4.6 Article

Diagnosis of Carpal Tunnel Syndrome in Patients Without Diabetes With Hemodialysis Using Ultrasonography: Is It a Useful Adjunctive Tool?

Journal

ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Volume 103, Issue 8, Pages 1551-1557

Publisher

W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2021.11.007

Keywords

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Funding

  1. Taiwan National Science Council [MOST 107-2314-B-006-065-MY3, MOST 108-2314-B-650-007, MOST 110-2622-E-006-023, MOST 110-2314-B-006-022]
  2. National Cheng Kung University [NCKUEDA 10903, NCKUEDA 110006]

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This study examines the ultrasonography characteristics in patients with H-CTS and evaluates the accuracy of a proposed US parameter in diagnosing H-CTS. The results indicate that RMHD might be a useful US parameter in diagnosing CTS in patients without diabetes undergoing hemodialysis.
Objective: (1) To examine the ultrasonography (US) characteristics in patients with hemodialysis-related carpal tunnel syndrome (H-CTS) and (2) to evaluate the accuracy of a proposed US parameter-dynamic ratio of median nerve-to-hamate hook distance (RMHD) in diagnosis of H-CTS. Design: A case-control study. Setting: A tertiary medical center and a secondary hospital from November 2017 to March 2021. Participants: Consecutive patients (N=207) without diabetes under hemodialysis were recruited and divided into a hemodialysis without carpel tunnel syndrome (CTS) (H-Control) group and an H-CTS group. Age-matched volunteers (N=89) without diabetes or upper extremity disorders were enrolled as the control group. Intervention: US examinations by 2 operators blinded to the patient's clinical information. Main Outcome Measures: US parameters including cross-sectional area of the median nerve at the carpal tunnel inlet (CSA-I) and outlet (CSA-O), the flattening ratio of the median nerve at the inlet (FR-I) and outlet (FR-O), and RMHD. Results: Handedness and arteriovenous fistula showed no associations with CSA-I/O and FR-I/O. Compared with the control group (n=69), the CSA-I was significantly larger in the H-Control group (n=63) and H-CTS group (n=76) (P<. 001, both). There were no significant differences in the FR-I/-O among the 3 groups. For the second aim, in the H-CTS group (n=38), there was a significantly lower RMHD compared with both the control (n=20) and H-Control groups (n=30) (0.1%+/- 2.2% vs 3.5 +/- 2.3% and 3.8 +/- 1.7%, P<. 001, both). An RMHD cutoff value of < 2.7% yielded a specificity of 80.0%, a sensitivity of 94.7%, and an overall accuracy of 88.2% in the diagnosis of H-CTS. Conclusions: Neither CSA-I/-O or FR-I/-O have a role in the diagnosis of H-CTS. RMHD might be a useful US parameter in the diagnosis of CTS in patients without diabetes undergoing hemodialysis. (c) 2021 by the American Congress of Rehabilitation Medicine.

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