Hand dysfunction in patients on chronic hemodialysis

We studied hand function by clinical examination (sensory, motor, coordination, activities of daily living), hand roentgenograms, and nerve conduction studies in 26 patients, aged 62 +/- 11 (SD) years and dialyzed by hemodialysis for 7 +/- 6 years. Multiple sensory deficits were found in 98% of the hands. Motor function and coordination were abnormal in two-thirds of the hands. Roentgenograms were abnormal in 88% of the hands. Metabolic bone disease, joint disease and extraosseous calcifications were detected often. Nerve conduction studies disclosed polyneuropathy and carpal tunnel syndrome, alone or combined, in 90% of the hands. Clinical examination was sensitive, but not specific in detecting neuropathy, and could not distinguish accurately between polyneuropathy and carpal tunnel syndrome. Organic causes of progressive severe hand dysfunction included carpal tunnel syndrome and, in diabetics only, hand gangrene. Disuse led also to hand dysfunction, even in the absence of anatomic hand disease.