ORIJINAL ARAŞTIRMA
Karpal Tünel Sendromunda Nöropatik Ağrı: Elektrofizyolojik Bulgular ve Fonksiyonel Durumla İlişkisi
Neuropathic Pain in Carpal Tunnel Syndrome: Association withElectrophysiological Findings and Functional Status
Received Date : 19 Aug 2022
Accepted Date : 08 Nov 2022
Available Online : 16 Nov 2022
Sıtkı AĞADAYIa, Filiz ESERb, Ezgi AĞADAYIc, Hatice BODURd
aClinic of Physical Medicine and Rehabilitation, Sivas Numune Hospital, Sivas, Türkiye
bClinic of Physical Medicine and Rehabilitation, University of Health Sciences Ankara City Hospital, Ankara, Türkiye
cDepartment of Medical Education, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
dDepartment of Physical Medicine and Rehabilitation, Ankara Yıldırım Beyazıt University Ankara City Hospital, Ankara, Türkiye
Doi: 10.31609/jpmrs.2022-91787 - Makale Dili: EN
J PMR Sci. 2023;26(1):87-93
ÖZET
Amaç: Bu çalışmanın amacı, elektrofizyolojik olarak doğrulanmış
karpal tünel sendromu (KTS) olan hastalarda Leeds Nöropatik Semptom ve
Bulgu Değerlendirmesine [The Leeds Assessment of Neuropathic Semptom
and Sign (LANSS)] göre nöropatik ağrının varlığının belirlenmesi ve
nöropatik ağrının klinik ve elektrofizyolojik bulgular ve el işlevselliği ile
ilişkisinin araştırılmasıdır. Gereç ve Yöntemler: Elektrofizyolojik test
sonuçları KTS ile uyumlu olan 175 hasta (234 el) çalışmaya dâhil edildi.
Her hastaya standart elektrofizyolojik testler, LANSS ve Kol, Omuz ve El
Özürlülük Skalası [Quick Disability of the Arm, Shoulder, and Hand (QDASH)]
uygulandı. LANSS skoru; 12 olan hastalar Grup 1’i ve <12 olan
hastalar Grup 2’yi oluşturdu. Bulgular: Hastaların %58,11’inin (136 el)
LANSS skoru ≥12 (Grup 1) ve %41,89’unun (98 el) LANSS skoru <12
(Grup 2) idi. Kadın cinsiyet, semptom süresi, medyan sinir tarafından innerve
edilen elde saptanan duyu kaybı, abdüktör pollisis kas kuvveti, tenar
atrofi, phalen işaret pozitifliği ve Q-DASH skorları Grup 1’de daha yüksekti
(p<0,05). Elektrofizyolojik şiddet Grup 1’de daha yüksek bulundu
(p<0,005). Medyan sinir motor distal latansı ve medyan sinir 2. parmak-el
bileği duyusal distal latansı Grup 1’de daha uzundu (p<0,05). Medyan sinir
2. parmak-el bileği duyusal amplitüdü ve medyan sinir 2. parmak-el bileği
duyusal hızı Grup 1’de anlamlı olarak daha düşük bulundu (p<0,05). Sonuç:
KTS’li hastalarda nöropatik ağrı varlığını belirlemek için medyan sinir
motor distal latansı ve duyusal sinir iletim çalışmalarının kullanılabileceği
gösterildi. KTS’li hastalarda nöropatik ağrının varlığının ve mekanizmasının
bilinmesi uygun tedavi stratejisinin belirlenmesinde klinisyene yol gösterecektir.
Anahtar Kelimeler: Karpal tünel sendromu; elektronöromiyografi; nöropatik ağrı
ABSTRACT
Objective: Aims of the present study are to determine the
presence of neuropathic pain according to The Leeds Assessment of Neuropathic
Symptoms and Sign (LANSS) in patients with electrophysiologically
confirmed carpal tunnel syndrome (CTS) and investigate the
association of neuropathic pain with clinical and electrophysiological findings
and hand functionality. Material and Methods: 175 patients (234
hands) whose electrophysiological test results were compatible with CTS
were included. Standard electrophysiological tests, LANSS and Quick Disability
of the Arm, Shoulder, and Hand (Q-DASH) were applied to each patient.
Patients with LANSS score; 12 formed Group 1 and <12 formed
Group 2. Results: Of patients, 58.11% (136 hands) had a LANSS score ≥12
(Group 1) and 41.89% (98 hands) had a LANSS score <12 (Group 2). Female
sex, symptom duration, sensory loss detected in the hand innervated by
the median nerve, abductor pollicis muscle strength, thenar atrophy, phalen
sign positivity and Q-DASH scores were higher in Group 1 (p<0.05). Electrophysiological
severity was found to be higher in Group 1 (p<0.005). Median
nerve motor distal latency and median nerve 2nd digit-wrist sensory
distal latency were longer (p<0.05) in Group 1. Median nerve 2nd digitwrist
sensory amplitude and median nerve 2nd digit-wrist sensory velocity
were found to be significantly lower in Group 1 (p<0.05). Conclusion: It has
been shown that median nerve motor distal latency and sensory nerve conduction
studies can be used to determine the presence of neuropathic pain
in patients with CTS. Knowing the presence and mechanism of neuropathic
pain in patients with CTS will guide the clinician in determining the appropriate
treatment strategy.
Keywords: Carpal tunnel syndrome; electroneuromyography; neuropathic pain
REFERENCES
- Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282:153-8. [Crossref] [PubMed]
- Neal NC, McManners J, Stirling GA. Pathology of the flexor tendon sheath in the spontaneous carpal tunnel syndrome. J Hand Surg Br. 1987;12:229-32. [Crossref] [PubMed]
- Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002;113:1373-81. [Crossref] [PubMed]
- Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630-5. [Crossref] [PubMed]
- Guidelines in electrodiagnostic medicine. American Association of Electrodiagnostic Medicine. Muscle Nerve. 1992;15:229-53. [Crossref] [PubMed]
- Yucel A, Senocak M, Kocasoy Orhan E, et al. Results of the Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study. J Pain. 2004;5:427-32. [Crossref] [PubMed]
- Koldas Dogan S, Ay S, Evcik D, et al. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30:185-91. [Crossref] [PubMed]
- Mackinnon SE. Pathophysiology of nerve compression. Hand Clin. 2002;18:231-41. [Crossref] [PubMed]
- Padua L, Padua R, Aprile I, et al. Carpal tunnel syndrome: relationship between clinical and patient-oriented assessment. Clin Orthop Relat Res. 2002:128-34. [Crossref] [PubMed]
- Sonohata M, Tsuruta T, Mine H, et al. The relationship between neuropathic pain, and the function of the upper limbs based on clinical severity according to electrophysiological studies in patients with carpal tunnel syndrome. Open Orthop J. 2013;7:99-102. [Crossref] [PubMed] [PMC]
- Gürsoy AE, Kolukısa M, Yıldız GB, et al. Relationship between electrodiagnostic severity and neuropathic pain assessed by the LANSS pain scale in carpal tunnel syndrome. Neuropsychiatr Dis Treat. 2013;9:65-71. [Crossref] [PubMed] [PMC]
- Truini A, Padua L, Biasiotta A, et al. Differential involvement of A-delta and A-beta fibres in neuropathic pain related to carpal tunnel syndrome. Pain. 2009;145:105-9. [Crossref] [PubMed]
- Torrance N, Smith BH, Bennett MI, et al. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain. 2006;7:281-9. [Crossref] [PubMed]
- Fillingim RB, King CD, Ribeiro-Dasilva MC, et al. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009;10:447-85. [Crossref] [PubMed] [PMC]
- Myers RR. 1994 ASRA Lecture. The pathogenesis of neuropathic pain. Reg Anesth. 1995;20:173-84. [PubMed]
- Fernández-de-las-Pe-as C, de la Llave-Rincón AI, Fernández-Carnero J, et al. Bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome: evidence of central processing in unilateral neuropathy. Brain. 2009;132:1472-9. [Crossref] [PubMed]
- Dandinoğlu T, Karadeniz M, Yılmaz V, et al. Evaluating neuropathic complaints by DN4 and LANSS scales after local corticosteroid therapy in carpal tunnel syndrome. J Back Musculoskelet Rehabil. 2016;29:575-80. [Crossref] [PubMed]
- Oncel C, Bir LS, Sanal E. The relationship between electrodiagnostic severity and Washington Neuropathic Pain Scale in patients with carpal tunnel syndrome. Agri. 2009;21:146-8. [PubMed]
- Jablecki CK, Andary MT, So YT, et al. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee. Muscle Nerve. 1993;16:1392-414. [Crossref] [PubMed]
- Padua L, Padua R, Aprile I, et al; Italian CTS Study Group. Carpal tunnel syndrome. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology. 2001;56:1459-66. [Crossref] [PubMed]
