Carpal Tunnel Syndrome and Systemic Sclerosis

Machet, L.; Vaillant, L; Machet, Marie‐Christine; Esteve, Eva Mas; Müller, Ch.; Khallouf, R.; Lorette, G

doi:10.1159/000247422

Cited by 28 publications

(12 citation statements)

References 12 publications

(17 reference statements)

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“…Among the participants in this study, the most common type of MNW was asymptomatic, which was similar to the previous studies [ 8 , 10 ]. Although most of the MNW cases were subclinical, which did not directly affect the routine activity of daily living in SSc patients, a manifestation sign of increased vulnerability to the expression of underlying diffuse damage to the peripheral nervous system was hypothesized.…”

Section: Discussionsupporting

confidence: 90%

“…These results suggested that MNW in SSc patients involves directly increased stiffness of the median nerve [ 7 ]. Therefore, the most common peripheral neuropathy in SSc patients is MNW, which occurs in about 3.2–44% [ 8 – 13 ]. The prevalence of MNW in such patients was higher than in the general population, which was found to be about 0.9–10% [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Median neuropathy at the wrist in patients with systemic sclerosis: two-year follow-up study

Sriwong¹,

Sirasaporn²,

Foochareon³

et al. 2018

Reumatologia

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ObjectivesTo determine the incidence and factors associated with median neuropathy at the wrist (MNW) in systemic sclerosis (SSc) patients using an electrodiagnostic (EDX) study.Material and methodsSSc patients who attended the scleroderma clinic, Srinagarind Hospital, were prospectively evaluated by questionnaire, physical examination, and EDX study. The questionnaire consisted of the baseline characteristics, type of scleroderma, clinical signs and symptoms associated with scleroderma, and the Boston questionnaire. The physical examinations were the Modified Rodnan Skin Score, motor power grading of bilateral abductor pollicis brevis muscle, and pinprick sensation of median nerve distribution of both hands. Moreover, the EDX study, which was composed of median and ulnar sensory and motor nerve conduction studies of both hands and electromyography of the abductor pollicis brevis muscles, was evaluated at baseline and following two years.ResultsOut of 75 systemic sclerosis patients, 50 individuals participated in the study. Diffuse cutaneous type of SSc is the most common type (72%). The common SSc associated symptoms were Raynaud phenomenon, skin tightness and hand deformity. Incidence of MNW was 90 cases per 1000 person-years. Following a two-year interval, the percentages of mild, moderate and severe MNW were 28%, 22% and 6% respectively. Most of those with MNW were still particularly asymptomatic in a mild degree. Moreover, 12 out of 50 patients (24%) had a worse EDX result. There was no statistically significant association between MNW occurrence and studied factors.ConclusionsMNW commonly has high incidence in SSc patients. Therefore, SSc patients should be followed up in both clinical and EDX studies for MNW screening. SSc patients with asymptomatic MNW might need clinical follow-up for early diagnosis.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Median neuropathy at the wrist in patients with systemic sclerosis: two-year follow-up study

Sriwong¹,

Sirasaporn²,

Foochareon³

et al. 2018

Reumatologia

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“…18 Trigeminal sensory neuropathy is the most frequent manifestation and occurs in 5-9% of patients with scleroderma. 2,11 Although neurologic complications occur in 0.8 -5.6% of patients in prospective studies, 8,21 generalized peripheral neuropathy was not observed in a series of 150 and 727 patients. 9,21 Of the 125 patients prospectively followed by Lee et al, only one had peripheral neuropathy and another mononeuritis multiplex.…”

Section: Discussionmentioning

confidence: 97%

Peripheral neuropathy in scleroderma

Poncelet

Connolly

2003

Muscle and Nerve

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Because patients with scleroderma report neuropathic symptoms including numbness, paresthesias, and dysesthesias, we assessed peripheral nerve function in such patients. Fourteen scleroderma patients underwent complete neurologic examination, nerve conduction studies (NCS) and quantitative sensory testing (QST). Neurologic examination revealed reduced vibration (7) or pinprick (4) sensation in the upper or lower extremities, focal atrophy or proximal weakness (2), and decreased deep tendon reflexes (2). NCS showed reduced sensory nerve action potentials (1) and carpal tunnel syndrome (1). QST of the upper and lower extremity revealed increased cold or vibration detection thresholds in 8 of 14 patients. Our findings suggest that peripheral neuropathy occurs in patients with scleroderma at a higher frequency than previously appreciated. These findings cannot be ascribed to compression neuropathies, but rather involve large and small fibers in a non-length-dependent fashion. Larger, prospective studies using the more sensitive QST as well as pathologic studies of nerve, including cutaneous innervation, are needed to further assess the characteristics and etiology of the neuropathy.

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“…However, skin biopsy evaluation was not performed in this study for the assessment of small fiber polyneuropathy. Following previously published recommendations for research in polyneuropathy, we required both clinical and NCS criteria for polyneuropathy to be fulfilled to make a diagnosis of definite large fiber symmetrical polyneuropathy 10 . Similarly, the correlation of clinical symptoms and NCS‐defined focal neuropathy was required before a diagnosis of definite focal neuropathy was made.…”

Section: Methodsmentioning

confidence: 99%

“…Second, direct nerve compression damage by calcinosis or edema in the early phase of disease and fibrosis in the advanced stage of disease may occur 6 . This can also contribute to focal entrapment neuropathies seen in SSc, commonly carpal tunnel syndrome 8‐10 . Third, the presence of anti‐neuronal antibodies linked to SSc could suggest an immune‐mediated mechanism directed toward the peripheral nerve 1 …”

Section: Introductionmentioning

confidence: 99%

Large fiber peripheral neuropathy in systemic sclerosis: A prospective study using clinical and electrophysiological definition

et al. 2021

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Aim The reported prevalence of peripheral neuropathy in systemic sclerosis (SSc) is variable between 0.01% to 28%, probably due to differences in sample size, study design and population. Our aim is to determine the prevalence of large fiber peripheral neuropathy in SSc and to identify any contributing factors. Method A prospective cross‐sectional study of 60 SSc patients were evaluated for large fiber neuropathy using the modified clinical Total Neuropathy Score (cTNS) and nerve conduction study (NCS) of the upper and lower limbs. A combination of clinical (cTNS score ≥ 2) and NCS criteria (≥2 abnormal nerves including 1 sural [symmetrical polyneuropathy] and NCS abnormalities consistent with individual nerves/nerve roots [focal neuropathy]) was used to diagnose peripheral neuropathy. Results The majority had limited cutaneous subset (75%). Mean age was 55.73 (SD ± 13.04) years and mean disease duration was 8.61 (SD ± 8.09) years. Twenty‐two (36.7%) had combined clinical and NCS criteria for peripheral neuropathy, 14 (23.3%) with symmetrical polyneuropathy and 8 (13.3%) with focal neuropathy. Symmetrical polyneuropathy patients had significantly lower hemoglobin levels (11.2 vs. 12.35 g/L; P = .047). Serum vitamin B12 levels were normal, therefore excluding vitamin B12 deficiency. No other associations were found for both polyneuropathy and focal neuropathy with demography, co‐morbid diseases and SSc disease factors such as Raynaud's phenomenon and modified Rodnan skin score. Conclusion Large fiber neuropathy is common in SSc patients, which could contribute to non‐lethal burden in SSc with sensory loss and muscle weakness. Apart from lower hemoglobin in polyneuropathy, there were no associations with disease‐specific features or co‐morbid diseases.

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Carpal Tunnel Syndrome and Systemic Sclerosis

Cited by 28 publications

References 12 publications

Median neuropathy at the wrist in patients with systemic sclerosis: two-year follow-up study

Median neuropathy at the wrist in patients with systemic sclerosis: two-year follow-up study

Peripheral neuropathy in scleroderma

Large fiber peripheral neuropathy in systemic sclerosis: A prospective study using clinical and electrophysiological definition

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