Abstract
Objective
(1) To examine the ultrasonography (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
A tertiary medical center and a secondary hospital from November 2017 to March 2021.
Participants
Consecutive patients (N=207) without diabetes under hemodialysis were recruited and
divided into a hemodialysis without carpel tunnel syndrome (CTS) (H-Control) group
and an H-CTS group. Age-matched volunteers (N=89) without diabetes or upper extremity
disorders were enrolled as the control group.
Intervention
US examinations by 2 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 the control group (n=69), the CSA-I was significantly larger in the
H-Control group (n=63) and H-CTS group (n=76) (P<.001, both). There were no significant differences in the FR-I/-O among the 3 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% vs 3.5±2.3%
and 3.8±1.7%, P<.001, both). 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 patients without diabetes undergoing
hemodialysis.
Keywords
List of abbreviations:
ANOVA (analysis of variance), AVF (arteriovenous fistula), CSA (cross-sectional area), CSA-I (cross-sectional area of the median nerve at the inlet of the carpal tunnel), CSA-O (cross-sectional area of the median nerve at the outlet of the carpal tunnel), CTS (carpal tunnel syndrome), FR-I (flattening ratio of the median nerve at the inlet of the carpal tunnel), FR-O (flattening ratio of the median nerve at the outlet of the carpal tunnel), gMHD (hamate hook-to-median nerve distance in the gripping position), H-Control (patients under hemodialysis without carpal tunnel syndrome), H-CTS (hemodialysis-related carpal tunnel syndrome), ICC (intraclass correlation coefficient), NCS (nerve conduction study), rMHD (hamate hook-to-median nerve distance in the resting position), RMHD (dynamic ratio of the median nerve-to-hamate hook distance), US (ultrasonography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 16, 2021
Accepted:
November 23,
2021
Received in revised form:
October 27,
2021
Received:
July 12,
2021
Footnotes
Supported by the Taiwan National Science Council (grants: MOST 107-2314-B-006-065-MY3, MOST 108-2314-B-650-007, MOST 110-2622-E-006-023, MOST 110-2314-B-006-022) and National Cheng Kung University (grants: NCKUEDA 10903, NCKUEDA 110006).
Disclosures: none
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
