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ORIJINAL ARAŞTIRMA

Karpal Tünel Sendromu Tanısı Almış Kadınlarda El Bilek Eklem Hareket Açıklığının ve El Kavrama Gücünün Değerlendirilmesi: Kontrollü Çalışma
Evaluation of Wrist Range of Motion and Hand Grip Strength in Women with the Diagnosis of Carpal Tunnel Syndrome: A Controlled Study
Received Date : 08 Aug 2019
Accepted Date : 23 Jan 2020
Available Online : 05 Feb 2020
Doi: 10.31609/jpmrs.2019-70503 - Makale Dili: EN
J PMR Sci. 2020;23(2):57-61
ÖZET
Amaç: Karpal tünel sendromu (KTS) toplumda en sık görülen tuzak nöropatidir. Erken tanı konulduğu zaman farmakolojik ve farmakolojik olmayan yöntemlerle kolayca tedavi edilebilir. Bu çalışmanın amacı karpal tünel sendrom tanısı almış kadınlarda el bileği hareket açıklığı ve kavrama kuvvetini değerlendirmek ve kontrol grubu ile karşılaştırmak idi. Gereç ve Yöntemler: Kesitsel çalışmamıza elektrofizyolojik olarak hafif- orta şiddette bilateral karpal tünel sendromu tanısı almış 28 kadın dahil edildi. Kontrol grubu yaş ve cinsiyet eşitliği sağlanmış sağ el dominant olan sağlıklı 41 gönüllüden oluşuyordu. El bileği eklem hareket açıklığı (EHA) gonyometre ile ölçüldü. Uygulayıcılar arası ve test uygulamaları arası güvenilirlik çalışmaları için, çalışmanın başında 10 sağlıklı gönüllüde bilek EHA ölçümleri yapıldı. Sınıf içi korelasyon katsayısı (SKK) hesaplandı. El kavrama kuvveti, hidrolik el dinamometresi ile ölçüldü. Bulgular: KTS ve kontrol grubunda el bileği ekstansiyon derecesi sırasıyla 62,66°±15,56°ve 77°±9,9° idi. El bileği fleksiyon derecesi KTS’e 57,66°±11,89°, kontrol grubunda 67,38°±4,7° idi. Hasta ve kontrol grubundaki ortalama kavrama kuvveti sırasıyla 15,32±7,27 kg ve 40,40±7,80 kg idi (p<0,001). SKK değerleri uygulamalar arası güvenilirliği için 0.61-0.98 arasındaydı, SKK değerleri 0.76-0.97 arasındaydı. KTS grubundaki el bileği fleksiyonu, ekstansiyonu ve radial, ulnar deviasyon derecesi ve el kavrama kuvveti kontrol grubundan anlamlı derecede düşük olarak değerlendirildi (p<0.00). Sonuç: KTS’li hastalar, sağlıklı kontrol grubu ile karşılaştırıldığında el bilek hareketlerinde ve el kavrama kuvvetinde azalma görülebilir. El bileği EHA ve el kavrama kuvvetini değerlendirmek, KTS değerlendirmesinde kullanılabilecek ölçülebilir parametrelerdir.
ABSTRACT
Objective: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the community. When diagnosed early, it can be easily treated by pharmacological and non-pharmacological methods. The aim of this study was to evaluate wrist range of motion (ROM) and grip strength in women diagnosed with carpal tunnel syndrome and to compare the results with those of the controls. Material and Methods: Twenty-eight women with bilateral CTS were included in this cross-sectional study. The control group consisted of 41 healthy age and gender matched volunteers who had right hand dominancy. Wrist range of motions (ROM) were measured by goniometer. For the intrarater and interrater reliability studies, wrist ROM measurements were performed in 10 healthy volunteers at the beginning of the study. Intraclass correlation coefficient (ICC) values were calculated. Grip strength was measured by hydraulic hand dynamometer. Results: Wrist extension values in the CTS and control groups were 62.66±15.56° and 77±9.9°, respectively. Wrist flexion values were 57.66±11.89° in the CTS and 67.38±4.7° in the control groups. The mean grip strength values in the patient and control groups were 15.32±7.27 kg and 40.40±7.80 kg, respectively (p<0.001). The ICC values were between 0.61-0.98 for the intrarater reliability, ICC values were between 0.76-0.97. Wrist flexion, extension, radial, ulnar deviation and hand grip strength were significantly lower in the CTS group than the control group (p<0.00). Conclusion: Wrist ROM and hand grip strength of patients with CTS resulted in decreased wrist movements and hand grip strength when they were compared with the healthy control group. Evaluating wrist ROM and hand grip strength are measurable parameters that can be used in CTS assessment.
REFERENCES
  1. Atroshi I, Gummesson C, Johnson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282:153-8. [Crossref]  [PubMed] 
  2. Geere J, Chester R, Kale S, et al. Power grip, pinch grip, manual muscle testing or thenar atrophy-which should be assessed as a motor outcome after carpal tunnel decompression? A systematic review. BMC Musculoskelet Disord. 2007;8:114. [Crossref]  [PubMed]  [PMC] 
  3. Goss BC, Agee JM. Dynamics of intracarpal tunnel pressure in patients with carpal tunnel syndrome. J Hand Surg Am. 2010;5A:197-206. [Crossref]  [PubMed] 
  4. Bland JD. Carpal tunnel syndrome. BMJ. 2007;335:343-6. [Crossref]  [PubMed]  [PMC] 
  5. Diao E, Shao F, Liebenberg E, et al. Carpal tunnel pressure alters median nerve function in a dose-dependent manner: a rabbit model for carpal tunnel syndrome. J Orthop Res. 2005;23:218-23. [Crossref]  [PubMed] 
  6. Sud V, Freeland AE. Biochemistry of carpal tunnel syndrome. Microsurgery. 2005;25:44-6. [Crossref]  [PubMed] 
  7. Ugbolue UC, Hsu WH, Goitz RJ, Li ZM. Tendon and nerve displacement at the wrist during finger movement. Clin Biomech (Bristol, Avon). 2005;20:50-6. [Crossref]  [PubMed] 
  8. Jinrok O, Zhao C, Amadio PC, et al. Vascular pathologic changes in the flexor tenosynovium (subsynovial connective tissue) in idiopathic carpal tunnel syndrome. J Orthop Res. 2004;22:1310-5. [Crossref]  [PubMed] 
  9. Nora DB, Becker J, Ehlers JA, et al. Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg. 2004;107:64-9. [Crossref]  [PubMed] 
  10. Nora DB, Becker J, Ehler JA, et al. What symptoms are truly caused by median nerve compression in carpal tunnel syndrome? Clin Neurophysiol. 2005;116:275-83. [Crossref]  [PubMed] 
  11. Walker JM, Sue D, Miles-Elkousy N, et al. Active mobility of the extremities in older subjects. Phys Ther. 1984;64:919-23. [Crossref]  [PubMed] 
  12. Alperovitch-Najason D, Carmeli E, Coleman R, et al. Hand grip strength as a diagnostic tool in work-related upper extremity musculoskeletal disorders in women. ScientificWorldJournal. 2004;4:111-7. [Crossref]  [PubMed]  [PMC] 
  13. Cambridge-Keeling CA. ROM measurement of the hand. In: Hunter JM, Callahan AD, Skirven TM et al, eds. Rehabilitation of the Hand and Upper Extremity. 5th ed. Missouri; Mosby Inc; 2002. p.169-82.
  14. Armstrong BK, White E, Sarraci R, Principles of Exposure Measurement in Epidemiology. 1st ed. New York: Oxford University Press; 1994. p.351.
  15. Levine DW, Simmons BP, Koris MJ, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75:1585-92. [Crossref]  [PubMed] 
  16. Sezgin M, Incel NA, Serhan S, et al. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and validity of the Turkish version of the Boston Questionnaire. Disabil Rehabil. 2006;28:1281-5. [Crossref]  [PubMed] 
  17. Wilson JK, Sevier TL. A review of treatment for carpal tunnel syndrome. Disabil Rehabil. 2003;25:113-9. [Crossref]  [PubMed] 
  18. Yoshii Y, Zhao C, Henderson J, et al. Effects of carpal tunnel release on the relative motion of tendon, nerve, and subsynovial connective tissue in a human cadaver model. Clin Biomech (Bristol, Avon). 2008;23:1121-7. [Crossref]  [PubMed]  [PMC] 
  19. Lluch AL. Thickening of the synovium of the digital flexor tendons: cause or consequence of the carpal tunnel syndrome? J Hand Surg Br. 1992;17:209-12. [Crossref] 
  20. Franco OI, Zurakowski D, Day CS. Functional disability of the wrist: direct correlation with decreased wrist motion. J Hand Surg Am. 2008;33:485-92. [Crossref]  [PubMed] 
  21. Baker NA, Moehling KK, Desai AR, et al. Effect of carpal tunnel syndrome on grip and pinch strength compared with sex- and age-matched normative data. Arthritis Care Res (Hoboken). 2013;65:2041-5. [Crossref]  [PubMed] 
  22. Fernandes CH, Meirelles LM, Raduan Neto J, et al. Carpal tunnel syndrome with thenar atrophy: evaluation of the pinch and grip strength in patients undergoing surgical treatment. Hand (N Y). 2013;8:60-3. [Crossref]  [PubMed]  [PMC] 
  23. Jerosch-Herold C, Shepstone L, Miller L, et al. The responsiveness of sensibility and strength tests in patients undergoing carpal tunnel decompression. BMC Musculoskelet Disord. 2011;12:244. [Crossref]  [PubMed]  [PMC] 
  24. Brumfield RH, Champoux JA. A biomechanical study of normal functional wrist motion. Clin Orthop Relat Res. 1984;187:23-5. [Crossref] 
  25. Palmer AK, Skahen JR, Werner FW, et al. The extensor retinaculum of the wrist: an anatomical and biomechanical study. J Hand Surg Br. 1985;10:11-6. [Crossref] 
  26. Ryu JY, Cooney WP 3rd, Askew LJ, et al. Functional ranges of motion of the wrist joint. J Hand Surg Am. 1991;16:409-19. [Crossref]