Download PDF
J Hand Microsurg
DOI: 10.1055/s-0043-1764163
Original Article

Diabetes Increases Median Nerve Cross-Sectional Area but Not Disease Severity in Patients with Carpal Tunnel Syndrome

Colin H. Beckwitt
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
William Schulz
2   Department of Orthopaedic Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, United States
,
Sabrina Carrozzi 
2   Department of Orthopaedic Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, United States
,
Jeffrey Wera
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Karen Wasil
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
John R. Fowler
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background Ultrasonography (US) is a useful diagnostic modality for diagnosis of carpal tunnel syndrome (CTS). Diabetes mellitus is increasingly prevalent and is a risk factor for CTS. Given the increasing use of US in the diagnosis of CTS, our goal was to evaluate the influence of diabetes on CTS severity and the cross-sectional area (CSA) of the median nerve in patients with CTS.

Methods Patients with clinically diagnosed CTS were seen in the outpatient setting from October 2014 to February 2021. Median nerve CSA and patient reported severity measures were obtained: Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6. For patients with diabetes, additional parameters were collected including most recent A1c, insulin pharmacotherapy, and polypharmacy.

Results Ninety-nine patients (122 nerves) without diabetes and 55 patients (82 nerves) with diabetes were recruited for the study. Patients in the diabetes group were more obese and older and had a significantly increased median nerve CSA compared with patients without diabetes. Obesity was associated with higher median nerve CSA in all patients but not in patients with diabetes. There was no difference in disease severity in patients with and without diabetes as reported by BCTSQ or CTS-6 scores. In patients with diabetes, there was significantly decreased median nerve CSA with A1c of 6.5 or higher and a trend to decreased CSA with polypharmacy. There was no influence of insulin therapy on median nerve CSA.

Conclusion Diabetes is associated with higher median nerve CSA in patients with CTS of similar disease severity. The increased median nerve CSA in patients with diabetes may be reflective of diabetes-related microvascular changes. Interestingly, the trend to decreased median nerve CSA in patients with suboptimal diabetic control (A1c ≥ 6.5) may suggest eventual degenerative changes to the median nerve. In summary, clinicians should be cautious with interpreting a larger median nerve CSA as more severe CTS in patients with diabetes.

Level of Evidence Level 3 Diagnostic.

Keywords

carpal tunnel - diabetes - median nerve - obesity - ultrasonography


Publication History

Article published online:
13 March 2023

© 2023. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Ho JY, Kalainov DM, Hartigan BJ. Carpal tunnel syndrome. 2007; 15 (09) 537-548
    PubMedGoogle Scholar
  • 2 Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal tunnel syndrome: a review of literature. Cureus 2020; 12 (03) e7333
    PubMedGoogle Scholar
  • 3 Becker J, Nora DB, Gomes I. et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002; 113 (09) 1429-1434
    CrossrefPubMedGoogle Scholar
  • 4 Shin J, Kim YW, Lee SC, Yang SN, Chang JS, Yoon SY. Effects of diabetes mellitus on the rate of carpal tunnel release in patients with carpal tunnel syndrome. Sci Rep 2021; 11 (01) 15858 DOI: 10.1038/s41598-021-95316-9.
    CrossrefPubMedGoogle Scholar
  • 5 Tulipan JE, Ilyas AM. Carpal tunnel syndrome surgery: what you should know. Plast Reconstr Surg Glob Open 2020; 8 (03) e2692 DOI: 10.1097/GOX.0000000000002692.
    CrossrefPubMedGoogle Scholar
  • 6 Tulipan JE, Kachooei AR, Shearin J, Braun Y, Wang ML, Rivlin M. Ultrasound evaluation for incomplete carpal tunnel release. Hand (N Y) 2020; 15 (06) 780-784
    CrossrefPubMedGoogle Scholar
  • 7 Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res 2011; 469 (04) 1089-1094
    CrossrefPubMedGoogle Scholar
  • 8 Mhoon JT, Juel VC, Hobson-Webb LD. Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electrodiagnostic abnormality. Muscle Nerve 2012; 46 (06) 871-878
    CrossrefPubMedGoogle Scholar
  • 9 Lin TY, Chang KV, Wu WT, Özçakar L. Ultrasonography for the diagnosis of carpal tunnel syndrome: an umbrella review. J Neurol 2022; 269 (09) 4663-4675
    CrossrefPubMedGoogle Scholar
  • 10 Chen IJ, Chang KV, Lou YM, Wu WT, Özçakar L. Can ultrasound imaging be used for the diagnosis of carpal tunnel syndrome in diabetic patients? A systemic review and network meta-analysis. J Neurol 2020; 267 (07) 1887-1895
    CrossrefPubMedGoogle Scholar
  • 11 Wipperman J, Goerl K. Carpal tunnel syndrome: diagnosis and management. Am Fam Physician 2016; 94 (12) 993-999 http://www.ncbi.nlm.nih.gov/pubmed/28075090
    PubMedGoogle Scholar
  • 12 Dale AM, Harris-Adamson C, Rempel D. et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health 2013; 39 (05) 495-505
    CrossrefPubMedGoogle Scholar
  • 13 Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA 2015; 314 (10) 1021-1029
    CrossrefPubMedGoogle Scholar
  • 14 Attah FA, Asaleye CM, Omisore AD, Kolawole BA, Aderibigbe AS, Alo M. Relationship between sonographically measured median nerve cross-sectional area and presence of peripheral neuropathy in diabetic subjects. World J Diabetes 2019; 10 (01) 47-56
    CrossrefPubMedGoogle Scholar
  • 15 Nkrumah G, Blackburn AR, Goitz RJ, Fowler JR. Ultrasonography findings in severe carpal tunnel syndrome. Hand (N Y) 2020; 15 (01) 64-68
    CrossrefPubMedGoogle Scholar
  • 16 Zhang X, Gregg EW, Williamson DF. et al. A1C level and future risk of diabetes: a systematic review. Diabetes Care 2010; 33 (07) 1665-1673
    CrossrefPubMedGoogle Scholar
  • 17 Palta P, Huang ES, Kalyani RR, Golden SH, Yeh H-C. Hemoglobin A1c and mortality in older adults with and without diabetes: results from the National Health and Nutrition Examination surveys (1988-2011). Diabetes Care 2017; 40 (04) 453-460
    CrossrefPubMedGoogle Scholar
  • 18 Younger DS. Diabetic neuropathy: a clinical and neuropathological study of 107 patients. Neurol Res Int 2010; 2010: 140379 DOI: 10.1155/2010/140379.
    CrossrefPubMedGoogle Scholar
  • 19 Aragaki D, Basu A, Conlon C. et al. Quality of electrodiagnostic testing for carpal tunnel syndrome: adherence to quality measures. Muscle Nerve 2020; 62 (01) 50-59
    CrossrefPubMedGoogle Scholar
  • 20 Lew HL, Date ES, Pan SS, Wu P, Ware PF, Kingery WS. Sensitivity, specificity, and variability of nerve conduction velocity measurements in carpal tunnel syndrome. Arch Phys Med Rehabil 2005; 86 (01) 12-16
    CrossrefPubMedGoogle Scholar
  • 21 Cioni R, Passero S, Paradiso C, Giannini F, Battistini N, Rushworth G. Diagnostic specificity of sensory and motor nerve conduction variables in early detection of carpal tunnel syndrome. J Neurol 1989; 236 (04) 208-213
    CrossrefPubMedGoogle Scholar
  • 22 Goyal V, Bhatia M, Padma MV, Jain S, Maheshwari MC. Electrophysiological evaluation of 140 hands with carpal tunnel syndrome. J Assoc Physicians India 2001; 49: 1070-1073 http://www.ncbi.nlm.nih.gov/pubmed/11868858
    PubMedGoogle Scholar
  • 23 Kuntzer T. Carpal tunnel syndrome in 100 patients: sensitivity, specificity of multi-neurophysiological procedures and estimation of axonal loss of motor, sensory and sympathetic median nerve fibers. J Neurol Sci 1994; 127 (02) 221-229
    CrossrefPubMedGoogle Scholar
  • 24 Tackmann W, Kaeser HE, Magun HG. Comparison of orthodromic and antidromic sensory nerve conduction velocity measurements in the carpal tunnel syndrome. J Neurol 1981; 224 (04) 257-266
    CrossrefPubMedGoogle Scholar
  • 25 Aktürk S, Büyükavcı R, Ersoy Y. Median nerve ultrasound in carpal tunnel syndrome with normal electrodiagnostic tests. Acta Neurol Belg 2020; 120 (01) 43-47
    CrossrefPubMedGoogle Scholar
  • 26 Hersh B, D'Auria J, Scott M, Fowler JR. A comparison of ultrasound and MRI measurements of the cross-sectional area of the median nerve at the wrist. Hand (N Y) 2019; 14 (06) 746-750
    CrossrefPubMedGoogle Scholar
  • 27 Ridolfi M, Caruso P, Buoite Stella A, Manganotti P. Very high-resolution ultrasound of the distal median nerve. Clin Neurophysiol 2020; 131 (06) 1267-1271
    CrossrefPubMedGoogle Scholar
  • 28 Hassan A, Leep Hunderfund AN, Watson J, Boon AJ, Sorenson EJ. Median nerve ultrasound in diabetic peripheral neuropathy with and without carpal tunnel syndrome. Muscle Nerve 2013; 47 (03) 437-439
    CrossrefPubMedGoogle Scholar
  • 29 Kim YH, Yang KS, Kim H. et al. Does diabetes mellitus influence carpal tunnel syndrome?. J Clin Neurol 2017; 13 (03) 243-249
    CrossrefPubMedGoogle Scholar
  • 30 Lee CH, Choi H, Yoon JS, Kang S. Carpal tunnel syndrome assessment with ultrasonography: a comparison between non-diabetic and diabetic patients. Ann Rehabil Med 2018; 42 (01) 85-91
    CrossrefPubMedGoogle Scholar