Early detection of carpal and tarsal tunnel syndromes in fibromyalgia patients by using electrophysiological and ultrasonographic values

Document Type : Original Article

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Rheumatology and Rehabilitation Department ,Faculty of Medicine for Girls, Cairo, Al-Azhar University, Egypt.

Abstract

Background: Carpal tunnel syndrome (CTS) is a focal and compressive neuropathy of the median nerve at the wrist, being the evidence of increasing pressure within the carpal tunnel, Tarsal tunnel syndrome (TTS)is tibial nerve entrapment or neuralgia. The common disorder known as fibromyalgia is characterized by chronic and widespread pain. FM patients also frequently experience headaches, paraesthesia, sleep disturbances, and psychological manifestations. it is important to distinguish between the symptoms of fibromyalgia (FM) and entrapment neuropathies, which are easily misdiagnosed in FM patients, which seems to impact the patient's quality of life when people can't enjoy life because of pain, numbness in the hands, they are exhausted mentally, emotionally, and physically, so we conducted this study for early detection of mild CTS and TTS.   
Objective: To assess fibromyalgia as a risk factor in the occurrence of carpal tunnel syndrome and tarsal tunnel syndrome compared to non-fibromyalgia control by using electrophysiological and ultrasonographic values.
Methodology: In this case control study, 100 patients with Fibromyalgia attending the rheumatology and rehabilitation and psychiatric departments of Al Zahraa University Hospital were compared to 100 age-and sex matched apparently healthy people as controls. Tender points count, widespread pain index, symptom severity scale, fibromyalgia score and fibromyalgia impact questionnaire were recorded for FM patients group. The median and posterior tibial nerves were evaluated by electrophysiological studies and by ultrasonography.
Results: The occurrence of tarsal tunnel syndrome and carpal tunnel syndrome is higher in the fibromyalgia group than in the control group in female middle-aged patient, with a statistically significant difference (p < 0.001).
Conclusion: Carpal tunnel and tarsal tunnel syndromes were found to be significantly higher in fibromyalgia patients. Musculoskeletal ultrasound is considered as a significant tool for testing for early diagnosis of entrapment neuropathy in cases of FM presented with paresthesia especially when used in combination with electrophysiological.

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