Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment
Abstract Background Carpal tunnel syndrome (CTS) is known as one of the most common neurological extra-articular manifestations in rheumatoid arthritis (RA) patients. Studies on CTS in RA depend mostly on electrophysiological assessment. Few studies have used ultrasonography for evaluation of the lo...
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ftdoajarticles:oai:doaj.org/article:0f83f7e14c9440cc8a24e54fd93499e3 2023-05-15T16:02:09+02:00 Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment Wafaa Mahmoud Mona Mansour Hassab El-Naby Ahmed Abdellatif Awad 2022-11-01T00:00:00Z https://doi.org/10.1186/s43166-022-00147-9 https://doaj.org/article/0f83f7e14c9440cc8a24e54fd93499e3 EN eng SpringerOpen https://doi.org/10.1186/s43166-022-00147-9 https://doaj.org/toc/1110-161X https://doaj.org/toc/2090-3235 doi:10.1186/s43166-022-00147-9 1110-161X 2090-3235 https://doaj.org/article/0f83f7e14c9440cc8a24e54fd93499e3 Egyptian Rheumatology and Rehabilitation, Vol 49, Iss 1, Pp 1-15 (2022) Carpal tunnel syndrome Rheumatoid arthritis Ultrasonography Nerve conduction studies Diseases of the musculoskeletal system RC925-935 article 2022 ftdoajarticles https://doi.org/10.1186/s43166-022-00147-9 2022-12-30T23:16:48Z Abstract Background Carpal tunnel syndrome (CTS) is known as one of the most common neurological extra-articular manifestations in rheumatoid arthritis (RA) patients. Studies on CTS in RA depend mostly on electrophysiological assessment. Few studies have used ultrasonography for evaluation of the local causes with much focus on wrist arthritis and tenosynovitis as the main cause of entrapment neuropathy of the median nerve in RA. The aim of our study is to assess the local causes of carpal tunnel syndrome in rheumatoid arthritis patients by ultrasonography and whether inflammatory or anomalous variations could affect decision-making and patient management. Results Carpal tunnel syndrome was diagnosed in 71 out of 74 examined RA wrists by nerve conduction studies (NCSs) and was categorized from minimal to severe according to Padua et al.’s (Ital J Neurol Sci 18:145–50, 1997) grading criteria. Median nerve CSA at the level of the carpal tunnel inlet and flattening ratio showed statistically significant relation with CTS severity. Bifid MN was found in 20 wrists (10 mild CTS wrists and 10 moderate CTS wrists), a persistent median artery was found in 4 wrists with moderate CTS, and an accessory muscle bundle was present in 3 wrists (2 mild CTS and 1 moderate CTS). The majority of the examined hands (85.1%) showed flexor tendon tenosynovitis at the wrist level and radio-carpal joint synovitis. The US7-joint score using GSUS7 & PDUS7 for synovitis, tenosynovitis and erosions showed significant relation with patients’ disease activity by DAS28 score. Significant relations between CTS severity and the following nerve conduction studies’ parameters, median nerve distal motor latency (DML), motor/sensory NCV, peak sensory latency, amplitude of SNAP, and median-radial latency difference test, were observed. Conclusion Synovial inflammation and local causes of median nerve compression such as bifid median nerve, persistent median artery, and accessory muscle bundle are collectively contributing factors in the etiology ... Article in Journal/Newspaper DML Directory of Open Access Journals: DOAJ Articles Egyptian Rheumatology and Rehabilitation 49 1 |
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ftdoajarticles |
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English |
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Carpal tunnel syndrome Rheumatoid arthritis Ultrasonography Nerve conduction studies Diseases of the musculoskeletal system RC925-935 |
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Carpal tunnel syndrome Rheumatoid arthritis Ultrasonography Nerve conduction studies Diseases of the musculoskeletal system RC925-935 Wafaa Mahmoud Mona Mansour Hassab El-Naby Ahmed Abdellatif Awad Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment |
topic_facet |
Carpal tunnel syndrome Rheumatoid arthritis Ultrasonography Nerve conduction studies Diseases of the musculoskeletal system RC925-935 |
description |
Abstract Background Carpal tunnel syndrome (CTS) is known as one of the most common neurological extra-articular manifestations in rheumatoid arthritis (RA) patients. Studies on CTS in RA depend mostly on electrophysiological assessment. Few studies have used ultrasonography for evaluation of the local causes with much focus on wrist arthritis and tenosynovitis as the main cause of entrapment neuropathy of the median nerve in RA. The aim of our study is to assess the local causes of carpal tunnel syndrome in rheumatoid arthritis patients by ultrasonography and whether inflammatory or anomalous variations could affect decision-making and patient management. Results Carpal tunnel syndrome was diagnosed in 71 out of 74 examined RA wrists by nerve conduction studies (NCSs) and was categorized from minimal to severe according to Padua et al.’s (Ital J Neurol Sci 18:145–50, 1997) grading criteria. Median nerve CSA at the level of the carpal tunnel inlet and flattening ratio showed statistically significant relation with CTS severity. Bifid MN was found in 20 wrists (10 mild CTS wrists and 10 moderate CTS wrists), a persistent median artery was found in 4 wrists with moderate CTS, and an accessory muscle bundle was present in 3 wrists (2 mild CTS and 1 moderate CTS). The majority of the examined hands (85.1%) showed flexor tendon tenosynovitis at the wrist level and radio-carpal joint synovitis. The US7-joint score using GSUS7 & PDUS7 for synovitis, tenosynovitis and erosions showed significant relation with patients’ disease activity by DAS28 score. Significant relations between CTS severity and the following nerve conduction studies’ parameters, median nerve distal motor latency (DML), motor/sensory NCV, peak sensory latency, amplitude of SNAP, and median-radial latency difference test, were observed. Conclusion Synovial inflammation and local causes of median nerve compression such as bifid median nerve, persistent median artery, and accessory muscle bundle are collectively contributing factors in the etiology ... |
format |
Article in Journal/Newspaper |
author |
Wafaa Mahmoud Mona Mansour Hassab El-Naby Ahmed Abdellatif Awad |
author_facet |
Wafaa Mahmoud Mona Mansour Hassab El-Naby Ahmed Abdellatif Awad |
author_sort |
Wafaa Mahmoud |
title |
Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment |
title_short |
Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment |
title_full |
Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment |
title_fullStr |
Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment |
title_full_unstemmed |
Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment |
title_sort |
carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment |
publisher |
SpringerOpen |
publishDate |
2022 |
url |
https://doi.org/10.1186/s43166-022-00147-9 https://doaj.org/article/0f83f7e14c9440cc8a24e54fd93499e3 |
genre |
DML |
genre_facet |
DML |
op_source |
Egyptian Rheumatology and Rehabilitation, Vol 49, Iss 1, Pp 1-15 (2022) |
op_relation |
https://doi.org/10.1186/s43166-022-00147-9 https://doaj.org/toc/1110-161X https://doaj.org/toc/2090-3235 doi:10.1186/s43166-022-00147-9 1110-161X 2090-3235 https://doaj.org/article/0f83f7e14c9440cc8a24e54fd93499e3 |
op_doi |
https://doi.org/10.1186/s43166-022-00147-9 |
container_title |
Egyptian Rheumatology and Rehabilitation |
container_volume |
49 |
container_issue |
1 |
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1766397747560185856 |