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Diagnosis and treatment of carpal tunnel syndrome
1IInd Department of Internal Medicine, Charles University, Prague, Czechoslovakia.
Insights
Secondary amyloidosis is common in long-term hemodialysis patients, often presenting as shoulder pain and carpal tunnel syndrome (CTS). The incidence of these symptoms increases with dialysis duration, impacting quality of life and potentially requiring surgery.
Area of Science:
- Nephrology
- Rheumatology
- Neurology
Background:
- Secondary amyloidosis is a known complication in patients undergoing long-term hemodialysis.
- Early clinical manifestations typically include shoulder joint pain and carpal tunnel syndrome (CTS).
Purpose of the Study:
- To investigate the prevalence of shoulder joint pain and carpal tunnel syndrome (CTS) in patients on long-term hemodialysis.
- To assess the correlation between the duration of hemodialysis and the incidence and severity of these symptoms.
Main Methods:
- A cohort of 74 patients on regular hemodialysis was divided into three groups based on treatment duration (1-4 years, 5-9 years, >10 years).
- Patients were evaluated for shoulder joint pain and/or CTS symptoms.
- Surgical indications and histological confirmation of amyloidosis were noted.
- Electromyography (EMG) was used to assess median nerve conduction in surgically treated patients.
Main Results:
- The prevalence of shoulder joint pain and/or CTS increased with hemodialysis duration: 43% in Group 1 (1-4 years), 68% in Group II (5-9 years), and 76% in Group III (>10 years).
- Surgical intervention for CTS was indicated in 3 patients (Group II) and 5 patients (Group III).
- Histological confirmation of amyloidosis was found in 2 cases (Group II) and 1 case (Group III).
- Post-operative EMG showed no improvement in 2 cases and normalization in 5 cases.
Conclusions:
- Shoulder joint pain and carpal tunnel syndrome are increasingly prevalent in patients with longer durations of hemodialysis.
- These conditions can significantly impact patient quality of life, sometimes necessitating surgical intervention.
- While amyloidosis is implicated, further investigation into the underlying mechanisms and diagnostic accuracy is warranted.
Abstract:
Secondary amyloidosis is a complication typical for patients on long-term hemodialysis. The first clinical signs are usually shoulder joint pain and carpal tunnel syndrome (CTS). We have questioned 74 patients who were on regular hemodialysis (HD) treatment and divided them into 3 groups according to the length of HD. Group 1--on HD for 1-4 years: There were 35 patients in this group, 15 of them (i.e., 43%) had shoulder joint pain and/or CTS. None of these patients had symptoms that would require surgical treatment. Group II--on HD for 5-9 years: There were 22 patients in this group, 15 of them (i.e., 68%) had shoulder joint pain and/or CTS. Three patients from this group had severe night pain and were therefore indicated for surgical treatment for CTS, each of them on 1 hand only. In 2 cases amyloid was present in the histological examination. Group III--on HD for over 10 years: There were 17 patients in this group, 13 of them (i.e., 76%) had shoulder joint pain and/or CTS. Five patients from this group were operated on both hands for severe night pain due to carpal tunnel syndrome. Only 1 patient had positive amyloid on both hands in the histological examination. All the 8 patients (i.e., 13 hands) were examined by EMG before the operation, showing reduction of motor conduction on n. medianus by 30.7 +/- 15.1%. After the operation the EMG control was done in 4 patients (7 hands), showing no improvement in 2 cases and in 5 cases the conduction on the n. medianus was found to be in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)