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Diagnosis of Carpal Tunnel Syndrome in Patients Without Diabetes With Hemodialysis Using Ultrasonography: Is It a Useful Adjunctive Tool?

  • Author Footnotes
    ⁎ I-Te Tu and I-Ming Jou contributed equally to this work.
    I-Te Tu
    Footnotes
    ⁎ I-Te Tu and I-Ming Jou contributed equally to this work.
    Affiliations
    Department of Biomedical Engineering, National Cheng Kung University, Tainan

    Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan
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  • Author Footnotes
    ⁎ I-Te Tu and I-Ming Jou contributed equally to this work.
    I-Ming Jou
    Footnotes
    ⁎ I-Te Tu and I-Ming Jou contributed equally to this work.
    Affiliations
    Department of Orthopedics, E-Da Hospital, Kaohsiung

    School of Medicine, College of Medicine, I-Shou University, Kaohsiung

    GEG Orthopedic Clinic, Tainan
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  • Po-Yen Ko
    Affiliations
    Department of Biomedical Engineering, National Cheng Kung University, Tainan

    Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
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  • Jung-Shun Lee
    Affiliations
    Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan

    Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan
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  • Li-Chieh Kuo
    Affiliations
    Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan

    Medical Device Innovation Center, National Cheng Kung University, Tainan
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  • Chung-Yi Li
    Affiliations
    Department of Public Health, College of Medicine, National Cheng Kung University, Tainan

    Department of Public Health, College of Public Health, China Medical University, Taichung

    Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung
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  • Po-Ting Wu
    Correspondence
    Corresponding author Po-Ting Wu, MD, PhD, Department of Orthopedics, College of Medicine, National Cheng Kung University, 1 University Rd, East District, Tainan City 701, Taiwan.
    Affiliations
    Department of Biomedical Engineering, National Cheng Kung University, Tainan

    Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan

    Medical Device Innovation Center, National Cheng Kung University, Tainan

    Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan

    Department of Orthopedics, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
    Search for articles by this author
  • Author Footnotes
    ⁎ I-Te Tu and I-Ming Jou contributed equally to this work.
Published:December 16, 2021DOI:https://doi.org/10.1016/j.apmr.2021.11.007

      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)
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