Relationship of Physical Exam and Severity of Carpal Tunnel Syndrome with diabetic polyneuropathy

초록

Objective: There is a growing interest on carpal tunnel syndrome (CTS) because the large number of people suffers from hand tingling sensation. Diabetic polyneuropathy (DPN) is another disease that can cause hand tingling sense. This study was designed to understand the relation between clinical severity on physical examination (PE) and that of NCS in CTS with or without DPN. Subject & Method: We have recruited 63 patients (55.0±11.7 yrs, 31-80) with 126 hands that underwent NCS for evaluation of DPN and CTS. The examiners checked Tinel sign (TS), Phalen test (PT), and hand elevation test (HET) on both hands. Time taken for PT and HET was graded; 1-20 sec as grade 1, 21-40 sec as grade 2, 40-60 sec as grade 3, and over 60 sec as grade 4. The electrophysiolgic severity of CTS was classified according to Bland JDP’s classification (mild = grade 1, moderately severe = grade 2, very severe = grade 3). We compared PE grade to electrophysiologic CTS grade in patients with or without DPN. And we analyzed the relation between electrophysiologic severity of CTS and the grade of CTS physical examinations. Results: Except for 8 hands that were diagnosed as normal, 118 hands were used in the analysis. By electrophysiologic examination, 118 hands were classified into three degrees; 73 as mild, 34 as moderate severe, and 11 hands as very severe. 1. CTS grade vs PE: Comparing CTS grade 1 to 3 with the grade of physical exams, the grade of PT showed 3.8±0.6 (p<0.05) in CTS grade 1, 2.3±1.2 (p<0.05) in CTS grade 2, 1.3±0.5 (p<0.05) in CTS grade 3. And the comparison of CTS severity with the grade of HET showed 3.9±0.6 (p<0.05) in CTS grade 1, 1.4±0.8 (p<0.05) in CTS grade 2, 2.3±1.5 (p<0.05) in CTS grade 3. TS and the severity of CTS didn’t show any relation (p>0.05). 2. Relation of CTS & grade of PE in with/without DM: By Spearman analysis of CTS without DPN group, PT (r=0.719) showed a meaningful correlation and HET (rr=0.708) showed a meaningful correlation as well.