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

  • I-Te Tu
    Affiliations
    Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan

    Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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  • I-Ming Jou
    Affiliations
    Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan

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

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

    Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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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, Taiwan
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  • Li-Chieh Kuo
    Affiliations
    Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan

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

    Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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  • Po-Ting Wu
    Correspondence
    Correspondence and Reprint Requests to: Associate Professor Po-Ting Wu, MD, PhD, Department of Orthopedics, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City 701, Taiwan
    Affiliations
    Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan

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

    Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan

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

    Department of Orthopedics, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
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Published:December 16, 2021DOI:https://doi.org/10.1016/j.apmr.2021.11.007

      Highlights

      • 1
        Cross-sectional area of median nerve has no diagnostic role in hemodialysis-related carpal tunnel syndrome (H-CTS).
      • 2
        The dynamic ratio of median nerve-to-hamate hook distance (RMHD) was significantly less in non-diabetic patients with H-CTS.
      • 3
        An RMHD cutoff value of <2.7% yielded an accuracy of 88.2% in non-diabetic H-CTS diagnosis.

      Abstract

      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.

      Keywords

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