Diagnosis of carpal tunnel syndrome

Carpal Tunnel Syndrome in Diabetes Mellitus

The aim of the present brief review was to discuss carpal tunnel syndrome (CTS) in diabetes mellitus (DM). Generally, CTS is more common in DM, especially in subjects with coexisting diabetic polyneuropathy (DPN) and/or long DM duration. There is no agreement if it is more frequent in type 1 or type 2 DM. The precise underlying mechanisms are not entirely clear but appear to involve hyperglycaemia-induced median nerve oedema, increased sensitivity to exogenous trauma and nerve myelin ischaemia and axonal degeneration. More recently, increased vascular endothelial growth factor (VEGF) and advanced glycation endproducts (AGEs) appear to also play an important role. Median nerve conduction study remains the cornerstone of CTS diagnosis in DM, being more sensitive than clinical examination. CTS can be treated medically or surgically. The latter appears now to be equally effective in subjects with vs. without DM in terms of recurrence rates and quality of life.

Carpal tunnel syndrome in patients who are receiving long-term renal hemodialysis

INTRODUCTION

The development of a carpal tunnel syndrome has become an increasingly recognized problem in patients who are treated by long-term hemodialysis. Arteriovenous fistula has been identified as one of the possible cause for the development of carpal tunnel syndrome.

MATERIALS AND METHODS

Wrists of 558 hemodialysis patients who had fistula at least 1 year served as the case group and the other intact wrists of the same patients served as the control group. Carpal tunnel syndrome was diagnosed clinically; however, 232 random patients underwent electrodiagnostic studies the day after hemodialysis.

RESULTS

In 170 (30.5%) wrists with arteriovenous fistula developed carpal tunnel syndrome versus 68 (12.2%) in the contralateral wrist. Three patients had a concurrent diagnosed radial steal syndrome. In all three wrists that had radial steal syndrome developed carpal tunnel syndrome. There was a correlation, however, between the development of the carpal tunnel syndrome, and the side of the longest vascular access. Contrary to the clinical assessment, electrodiagnostic studies did not indicate any significant association between the frequency of carpal tunnel syndrome and arteriovenous fistula or its duration.

CONCLUSION

Hemodialysis patients are at considerable risk of developing carpal tunnel syndrome in the wrist with an arteriovenous fistula. Close observation and routine clinical examination is mandatory to prevent further problems.

Association between Carpel Tunnel Syndrome and Arteriovenous Fistula in Hemodialysis Patients

BACKGROUND

Carpal tunnel syndrome is more common in hemodialysis patients than in the general population. In addition to uremic neuropathy, arteriovenous fistula has been identified as one of the possible causes for the development of carpal tunnel syndrome.

METHODS

Wrists of 279 hemodialysis patients who had arteriovenous fistula for at least 6 months served as the case group and the other intact wrists of the same patients served as the control group. Carpal tunnel syndrome was diagnosed clinically; however, 116 random patients underwent electrodiagnostic studies the day after hemodialysis.

RESULTS

Clinically, carpal tunnel syndrome was diagnosed less frequently in the contralateral wrist than in the wrist with arteriovenous fistula (12.2 percent versus 30.5 percent, p < 0.0001). Meanwhile, the authors found a positive correlation between the duration of fistula and the development of carpal tunnel syndrome (p < 0.028). The site of fistula (snuffbox, radiocephalic) used, however, had no effect on the rate of development of carpal tunnel syndrome (p > 0.2). Contrary to the clinical assessment, electrodiagnostic studies did not indicate any significant association between the frequency of carpal tunnel syndrome and arteriovenous fistula or its duration. With the nerve conduction velocity abnormalities observed in patients with uremic polyneuropathy, the authors believe that clinical diagnosis of carpal tunnel syndrome is more indicative of the development of the condition than the electrodiagnostic results.

CONCLUSIONS

The authors' clinical results have revealed that hemodialysis patients are at considerable risk of developing carpal tunnel syndrome in the wrist with an arteriovenous fistula. These patients should be under close observation and receive routine checkup.