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Carpal tunnel syndrome in uremia
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Sir,
I read an interesting article on carpal tunnel syndrome (CTS) by Shende et al.[1] I would like to share our experience and views:
The authors have excluded the other relevant causes of CTS. Here I think hypothyroidism, which is an important causes of CTS,[2] either the eminent authors have forgotten to mention in the article or not considered. It requires an attention as besides diabetes hypothyroidism is quite a common cause of CTS.[2]
Of course the authors have mentioned the recommendations of American Academy of Orthopedic Surgeons (AAOS) that ultrasound and newer diagnostic modalities like magnetic resonance imaging or computed tomography are not of routine. But here my experience says that these are of use in some patients to rule out certain treatable causes, as is also recommended by AAOS. This view is further supported by a recent study that use of fractional anisotropy measured at the carpal tunnel inlet is optimal for diagnosing carpal tunnel syndrome[3] So, these diagnostic modalities are better included in such larger studies where we are likely to get some extra confounding causes of CTS.
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References
- A study of median nerve entrapment neuropathy at wrist in uremic patients. Indian J Nephrol. 2015;25:229-33.
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- The effects of hypothyroidism and thyroid replacement on the development of carpal tunnel syndrome. J Hand Surg Am. 2000;25:734-9.
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- Optimal parameters and location for diffusion-tensor imaging in the diagnosis of carpal tunnel syndrome: A prospective matched case-control study. AJR Am J Roentgenol. 2015;204:1248-54.
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