الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This study aimed at assessing the potential and value of electrophysiology in the diagnosis of carpal tunnel syndrome in patients with diabetic neuropathy. The study also aimed at verifying the presence of correlations between clinical and electrophysiological findings in such patients, as well as assessing the extent of such relations. The study included 60 male and female patients and 20 male and female healthy control subjects. The patients and healthy subjects were classified into 4 groups with a population of 20 patients per group. Healthy control subjects were enrolled in group 1, group 2 contained non diabetic carpal tunnel syndrome patients, group 3 contained diabetic neuropathy patients showing no clinical sings of carpal tunnel syndrome while group 4 contained diabetic neuropathy patients with clinical signs of carpal tunnel syndrome. All cases were thoroughly evaluated clinically before proceeding to the electrophysiological measurement. Electrodiagnostic techniques included measuring sensory latency amplitude and conduction velocity for the median, ulnar and superficial radial nerves in the hand (wrist to digit segment) in addition to motor latency and amplitude for median and ulnar nerves in the hand and measuring their motor conduction velocities in the arm and forearm. In addition, segmental sensory conduction studies were done to the median nerve in the hand dividing in into 2 segments: the midpalm to digit segment and the midpalm to wrist segment. The axillary F central latencies (AFCL) for the median and ulnar nerves were determined. All the electrodiagnostic procedures were done in room temperature in the department of Physical Medicine, Rheumatology and Rehabilitation using the “Neuropack2” electromyograph manufactured by Nihon Kohden®. Results were tabulated and statistically evaluated. Statistical analysis of clinical data showed relations between the appearance of carpal tunnel syndrome in a diabetic neuropathy patient and the patient’s sex, occupation, duration of diabetes, being on insulin therapy rather than oral antidiabetics and compliance to drug therapy. Statistical analysis of electrodiagnostic results showed significant differences between patients with diabetic neuropathy only (group 3) and those with carpal tunnel syndrome on top of neuropathy (group 4) in the midpalm- wrist sensory latency , midpalm-wrist sensory conduction velocity whole median (wrist-digit)sensory latency and median motor latency. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity, specificity and accuracy of all the techniques used in median nerve assessment between group 3 and group 4.ROC curve analysis showed the midpalm-wrist sensory conduction velocity measurement to be the most reliable with a 90% sensitivity, a 100% specificity and a 95% accuracy. The statistics showed the presence of relations between the electrophysiological changes and the patients’ age, sex, occupation, duration of diabetes and compliance to medications used for diabetes management. The statistics also showed that although most of group 4 patients (diabetic neuropathy patients with carpal tunnel syndrome) used insulin rather than oral antidiabetics, the drug therapy (insulin or oral antidiabetics) had no relations with electrophysiological changes.