J Korean Acad Rehabil Med.  2008 Apr;32(2):216-221.

Ultrasonographic Findings of Carpal Tunnel Syndrome in Patients with Paraplegia

Affiliations
  • 1Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Korea. rehab@wonkwang.ac.kr
  • 2Department of Nuclear Medicine, Wonkwang University School of Medicine, Korea.
  • 3Institute of Wonkwang Medical Science, Korea.
  • 4Department of Rehabilitation Medicine, Wonkwang University School of Oriental Medicine, Korea.

Abstract


OBJECTIVE
To assess the diagnostic value of ultrasonography for the median nerve, the state of life style activities and the pain degree of upper extremities in paraplegics with carpal tunnel syndrome (CTS). METHOD: Eighteen wheelchair ambulators with spinal cord injury who had neurological level below T2 were studied. Patients with peripheral or central neuropathies were excluded. Patients were assigned to either the electrodiagnostic CTS (group CTS, 7) or electrodiagnostically negative (group non- CTS, 11), and healthy volunteers (15) were classified as control group. The cross sectional area of the median nerve (MN-CSA) at carpal pisiform level was ultrasonographically measured. The degree of painful restriction to execute ADL by hands (TR-ADL), the pain grade (visual analog scale, VAS) of upper extremities and revised version of Korean spinal cord independence measure (KSCIM-R) for functional level were measured and analyzed.
RESULTS
Nine hands (14.3%) of 7 patients out of 34 hands had CTS in electrodiagnostic study. There were significant difference among groups in TR-ADL hours (CTS group; 5.0 vs non-CTS group; 10.2, p<0.05), VAS (4.1 vs 2.0, respectively, p<0.05), and no statistical difference in KSCIM-R (68.4 vs 52.1, p>0.05), MN-CSA (12.3 mm2 vs 7.9 mm2 vs control group; 8.0 mm2, p<0.05). Using the ROC curve, the cut-off value of MN-CSA produced 8.5 mm2 providing a diagnostic sensitivity of 77.8% and specificity of 59.6%.
CONCLUSION
The ultrasonographic measurement of the median nerve may be a useful non-invasive screening test for the diagnosis of CTS in paraplegic patients with wrist pain.

Keyword

Spinal cord injury; Median nerve; Carpal tunnel syndrome; Ultrasonography; Paraplegia

MeSH Terms

Activities of Daily Living
Carpal Tunnel Syndrome
Hand
Humans
Life Style
Mass Screening
Median Nerve
Paraplegia
ROC Curve
Sensitivity and Specificity
Spinal Cord
Spinal Cord Injuries
Upper Extremity
Wheelchairs
Wrist
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