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

Abstract

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.

Ultrasonographic measurement of median nerve and wrist skin thickness in patients with carpal tunnel syndrome: relationship with clinical, electrophysiologic and functionality

“…We performed this measurement because we hypothesize that increased skin thickness may increase compression and decrease carpal tunnel compliance. In the literature, studies show that increased skin thickness due to fibrosis of the skin in scleroderma patients causes median nerve neuropathy due to mechanical compression of the median nerve [30][31][32] . Based on these studies, we evaluated the relationship…”

Clinical Manifestations, Pathogenesis, Diagnosis and Treatment of Peripheral Neuropathies in Connective Tissue Diseases: More Diverse and Frequent in Different Subtypes than Expected

“…A systematic review from Turkey concluded that trigeminal neuropathy (TN) (16.5%), peripheral sensorimotor polyneuropathy (14.3%), and carpal tunnel syndrome (CTS) (6.6%) were the most frequent forms of PN-SSc [29], and individual cases of TN in SSc were mainly reported in the last 5 years. In the studies by Yagci et al [29] and Sriwong PT et al [30], the prevalence of median neuropathy in SSc was about 35%. Most CTS in patients with SSc were asymptomatic.…”

High-resolution ultrasound of peripheral neuropathies in rheumatological patients: An overview of clinical applications and imaging findings

“…In regard to PNs, in a cross-sectional study by Raja et al ( 73 ) and Paik et al ( 74 ), the prevalence of PN in SSc varied from 28 to 36.6%. In a recent systematic review from AlMehmadi et al ( 75 ), compression neuropathies were reported in 26.5% of the studies, and according to Yagci et al ( 76 ) and Sriwong et al ( 77 ), the prevalence of median neuropathy in SSc is estimated to be 35%. Most CTS in patients with SSc were asymptomatic.…”

“…Calcinosis cutis and, less commonly, soft tissue thickening, resulted in the main risk factor for compression neuropathies in SSc ( Figure 7 ). Risk factors for non-compression neuropathies include advanced diffuse diseases, anti-centromere antibodies, presence of vasculitis, iron deficiency with anemia, drugs such as metoclopramide and pembrolizumab, silicosis, and uremia ( 77 ). Autonomic nervous systems, especially cardiac autonomic functions, may also be altered in SSc ( 78 ).…”