Clinical and ultrasonographic screening for carpal tunnel syndrome in hemodialysis patients

Tharwat, Samar; Nassar, Mohammed Kamal

doi:10.23876/j.krcp.20.011

Cited by 5 publications

(5 citation statements)

References 35 publications

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“…Musculoskeletal (MSK) complications are one of the most common health concerns that impact individuals on maintenance HD [ 8 ]. Bone cysts, destructive arthropathy, amyloidosis, carpal tunnel syndrome, and spontaneous tendons rupture are some of these MSK complications [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic assessment of entheseal sites of upper and lower extremities in hemodialysis patients using Madrid Sonography Enthesitis Index

Sabry

Tharwat

Nassar

et al. 2022

BMC Musculoskelet Disord

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Background There is no much information about the entheseal involvement among hemodialysis (HD) patients. The aim of this study was to assess the frequency and distribution of ultrasonographic (US) entheseal alterations in HD patients and to evaluate the association between US abnormalities and both clinical and laboratory data. Methods This study was conducted on 41 HD patients and 23 sex- and age- matched controls. All participants were evaluated clinically for any signs of enthesopathy. Six entheses sites were scanned bilaterally using grey scale (GS) and power Doppler (PD) US and were scored using Madrid Sonography Enthesitis Index (MASEI) scoring system. Results In HD patients, at least one clinical sign suggestive of enthesopathy was found in 69 (14%) of 492 entheses. HD patients had statistically significant higher scores of structural tendon abnormalities (p < 0.001), enthesis thickening (p < 0.001), bone erosions (p < 0.001) and calcification (p = 0.037) than the healthy controls. Total MASEI score was higher in HD patients than healthy controls (median;18 vs 8, p < 0.001), also, MASEI-inflammatory (median;11 vs 3, p < 0.001) and damage scores (median;6 vs 0, p < 0.001). There was a statistically significant positive association between total MASEI score and both age (p = 0.032) and duration of HD (p = 0.037). Duration of HD was predictive for both MASEI-damage component (p = 0.004) and total MASEI score (p = 0.014). Conclusion There is a high prevalence of subclinical enthesopathy in HD patients. The entheseal US alterations is much higher in HD patients than in healthy subjects. The duration of HD is the significant predictor of enthesopathy in HD patients.

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Section: Introductionmentioning

confidence: 99%

Ultrasonographic assessment of entheseal sites of upper and lower extremities in hemodialysis patients using Madrid Sonography Enthesitis Index

Sabry

Tharwat

Nassar

et al. 2022

BMC Musculoskelet Disord

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“…Imaging studies such as neuromuscular ultrasonography (US), instructional videos and magnetic resonance imaging may be useful for the evaluation of CTS in some cases, particularly if there is a concern for structural abnormality of the wrist such as a tumor, deformity, or other bone or joint disease [13]. A recent study has suggested that ultrasonic measurement of median nerve cross-sectional area (CSA) might be helpful in the detection of CTS as an alternative to electrodiagnostic studies in HD patients [14]. According to Hobson-Webb et al, the wrist-to-forearm ratio (WFR) of the median nerve was associated with CTS in nonchronic kidney disease (CKD) patients [15].…”

Section: Introductionmentioning

confidence: 99%

Median nerve swelling is an independent risk factor of carpal tunnel syndrome in chronic hemodialysis patients

Kim

et al. 2021

Ther Apher Dial

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Carpal tunnel syndrome (CTS) has a wide variety of underlying causes and occurs in association with dialysis. Early diagnosis is essential to prevent permanent nerve damage and functional sequelae. We evaluated the association between CTS and cross-sectional area (CSA) of the median nerve in chronic hemodialysis (HD) patients. Patients with end-stage renal disease on maintenance HD via arteriovenous fistula were enrolled. We divided 43 patients into two groups; patients diagnosed with CTS (n = 19) and patients without CTS (n = 24). The median nerve CSA was measured at the wrist (CSA-W) and forearm (CSA-F) by ultrasonography. Median nerve swelling was assessed by the wrist-to-forearm ratio (WFR). There were no significant differences in the underlying causes of chronic kidney disease and adequacy of dialysis between the two groups (p = NS). The patients with CTS showed significantly higher WFR than the patients without CTS (p = 0.001). Univariate Cox regression analysis revealed that WFR >1.25 (odds ratio, 6.30; 95% confidence interval, 1.44-27.45; p = 0.014) was associated with CTS in HD patients. The factors traditionally associated with CTS such as age, sex, diabetes, vintage of HD, β2-MG, intact PTH, and Kt/V were not associated with CTS. After adjustment for age and sex, we found a strong correlation between CTS and the WFR >1.25 (odds ratio, 10.8; 95% confidence interval, 1.85-62.4; p = 0.008). High WFR was associated with the development of CTS, and median nerve swelling was an independent risk factor of CTS in chronic HD patients.

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“…[17,18] CTS is a well-known musculoskeletal complication in patients with CKD on dialysis. [19] The known mechanisms of this involvement include the infiltration of dialysis-related amyloidosis to the tendon, synovium, and nerve and soft tissue calcification, which is related to the alterations in the phosphate and calcium metabolisms in CKD patients. [20] Previous studies have reported a higher incidence of operation in CKD on dialysis patients to treat CTS.…”

Section: Discussionmentioning

confidence: 99%

Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study

Doh,

Kim,

Kim

et al. 2024

Medicine

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Several studies have revealed the risk factors for carpal tunnel syndrome (CTS). However, no studies have evaluated the influence of these risk factors on the selection of treatment modalities for CTS. This study aimed to determine the influence of CTS risk factors on the selection of CTS treatment modalities with a focus on corticosteroid injection (CI) and surgery. We conducted a retrospective cohort study of patients aged ≥20 years with newly diagnosed CTS in the Korean health insurance review and assessment service between 2010 and 2019. We evaluated the demographic information, the existence of CTS risk factors, and the applied treatment modalities for CTS, including CI and operation. The CTS risk factors include age, sex, diabetes mellitus, osteoarthritis of the hand or wrist, rheumatoid arthritis, hypothyroidism, gout, chronic kidney disease (CKD) on dialysis, antiestrogen or aromatase inhibitor medication, and a history of distal radius fracture (DRF). Multivariable logistic regression analyses were conducted. Age over 80 years was the most significantly associated factor for the selection of CI in CTS (odd ratio [OR], 2.149; 95% confidence interval [CI], 2.092 to 2.209; P < .001). Among underlying diseases or medications, CKD on dialysis (OR, 4.001; 95% CI, 3.819–4.193; P < .001) was the most significant associated factor for the selection of operation for CTS, followed by a history of DRF (OR, 1.803; 95% CI, 1.749–1.860; P < .001). Old age was the most significantly related factor for selecting CI. Among underlying diseases or medications, CKD on dialysis and the history of DRF were the most significantly related factors for selecting operative treatment. For these patients, clinicians should proactively consider an operation to reduce the long-term discomfort and economic burdens.

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Clinical and ultrasonographic screening for carpal tunnel syndrome in hemodialysis patients

Cited by 5 publications

References 35 publications

Ultrasonographic assessment of entheseal sites of upper and lower extremities in hemodialysis patients using Madrid Sonography Enthesitis Index

Ultrasonographic assessment of entheseal sites of upper and lower extremities in hemodialysis patients using Madrid Sonography Enthesitis Index

Median nerve swelling is an independent risk factor of carpal tunnel syndrome in chronic hemodialysis patients

Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study

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