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Ultrasound changes of the carpal tunnel in patients receiving long-term hemodialysis: a cross-sectional and longitudinal study

T. Takahashi, A. Kato, N. Ikegaya, T. Takita, Y. Maruyama, A. Hishida and M. Takahashi

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Volume 57 (2002) p. 230 - 236

Abstract

T. Takahashi, A. Kato, N. Ikegaya, T. Takita, Y. Maruyama, A. Hishida and M. Takahashi

¹Maruyama Hospital, ²First Department of Medicine and ³Orthopedics Surgery, Hamamatsu University School of Medicine and ⁴Shizuoka University, Hamamatsu, Shizuoka, Japan
Background: Carpal tunnel syndrome
(CTS) is one of the major problems of long-term hemodialysis (HD), but sometimes difficult
to distinguish from uremic or diabetic neuropathy by clinical symptoms. Patients and
methods: To evaluate the diagnosis of CTS more precisely, we examined the
ultrasonographic alterations of the carpal tunnel and tendons of 90 wrists from 45
patients undergoing HD for more than 5 years. We measured the thickness of the palmar
radiocarpal ligament (PRL), corresponding to the posterior wall of the carpal tunnel (CT),
and the width of the CT, and compared those values with sensory (SCV), motor conduction
velocity (MCV) of the median nerve and clinical symptoms. In addition, we longitudinally
measured CT and PRL in the same patients for 5 years, and compared ultrasonographic
changes and clinical parameters. Results: A linear positive relationship was found
between HD duration and PRL thickness (r = 0.43, p < 0.01) or CT width (r = 0.53, p
< 0.01). CT diameter was negatively correlated with MCV (r = –0.30, p < 0.01)
and SCV (r = –0.33, p < 0.04). PRL thickness was also inversely correlated with
MCV (r = –0.44, p < 0.01) and SCV (r = –0.46, p < 0.01) of the median
nerve, respectively. The wrists with clinical CTS and/or previous CTS surgery had
significantly greater CT and PRL values compared to patients without CTS (CT: 6.1 ± 0.2
vs. 8.0 ± 0.3 mm, p < 0.01; PRL: 1.9 ± 0.1 vs. 3.6 ± 0.2 mm, p < 0.01). There was
a significant increase in CT width from 6.2 ± 0.2 to 7.1 ± 0.2 mm (p < 0.01) and PRL
thickness from 2.4 ± 0.2 to 2.8 ± 0.2 mm (p < 0.01) during the 5-year observation,
respectively. PRL thickness was constantly increased at the rate of 0.4 mm during the
study. However, no significant association was found between the 5-year increases in CT
and PRL distance and age, gender, the prevalence of diabetes, or laboratory parameters
such as blood b₂-microglobulin,
pentosidine and Kt/Vurea. Conclusion: Our data suggest that echographic evaluation
of the wrist tissue thickness was useful to assess the progression of CTS. Serial
measurements of the wrist by echography may be helpful to clarify the advance of
subclinical CTS in patients receiving long-term HD.

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