Carpal Tunnel Syndrome in Patients With Diabetic Polyneuropathy
- Bruce A. Perkins, FRCPC12,
- David Olaleye, PHD3 and
- Vera Bril, MD, FRCPC4
- 1From the Beth Israel Deaconness Medical Center, Harvard Medical School, Boston, Massachusetts
- 2Joslin Diabetes Center, Boston, Massachusetts
- 3iBiomatics, Cary, North Carolina
- 4Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
Abstract
OBJECTIVE—Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. The prevalence of clinical CTS and the most efficient electrodiagnostic discriminators of CTS from diffuse neuropathy are uncertain.
RESEARCH DESIGN AND METHODS—A total of 478 subjects, including reference subjects (without diabetes and without neuropathy), nonneuropathic subjects with diabetes, and diabetic subjects with mild, moderate, and severe neuropathy, were evaluated in a cross-sectional design for clinical features of CTS. In the ascertainment of the cohort, a clinical stratification method was used to ensure a broad spectrum of neuropathy severity. All subjects underwent nerve conduction study determinations of median, ulnar, and sural nerve parameters.
RESULTS—The prevalence of clinical CTS was 2% in the reference population, 14% in diabetic subjects without DPN, and 30% in those with DPN. Multiple linear regression analysis revealed that mean electrodiagnostic parameters are not significant predictors of clinical CTS in patients with diabetes. Generally, the parameters worsened with severity of neuropathy, but none reliably distinguished diabetic patients with and without CTS.
CONCLUSIONS—Given the high prevalence of CTS in patients with DPN and that electrodiagnostic criteria cannot distinguish those with clinical CTS, it is recommended that therapeutic decisions for CTS be made independently of electrodiagnostic findings.
- CTS, carpal tunnel syndrome
- DMMA, distal median nerve motor amplitude
- DMML, distal median nerve motor latency
- DMSA, distal median sensory amplitude
- DMSCV, distal median sensory conduction velocity
- DMSL, distal median sensory latency
- DPN, diabetic polyneuropathy
- DUMA, distal ulnar motor amplitude
- DUML, distal ulnar motor latency
- DUSA, distal ulnar sensory amplitude
- DUSCV, distal ulnar sensory conduction velocity
- DUSL, distal ulnar sensory latency
- NCS, nerve conduction study
- PMSCV, proximal median sensory conduction velocity
- PMSL, proximal median sensory latency
- SA, sural amplitude
- SCV, sural conduction velocity
- SL, sural latency
- UHN, University Health Network
Footnotes
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Received for publication 2 August 2001 and accepted in revised form 7 December 2001.
Address correspondence and reprint requests to Dr. Vera Bril, EN 11-209, TGH, University Health Network, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4. E-mail: vera.bril{at}utoronto.ca.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE
