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Year : 2007  |  Volume : 55  |  Issue : 1  |  Page : 8

How to optimize the evaluation of carpal tunnel syndrome in patients with polyneuropathy?


Department of Neurology, Bellevue Hospital, CHU Saint-Etienne, 42055 Saint-Etienne Cedex 02, France

Correspondence Address:
Jean-Philippe Camdessanche
Department of Neurology, Bellevue Hospital, CHU Saint-Etienne, 42055 Saint-Etienne Cedex 02
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.30417

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How to cite this article:
Camdessanche JP. How to optimize the evaluation of carpal tunnel syndrome in patients with polyneuropathy?. Neurol India 2007;55:8

How to cite this URL:
Camdessanche JP. How to optimize the evaluation of carpal tunnel syndrome in patients with polyneuropathy?. Neurol India [serial online] 2007 [cited 2019 Aug 25];55:8. Available from: http://www.neurologyindia.com/text.asp?2007/55/1/8/30417


Carpal tunnel syndrome (CTS) is the most frequent peripheral nerve entrapment.[1] Treatment decision depends on a combination of clinical criteria including tolerance of pain and presence of sensory or motor deficits and intensity of electrophysiological abnormalities. Existence of an underlying polyneuropathy in a patient with CTS may complicate the matters since standard electrophysiological explorations are often unable to differentiate abnormalities due to the polyneuropathy and the entrapment. However, in this situation, electrophysiological conclusions are especially important because carpal tunnel syndrome is more frequent in case of polyneuropathy, particularly in association with diabetes.[2] Furthermore, an early diagnosis of carpal tunnel entrapment may be warranted since the polyneuropathy frequently reduces nerve abilities to regenerate preventing a good outcome after treatment. On another hand, interpreting electrophysiological abnormalities in patients with polyneuropathy may lead to an over-diagnosis of CTS.

In the exploration of CTS, sensory conduction velocities are clearly more sensitive than motor conduction velocities to detect abnormalities.[3] However, in case of polyneuropathy, sensory nerves are often more severely involved. Comparison of median and ulnar sensory nerve velocities on the fourth digit or on two different digits is the usual method to differentiate the respective consequences of the neuropathy and the CTS on nerve conduction. Development or expertise of new tools is always interesting. In this issue, Tokηaer et al propose to study the palmar cutaneous nerve, a branch of the median nerve which does not pass through the carpal tunnel. The ratio of conduction velocities of this nerve and the first digit median nerve branch appears to be both sensitive and specific to detect a CTS in patients with an associated polyneuropathy and can thus be used in addition to conventional methods especially.

 
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1.Tokηaer AB, G φπüş F, Güllap S, Keleş I, G φkηe M. The role of sensory nerve conduction study of the palmar cutaneous nerve in the diagnosis of carpal tunnel syndrome in patients with polyneuropathy. Neurol India 2007;55:17.21.  Back to cited text no. 1    
2.Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care 2002;25:565-9.  Back to cited text no. 2    
3.American Association of Electrodiagnostic Medicine, American Academy of Neurology and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: Summary statement. Muscle Nerve 2002;25:918-22.  Back to cited text no. 3    



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2 Value of Gilliattæs pneumatic tourniquet test for diagnosis of carpal tunnel syndrome
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[Pubmed]



 

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Online since 20th March '04
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