Hemodialysis-related lesions of the hand.
Chronic hemodialysis patients often have lesions of the hands characterized by distinctive etiopathogenic mechanisms and functional consequences. We conducted a prospective cross-sectional study in 116 patients with a mean age of 55.9 years and a mean hemodialysis duration of 8.17 years. Carpal tunnel syndrome was present in 28.4% of patients. Median nerve entrapment was bilateral in a large proportion of cases. Wasting of the lateral thenar muscles was often present at diagnosis, denoting advanced nerve compression. Amyloid was demonstrated in the carpal tunnel in 74% of cases of carpal tunnel syndrome. Digital flexor tendon lesions responsible for trigger finger or restriction of active flexion were seen in 21.5% of patients. Erosive arthropathy manifesting as deformities, pain and loss of function affected the distal interphalangeal joints in 11% of patients and the proximal interphalangeal joints or trapeziometacarpal joint in a smaller proportion of patients. Thirty per cent of patients had bony cysts located in the carpometacarpal area, carpal bones, or distal forearm bones; communication with the adjacent joint space was seen occasionally, and intracarpal derangement was a feature in some patients. Most patients had several types of lesions. The rate of occurrence of hand lesions increased markedly after ten years on hemodialysis, with devastating functional consequences.
Asencio
G
G
Department of Orthopedic Surgery and Traumatology, Nîmes Teaching Hospital, France.
Rigout
C
C
Ramperez
P
P
Branger
B
B
Oules
R
R
Bertin
R
R
Megy
B
B
Leonardi
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006225:Hand; D006801:Humans; D007592:Joint Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects*; D013710:Tendons / Q000503:physiopathology*; D014954:Wrist Injuries / Q000000981:diagnostic imaging