Khan Firosh, Shehna Abdulkhader, Ramesh Sivaramakrishnan, Sandhya Kakkassery Sankaran, Paul Reji
Department of Neurology, Mother Hospital, Thrissur, Kerala, India.
Psycho-Oncology, Department of Radiotherapy and Oncology, Government Medical College, Thrissur, Kerala, India.
Ann Indian Acad Neurol. 2017 Jan-Mar;20(1):69-72. doi: 10.4103/0972-2327.199909.
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and is one of the most common requests for electrodiagnosis. We aimed to note the relationship of subjective symptom severity of CTS, with objective electrophysiological severity and psychological status of patients.
One hundred and forty-four consecutive patients of CTS referred to neurophysiology laboratory of a tertiary care hospital over 1 year were prospectively studied. Boston CTS Assessment Questionnaire (BCTSAQ) and visual analog scale (VAS) were used to assess subjective symptom severity. Psychological status was assessed by Hospital Anxiety and Depression Scale (HADS). Electrophysiological severity of CTS was estimated by median motor distal latency and median to ulnar peak sensory latency difference across the wrist. Each parameter in both hands was scored from 0 to 3 depending on the severity grade, and a composite electrophysiological severity score (CEPSS) was calculated for each patient by summing up the scores in both hands. Statistical analysis was done by Spearman's rank correlation test.
There was significant correlation of BCTSAQ with VAS ( = 0.001), HADS anxiety score ( < 0.001), and HADS depression score ( = 0.01). CEPSS had no significant correlation with VAS ( = 0.103), HADS anxiety score ( = 0.211), or HADS depression score ( = 0.55). CEPSS had a borderline correlation with BCTSAQ ( = 0.048).
While the subjective symptoms of CTS are well correlated with psychological factors, their correlation with objective electrophysiological severity is weak. Hence, prompt treatment of psychological comorbidity is important in symptomatic management of CTS; decision about surgical intervention should be based on electrophysiological severity rather than symptom severity.
腕管综合征（CTS）是最常见的卡压性神经病，也是最常见的电诊断需求之一。我们旨在研究CTS主观症状严重程度与患者客观电生理严重程度及心理状态之间的关系。
前瞻性研究了一家三级护理医院神经生理学实验室在1年期间连续收治的144例CTS患者。采用波士顿CTS评估问卷（BCTSAQ）和视觉模拟量表（VAS）评估主观症状严重程度。采用医院焦虑抑郁量表（HADS）评估心理状态。通过正中神经运动远端潜伏期和腕部正中神经与尺神经感觉峰值潜伏期差评估CTS的电生理严重程度。根据严重程度等级，双手的每个参数从0到3评分，通过将双手的评分相加为每位患者计算复合电生理严重程度评分（CEPSS）。采用Spearman等级相关检验进行统计分析。
BCTSAQ与VAS显著相关（P = 0.001）、HADS焦虑评分（P < 0.001）和HADS抑郁评分（P = 0.01）。CEPSS与VAS（P = 0.103）、HADS焦虑评分（P = 0.211）或HADS抑郁评分（P = 0.55）无显著相关性。CEPSS与BCTSAQ有边缘相关性（P = 0.048）。
虽然CTS的主观症状与心理因素密切相关，但它们与客观电生理严重程度的相关性较弱。因此，在CTS的症状管理中，及时治疗心理合并症很重要；手术干预的决策应基于电生理严重程度而非症状严重程度。
