Does Diabetes Mellitus Influence Carpal Tunnel Syndrome?
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose Diabetes mellitus (DM) has been proposed as a risk factor for carpal tunnel syndrome (CTS), but this remains controversial. We investigated the association between DM and CTS using both ultrasonography (US) and nerve conduction study (NCS) data. Methods We analyzed a prospectively recruited database of neuromuscular US and medical records of subjects who had undergone NCSs and electromyography for symptoms suggestive of CTS. Subjects were assigned to the follow groups: Group I, CTS with DM; Group II, CTS without DM; Group III, no CTS with DM; and Group IV, no CTS without DM. US cross-sectional area (CSA) and NCS measurements at the median nerve (MN) were compared among groups. We used a general linear mixed model to adjust for statistically significant covariates. Results The 230 participants comprised 22, 83, 19, and 106 in Groups I–IV, respectively. In multivariate analyses, the MN action potential amplitude in females was the only variable that was significantly associated with DM (p<0.001). Groups with DM tended to have a longer latency, smaller amplitude, and lower conduction velocity in the NCSs compared to groups without DM. The measured US CSA values did not differ significantly among the groups. Conclusions NCS measurements of the MN tended to differ between DM and non-DM patients regardless of the presence or absence of CTS. However, US did not reveal any statistically significant relationship between CTS and DM.
Abstract
Background and Purpose Diabetes mellitus (DM) has been proposed as a risk factor for carpal tunnel syndrome (CTS), but this remains controversial. We investigated the association between DM and CTS using both ultrasonography (US) and nerve conduction study (NCS) data. Methods We analyzed a prospectively recruited database of neuromuscular US and medical records of subjects who had undergone NCSs and electromyography for symptoms suggestive of CTS. Subjects were assigned to the follow groups: Group I, CTS with DM; Group II, CTS without DM; Group III, no CTS with DM; and Group IV, no CTS without DM. US cross-sectional area (CSA) and NCS measurements at the median nerve (MN) were compared among groups. We used a general linear mixed model to adjust for statistically significant covariates. Results The 230 participants comprised 22, 83, 19, and 106 in Groups I–IV, respectively. In multivariate analyses, the MN action potential amplitude in females was the only variable that was significantly associated with DM (p<0.001). Groups with DM tended to have a longer latency, smaller amplitude, and lower conduction velocity in the NCSs compared to groups without DM. The measured US CSA values did not differ significantly among the groups. Conclusions NCS measurements of the MN tended to differ between DM and non-DM patients regardless of the presence or absence of CTS. However, US did not reveal any statistically significant relationship between CTS and DM.
참고문헌 (33)
- de Krom MC, "Risk factors for carpal tunnel syndrome", Am J Epidemiol, 132, pp.1102~1110 (1990)
- Silverstein BA, "Occupational factors and carpal tunnel syndrome", Am J Ind Med, 11, pp.343~358 (1987)
- Atroshi I, "Prevalence of carpal tunnel syndrome in a general population", JAMA, 282, pp.153~158 (1999)
- Wilbourn AJ, "Diabetic Neuropathy", pp.481~508 (1999), Saunders
- Gulliford MC, "Increased incidence of carpal tunnel syndrome up to 10 years before diagnosis of diabetes", Diabetes Care, 29, pp.1929~1930 (2006)
- Aroori S, "Carpal tunnel syndrome", Ulster Med J, 77, pp.6~17 (2008)
- Chen LH, "Risk of hand syndromes in patients with diabetes mellitus: a population-based cohort study in Taiwan", Medicine (Baltimore), 94, pp.e1575~ (2015)
- Valls-Canals J, "Diabetic polyneuropathy. Axonal or demyelinating?", Electromyogr Clin Neurophysiol, 42, pp.3~6 (2002)
- Chen SF, "Ultrasonographic assessment of carpal tunnel syndrome of mild and moderate severity in diabetic patients by using an 8-point measurement of median nerve cross-sectional areas", BMC Med Imaging, 12, pp.15~ (2012)
- Watanabe T, "Sonographic evaluation of the median nerve in diabetic patients: comparison with nerve conduction studies", J Ultrasound Med, 28, pp.727~734 (2009)
- Bland JD, "Do nerve conduction studies predict the outcome of carpal tunnel decompression?", Muscle Nerve, 24, pp.935~940 (2001)
- Chan L, "The relationship between electrodiagnostic findings and patient symptoms and function in carpal tunnel syndrome", Arch Phys Med Rehabil, 88, pp.19~24 (2007)
- Cartwright MS, "Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome", Muscle Nerve, 46, pp.287~293 (2012)
- Hassan A, "Median nerve ultrasound in diabetic peripheral neuropathy with and without carpal tunnel syndrome", Muscle Nerve, 47, pp.437~439 (2013)
- Kim LN, "Sonography of the median nerve in carpal tunnel syndrome with diabetic neuropathy", Am J Phys Med Rehabil, 93, pp.897~907 (2014)
- Visser LH, "High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome", J Neurol Neurosurg Psychiatry, 79, pp.63~67 (2008)
- Bland JD, "A neurophysiological grading scale for carpal tunnel syndrome", Muscle Nerve, 23, pp.1280~1283 (2000)
- Kumar R, "Evidence for current diagnostic criteria of diabetes mellitus", World J Diabetes, 7, pp.396~405 (2016)
- 구용서, "Pitfalls in Using Electrophysiological Studies to Diagnose Neuromuscular Disorders", Journal of Clinical Neurology, 8(1), pp.1~14 (2012), 대한신경과학회
- Jablecki CK, "Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation", Neurology, 58, pp.1589~1592 (2002)
- Kim BJ, "Physiologic changes of compound muscle action potentials related to voluntary contraction and muscle length in carpal tunnel syndrome", J Electromyogr Kinesiol, 15, pp.275~281 (2005)
- Werner RA, "Electrodiagnostic evaluation of carpal tunnel syndrome", Muscle Nerve, 44, pp.597~607 (2011)
- Kim JS, "The significance of muscle echo intensity on ultrasound for focal neuropathy: the median- to ulnar-innervated muscle echo intensity ratio in carpal tunnel syndrome", Clin Neurophysiol, 127, pp.880~885 (2016)
- Jang JH, "Pattern analysis of nerve enlargement using ultrasonography in chronic inflammatory demyelinating polyneuropathy", Clin Neurophysiol, 125, pp.1893~1899 (2014)
- Gilliatt RW, "Peripheral nerve conduction in diabetic neuropathy", J Neurol Neurosurg Psychiatry, 25, pp.11~18 (1962)
- Mulder DW, "The neuropathies associated with diabetes mellitus. A clinical and electromyographic study of 103 unselected diabetic patients", Neurology, 11, pp.275~284 (1961)
- Spahn G, "Metaanalysis for the evaluation of risk factors for carpal tunnel syndrome (CTS)part I. General factors", Z Orthop Unfall, 150, pp.503~515 (2012)
- Hendriks SH, "Type 2 diabetes seems not to be a risk factor for the carpal tunnel syndrome: a case control study", BMC Musculoskelet Disord, 15, pp.346~ (2014)
- Becker J, "An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome", Clin Neurophysiol, 113, pp.1429~1434 (2002)
- Werner RA, "Carpal tunnel syndrome: pathophysiology and clinical neurophysiology", Clin Neurophysiol, 113, pp.1373~1381 (2002)
- Viikari-Juntura E, "Role of physical load factors in carpal tunnel syndrome", Scand J Work Environ Health, 25, pp.163~185 (1999)
- Nukada H, "Perivascular demyelination and intramyelinic oedema in reperfusion nerve injury", J Anat, 185(Pt 2), pp.259~266 (1994)
- Moon HI, "Ultrasonography of palm to elbow segment of median nerve in different degrees of diabetic polyneuropathy", Clin Neurophysiol, 125, pp.844~848 (2014)