellitus was 11.3% (176 of 1564). Diabetic patients were more likely to have severe neurophysiological findings at presentation. Patients with diabetes had poorer QuickDASH scores at one year post-operatively (p = 0.028), although the mean difference was lower than the minimal clinically important difference for this score. After controlling for underlying differences in age and gender, there was no difference between groups in the magnitude of improvement after decompression (p = 0.481). Patients with diabetes mellitus can therefore be expected to enjoy a similar improvement in function.

P30-20 Clinical characteristics of carpal tunnel syndrome in diabetic patients

P30-20 Clinical characteristics of carpal tunnel syndrome in diabetic patients

High incidence of carpal tunnel syndrome in diabetic patients after combined pancreas and kidney transplantation

Fifty-eight patients with long-standing type 1 (insulin-dependent) diabetes were studied prospectively after combined pancreas and kidney transplantation for a mean observation period of 47.9 months (range 17-116 months). Thirty-three per cent of these patients (19/58) developed carpal tunnel syndrome after a mean interval of 1.7 years (range 3 months-5 years). This rate is about twice that in type 1 diabetic patients. The manifestation of carpal tunnel syndrome was not significantly associated with worsening of diabetic polyneuropathy or with deterioration of kidney or pancreas function. In all but one patient symptoms improved without surgical intervention. This study suggests that patients after combined pancreas and kidney transplantation have an increased risk of carpal tunnel syndrome for which the etiology and pathophysiology are unknown. In most patients no surgical intervention is necessary.