ULTRASONOGRAPHIC EVALUATION OF THE CARPAL-TUNNEL SYNDROME IN HEMODIALYSIS-PATIENTS

The carpal tunnel syndrome (CTS) is the most frequent clinical symptom of dialysis-related amyloidosis. We examined CTS by ultrasound imagin g and correlation between CTS and bone amyloidosis was sought. One hun dred and forty-two wrists of 71 hemodialysis (HD) patients and 28 of 1 4 normal volunteers (group 1) were studied. Patients on HD were divide d into 4 groups based on HD duration: Group 2, less than 5 years; grou p 3, 5-10 years; group 4, 10-15 years; and group 5, more than 15 years . The frequency of CTS increased gradually with HD duration: 0% in gro up 2, 35.3% in group 3, 36.4% in group 4 and 74.1% in group 5. The thi ckness of the palmar radiocarpal ligament (PRL), corresponding to the posterior wall of the carpal tunnel was significantly greater in group s 4 (p <0.05), and 5 (p <0.05) than in group 1 (2.25 +/- 1.30 and 3.11 +/- 1.02 in group 4 and 5 vs 1.15 +/- 0.34 mm in group 1); and the wi dth of the carpal tunnel (CT) was significantly larger in group 5 than in group 1 (6.92 +/- 1.78 in group 5 vs 5.53 +/- 1.48 mm in group 1, p <0.05). Wrists operated on for CTS had significantly increased PRL, and CT compared to the control group and patients without CTS. Patient s with CTS had wider PRL than the control and HD patients without CTS. Cystic radiolucent lesions (CRL) of carpal bones characteristic of bo ne amyloidosis were noted in 15 of 71 HD patients. The thickness of PR L and width of CT in HD patients with CRL exceeded those in patients w ithout CRL. These data indicated that ultrasonographic findings of wri sts were closely correlated with the degree of CTS and CRL. The useful ness of ultrasonographic evaluation of PRL thickness and CT width in t he evaluation of dialysis-related amyloidosis should be evaluated.