손목굴증후군에서 감각이상분포의 임상적 의미
Clinical Significance of Paresthesia Distribution in Carpal Tunnel Syndrome
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Background: Carpal tunnel syndrome (CTS) is defined by symptoms associated with damage to the median nerve within the carpal tunnel. Abnormal sensation in the median nerve territory is one of the primary clinical diagnostic criteria for CTS. However, extramedian sensory abnormalities in CTS are common. The purpose of this study was to identify the clinical significance of the paresthesia distribution in CTS. Methods: This was a cross-sectional retrospective study involving patients with CTS diagnosed based on the American Academy of Neurology criteria between January 2009 and January 2011. In total, 109 hands of 57 enrolled patients were analyzed. The participants were divided into two groups according to the distribution of sensory abnormalities: (1)sensory symptoms confined to the median nerve distribution (median group), and (2) sensory symptoms distributed diffusely over the entire hand (glove group). Clinical features and electrophysiological findings were investigated by thorough chart reviews. Results: Forty-seven (43.1%) hands belonged to the glove group. The frequency of sensory abnormalities and motor weakness was higher in the median group (38.7 vs 9.7%) than in the glove group (12.8% vs. 0.0%) on neurological examination. The conduction velocities of sensory nerves of the wrist and finger were significantly slower in the median group than in the glove group. Conclusions: Evaluation of the sensory symptom distribution in CTS may predict the degree of nerve damage, with sensory abnormality restricted to the median nerve distribution reflecting more severe nerve damage in CTS.
Abstract
Background: Carpal tunnel syndrome (CTS) is defined by symptoms associated with damage to the median nerve within the carpal tunnel. Abnormal sensation in the median nerve territory is one of the primary clinical diagnostic criteria for CTS. However, extramedian sensory abnormalities in CTS are common. The purpose of this study was to identify the clinical significance of the paresthesia distribution in CTS. Methods: This was a cross-sectional retrospective study involving patients with CTS diagnosed based on the American Academy of Neurology criteria between January 2009 and January 2011. In total, 109 hands of 57 enrolled patients were analyzed. The participants were divided into two groups according to the distribution of sensory abnormalities: (1)sensory symptoms confined to the median nerve distribution (median group), and (2) sensory symptoms distributed diffusely over the entire hand (glove group). Clinical features and electrophysiological findings were investigated by thorough chart reviews. Results: Forty-seven (43.1%) hands belonged to the glove group. The frequency of sensory abnormalities and motor weakness was higher in the median group (38.7 vs 9.7%) than in the glove group (12.8% vs. 0.0%) on neurological examination. The conduction velocities of sensory nerves of the wrist and finger were significantly slower in the median group than in the glove group. Conclusions: Evaluation of the sensory symptom distribution in CTS may predict the degree of nerve damage, with sensory abnormality restricted to the median nerve distribution reflecting more severe nerve damage in CTS.
참고문헌 (17)
- Caliandro P, "Distribution of paresthesias in Carpal Tunnel Syndrome reflects the degree of nerve damage at wrist", Clin Neurophysiol, 117, pp.228~231 (2006)
- Wilder-Smith EP, "Sensory distribution indicates severity of median nerve damage in carpal tunnel syndrome", Clin Neurophyiol, 119, pp.1619~1625 (2008)
- Their Madasamy A, "Factors related to the distribution of hand symptoms in Singaporean patients with carpal tunnel syndrome", Clin Neurophysiol, 117(1), pp.74~ (2006)
- Sharma V, "Self-administered hand symptom diagram for carpal tunnel syndrome diagnosis", J Hand Surg Br, 29, pp.571~574 (2004)
- Wilder-Smith EP, "Diagnosing carpal tunnel syndrome-clinical criteria and ancillary tests", Nat Clin Prac Neurol, 2, pp.366~374 (2006)
- Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement, "American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation", Muscle Nerve, 16, pp.1390~1391 (1993)
- Nora DB, "What symptoms are truly caused by median nerve compression in carpal tunnel syndrome?", Clin Neurophiol, 116, pp.257~283 (2005)
- Gupta SK, "Symptoms experienced by patients with carpal tunnel syndrome", Can J Neurol Sci, 24, pp.338~342 (1997)
- Stevens JC, "Symptoms of 100 patients with electromyographically verified carpal tunnel syndrome", Muscle Nerve, 22, pp.1448~1456 (1999)
- Zanette G, "Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms", Pain, 122, pp.264~270 (2006)
- Caliandro P, "Pattern of paresthesia in patients with carpal tunnel syndrome", Clin Neurophysiol, 118, pp.1648~ (2007)
- Ginanneschi F, "Evidence of altered motor axon properties of the ulnar nerve in carpal tunnel syndrome", Clin Neurophysiol, 118, pp.1569~1576 (2007)
- Ginanneschi F, "Ulnar sensory nerve impairment at the wrist in carpal tunnel syndrome", Muscle Nerve, 37, pp.183~189 (2008)
- Tamburin S, "Ulnar nerve impairment at the wrist dose not contribute to extramedian sensory symptoms in carpal tunnel syndrome", Clin Neurophysiol, 120, pp.1687~1692 (2009)
- Zanette G, "Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms", Pain, 148, pp.227~236 (2010)
- Djouhri L, "Spontaneous pain, both neuropathic and inflammatory, is related to frequency of spontaneous firing in intact C-fiber nociceptors", J Neurosci, 26, pp.1281~1292 (2006)
- Tecchio F, "Carpal tunnel syndrome modifies sensory hand cortical somatotopy : a MEG study", Hum Brain Mapp, 17, pp.28~36 (2002)