RESUMO
Objective: To evaluate the upper extremity nerves of stroke patients morphologically and electrophysiologically and to determine whether there is a relationship between clinical evaluations, ultrasonographic measurements, and electrodiagnostic findings. Methods: This cross-sectional study included 30 chronic stroke patients. After recording demographical data, clinical, ultrasonographic, and electrophysiological evaluations were performed. Clinical evaluations included Brunnstrom Recovery Stages (BRS), Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motricity index (MI), Functional Independence Measurement (FIM), and Functional Ambulation Scale (FAS). For ultrasonographic measurements, median and ulnar nerves were scanned. Median and ulnar nerve conduction studies were performed bilaterally. Results: Mean ages of the patients were 62.2 ± 13.0 years (range 24-84 years; 22 males, 8 females). There was no significant difference in median/ulnar nerve ultrasonographic measurements between paretic and non-paretic sides (p > .05), whereas median nerve motor conduction velocity was significantly slower and median nerve F-wave latency was prolonged on the paretic side (p < .05). The median and ulnar nerve compound motor action potential (CMAP) amplitudes of paretic sides were positively correlated with lower extremity BRS and FAS scores. Median CMAP amplitudes were also positively correlated with FIM scores and ulnar CMAP amplitudes were positively correlated with motricity scores. Moreover, on the paretic side, there were positive correlations of median SNAP amplitudes with FIM and FAS scores (p < .05). Conclusions: Our results showed electrophysiological changes in peripheral nerves on the paretic upper extremities, however, no morphological change was determined. Further studies with larger number of patients and longer follow-up periods are needed to clarify the effect of stroke and spasticity on the peripheral nervous system.
Assuntos
Eletromiografia/métodos , Nervo Mediano/diagnóstico por imagem , Espasticidade Muscular/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Nervo Ulnar/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Nervo Mediano/fisiologia , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Condução Nervosa/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Nervo Ulnar/fisiologia , Extremidade Superior/diagnóstico por imagem , Extremidade Superior/inervação , Adulto JovemRESUMO
The aim of this study was to examine the neuropathic pain component of knee osteoarthritis (OA) patients and to investigate the relationship between neuropathic pain, disease stage, functional state, depression, anxiety, and quality of life. This study included 60 patients with knee OA. All demographic data and radiological results were recorded. Visual Analog Scale (VAS), Timed Up and Go Test, Chair Stand Test, Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), PainDETECT questionnaire, DN4 questionnaire, Short form-36 questionnaire, and Hospital Anxiety Depression Scale were performed for each patient. Neuropathic pain was detected in 66.7% of patients based on the PainDETECT scale and in 46.7% of patients based on DN4 scale. VAS-resting, OA grade, WOMAC scores, and SF-scores showed a significant difference in patients that detected neuropathic pain with PainDETECT (p<0.05). Based on the DN4 scale, patients with neuropathic pain had significantly higher WOMAC scores and significantly lower SF-36 scores (p<0.05). The PainDETECT questionnaire scores showed positive correlations with Timed Up-and-go Test, VAS-resting, WOMAC scores, Hospital Anxiety Depression Scale scores, and a negative correlation with all SF-36 scores (p<0.05). DN4 questionnaire scores showed a negative correlation with SF-36 scores and positive correlation with WOMAC scores (p<0.05). To conclude, it should be kept in mind that patients with knee OA who describe intense pain may have a neuropathic component involved in the clinical condition. Quality of life and functional capacity are adversely affected in patients with knee OA who have neuropathic pain. This should be taken into account while planning the treatment of these patients.