Hamilton M L, Santos-Anzorandia C, Viera C, Coutin G, Cordies L
Servicio de Fisiología Aplicada, Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba.
Rev Neurol. 1999;28(12):1147-52.
The combination of carpal tunnel syndrome and diabetic polyneuropathy is common, and it is important to establish the correct diagnosis since carpal tunnel syndrome can be successfully treated by surgery, even in diabetic patients. Both conditions have similar clinical features and the usual neurophysiological investigations show very similar results.
To determine the differential diagnosis between carpal tunnel syndrome and diabetic polyneuropathyP.
Sensory and motor neuro-conduction studies were done on the median and ulnar nerves of a group of 30 healthy persons (group A), 30 patients with a history of carpal tunnel syndrome (group B) and 30 patients with diabetes mellitus type I or type II (group C) with diabetic polyneuropathy. The physiological variables in which the greatest differences were seen in the three groups were: the speed of sensory conduction in the palm-third finger segment of the median nerve, distal latency obtained on stimulation of the fourth finger, distal motor latency of the median nerve and distal latency of the sensory potentials obtained by stimulation at the wrist and recorded at the fourth finger.
With these variables for prediction, carpal tunnel syndrome was detected in 30% of the patients classified initially on clinical grounds as having diabetic polyneuropathy, and 60% of the patients were correctly reclassified after being initially classified on clinical grounds as having carpal tunnel syndrome.
腕管综合征与糖尿病性多发性神经病并存很常见,正确诊断很重要,因为即使是糖尿病患者,腕管综合征也可通过手术成功治疗。这两种病症具有相似的临床特征,常规的神经生理学检查结果也非常相似。
确定腕管综合征与糖尿病性多发性神经病之间的鉴别诊断。
对30名健康人(A组)、30名有腕管综合征病史的患者(B组)和30名患有I型或II型糖尿病且伴有糖尿病性多发性神经病的患者(C组)的正中神经和尺神经进行感觉和运动神经传导研究。三组中差异最大的生理变量为:正中神经手掌至第三指节段的感觉传导速度、刺激第四指获得的远端潜伏期、正中神经的远端运动潜伏期以及刺激腕部并在第四指记录的感觉电位的远端潜伏期。
利用这些预测变量,在最初根据临床诊断为糖尿病性多发性神经病的患者中,30%被检测出患有腕管综合征;在最初根据临床诊断为腕管综合征的患者中,60%被正确重新分类。