Diagnosis of carpal tunnel syndrome in non-diabetic patients with hemodialysis using ultrasound: Is it a useful adjunctive tool?

Arch Phys Med Rehabil. 2021 Dec 16:S0003-9993(21)01718-4. doi: 10.1016/j.apmr.2021.11.007. Online ahead of print.


OBJECTIVE: (1) To examine the ultrasound (US) characteristics in patients with hemodialysis-related carpal tunnel syndrome (H-CTS) and (2) to evaluate the accuracy of a proposed US parameter-dynamic ratio of median nerve-to-hamate hook distance (RMHD) in diagnosis of H-CTS.

DESIGN: A case-control study.

SETTING: In a tertiary medical center and a secondary hospital from Nov. 2017 to Mar. 2021.

PARTICIPANTS: Consecutive non-diabetes patients under hemodialysis were recruited and divided into a hemodialysis without CTS (H-Control) group and an H-CTS group. Age-matched volunteers without diabetes or upper extremity disorders were enrolled as the Control group.

INTERVENTION: Ultrasound examinations by two operators blinded to the patient’s clinical information.

MAIN OUTCOME MEASURES: US parameters including cross-sectional area of the median nerve at the carpal tunnel inlet (CSA-I) and outlet (CSA-O), the flattening ratio of the median nerve at the inlet (FR-I) and outlet (FR-O), and RMHD.

RESULTS: Handedness and arteriovenous fistula showed no associations with CSA-I/O and FR-I/O. Compared with Control group (n=69), the CSA-I was significantly larger in the H-Control group (n=63) and H-CTS group (n=76) (p<0.05). There were no significant differences in the FR-I/-O among the three groups. For the second aim, in the H-CTS group(n=38), there was a significantly lower RMHD compared with both the Control (n=20) and H-Control groups (n=30) (0.1%±2.2% versus 3.5±2.3% and 3.8±1.7%, p<0.05). An RMHD cutoff value of <2.7% yielded a specificity of 80.0%, a sensitivity of 94.7%, and an overall accuracy of 88.2% in the diagnosis of H-CTS.

CONCLUSIONS: Neither CSA-I/-O or FR-I/-O have a role in the diagnosis of H-CTS. RMHD might be a useful US parameter in the diagnosis of CTS in non-diabetic patients undergoing hemodialysis.

PMID:34922930 | DOI:10.1016/j.apmr.2021.11.007

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