Study of Clinical, Electrophysiological, Ultrasonographic Profile in Patients With Carpal Tunnel Syndrome

Abstract

BACKGROUND Carpal tunnel syndrome is the commonest entrapment neuropathy where median nerve gets entrapped in the tunnel formed by transverse carpal ligament (which is an unyielding fibrous structure) and carpal bones. Carpal tunnel syndrome prevails among individuals whose occupation need repeated wrist movements and also in certain medical conditions like diabetes mellitus, rheumatoid arthritis and hypothyroidism. Electrophysiological study of median nerve at wrist and ultrasonogram of the wrist helps in diagnosing carpal tunnel syndrome and to plan management. Aim-To evaluate the clinical, electrophysiological and ultrasonographic profile of patients presenting with symptoms of carpal tunnel syndrome (CTS). MATERIALS AND METHODS The study was conducted at Neurology Department, Government Stanley Medical College Hospital between January 2017 and August 2017. All subjects who satisfied the inclusion criteria and given their consent for the study underwent detailed neurological evaluation followed by biochemical investigations, electrophysiological study and ultrasonogram of both wrists. Biochemical investigations done were fasting blood sugar, postprandial blood sugar, thyroid profile, renal function test and rheumatoid arthritis factor. All patients who presented with paraesthesia of hands, mainly tingling or numbness in the median nerve distribution with or without objective signs of Tinel or Phalen were included in the study. Patients who have been previously diagnosed and on treatment for symptoms of carpal tunnel syndrome and other causes of neuropathy were excluded. SPSS software and Chi-square test were used for statistical analysis. Study Design-A cross-sectional descriptive study. RESULTS Most common age group affected was between 40 and 50 years with Female: Male ratio 3: 1 indicating female predilection. Dominant right hand is commonly involved compared to left hand. Type 2 diabetes was found in 30.6% and hypothyroidism was found in 11.3% in the study. In Electrophysiological Study (EPS), moderate grade was found in 50% of the patients. Ultrasonogram of the wrist had positive correlation irrespective of electrophysiological grading. CONCLUSION Bilateral carpal tunnel syndrome patients had severe electrophysiological grade with positive correlation with ultrasonogram of wrist helping in deciding the mode of treatment-medical versus surgical.