Norton Neuroscience Institute, Norton Healthcare, Louisville, KY, USA.
Neurodiagnostic Center of Louisville, Louisville, KY, USA.
J Oncol Pharm Pract. 2024 Jan;30(1):38-45. doi: 10.1177/10781552231167559. Epub 2023 Apr 4.
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and rarely develops after drug therapy. This study describes the clinical, electrodiagnostic (EDX), and ultrasound (US) findings in seven patients who experienced CTS due to anti-cancer therapeutic agents.
All patients underwent EDX testing, and four patients had an US study.
CTS occurred in four patients with aromatase inhibitors, two with immune checkpoint inhibitors, and one with a selective estrogen receptor modulator. The mean duration between initiation of the anti-cancer therapeutic agents and symptom onset was 6 weeks (range: 2-12 weeks). Decreased digit sensation was noted in all patients; wasting and weakness of the abductor pollicis brevis (APB) was observed in three (42.8%) patients. The compound muscle action potentials (CMAP) of the APB and sensory nerve action potentials of the second or third digit could not be recorded in two (28.5%) and four (57.1%) patients, respectively. The needle EMG detected fibrillations and positive sharp waves in the APB in two patients. The motor unit potentials of the APB were decreased with large polyphasics in three (42.8%) patients. Of the four patients who underwent US testing, all had increased cross-sectional area of the median nerve at the carpal tunnel inlet, three (75%) had thenar muscle atrophy, and two (50%) had a loss of fascicular pattern. Three (42.8%) patients underwent a CTR.
Physicians should be cognizant of the relationship between anti-cancer therapeutic agents and CTS. EDX studies and US play important roles in the diagnostic assessment of such patients.
腕管综合征（CTS）是最常见的嵌压性神经病，很少在药物治疗后发生。本研究描述了 7 例因抗癌治疗药物引起 CTS 的患者的临床、电诊断（EDX）和超声（US）表现。
所有患者均行 EDX 检查，4 例行 US 检查。
CTS 发生在 4 例芳香酶抑制剂、2 例免疫检查点抑制剂和 1 例选择性雌激素受体调节剂的患者中。从开始使用抗癌治疗药物到出现症状的平均时间为 6 周（范围：2-12 周）。所有患者均出现指感觉减退；3 例（42.8%）患者可见外展拇指短肌（APB）萎缩和无力。2 例（28.5%）和 4 例（57.1%）患者分别无法记录 APB 的复合肌肉动作电位（CMAP）和第二或第三指的感觉神经动作电位。2 例患者的针极肌电图在 APB 中检测到纤颤波和正锐波。3 例（42.8%）患者的 APB 运动单位电位减少，多相波增大。行 US 检查的 4 例患者中，均可见腕管入口正中神经横截面积增加，3 例（75%）可见鱼际肌萎缩，2 例（50%）可见束状结构丧失。3 例（42.8%）患者接受了 CTS 减压术。
医生应认识到抗癌治疗药物与 CTS 之间的关系。EDX 研究和 US 在这些患者的诊断评估中发挥重要作用。
