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THE EUROPEAN JOURNAL OF
lymphology
and related problems
VOLUME 29 • No. 75 • 2017
INDEXED IN EXCERPTA MEDICA
ULTRASONOGRAPHY CAN HELP IN THE DIAGNOSIS OF CARPAL TUNNEL SYNDROME IN BREAST-CANCER-RELATED LYMPHOEDEMA: A PROSPECTIVE ANALYTICAL STUDY
Principal Investigator: Other Investigator:
Thesis Director:
ESTELA MARTÍN CASTILLO 1
PROFESSOR ANÍBAL BÁEZ SUÁREZ 2
ANA BELÉN TACORONTE PÉREZ 3
ANA ISABEL MELIÁN MARTÍNEZ 3
MARÍA TERESA RODRÍGUEZ RODRÍGUEZ 3
ÁNGELO SANTANA DEL PINO 4
Professor and Doctor JUAN FRANCISCO LORO FERRER 5
1 Rehabilitation doctor. Grupo Socio-Sanitario ICOT. Doctoral Student. Las Palmas de Gran Canaria University. Spain.
2 Physiotherapist. Ciudad de San Juan de Dios. Associated Professor. Las Palmas de Gran Canaria University. Medical and Surgical Science Department. Las Palmas de Gran Canaria. Spain.
3 Physiotherapist. Complejo Hospitalario Universitario Insular-Materno Infantil de Las Palmas. Spain.
4 Full Professor. Las Palmas de Gran Canaria University. Mathematical Department, Las Palmas de
Gran Canaria, Spain.
5 Full Professor. Las Palmas de Gran Canaria University. Basic Sciences Department. Thesis Director
Program. Spain.
ABSTRACT
Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Meanwhile, breast cancer is the most common in women. Both, CTS and breast cancer are common diseases in older women and they will inevitably occur together. The gold standard test for CTS diagnosis is electromyography (EMG). Nowadays, there is scientific evidence to demonstrate the correlation between the ultrasound cross-sectional area of median nerve and EMG results. The aim of this study is to prove the efficacy of ultrasound results in patients with breast cancer related lymphoedema and CTS.
Method: Prospective, analytical and observational study. The principal investigator measured every patient with an ultrasound machine, and the valuation of the measurement of median nerve before treatment and after treatment (20 daily sessions). Clinical findings like paraesthesia, dysesthesia, Tinnel and Phalen signs, and an analogical visual scale (AVS) were also collected.
Results: 21 women with lymphoedema were recruited, with an average age of 62,45 (SD 9,615). After treatment, all of them present clinical findings of CTS in lymphoedema’s arm, like paraesthesia, dysesthesia, Tinnel sign positive or Phalen sign positive. AVS before treatment 6.56 (SD1.39), AVS after treatment 5.49 (SD1.42), Cross-sectional median area before treatment 0.17mm2 (SD 0.3), after treatment 0,15mm2 (SD 0.15), Cross-sectional median nerve healthy arm 0.11mm2 (SD 0.21).
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
Conclusions: Ultrasound has to be taken into account in the diagnosis of CTS in breast-cancer-related lymphoedema patients, because it can avoid unnecessary surgical procedures in patients with increased risk of postsurgical complications. The evaluation of CTS before physiotherapy treatment is not recommended, because the improvement of the oedema can result a clinical beneficial improvement of CTS.
Key Words: Ultrasonography, Carpal Tunnel Syndrom, breast- cancer, physical therapy modality, mastectomy, rehabilitation.
INTRODUCTION
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, with an incidence of 1-3 cases per 1000 population per year. It is more frequent in 40-60 years old women 1. Meanwhile, breast cancer is the most common in women around the world. Furthermore, CTS is a potential complication following mastectomy, with lymphoedema playing a role in their development. Both, CTS and breast cancer are common diseases in older women and they will inevitably occur together 2.
The gold standard test for CTS diagnosis is electromyography (EMG), but it is controverted because there are about 5-20% of false negative results and about 45% of false positives. Subcutaneous tissue thickness is a factor that contributes to change the EMG results and it is increased in women with lymphedema, so EMG in lymphoedema’s patient could be less reliable and advisable 3.
4