[Carpal tunnel syndrome in haemodialysis patients: analysis of clinical and electrophysiological findings in 268 patients (395 hands)].
OBJECTIVE
Along with arthropathies, carpal tunnel syndrome (CTS) may occur in patients on chronic haemodialysis, its incidence is correlating with the duration of the haemodialysis treatment. To evaluate clinical and electrophysiological findings, relation of the disease to the side of the arteriovenous shunt, gender ratio, and a concurrent tendovaginosis stenosans (TVS), 268 haemodialysis-patients with CTS or recurrent CTS were retrospectively analyzed. METHODS AND (CLINICAL) MATERIAL: Over a period of ten years (1994 - 2003), 268 haemodialysis patients presented to our peripheral neurosurgery practice with CTS or recurrent CTS. Diagnosis was confirmed with clinical and electrophysiological findings. The patients were divided into three groups based on their severity of disease as follows: Patients with only intermittent paraesthesias (CTS I degrees ), with persistent numbness in the area supplied by the median nerve (CTS II degrees ), and with paresis of the thenar muscles (CTS III degrees ). The average distal motor latency (DML), loss of sensory nerve action potentials (SNAP), and/or motor action potentials (MAP) were used as electrophysiological parameters.


RESULTS
During the above mentioned period, 395 primary CTS-operations were performed in 268 patients, and 83 operations of recurrent CTS in 53 patients, i.e. approximately 50 % of the patients had bilateral operations. A second recurrency of CTS was treated in 29 hands of 20 patients and a third recurrency in six hands of five patients. The ratio of women to men suffering from CTS was approximately 1 : 1. TVS occurred concurrent in 22 % of the patients in one hand and in 11.6 % in both hands. Decompression of the median nerve was performed more frequently on the shunt-side, or primarily on the shunt-side, if both hands were affected, as compared to the contralateral side. Recurrency of CTS, possibly a second or third recurrency, was found with increasing time of dialysis. The temporal interval from one operation to the other had a declining tendency. Whereas at the time of the primary operation in 27.4 % of the patients a CTS I degrees was found, patients suffered from CTS II degrees or III degrees in case of a second or third recurrency. Deterioration of clinical signs in CTS recurrency was reflected by the electrophysiological findings with an increasing loss of SNAP and MAP.


CONCLUSIONS
CTS is a typical complication of chronic haemodialysis, and differs from idiopathic CTS by a gender ratio of 1 : 1, a high frequency of concurrent TVS, as well as a tendency to recur. Since compression of the median nerve was found preferentially on the shunt-side, haemodynamic factors may play a role in the pathogenesis of the disease in addition to amyloidosis. Haemodialysis patients complaining of paraesthesia in their hands should undergo electrophysiological examination, even if a successful CTS-operation was performed in the past.
Neurochirurgische Gemeinschaftspraxis, Dossenheim/Heidelberg. info@neurochirurgie-dossenheim.de
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Staub
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Dombert
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Assmus
D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D004568:Electrodiagnosis; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000294:innervation; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008475:Median Nerve / Q000503:physiopathology / Q000601:surgery; D008866:Microsurgery; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation; D010243:Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006435:Renal Dialysis; D012307:Risk Factors; D012744:Sex Ratio; D013717:Tenosynovitis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery