Comparison of Histopathology of Transverse Carpal Ligament in Patients with Idiopathic Carpal Tunnel Syndrome and Hemodialysis Patients with Carpal Tunnel Syndrome

Abstract

The aim of this paper is to point out the growing clinical importance of Carpal tunnel syndrome in patients on hemodialysis especially in aspect of the diagnosis, treatment and possible cause of the syndrome. Sixty patients with clinical diagnosis of Carpal Tunnel Syndrome was defined as the presence of two subjective symptoms (numbness, tingling in the median nerve distribution). The diagnosis was confirmed by electromyography. The patients with rheumatoid arthritis, thalasemia and thyroid dysfunction and the patients having pain due to arthritis or tenosynovitis were excluded. Fifty patients with clinical diagnosis of idiopathic CTS and seven hemodialysis patients having CTS were analyzed. Of 50 patients (47 female, 3 male) with clinical diagnosis of idiopathic CTS, 11 patients (22%) were involved bilaterally, 25 patients (50%) were affected only on the right and 14 patients (28%) were symptomatic only on the left. Of 7 hemodialysis patients (2 female, 5 male) with CTS, 1 patient (14%) was involved bilaterally (having two-sided A-V fistula), 4 patients (57%) were affected only on the right and 2 patients (28%) were symptomatic only on the left. There was significant correlation between the arteriovenous fistula and subsequent development of CTS. The all patients had fistulas in the affected side (5 of them were patent and 2 were occluded). In the relation between the duration of hemodialysis and development of CTS, 4 patients were over 10 years of hemodialysis, 2 patients were between 5 to 9 years and only 1 patient was below 4 years of duration. Amyloid deposit was demonstrated in 4 of 7 operated hands in the hemodialysis group. When we compared the presence of amyloid deposits in these groups, the difference between these two groups were found as statistically significant (p < 0.009). Although hemodialysis has no significant effect on development of fibrosis, the incidence of fibrosis was found as statistically significant in idiopathic carpal tunnel syndrome (p < 0.048). It is likely that there are numerous factors that may act either independently or in concert to potentiate the risk for developing CTS in patients on long-term hemodialysis.

Share and Cite:

E. Civelek, T. Cansever, S. Kabatas, E. Demiralay, E. Demircay, C. Comunoglu, C. Yilmaz and N. Altınors, "Comparison of Histopathology of Transverse Carpal Ligament in Patients with Idiopathic Carpal Tunnel Syndrome and Hemodialysis Patients with Carpal Tunnel Syndrome," Surgical Science, Vol. 2 No. 1, 2011, pp. 8-12. doi: 10.4236/ss.2011.21003.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] V. K. Jain, R. V. Cestero and J. Baum, “Carpal Tunnel Syndrome in Patients Undergoing Maintenance Hemodialysis,” Journal of the American Veterinary Medical Association, Vol. 242, No. 26, 1979, pp. 2868-2869. doi:10.1001/jama.242.26.2868
[2] H. G. Kachel, P. Altmeyer, C. A. Baldamus and K. Koch, “Deposition of an Amyloid-like Substance as a Possible Complication of Regular Dialysis Treatment,” Contributions to Nephrology, Vol. 36, 1983, pp. 127-132.
[3] W. R. Brian and A. D. Wright, “Spontaneous Compression of Both Median Nerves in the Carpal Tunnel,” Lancet, Vol. 1, 1947, pp. 277-282.
[4] E. Viikari-Juntura and B. Silverstein, “Role of Physical Load Factors in Carpal Tunnel Syndrome,” Scandinavian Journal of Work, Environment & Health, Vol. 25, No. 5, 1999, pp. 163-185.
[5] T. Bardin, J. Zingraff, D. Kuntz and T. Drueke, “Dialsis-related Amyloidosis,” Nephrol Dial Transplant, Vol. 1, No. 3, 1986, pp.151-154.
[6] E. A. Brown, I. R. Arnold and P. E. Gower, “Dialysis Arthropathy: A Complication of Long-term Treatment with Haemodialysis,” British Medical Journal, Vol. 292, No. 6514, 1986, pp. 163-166.
[7] Y. Shimizu, A. Van Sevevter, K. J. Horgan and S. Shaw, “Regulated Expression and Binding of Three VLA (beta 1) Integrin Receptors on Tcells,” Nature, Vol. 345, No. 6272, 1990, pp.250-253. doi:10.1038/345250a0
[8] G. S. Phalen, “Reflections on 21 Years Experience with the Carpal-tunnel Syndrome,” Journal of the American Medical Association, Vol. 212, No. 8, 1970, pp.1365- 1367.
[9] G. S. Phalen, “The Carpal-tunnel Syndrome. Clinical Evaluation of 598 Hands,” Clinical Orthopaedics and Related Research, Vol. 83, 1972, pp.29-40. doi:10.1097/00003086-197203000-00007
[10] I. Kimura and D. R. Ayyar, “The Carpal Tunnel Syndrome: Electrophysiological Aspects of 639 Symptomatic Extremities,” Electromyography & Clinical Neurophysiology, Vol. 25, No. 2-3, 1985, pp. 151- 164.
[11] J. Chanard, S. Lavaud, O. Toupance, H. Roujouleh and J. P. Melin, “Carpal Tunnel Syndrome and Type of Dialysis Membrane Used in Patients Undergoing Long-term Hemodialysis,” Arthritis Rheum, Vol. 29, No. 9, 1986, pp. 1170-1171. doi:10.1002/art.1780290919
[12] R. F. Gagnon, P. Somerville and M. Kaye, “β2-micro- globulin Serum Levels in Patients on Long-term Dialysis,” Perit Dial Bull, Vol. 7, No. 6, 1987, pp. 29-31.
[13] L. H. Connors, T. Shirahama, M. Skinner, A. Fenves and A. S. Cohen, “In Vitro Formation of Amyloid Fibrils from Intact β2-microglobulin,” Biochemical and Biophysical Research Communications, Vol. 131, No. 3, 1985, pp. 1063-1068. doi:10.1016/0006-291X(85)90198-6
[14] N. Miyasaka, K. Sato, Y. Kitano, M. Higaki, K. Nishioka and K. Ohta, “Aberrant Cytokine Production from Tenosynovium in Dialysis Associated Amyloidosis,” Annals of the Rheumatic Diseases, Vol. 51, No. 6, 1992, pp.797-802.
[15] J. A. Delmez, B. Holtmann, G. A. Sicard, A. P. Goldberg and H. R. Harter, “Peripheral Nerve Entrapment Syndromes in Chronic Hemodialysis Patients,” Nephron, Vol. 30, No. 2, 1982, pp.118-123. doi:10.1159/000182447
[16] J. A. Bussell, J. A. Abbot and R. C. Lim, “A Radial Steal Syndrome with Arteriovenous Fistula for Hemodialysis. Studies in Seven Patients,” Annals of Internal Medicine, Vol. 75, No. 3, 1971, pp.387-394.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.