Occurrence of Carpal Tunnel Syndrome in Chronic Hemodialysis Patients | Chapter 10 | Medical Science: Trends and Innovations Vol. 7

Background: Despite significant advances in hemodialysis (HD) practice, carpal tunnel syndrome (CTS) remains a clinical concern among patients. Carpal tunnel syndrome (CTS) is a well-known manifestation of dialysis-related amyloidosis, mainly caused by the deposition of β2- microglobulin in the carpal tunnel. It is considered the most common mononeuropathy in endstage renal disease (ESRD) patients.

Aim: This study aimed to evaluate the prevalence of CTS and identify factors associated with its occurrence in chronic HD patients.

Methods: A cross-sectional study was conducted in December 2017, including consenting chronic HD patients with a dialysis vintage of at least three months, at a reference state center in Oujda, Eastern Morocco. CTS diagnosis was based on reported symptoms, clinical signs, and positive Tinel and Phalen manoeuvres. Symptomatic patients underwent electromyography (EMG) on non-dialysis days, performed by the same neurologist under standardized conditions. Data were analyzed using SPSS version 20.0 for Windows. Chi-square or Fisher exact tests were used for analyzing the correlation among categorical variables.

Results: A total of 112 chronic HD patients meeting the inclusion criteria were enrolled. CTS was diagnosed and confirmed by nerve conduction studies in 8.04% of patients. Diabetic nephropathy was the most common underlying nephropathy, observed in 36.3% of CTS cases. Patients with CTS were older (mean age: 52.99 ± 11.32 vs. 48.4 ± 12.6; p=0.002), predominantly male (63.6% vs. 55.4%; p=0.03), and active smokers in 18.5% of cases. CTS patients also had a longer HD duration (95.8 ± 15.75 vs. 82.11 ± 17.22 months; P<0.001). Additionally, CTS was significantly associated with a higher prevalence of diabetes mellitus (36.3% vs. 13.8%; p<0.001), hepatitis C virus (HCV) infection (18.18% vs. 2.97%; p=0.02), and reduced urine output (<100 ml/day: 27.2% vs. 3.98%; P=0.003). Multivariate logistic regression analysis revealed that HCV infection (OR: 1.45, 95% CI: 1.17–1.87, p=0.034), prolonged HD vintage (OR: 1.95, 95% CI: 1.89–3.65, P<0.001), and urine output <100 ml/day (OR: 1.72, 95% CI: 1.03–2.57, P=0.01) were independently associated with CTS.

Conclusion: This cross-sectional study highlights that prolonged dialysis vintage, HCV infection, and loss of residual renal function are key factors associated with CTS in chronic HD patients. The surgical release procedure of the wrist is an effective treatment method. Further research is needed to elucidate the underlying mechanisms and pathogenesis of CTS in this patient population.

 

Author (s) Details

 

Intissar Haddiya
Department of Nephrology, Dialysis and Renal Transplantation, Mohamed VI University Hospital, University Mohamed First, Oujda, Morocco.

 

Hicham Yacoubi
Department of Orthopaedics, Mohamed VI University Hospital, University Mohamed First, Oujda, Morocco.

 

Fatima Zahra Berkchi
Hassan II Center for Chronic Diseases, Oujda, Morocco.

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v7/3682

A Comprehensive Review and Update on Conservative and Surgical Treatment of Carpal Tunnel Syndrome: Current Evidence and Future Research Direction | Chapter 11 | New Visions in Medicine and Medical Science Vol. 7

Carpal tunnel syndrome (CTS) is a multifactorial neuropathy caused by compression of the median nerve at the carpal tunnel. Its symptoms include pain, tingling or numbness affecting mainly the thumb, index and middle finger (sometimes the ring finger is also involved), with this sensation that could travel up the arm; hand weakness (mainly the thumb’s pinching muscles). Symptoms may vary in characteristics and severity and can be confound with other upper arm neuropathies and radiculopathies.
 
The diagnosis is made with accurate history taking and clinical examination, supported by electromyography (EMG) and nerve conduction studies.
 
Most people with mild to moderate symptoms are initially treated non-operatively. However, surgery is thought to provide more effective and durable symptom relief, especially for the most severe cases.
 
CTS is becoming more common, as is its surgical management. This constitutes a significant economic burden for societies. All surgical techniques have provided satisfactory results and have been proven to be effective options. After reviewing the most up to date literature, it could be said that evidence of superiority of one technique over the others is lacking from a high level of evidence point of view. Specific advantages and disadvantages of surgical methods can, however, be taken into account when choosing among treatments. The simple algorithm of leaving the choice of the surgical method to surgeons’ preference and experience (together with consideration of patients’ related factors) seem to be the best available option, which is supported by the most recent metanalysis and systematic reviews.
 
Research towards a universally accepted standardization should be aimed for by the authors, who have failed to date to sufficiently limit bias and limitations.

Author(s) Details:

Valerio Pace,
Trauma and Orthopaedic Surgery Consultant, AOSP Terni, Italy.

Daniele Sticchi,
Trauma and Orthopaedic Surgery Resident, University of Perugia, Italy.

Giacomo Placella,
Department of Trauma and Orthopaedics, IRCSS San Raffaele Hospital, Milan, Italy.

Please see the link here: https://stm.bookpi.org/NVMMS-V7/article/view/14228