Evaluation of effectiveness of local insulin injection in non-insulin-dependent diabetic patient with carpal tunnel syndrome

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common type of peripheral nerve entrapment and is a significant cause of morbidity. Carpal tunnel syndrome (CTS) has more incidences in diabetic patients. It has been suggested that insulin has an effect on nerve regeneration similar to that of nerve growth factor (NGF). Therefore, we aimed to evaluate the effectiveness of local insulin injection on the median nerve in patients with non-insulin-dependent diabetes mellitus (NIDDM) who have mild-to-moderate carpal tunnel syndrome (CTS).

MATERIALS AND METHODS

We carried out a prospective, randomized, single-blind, case-controlled study in these patients. We randomly selected 50 patients, 20 of whom had bilateral mild-moderate CTS. Therefore we had 70 hands and categorized them into two groups. At the baseline we injected NPH insulin (10U) directly into the carpal tunnel in group 1, and performed physiotherapy for the other group (group 2). Two weeks later, NPH insulin (10U) was injected into the carpal tunnel again and we continued physiotherapy for group 2. Electrodiagnostic study was performed for these two groups before treatment and 4 weeks after the last injection and physiotherapy. The patients were followed up for 6 weeks.

RESULTS

In both groups decrement of distal motor latency (DML) of the median nerves statistically was significant. In both groups, the increment of the sensory nerve conduction velocity was statistically significant. Also the decrement of pain, paresthesia, numbness, weakness/clumsiness and nocturnal awaking was statistically significant in both groups. But there was no significant difference between the two groups.

CONCLUSION

Local insulin injection is an effective and safe treatment for carpal tunnel syndrome in NIDDM patients as physiotherapy

The diagnostic value of ultrasonography in patients with electrophysiologicaly confirmed carpal tunnel syndrome

OBJECTIVE

To evaluate the diagnostic value of ultrasonography in patients with electrophysiologically confirmed carpal tunnel syndrome.

DESIGN

A prospective ultrasonographic study of 70 wrists with electrophysiologically confirmed carpal tunnel syndrome and of 80 normal wrists. Receiver-operating-characteristics curves for the ultrasonographic measurements of median nerve were plotted to identify the most optimal cutoff values.

RESULTS

The ultrasonographic measurements of median nerves were found to be increased significantly in patients with carpal tunnel syndrome when compared with controls, particularly in terms of cross-sectional area (P <0.001). According to receiver-operating-characteristics curve results, the most optimal cutoff value for the cross-sectional area of the median nerve was obtained at the level of middle carpal tunnel, which was 9.3 mm2, with a sensitivity of 80% and specificity of 77.5%.

CONCLUSION

Ultrasonographic examination of the median nerve seems to be a promising method in the diagnosis of carpal tunnel syndrome, evaluating the morphologic changes of the median nerve in patients with clinical signs and symptoms. Further studies with wider series are needed to confirm our preliminary results.

Brainstem auditory evoked potential (BAEP) in brucellosis

BACKGROUND

Brucellosis is a zoonosis still endemic in many parts of the world including coastal countries of Mediterranean Sea, Middle East regions and Central and South America. Now in this study we surveyed whether patients with systemic brucellosis, BAEP differ from healthy persons or not. This will help us later, when the patients with brucellosis refer to perform BAEP to prevent misdiagnosis.

MATERIALS AND METHODS

Fifteen patients with acute systemic brucellosis without neurological involvement and 15 apparently healthy persons underwent a brainstem auditory evoked potentials (BAEP) study.

RESULTS

Comparison of pooled data between the systemic brucellosis and healthy groups showed no significant differences in all BAEP parameters.

CONCLUSION

In conclusion, BAEP parameters in brucellosis group did not differ from healthy persons. Thus in interpretation of BAEP in patients that referred for another reason and have systemic brucellosis, it is not necessary to consider about the effect of brucellosis on BAEP.