Inching technique and comparative tests in the diagnosis of mild carpal tunnel syndrome

Introduction: Carpal tunnel syndrome [CTS] is the most common entrapment neuropathy. Its diagnosis depends on its typical clinical signs and symptoms and confirmed by electrophysiologic studies. Routine motor and sensory conduction studies failed to diagnose CTS in about 25% of cases [mild cases with distal motor latencies less than 4.2 ms]. The aim of the work: was to study the sensitivity and reliability of inching sensory technique of median nerve around wrist as well as comparative nerve conduction tests in diagnosis of mild CTS. and hence early application of suitable lines of treatments

Subjects and methods: This study comprised fifty apparently healthy subjects as a control group and patients group included one hundred and fifteen patients with mild CTS in 150 affected hands. Patients were thoroughly selected from 379 patients with 512 affected hands diagnosed clinically as having typical CTS and referred from Outpatient Clinics in Mansoura University Hospitals. Cases with mild CTS were selected according to conventional motor and sensory nerve conduction studies [NCS] and were having distal motor latencies less than 4.2 ms. All the studied groups were subjected to; sensitive NCV tests: mediansecond lumbrical versus ulnar-inrosseous test, median versus ulnar digit 4 sensory latencies test [ringdiff], median versus ulnar palm-to-wrist mixed nerve latencies test [palmdiff], median versus radial digit one antidromic sensory latencies [thumbdiff], combined sensory index [CSI] and inching sensory technique for median nerve at wrist. different surgical approaches were planned to relieve nerve compression after failure of other therapeutic modalities depending on accurate diagnosis using inching sensory test and other comparative tests

Results: Mild CTS was diagnosed in 29.3% of all cases of CTS. In comparative tests, median versus ulnar palm-to-wrist mixed nerve latencies [palmdiff] was the most sensitive [93.33%] with specificity of 99.3%. CSI was the most sensitive test in our study [sensitivity=99.33% and specificity =100%] followed by inching sensory test as its sensitivity was 94% and specificity 100%

Conclusion: Comparative studies and CSI are easily applied, non painful, sensitive and specific tests can be applied firstly in diagnosis of mild CTS and followed by inching sensory technique which is also, very sensitive and specific but it may be painful and time consuming. We can approach to diagnosis of mostly all cases of mild CTS by this regimen so early diagnosis with selection of suitable lines of treatment will improve the results of patient's outcome

Simple, easy, fast and reliable screening tests for clinical diagnosis of diabetic peripheral polyneuropathy

Early diagnosis of diabetic peripheral polyneuropathy is very important as it can cause significant morbidity and mortality. For diagnosing polyneuropathy, no golden standard is available. Was to evaluate the role of Diabetic Neuropathy Symptom Score [DNSS], Diabetic Neuropathy Examination Score [DNES] and Semmes-Winstein Monofilament Examination [SWME] tests in diagnosis of diabetic peripheral polyneuropathy and study their correlation with parameters of nerve conduction studies [NCS]. This study was carried out on 50 patients with type II diabetes mellitus in addition to 15 apparently healthy subjects matched for age and sex as a control group. All patients were subjected to full history taking, general examination, and full neurological examination, and DNSS, DNES, SWME and laboratory investigations. Nerve conduction studies were carried out for all patients and the control group. Polyneuropathy was diagnosed in 35 patients [70%] by DNSS, in 36 patients [72%] by DNES, in 27 patients [54%] by SWME and in 45 patients [90%] by NCS. There were significant correlation between DNSS, DNES, SWME and the parameters of NCS. DNSS, DNES and SWME are simple, easy, fast, reliable and valid methods for diagnosis of most cases of peripheral polyneuropathy especially when used in combination

Anti-chromatin and anti-histone antibodies in Egyptian patients with systemic lupus erythematosus

There has been a renewed interest in anti-chromatin and anti-histone antibodies in the last few years. A number of research papers have demonstrated the clinical utility of these antibodies to help diagnosis of systemic lupus erythematosus [SLE]. To assess the prevalence of anti-chromatin and anti-histone antibodies in patients with SLE and to correlate serum levels of these antibodies with clinical features of the disease. The presence of anti-chromatin and antihistone antibodies in 38 patients with SLE was investigated by an enzyme- linked immunosorbent assay [ELISA] To determine the specificity of these antibodies, 15 patients with rheumatoid arthritis, 15 patient with systemic sclerosis and 15 normal controls were also tested. Increased levels of anti-chromatin antibodies were detected in 89.5% of SLE patients. In contrast they were found in only 33.3% of those with rheumatoid arthritis [RA], 26.7% with systemic sclerosis [SSc] and in non of the healthy controls. Increased levels of anti-histone antibodies were detected in 92.1% of SLE patients. In contrast they were found in only 20% of RA patients, 33.3% of SS patients and in non of the healthy controls. Sensitivity of anti-chromatin antibodies in SLE patients was 89.5% and specificity was 80.0%, while sensitivity of anti-histone antibodies was 92.1% and specificity was 82.2%. Significant associations were found between the levels of anti-chromatin antibodies and arthritis, malar rash, oral ulcer, and pulmonary affection [P<0.05] and also, lupus nephritis [P<0.01], and disease activity score as measured by SLE disease activity index [SLEDAI] [P<0.001]. Significant association was found between anti-histone antibodies and fatigue [P<0.05]. The incidence of positive anti-chromatin and anti-histone antibodies was significantly higher than that of anti-dsDNA antibodies in early stage of the disease. Anti-chromatin and anti-histone antibodies are both sensitive and specific for SLE and could be a useful addition to the laboratory tests that can help in the diagnosis of SLE. Anti-chromatin antibodies seem to be a promising marker useful in early diagnosis and assessment of disease activity in SLE patients especially in patients who are negative for anti-dsDNA antibodies