Ing-Jeng Chen1, Ke-Vin Chang2,3, Yueh-Ming Lou1, Wei-Ting Wu4, Levent Özçakar5. 1. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China. 2. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China. pattap@pchome.com.tw. 3. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, Republic of China. pattap@pchome.com.tw. 4. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, Republic of China. 5. Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.
Abstract
BACKGROUND: High-resolution ultrasound (US) becomes a reliable tool for diagnosing carpal tunnel syndrome (CTS), but whether it can be applied to patients with preexisting diabetes mellitus (DM) remains unclear. METHODS: We searched PubMed and Embase and systemically reviewed studies exploring the median nerve CSAs at the wrist level by US imaging. Nine studies enrolling at least one subgroup comprising patients with both DM and CTS were included for network meta-analysis. The primary outcome was the inter-group difference of the wrist-level median nerve CSA. RESULTS: The median nerve size at the wrist level was larger in patients with only CTS than in patients with only DM [CSA difference = 3.14 mm2, 95% confidence interval (CI) 1.92-4.35]. Patients with DM and CTS had a slightly enlarged median nerve CSA than did patients with only CTS, but the difference was not statistically significant (0.52 mm2, 95% CI - 0.54 to 1.59). According to rank probabilities, median nerve CSAs in patients with DM and CTS were likely to be ranked as the largest, followed by patients with only CTS, patients with only DM, and healthy controls. Furthermore, median nerve CSAs seemed smaller in patients with than without diabetic polyneuropathy. CONCLUSIONS: Although DM causes swelling of the median nerve at the wrist level, patients with CTS have a larger CSA regardless of preexisting DM. The add-on effect of DM on median nerve CSAs in patients with CTS is limited. Diabetic polyneuropathy tends to result in less swollen median nerves in the CTS population.
BACKGROUND: High-resolution ultrasound (US) becomes a reliable tool for diagnosing carpal tunnel syndrome (CTS), but whether it can be applied to patients with preexisting diabetes mellitus (DM) remains unclear. METHODS: We searched PubMed and Embase and systemically reviewed studies exploring the median nerve CSAs at the wrist level by US imaging. Nine studies enrolling at least one subgroup comprising patients with both DM and CTS were included for network meta-analysis. The primary outcome was the inter-group difference of the wrist-level median nerve CSA. RESULTS: The median nerve size at the wrist level was larger in patients with only CTS than in patients with only DM [CSA difference = 3.14 mm2, 95% confidence interval (CI) 1.92-4.35]. Patients with DM and CTS had a slightly enlarged median nerve CSA than did patients with only CTS, but the difference was not statistically significant (0.52 mm2, 95% CI - 0.54 to 1.59). According to rank probabilities, median nerve CSAs in patients with DM and CTS were likely to be ranked as the largest, followed by patients with only CTS, patients with only DM, and healthy controls. Furthermore, median nerve CSAs seemed smaller in patients with than without diabetic polyneuropathy. CONCLUSIONS: Although DM causes swelling of the median nerve at the wrist level, patients with CTS have a larger CSA regardless of preexisting DM. The add-on effect of DM on median nerve CSAs in patients with CTS is limited. Diabetic polyneuropathy tends to result in less swollen median nerves in the CTS population.
Entities:
Keywords:
Diabetes mellitus; Electromyography; Median nerve; Sonography; Wrist
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