Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes
In diabetic patients, controversies still exist about the validity of electrodiagnostic and nerve ultrasound diagnosis for carpal tunnel syndrome (CTS). We analyzed 69 patients with type 2 diabetes. Nerve conduction studies and peripheral nerve ultrasound of the median nerve over the carpal tunnel w...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-06-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/11/12/3374 |
| _version_ | 1797486056576122880 |
|---|---|
| author | Bianka Heiling Leonie I. E. E. Wiedfeld Nicolle Müller Niklas J. Kobler Alexander Grimm Christof Kloos Hubertus Axer |
| author_facet | Bianka Heiling Leonie I. E. E. Wiedfeld Nicolle Müller Niklas J. Kobler Alexander Grimm Christof Kloos Hubertus Axer |
| author_sort | Bianka Heiling |
| collection | DOAJ |
| description | In diabetic patients, controversies still exist about the validity of electrodiagnostic and nerve ultrasound diagnosis for carpal tunnel syndrome (CTS). We analyzed 69 patients with type 2 diabetes. Nerve conduction studies and peripheral nerve ultrasound of the median nerve over the carpal tunnel were performed. CTS symptoms were assessed using the Boston Carpal Tunnel Questionnaire. Polyneuropathy was assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Although 19 patients reported predominantly mild CTS symptoms, 37 patients met the electrophysiological diagnosis criteria for CTS, and six patients were classified as severe or extremely severe. The sonographic cross-sectional area (CSA) of the median nerve at the wrist was larger than 12 mm<sup>2</sup> in 45 patients (65.2%), and the wrist-to-forearm-ratio was larger than 1.4 in 61 patients (88.4%). Receiver operating characteristic analysis showed that neither the distal motor latency, the median nerve CSA, nor the wrist-to-forearm-ratio could distinguish between patients with and without CTS symptoms. Diagnosis of CTS in diabetic patients should primarily be based upon typical clinical symptoms and signs. Results of electrodiagnostic testing and nerve ultrasound have to be interpreted with caution and additional factors have to be considered especially polyneuropathy, but also body mass index and hyperglycemia. |
| first_indexed | 2024-03-09T23:28:43Z |
| format | Article |
| id | doaj.art-dbe226936f304ff8ad3bf5af61ce1ea4 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:28:43Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-dbe226936f304ff8ad3bf5af61ce1ea42023-11-23T17:14:56ZengMDPI AGJournal of Clinical Medicine2077-03832022-06-011112337410.3390/jcm11123374Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 DiabetesBianka Heiling0Leonie I. E. E. Wiedfeld1Nicolle Müller2Niklas J. Kobler3Alexander Grimm4Christof Kloos5Hubertus Axer6Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, GermanyDepartment of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, GermanyDepartment of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, 07747 Jena, GermanyDepartment of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, GermanyDepartment of Neurology, Tuebingen University Hospital, 72076 Tuebingen, GermanyDepartment of Internal Medicine III, Jena University Hospital, Friedrich Schiller University, 07747 Jena, GermanyDepartment of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, GermanyIn diabetic patients, controversies still exist about the validity of electrodiagnostic and nerve ultrasound diagnosis for carpal tunnel syndrome (CTS). We analyzed 69 patients with type 2 diabetes. Nerve conduction studies and peripheral nerve ultrasound of the median nerve over the carpal tunnel were performed. CTS symptoms were assessed using the Boston Carpal Tunnel Questionnaire. Polyneuropathy was assessed using the Neuropathy Symptom Score and the Neuropathy Disability Score. Although 19 patients reported predominantly mild CTS symptoms, 37 patients met the electrophysiological diagnosis criteria for CTS, and six patients were classified as severe or extremely severe. The sonographic cross-sectional area (CSA) of the median nerve at the wrist was larger than 12 mm<sup>2</sup> in 45 patients (65.2%), and the wrist-to-forearm-ratio was larger than 1.4 in 61 patients (88.4%). Receiver operating characteristic analysis showed that neither the distal motor latency, the median nerve CSA, nor the wrist-to-forearm-ratio could distinguish between patients with and without CTS symptoms. Diagnosis of CTS in diabetic patients should primarily be based upon typical clinical symptoms and signs. Results of electrodiagnostic testing and nerve ultrasound have to be interpreted with caution and additional factors have to be considered especially polyneuropathy, but also body mass index and hyperglycemia.https://www.mdpi.com/2077-0383/11/12/3374carpal tunnel syndromediabetes mellitusnerve conduction studyperipheral nerve ultrasound |
| spellingShingle | Bianka Heiling Leonie I. E. E. Wiedfeld Nicolle Müller Niklas J. Kobler Alexander Grimm Christof Kloos Hubertus Axer Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes Journal of Clinical Medicine carpal tunnel syndrome diabetes mellitus nerve conduction study peripheral nerve ultrasound |
| title | Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes |
| title_full | Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes |
| title_fullStr | Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes |
| title_full_unstemmed | Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes |
| title_short | Electrodiagnostic Testing and Nerve Ultrasound of the Carpal Tunnel in Patients with Type 2 Diabetes |
| title_sort | electrodiagnostic testing and nerve ultrasound of the carpal tunnel in patients with type 2 diabetes |
| topic | carpal tunnel syndrome diabetes mellitus nerve conduction study peripheral nerve ultrasound |
| url | https://www.mdpi.com/2077-0383/11/12/3374 |
| work_keys_str_mv | AT biankaheiling electrodiagnostictestingandnerveultrasoundofthecarpaltunnelinpatientswithtype2diabetes AT leonieieewiedfeld electrodiagnostictestingandnerveultrasoundofthecarpaltunnelinpatientswithtype2diabetes AT nicollemuller electrodiagnostictestingandnerveultrasoundofthecarpaltunnelinpatientswithtype2diabetes AT niklasjkobler electrodiagnostictestingandnerveultrasoundofthecarpaltunnelinpatientswithtype2diabetes AT alexandergrimm electrodiagnostictestingandnerveultrasoundofthecarpaltunnelinpatientswithtype2diabetes AT christofkloos electrodiagnostictestingandnerveultrasoundofthecarpaltunnelinpatientswithtype2diabetes AT hubertusaxer electrodiagnostictestingandnerveultrasoundofthecarpaltunnelinpatientswithtype2diabetes |