Özdemir Ali, Acar Mehmet Ali, Güleç Ali, Durgut Fatih, Cebeci Hakan
Department of Orthopedy and Traumatology, Selcuk University, Akademi Mahallesi, Selçuklu/Konya, Turkey.
Department of Orthopedy and Traumatology, Selcuk University, Akademi Mahallesi, Selçuklu/Konya, Turkey.
J Hand Surg Am. 2020 Dec;45(12):1141-1147. doi: 10.1016/j.jhsa.2020.06.006. Epub 2020 Jul 22.
This is a retrospective observational study that assessed the prevalence of positive diagnostic imaging and electrodiagnostic (EDX) findings in patients diagnosed with pronator syndrome (PS), who previously had a carpal tunnel syndrome (CTS) surgery. The other purpose of our study was to determine how often PS occurred and was missed in patients treated surgically for CTS.
The files of 180 patients who underwent CTS surgery were reviewed retrospectively. We assessed all patients for a diagnosis of PS. We accepted the clinical findings and patient history as the reference standard for the diagnosis of PS. Anteroposterior and lateral radiographs of the elbow, bilateral upper limb magnetic resonance imaging (MRI) studies, and bilateral dynamic forearm ultrasound (US) were performed on patients with clinical symptoms and physical examinations that indicated PS. Bilateral upper limb EDX was also performed for these patients. One patient refused additional tests.
A total of 174 extremities in 146 patients were included in the study. Pronator syndrome was diagnosed by 2 hand surgeons in 22 extremities (19 patients) through a clinical evaluation that included a history and physical examination. Diagnostic testing was positive for findings of PS in 24% of extremities (5 of 21) tested by EDX, in 57% of extremities (12 of 21) tested by US, and 5% of extremities (1 of 21) tested by MRI. There was no lower humeral spur that could cause median nerve compression on any plain radiographs.
With clinical evaluation as the reference standard, EDX, US, and MRI are not helpful in making a diagnosis of PS concurrent with CTS.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.
这是一项回顾性观察研究，评估了既往接受过腕管综合征（CTS）手术的旋前圆肌综合征（PS）患者中，诊断性影像学检查和电诊断（EDX）结果呈阳性的患病率。我们研究的另一个目的是确定在接受CTS手术治疗的患者中，PS的发生频率以及漏诊情况。
回顾性分析了180例行CTS手术患者的病历。我们对所有患者进行了PS诊断评估。我们将临床发现和患者病史作为PS诊断的参考标准。对有临床症状且体格检查提示PS的患者进行了肘部正侧位X线片、双侧上肢磁共振成像（MRI）检查以及双侧动态前臂超声（US）检查。这些患者还进行了双侧上肢EDX检查。有1例患者拒绝进一步检查。
本研究共纳入146例患者的174个肢体。2名手外科医生通过包括病史和体格检查在内的临床评估，在22个肢体（19例患者）中诊断出PS。在接受EDX检查的肢体中，24%（21例中的5例）PS检查结果呈阳性；在接受US检查的肢体中，57%（21例中的12例）呈阳性；在接受MRI检查的肢体中，5%（21例中的1例）呈阳性。在任何X线平片上均未发现可导致正中神经受压的肱骨下端骨刺。
以临床评估为参考标准，EDX、US和MRI对CTS合并PS的诊断并无帮助。
研究类型/证据水平：诊断性IV级。
