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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
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.
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.
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