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Journal of the Korean Academy of Rehabilitation Medicine 2008;32(2):216-221.
Ultrasonographic Findings of Carpal Tunnel Syndrome in Patients with Paraplegia.
Joo, Min Cheol , Yang, Chung Yong , Kim, Tae Jin , Song, Jae Eun , Park, Soon Ah , Cho, Hae Joong , Kil, Eun Young , Shin, Yong Il
1Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Korea. rehab@wonkwang.ac.kr
2Department of Nuclear Medicine, Wonkwang University School of Medicine, Korea.
3Institute of Wonkwang Medical Science, Korea.
4Department of Rehabilitation Medicine, Wonkwang University School of Oriental Medicine, Korea.
하지마비 환자에서 수근관증후군의 초음파적 소견
주민철, 양충용, 김태진, 송재은, 박순아1, 조해중2, 길은영3, 신용일
원광대학교 의과대학 재활의학교실 및 1핵의학교실, 2원광의과학연구소, 3한의과대학 재활의학교실
Abstract
Objective
To assess the diagnostic value of ultrasonography for the median nerve, the state of life style activities and the pain degree of upper extremities in paraplegics with carpal tunnel syndrome (CTS).


Method
Eighteen wheelchair ambulators with spinal cord injury who had neurological level below T2 were studied. Patients with peripheral or central neuropathies were excluded. Patients were assigned to either the electrodiagnostic CTS (group CTS, 7) or electrodiagnostically negative (group non- CTS, 11), and healthy volunteers (15) were classified as control group. The cross sectional area of the median nerve (MN-CSA) at carpal pisiform level was ultrasonographically measured. The degree of painful restriction to execute ADL by hands (TR-ADL), the pain grade (visual analog scale, VAS) of upper extremities and revised version of Korean spinal cord independence measure (KSCIM-R) for functional level were measured and analyzed.


Results
Nine hands (14.3%) of 7 patients out of 34 hands had CTS in electrodiagnostic study. There were significant difference among groups in TR-ADL hours (CTS group; 5.0 vs non-CTS group; 10.2, p<0.05), VAS (4.1 vs 2.0, respectively, p<0.05), and no statistical difference in KSCIM-R (68.4 vs 52.1, p>0.05), MN-CSA (12.3 mm2 vs 7.9 mm2 vs control group; 8.0 mm2, p<0.05). Using the ROC curve, the cut-off value of MN-CSA produced 8.5 mm2 providing a diagnostic sensitivity of 77.8% and specificity of 59.6%.


Conclusion
The ultrasonographic measurement of the median nerve may be a useful non-invasive screening test for the diagnosis of CTS in paraplegic patients with wrist pain. (J Korean Acad Rehab Med 2008; 32: 216-221)

Key Words: Spinal cord injury, Median nerve, Carpal tunnel syndrome, Ultrasonography, Paraplegia


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