|
1
|
Hilbig-Vlatten L, Grauberger JN, Engmann TF, Stadelmeier LF, Dunn RM, Mandeville R, Ko JH, D'Hemecourt P, Dowlatshahi S. Soleal Sling Syndrome: A Narrative Review. J Peripher Nerv Syst 2025; 30:e70032. [PMID: 40391847 DOI: 10.1111/jns.70032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 05/05/2025] [Accepted: 05/10/2025] [Indexed: 05/22/2025]
Abstract
Soleal sling syndrome is a rare cause of lower extremity neuropathy due to compression of the proximal tibial nerve under the fibromuscular arch of the soleus muscle. It presents with plantar numbness/paresthesias, calf pain, and tenderness over the proximal calf. Chronic compression can lead to toe flexor weakness. This study reviews the clinical presentation, diagnostic workup, and treatment options for soleal sling syndrome. A query of the PubMed database up until August 30, 2022, was conducted to gather relevant clinical, anatomic, and radiographic findings. The literature review identified key features of soleal sling syndrome, highlighting the importance of considering it in patients with calf pain/tenderness and plantar foot neurosensory changes. Diagnosis typically relies on history and physical examination, often with a positive Tinel's sign, though imaging modalities show inconsistent utility. Soleal sling syndrome is underrecognized and overlaps with other syndromes. Radiological imaging modalities can rule out secondary causes of proximal tibial nerve compression but lack consistency for diagnosing idiopathic cases. Surgical decompression of the nerve, via a medial or posterior approach, is the definitive treatment for all causes of tibial nerve compression.
Collapse
Affiliation(s)
- Laura Hilbig-Vlatten
- Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer N Grauberger
- Division of Plastic Surgery, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Toni F Engmann
- Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lilly F Stadelmeier
- Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond M Dunn
- Division of Plastic Surgery, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason H Ko
- Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pierre D'Hemecourt
- Orthopedics and Sports Medicine Department, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sammy Dowlatshahi
- Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
|
2
|
Manchikanti L, Abd-Elsayed A, Kaye AD, Sanapati MR, Knezevic NN, Manocha V, Hirsch JA. Review of Guidelines for Implantable Peripheral Nerve Stimulation (PNS) in the Management of Chronic Pain. Curr Pain Headache Rep 2025; 29:89. [PMID: 40410617 DOI: 10.1007/s11916-025-01397-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2025] [Indexed: 05/25/2025]
Abstract
PURPOSE OF REVIEW This article assesses the current evidence and guidelines on peripheral nerve stimulation (PNS) and provides recommendations for its use in managing moderate to severe chronic pain. RECENT FINDINGS PNS has been utilized for over 50 years in the treatment of chronic pain. However, since 2015, the Food and Drug Administration (FDA) has approved percutaneously implanted PNS leads and neurostimulators, providing a minimally invasive, non-opioid alternative for managing persistent and refractory chronic pain. The American Society of Interventional Pain Physicians (ASIPP) has established evidence-based consensus guidelines for the clinical use of PNS systems in addressing chronic pain. ASIPP guidelines performed extensive evidence synthesis, including systematic reviews, randomized controlled trials (RCTs), and observational studies using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria or certainty of evidence, and qualitative synthesis based on the best available evidence. The evidence level and recommendations showed fair evidence with moderate strength of recommendation for implantable PNS systems following a trial or selective lumbar medial branch stimulation without a trial and for temporary PNS for 60 days. This review offers a comprehensive analysis of peripheral neuropathic pain as a cause of chronic, intractable, function-limiting, and high-impact pain. It discusses the diagnosis of peripheral nerve and neuropathic pain, evidence evaluation and synthesis, medical necessity criteria, patient education, and clinical recommendations. The goal is to enhance patient outcomes by integrating PNS technology into clinical practice.
Collapse
Affiliation(s)
- Laxmaiah Manchikanti
- Pain Management Centers of America, 67 Lakeview Drive, Paducah, KY, 42001, USA.
- Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA.
- Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, Shreveport, LA, USA.
| | - Alaa Abd-Elsayed
- UW Health Pain Services and University of Wisconsin, Madison, WI, USA
| | - Alan D Kaye
- Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
- Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA, USA
- Department of Anesthesiology and Pharmacology, LSU School of Medicine, New Orleans, LA, USA
| | - Mahendra R Sanapati
- Pain Management Centers of America, Evansville, IN, USA
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, KY, USA
- Part-Time Faculty, Indiana University School of Medicine, Evansville, IN, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center and College of Medicine, University of Illinois, Chicago, IL, USA
- Department of Surgery, College of Medicine, University of Illinois, Chicago, IL, USA
| | - Vivekanand Manocha
- Department of Surgery, Wright State University School of Medicine, Dayton, OH, USA
- Beacon Orthopedics & Sports Medicine, Cincinnati, OH, USA
| | - Joshua A Hirsch
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
3
|
Liao C, Zhang W. Nerve decompression for diabetic peripheral neuropathy with nerve entrapment: a narrative review. Ther Adv Neurol Disord 2024; 17:17562864241265287. [PMID: 39411723 PMCID: PMC11475385 DOI: 10.1177/17562864241265287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/12/2024] [Indexed: 10/19/2024] Open
Abstract
Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes which primarily affects the sensory nervous system. Pain is the most common complaint that prompts patients to seek medical advice. With various presentations and intricate pathological mechanisms, diabetic peripheral neuropathic pain is currently the most crucial and challenging aspect of managing diabetic complications. As a heterogeneous disorder, there is no medication or treatment modality that is effective for all types of DPN and its associated neuropathic pain. Peripheral nerve decompression provides a new option for treating patients with diabetic peripheral neuropathic pain in the lower extremities. However, the clinical applicability of nerve decompression has been debated since it was first proposed. This review discusses the theoretical basis of nerve decompression, the clinical indications, and the progress of basic research based on the pathological mechanisms and nerve impairment patterns of diabetic peripheral neuropathic pain. The heterogeneity of DPN patients is summarized in terms of three aspects: complex pathophysiological mechanisms, multilevel nervous system involvement, and various nerve impairment properties. Identifying the presence of nerve entrapment among complex pathophysiological mechanisms is the key to successful outcomes. Tinel signs, focal pain, mechanical allodynia, and two-point discrimination were reported to be prognostic factors for good surgical outcomes, and their predictive ability might stem from their association with the early stage of entrapment neuropathy.
Collapse
Affiliation(s)
- Chenlong Liao
- Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenchuan Zhang
- Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Shanghai Zhizaoju Road, Huangpu District, Shanghai 200011, China
| |
Collapse
|
|
4
|
Rozen SM, Wolfe GI, Vernino S, Raskin P, Hynan LS, Wyne K, Fulmer R, Pandian G, Sharma SK, Mohanty AJ, Sanchez CV, Hembd A, Gorman A. Effect of Lower Extremity Nerve Decompression in Patients With Painful Diabetic Peripheral Neuropathy: The Diabetic Neuropathy Nerve Decompression Randomized, Observation Group and Placebo Surgery-Controlled Clinical Trial. Ann Surg 2024; 280:35-45. [PMID: 38328975 DOI: 10.1097/sla.0000000000006228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To evaluate the effect of nerve decompression on pain in patients with lower extremity painful diabetic peripheral neuropathy (DPN). BACKGROUND Currently, no treatment provides lasting relief for patients with DPN. The benefits of nerve decompression remain inconclusive. METHODS This double-blinded, observation and same-patient sham surgery-controlled randomized trial enrolled patients aged 18 to 80 years with lower extremity painful DPN who failed 1 year of medical treatment. Patients were randomized to nerve decompression or observation group (2:1). Decompression-group patients were further randomized and blinded to nerve decompression in either the right or left leg and sham surgery in the opposite leg. Pain (11-point Likert score) was compared between decompression and observation groups and between decompressed versus sham legs at 12 and 56 months. RESULTS Of 2987 screened patients, 78 were randomized. At 12 months, compared with controls (n=37), both the right-decompression group (n=22) and left-decompression group (n=18) reported lower pain (mean difference for both: -4.46; 95% CI: -6.34 to -2.58 and -6.48 to -2.45, respectively; P < 0.0001). Decompressed and sham legs equally improved. At 56 months, compared with controls (n=m 14), pain was lower in both the right-decompression group (n=20; mean difference: -7.65; 95% CI: -9.87 to -5.44; P < 0.0001) and left-decompression group (n=16; mean difference: -7.26; 95% CI: -9.60 to -4.91; P < 0.0001). The mean pain score was lower in decompressed versus sham legs (mean difference: 1.57 95% CI: 0.46 to 2.67; P =0.0002). CONCLUSIONS Although nerve decompression was associated with reduced pain, the benefit of surgical decompression needs further investigation as a placebo effect may be responsible for part or all of these effects.
Collapse
Affiliation(s)
- Shai M Rozen
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gil I Wolfe
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY
| | - Steven Vernino
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Philip Raskin
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Linda S Hynan
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kathleen Wyne
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Rita Fulmer
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Geetha Pandian
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shiv K Sharma
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ahneesh J Mohanty
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Cristina V Sanchez
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Austin Hembd
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - April Gorman
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
|
5
|
Nguyen DT, Zaferanieh MH, Black AC, Hamedi KR, Goodwin RL, Nathaniel TI. Obstetric Neuropathy in Diabetic Patients: The “Double Hit Hypothesis”. Int J Mol Sci 2023; 24:ijms24076812. [PMID: 37047786 PMCID: PMC10094911 DOI: 10.3390/ijms24076812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
The two-hit model has been proposed to explain the effects of diabetes on mothers who are already in a putative subclinical damaged state and then undergo neuronal damage during the delivery process. However, the anatomical and pathophysiological mechanisms are not well understood. Our overarching hypothesis in this review paper is that pregnant women who are diabetic have a damaged peripheral nervous system, constituting the “first hit” hypothesis. The delivery process itself—the “second hit”—can produce neurological damage to the mother. Women with diabetes mellitus (DM) are at risk for neurological damage during both hits, but the cumulative effects of both “hits” pose a greater risk of neurological damage and pathophysiological changes during delivery. In our analysis, we introduce the different steps of our concept paper. Subsequently, we describe each of the topics. First, we outline the mechanisms by which diabetes acts as a detrimental variable in neuropathy by focusing on the most common form of diabetic neuropathy, diabetic distal symmetrical polyneuropathy, also known as distal sensorimotor neuropathy. The possible role of macrosomia in causing diabetic neuropathy and obstetric neurological injury is discussed. Second, we describe how vaginal delivery can cause various obstetrical neurological syndromes and pathophysiological changes. Third, we highlight the risk of obstetric neuropathy and discuss anatomical sites at which lesions may occur, including lesions during delivery. Fourth, we characterize the pathophysiological pathways involved in the causation of diabetic neuropathy. Finally, we highlight diabetic damage to sensory vs. motor nerves, including how hyperglycemia causes different types of damage depending on the location of nerve cell bodies.
Collapse
Affiliation(s)
- Dieu Thao Nguyen
- Greenville School of Medicine, University of South Carolina, 607 Grove Road, Greenville, SC 29605, USA
| | | | - Asa C. Black
- Greenville School of Medicine, University of South Carolina, 607 Grove Road, Greenville, SC 29605, USA
| | - Kamron Reza Hamedi
- Greenville School of Medicine, University of South Carolina, 607 Grove Road, Greenville, SC 29605, USA
| | - Richard L. Goodwin
- Greenville School of Medicine, University of South Carolina, 607 Grove Road, Greenville, SC 29605, USA
| | - Thomas I. Nathaniel
- Greenville School of Medicine, University of South Carolina, 607 Grove Road, Greenville, SC 29605, USA
| |
Collapse
|
|
6
|
Liao C, Li S, Nie X, Tian Y, Zhang W. Triple-nerve decompression surgery for the treatment of painful diabetic peripheral neuropathy in lower extremities: A study protocol for a randomized controlled trial. Front Neurol 2022; 13:1067346. [PMID: 36588890 PMCID: PMC9794581 DOI: 10.3389/fneur.2022.1067346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives Painful diabetic peripheral neuropathy (DPN) is often refractory to conventional medications. Triple-nerve decompression was proposed for painful DPN due to the frequent involvement of multiple nerve entrapments in diabetes. However, the role of decompressive surgery remains controversial. This trial aims to assess the efficacy of triple-nerve decompression for patients with painful DPN suggestive of nerve entrapment using a randomized controlled trial (RCT) design. Methods and analysis This trial is a single-center RCT and will be conducted in Shanghai Ninth People's Hospital. Enrolled subjects (n = 74) with painful DPN due to nerve compression, which can be detected by nerve conduction studies, will be randomly allocated at a 1:1 ratio into surgical and non-surgical groups. The primary outcome will be measured by 50% responder rates, which is defined as the proportion of subjects with at least 50% reduction of the mean weekly visual analog score (VAS) of pain from baseline after 6 months of treatment. Mean weekly VAS will be additionally evaluated 1 week (W1), 1 month (M1), and 3 months (M3) after treatment to monitor the changes in pain intensity. The secondary outcomes include two-point discrimination (TPD), Toronto clinical scoring system (TCSS), electrophysiological indexes, hospital anxiety and depression scale (HADS), and the medical outcome study short-form 36-item questionnaire (SF-36). A quantitative analgesic questionnaire (QAQ) will be used as a secondary outcome to quantify the analgesic medication weekly. TPD and TCSS will be conducted at W1, M1, M3, and M6 after treatment. Electrophysiological tests, HADS, and SF-36 will be performed at M3 and M6. Ethics and dissemination Ethics approval has been obtained from the Ethics Committee of Shanghai Ninth People's Hospital (SH9H-2-21-T323-2). It was registered on the Chinese Clinical Trial Registry website (http://www.chictr.org.cn) on 16 August 2021 with the number ChiCTR2100050049. Written informed consent will be obtained from all participants. The results of this trial will be disseminated via peer-reviewed journals, mass media, and presentations at national and international academic conferences.
Collapse
Affiliation(s)
- Chenlong Liao
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuo Li
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Nie
- Biostatistics Laboratory of Clinical Research Unit, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yayuan Tian
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenchuan Zhang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Wenchuan Zhang
| |
Collapse
|
|
7
|
Fakkel TM, Rinkel WD, Henk Coert J. Does Lower Extremity Nerve Decompression Surgery Improve Quality of Life? Plast Reconstr Surg 2022; 150:1351-1360. [PMID: 36161790 DOI: 10.1097/prs.0000000000009699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Entrapment neuropathies are more prevalent in patients with diabetes than in healthy patients. The aim of this study was to assess the effects of lower extremity nerve decompression surgery on quality of life and clarify predictors of this surgical outcome and the incidence of surgical site problems. METHODS Patients who underwent lower extremity nerve decompression surgery between September of 2017 and March of 2019 were followed prospectively at the outpatient clinic of University Medical Center Utrecht. The common, superficial, and deep peroneal nerve and tibial nerve at the tarsal tunnel and soleal sling were decompressed if an entrapment was diagnosed. The primary study outcome was quality of life as measured by the Norfolk Quality of Life-Diabetic Neuropathy questionnaire. Secondary outcomes of interest were change in Michigan Neuropathy Screening Instrument score, predictors of the Norfolk score at follow-up, and the occurrence of complications. RESULTS Sixty patients underwent surgery (45 unilateral, 15 bilateral), with a median postoperative follow-up of 13.0 months (interquartile range, 7.3 to 18.0 months). Quality of life improved significantly in this period of observation [baseline median, 46.0 (34.0 to 62.0) versus follow-up median, 37.0 (20.0 to 60.0); p = 0.011], as did Michigan Neuropathy Screening Instrument scores [7.0 (5.0 to 9.0) versus 3.0 (0.0 to 6.5); p < 0.01]. Predictors of quality of life were a higher baseline quality of life score [β, 0.59 ( p = 0.001)], longer follow-up time [β, 2.34 ( p < 0.001)], and hypertension [β, 16.38 ( p = 0.03)]. A total of 26.7 percent of patients had surgical site problems, including wound infections (18.3 percent). CONCLUSIONS Lower extremity nerve decompression surgery significantly improves quality of life by reducing neuropathy symptoms in patients with lower extremity nerve compressions. Attention should be given to lowering the risk of wound complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Tirzah M Fakkel
- From the Department of Plastic, Reconstructive, and Hand Surgery, Utrecht University Medical Center
| | - Willem D Rinkel
- From the Department of Plastic, Reconstructive, and Hand Surgery, Utrecht University Medical Center
| | - J Henk Coert
- From the Department of Plastic, Reconstructive, and Hand Surgery, Utrecht University Medical Center
| |
Collapse
|
|
8
|
Capodici A, Hagert E, Darrach H, Curtin C. An overview of common peroneal nerve dysfunction and systematic assessment of its relation to falls. INTERNATIONAL ORTHOPAEDICS 2022; 46:2757-2763. [PMID: 36169699 PMCID: PMC9674763 DOI: 10.1007/s00264-022-05593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE Compression of the peroneal nerve is recognized as a common cause of falls. The superficial course of the peroneal nerve exposes it to trauma and pressure from common activities such as crossing of legs. The nerve can be exposed also to distress due to metabolic problems such as diabetes. The purpose of our manuscript is to review common peroneal nerve dysfunction symptoms and treatment as well as provide a systematic assessment of its relation to falls. METHODS We pooled the existing literature from PubMed and included studies (n = 342) assessing peroneal nerve damage that is related in any way to falls. We excluded any studies reporting non-original data, case reports and non-English studies. RESULTS The final systematic assessment included 4 articles. Each population studied had a non-negligible incidence of peroneal neuropathy. Peroneal pathology was found to be consistently associated with falls. CONCLUSION The peroneal nerve is an important nerve whose dysfunction can result in falls. This article reviews the anatomy and care of the peroneal nerve. The literature review highlights the strong association of this nerve's pathology with falls.
Collapse
Affiliation(s)
- Angelo Capodici
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy.
- Department of Medicine (Biomedical Informatics), Stanford University - School of Medicine, Stanford, CA, USA.
| | - Elisabet Hagert
- Aspetar Orthopedic- and Sports Medicine Hospital, Doha, Qatar
- Deparment of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Halley Darrach
- Division of Plastic Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Catherine Curtin
- Department of Surgery - Veterans' Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
| |
Collapse
|
|
9
|
Wang P, Liu B, Rong T, Wu B. Is diabetes the risk factor for poor neurological recovery after cervical spine surgery? A review of the literature. Eur J Med Res 2022; 27:263. [PMID: 36419189 PMCID: PMC9686083 DOI: 10.1186/s40001-022-00879-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
The poor prognosis of cervical spine surgery is mainly manifested as poor neurological recovery and the presence of new upper extremity dysfunction that promotes significant psychological and physiological burdens on patients. Many factors influence the prognosis of cervical spine surgery, including the age of patients, the time and mode of surgery, and the surgical technique used. However, in clinical studies, it has been observed that patients with diabetes have a higher probability of poor prognosis after surgery. Therefore, we review the pathophysiology of diabetic neuropathies and discuss its impact on cervical nerve system function, especially in cervical nerve roots and upper limb peripheral nerve conduction.
Collapse
|
|
10
|
Abstract
This brief review describes the etiology, pathophysiology, clinical features, therapy and prognosis of the diabetic mononeuropathies and diabetic amyotrophy and neuropathic cachexia. Mononeuropathies include cranial neuropathies, of which the oculomotor nerve is most commonly affected, and are thought to be due to microvascular occlusion. Peripherally, entrapment neuropathies occur in both the upper and lower limbs and are due to compression of an already damaged nerve in anatomically restricted channels. Diabetic radiculopathies occur in the dermatones of the thorax and abdomen, mimicking intraabdominal or intrathoracic pathology. I also describe the features of the rare but very distinctive diabetic amyotrophy and neuropathic cachexia. Overall, the prognosis from these conditions is excellent with residual pain or muscle weakness being rare with the exception of diabetic amyotrophy where the prognosis is dependent upon cooperation with intensive rehabilitation. Therapies include "watchful waiting," physical therapy and rarely surgical intervention, which may be urgently needed for nerve decompression and reversal of motor defects.
Collapse
Affiliation(s)
- David S H Bell
- Southside Endocrinology, 1900 Crestwood Blvd, Suite 201, Irondale, AL, 35210, USA.
| |
Collapse
|
|
11
|
Smith S, Normahani P, Lane T, Hohenschurz-Schmidt D, Oliver N, Davies AH. Pathogenesis of Distal Symmetrical Polyneuropathy in Diabetes. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071074. [PMID: 35888162 PMCID: PMC9319251 DOI: 10.3390/life12071074] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/13/2022]
Abstract
Distal symmetrical polyneuropathy (DSPN) is a serious complication of diabetes associated with significant disability and mortality. Although more than 50% of people with diabetes develop DSPN, its pathogenesis is still relatively unknown. This lack of understanding has limited the development of novel disease-modifying therapies and left the reasons for failed therapies uncertain, which is critical given that current management strategies often fail to achieve long-term efficacy. In this article, the pathogenesis of DSPN is reviewed, covering pathogenic changes in the peripheral nervous system, microvasculature and central nervous system (CNS). Furthermore, the successes and limitations of current therapies are discussed, and potential therapeutic targets are proposed. Recent findings on its pathogenesis have called the definition of DSPN into question and transformed the disease model, paving the way for new research prospects.
Collapse
Affiliation(s)
- Sasha Smith
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Pasha Normahani
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Department of Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - David Hohenschurz-Schmidt
- Pain Research Group, Department of Surgery and Cancer, Imperial College London, London SW10 9NH, UK;
| | - Nick Oliver
- Section of Metabolic Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W2 1PG, UK;
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Alun Huw Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK
- Correspondence:
| |
Collapse
|
|
12
|
Fattah SA, Elmadani M, Abo-Elmatty DM, Awadallah M, Mehanna ET. Genetic variants of ALR (-106C → T /-12C → G) and serum PKC-δ are associated with peripheral neuropathy in Egyptian diabetic patients with impaired handwriting. J Diabetes Metab Disord 2022; 21:557-565. [PMID: 35673475 PMCID: PMC9167348 DOI: 10.1007/s40200-022-01008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose Diabetic peripheral neuropathy can injure the hand median nerve and cause extensive nerve damage. PKC and ALR are associated with progression of diabetic complications. We hypothesized a genetic association between the ALR polymorphisms (-106C → T/-12C → G) and elevated serum PKC-δ levels in diabetic neuropathy and its adverse effects on handwriting in Egyptian population. Methods One hundred DPN were compared with 100 DP and 100 healthy volunteers. ALR -106C → T/-12C → G variants were studied using the PCR-RFLP method. A routine set of standard laboratory markers was determined. Serum PKC-δ concentration was determined by ELISA. Logistic regression analysis and areas under the receiver characteristic curves (AUCs) were evaluated to investigate the predictors of diabetic neuropathy. Arabic handwriting was analyzed based on the recognition of functional features, word shape, and ascending/descending parts of letters. Results Individuals carrying ALR-106C → C and -12G → G had a significantly higher risk of developing diabetic neuropathy than individuals with -106C → T and -12C → G genotypes (P = 0.01, P = 0.02). Carriers of the (-106C → T) CC and (-12C → G) GG genotypes had significantly increased serum levels of PKC-δ, FBG, TC, and LDL-c. PKC- δ serum levels were significantly correlated with glycemic and lipid indicators (P < 0.001). PKC-δ is a significant predictor of diabetes with or without neuropathy at a cutoff value of 16.6, sensitivity was 89%, and specificity 100%. All DPN showed complete deterioration of handwriting after the onset of diabetic neuropathy. Conclusion The genetic variants ALR-106C → C / -12G → G and PKC-δ in serum may help in the detection and treatment of diabetic neuropathy in Egyptian population before writing performance is affected.
Collapse
Affiliation(s)
- Shaimaa A. Fattah
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522 Egypt
| | - Moshira Elmadani
- Forgery and Counterfeiting Researches Department, Forensic Medicine Authority, Minister of Justice, Ismailia, Egypt
| | - Dina M. Abo-Elmatty
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522 Egypt
| | - Mohamed Awadallah
- Forgery and Counterfeiting Researches Department, Forensic Medicine Authority, Minister of Justice, Ismailia, Egypt
| | - Eman T. Mehanna
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522 Egypt
| |
Collapse
|
|
13
|
Zimmerman M, Gottsäter A, Dahlin LB. Carpal Tunnel Syndrome and Diabetes—A Comprehensive Review. J Clin Med 2022; 11:jcm11061674. [PMID: 35329999 PMCID: PMC8952414 DOI: 10.3390/jcm11061674] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the general population and is frequently encountered among individuals with type 1 and 2 diabetes. The reason(s) why a peripheral nerve trunk in individuals with diabetes is more susceptible to nerve compression is still not completely clarified, but both biochemical and structural changes in the peripheral nerve are probably implicated. In particular, individuals with neuropathy, irrespective of aetiology, have a higher risk of peripheral nerve compression disorders, as reflected among individuals with diabetic neuropathy. Diagnosis of CTS in individuals with diabetes should be carefully evaluated; detailed case history, thorough clinical examination, and electrophysiological examination is recommended. Individuals with diabetes and CTS benefit from surgery to the same extent as otherwise healthy individuals with CTS. In the present review, we describe pathophysiological aspects of the nerve compression disorder CTS in relation to diabetes, current data contributing to the explanation of the increased risk for CTS in individuals with diabetes, as well as diagnostic methods, treatment options, and prognosis of CTS in diabetes.
Collapse
Affiliation(s)
- Malin Zimmerman
- Department of Hand Surgery, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden
- Department of Orthopaedic Surgery, Helsingborg Hospital, 251 87 Helsingborg, Sweden
- Correspondence:
| | - Anders Gottsäter
- Department of Medicine, Skåne University Hospital, 205 02 Malmö, Sweden;
- Department of Clinical Sciences Malmö, Lund University, 205 02 Malmö, Sweden
| | - Lars B. Dahlin
- Department of Hand Surgery, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
| |
Collapse
|
|
14
|
Erol K, Topaloğlu US, Göl MF. Frequency of carpal tunnel syndrome and hand dysfunction in prediabetes: A cross-sectional, controlled study. Turk J Phys Med Rehabil 2022; 68:62-69. [PMID: 35949959 PMCID: PMC9305650 DOI: 10.5606/tftrd.2022.6828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/25/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate the frequency of carpal tunnel syndrome (CTS), to investigate the impairment of hand functions in patients with prediabetes (PD), and to compare laboratory findings of PD patients with and without CTS. Patients and methods Between June 2018 and January 2019, a total of 115 patients (29 males, 86 females; mean age: 51.4±11.8 years; range, 24 to 78 years) who were recently diagnosed with PD and a total of 54 healthy participants (17 males, 37 females; mean age: 48.4±13.2 years; range, 21 to 78 years) as the control group were included. Demographic and clinical data of the patients including oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) were recorded, and both groups were examined for the presence of CTS. Clinically suspected CTS was confirmed by electrodiagnostic studies. The hand grip strength (HGS) was measured and hand functions were evaluated using the Duruöz Hand Index (DHI). Results There were no significant differences in the age, sex, occupation, body mass index (BMI), or insulin resistance between the groups. A total of 24 (20.9%) patients with PD and eight (14.8%) healthy controls had CTS (p=0.349). Hand functions were worse in the PD patients than the control group (p=0.044). Age, occupation, BMI, insulin resistance, OGTT at 0 and 2 h, and HbA1c values were similar between the PD patients with or without CTS. Conclusion Our study, for the first time, reveals that CTS is slightly more common and hand functions are impaired in PD compared to the healthy individuals. Based on these findings, we suggest that hand functions should be evaluated in PD patients.
Collapse
Affiliation(s)
- Kemal Erol
- Department of Rheumatology, Kayseri City Hospital, Kayseri, Turkey
| | | | | |
Collapse
|
|
15
|
Mondelli M, Aretini A, Ginanneschi F. Electrophysiological Study of the Tibial Nerve Across the Tarsal Tunnel in Distal Symmetric Diabetic Polyneuropathy. Am J Phys Med Rehabil 2022; 101:152-159. [PMID: 33901043 DOI: 10.1097/phm.0000000000001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to demonstrate abnormalities of motor conduction of the tibial nerve across the tarsal tunnel in type 2 diabetes. DESIGN One hundred twenty-four consecutive patients (mean age = 66.6 yrs, 62.1% male) with distal symmetric diabetic polyneuropathy clinically diagnosed were prospectively enrolled. Nerve conduction studies of deep peroneal, tibial, superficial peroneal, medial plantar, and sural nerves and standard needle electromyography in the lower limbs were performed. Demographic, anthropometric, and clinical findings were collected. RESULTS Motor conduction velocity of the tibial nerve across tarsal tunnel was slowed in 60.5% of patients; another 4% showed conduction block across tarsal tunnel without reduction of motor conduction velocity. Overall percentage of abnormalities across tarsal tunnel (64.5%) exceeds that of the sensory conduction velocities of proximal sural and superficial peroneal nerves. Abnormal tibial motor conduction velocity across tarsal tunnel represents the most common abnormality among all motor nerve conduction study parameters and significantly correlates with hemoglobin level, diabetic neuropathic index score, and diabetic complications frequency. CONCLUSIONS Tibial conduction abnormalities across tarsal tunnel are the most sensitive motor parameter in distal symmetric diabetic polyneuropathy, second only to conduction abnormalities of sensory/mixed distal nerves of the feet. The use of nerve conduction studies across tarsal tunnel of the tibial nerve may be useful in the electrophysiological protocol to confirm the diagnosis of distal symmetric diabetic polyneuropathy.
Collapse
Affiliation(s)
- Mauro Mondelli
- From the EMG Service, Local Health Unit Toscana Sud Est, Siena, Italy (MM, AA); and Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy (FG)
| | | | | |
Collapse
|
|
16
|
Cost-Effectiveness of Lower Extremity Nerve Decompression Surgery in the Prevention of Ulcers and Amputations: A Markov Analysis. Plast Reconstr Surg 2021; 148:1135-1145. [PMID: 34705790 DOI: 10.1097/prs.0000000000008440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The costs and health effects associated with lower extremity complications in diabetes mellitus are an increasing burden to society. In selected patients, lower extremity nerve decompression is able to reduce symptoms of neuropathy and the concomitant risks of diabetic foot ulcers and amputations. To estimate the health and economic effects of this type of surgery, the cost-effectiveness of this intervention compared to current nonsurgical care was studied. METHODS To estimate the incremental cost-effectiveness of lower extremity nerve decompression over a 10-year period, a Markov model was developed to simulate the onset and progression of diabetic foot disease in patients with diabetes and neuropathy who underwent lower extremity nerve decompression surgery, compared to a group undergoing current nonsurgical care. Mean survival time, health-related quality of life, presence or risk of lower extremity complications, and in-hospital costs were the outcome measures assessed. Data from the Rotterdam Diabetic Foot Study were used as current care, complemented with information from international studies on the epidemiology of diabetic foot disease, resource use, and costs, to feed the model. RESULTS Lower extremity nerve decompression surgery resulted in improved life expectancy (88,369.5 life-years versus 86,513.6 life-years), gain of quality-adjusted life-years (67,652.5 versus 64,082.3), and reduced incidence of foot complications compared to current care (490 versus 1087). The incremental cost-effectiveness analysis was -€59,279.6 per quality-adjusted life-year gained, which is below the Dutch critical threshold of less than €80,000 per quality-adjusted life-year. CONCLUSIONS Decompression surgery of lower extremity nerves improves survival, reduces diabetic foot complications, and is cost saving and cost-effective compared with current care, suggesting considerable socioeconomic benefit for society.
Collapse
|
|
17
|
Zhang Y, Liu X, Jia J, Zhang Q, Lin Y, Zhang L, Lu Q, Lv H, Zheng X. Diabetic polyneuropathy and carpal tunnel syndrome together affect hand strength, tactile sensation and dexterity in diabetes patients. J Diabetes Investig 2021; 12:2010-2018. [PMID: 34003578 PMCID: PMC8565424 DOI: 10.1111/jdi.13580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) can occur together, and this concomitance is thought to be higher in diabetes patients. We aimed to examine and compare hand function in type 2 diabetes mellitus patients without CTS and DPN (CTS-DPN-), patients with CTS without DPN (CTS+DPN-), patients with DPN without CTS (CTS-DPN+), and patients with CTS and DPN (CTS+DPN+). MATERIALS AND METHODS A total of 161 type 2 diabetes mellitus patients underwent physical examination and electrodiagnostic tests. Grip and pinch strengths, tactile sensory thresholds were measured for each participant. Purdue pegboard test was used in evaluating the hand dexterity of the participants. RESULTS Of the 161 type 2 diabetes mellitus participants, 36 (22.4%) had both CTS and DPN. CTS participants had lower grip (26.6 ± 10.6 vs 35.2 ± 14.3, P < 0.001) and pinch (6.3 ± 2.6 vs 7.5 ± 2.9, P = 0.026) strengths compared with non-CTS participants, whereas DPN participants had elevated tactile sensory thresholds of both the second (2.8 [2.8-3.6] vs 2.4 [2.4-2.8], P < 0.001) and the fifth (2.8 [2.8-3.6] vs 2.4 [2.4-2.8], P < 0.001) fingers compared with non-DPN participants. The CTS+DPN+ group had lower Purdue pegboard test scores than other groups. Grip (r = 0.482, 0.530, 0.467, 0.498, all P < 0.001) and pinch (r = 0.246, P = 0.003; r = 0.265, P = 0.001; r = 0.264, P = 0.001; r = 0.235, P = 0.005) strengths were positively correlated with Purdue pegboard test scores, whereas tactile sensory thresholds were negatively correlated with Purdue pegboard test scores (r = -0.447 to -0.359, all P < 0.001). CONCLUSION Type 2 diabetes mellitus patients with both DPN and CTS had lower grip and pinch strengths and decreased tactile sensation, both of which were correlated with poorer hand dexterity.
Collapse
Affiliation(s)
- Yan Zhang
- People's Hospital of Jiaozuo CityJiaozuoHenan ProvinceChina
| | - Xinhua Liu
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Jie Jia
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Qi Zhang
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Yifang Lin
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Li Zhang
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Qi Lu
- People's Hospital of Jiaozuo CityJiaozuoHenan ProvinceChina
| | - Haidong Lv
- People's Hospital of Jiaozuo CityJiaozuoHenan ProvinceChina
| | - Xianzhao Zheng
- People's Hospital of Jiaozuo CityJiaozuoHenan ProvinceChina
| |
Collapse
|
|
18
|
Rhee SY, Cho HE, Kim JH, Kim HS. Incidence and Reappraisal of Known Risk Factors Associated with Carpal Tunnel Syndrome: A Nationwide, 11-Year, Population-Based Study in South Korea. J Clin Neurol 2021; 17:524-533. [PMID: 34595860 PMCID: PMC8490900 DOI: 10.3988/jcn.2021.17.4.524] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Previous studies have revealed various risk factors for carpal tunnel syndrome (CTS), but few large-scale studies have been conducted. We used data from the 11-year, longitudinal, nationwide population-based National Health Insurance Service–National Health Screening cohort to identify the actual risk factors for CTS. Methods We collected patients with CTS newly diagnosed using electrodiagnostic studies while excluding radiculopathy, plexopathy, or polyneuropathy, which can be confused with CTS. The crude and standardized incidence rates of CTS were calculated. Univariate and multivariate Cox analyses and the incidence of CTS were used to identify the risk factors for newly diagnosed CTS. Results The standardized incidence was 130.8/100,000 person-years based on the World Health Organization World Standard Population as a reference. Multivariate Cox analysis identified that the risk factors for CTS were being middle-aged, female, and obese, and having rheumatoid arthritis and Raynaud's syndrome, whereas gout and hypothyroidism were not risk factors. Diabetes and end-stage renal disease did not show a significant hazard ratio, although it is implicit that the durations of these diseases affect the development of CTS. Conclusions This study calculated the incidence of CTS and reappraised the associated risk factors found in previous studies. This information will be helpful for determining the pathophysiology of CTS, and hence aid the establishment of effective new public health policies.
Collapse
Affiliation(s)
- Seung Yeon Rhee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Han Eol Cho
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hun Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| |
Collapse
|
|
19
|
Samakidou G, Eleftheriadou I, Tentolouris A, Papanas N, Tentolouris N. Rare diabetic neuropathies: It is not only distal symmetrical polyneuropathy. Diabetes Res Clin Pract 2021; 177:108932. [PMID: 34216680 DOI: 10.1016/j.diabres.2021.108932] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/12/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
The prevalence of diabetes mellitus is increasing at an epidemic level, leading to a consequent increase of its chronic complications, including neuropathy. Diabetic neuropathy constitutes a heterogeneous group of disorders with distinct clinical presentations and pathophysiological mechanisms. These distinct forms may be categorised according to their clinical presentation as symmetrical (distal symmetrical polyneuropathy, autonomic and acute sensory neuropathy) and focal or multifocal (radiculoplexus neuropathies, entrapment syndromes, cranial palsies and other mononeuropathies). Additionally, people with diabetes may have neuropathies due to causes other than diabetes. The commonest forms of diabetic neuropathy are distal symmetrical polyneuropathy and autonomic neuropathy. However, clinicians should be aware that people with diabetes may suffer from less common forms of neuropathy and should be able to recognise their symptoms and signs. The recognition of the rare diabetic neuropathies is crucial, as they often lead to different clinical outcomes and require different management. The aim of the present narrative, non-systematic review is to outline the rare types of diabetic neuropathies.
Collapse
Affiliation(s)
- Georgia Samakidou
- Diabetes Centre, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Eleftheriadou
- Diabetes Centre, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Anastasios Tentolouris
- Diabetes Centre, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Tentolouris
- Diabetes Centre, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
| |
Collapse
|
|
20
|
Khan S, Qamar N, Ullah I. Health economic evaluation of different treatment strategies for peripheral entrapment mononeuropathies: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2021; 21:943-952. [PMID: 33896326 DOI: 10.1080/14737167.2021.1919088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: In this era of cost-conscious health systems, it is of utmost importance to identify and establish the most cost-effective treatment option. However, in the case of peripheral entrapment mononeuropathies there is alack of data regarding economically effective treatment strategies. Therefore, the objective was to conduct an economic evaluation including both costs and benefits of various treatment strategies applied to peripheral entrapment mononeuropathies to estimate the relative cost-effective treatment regimens.Areas covered: Over the 19 years, seven excellent-high quality economic evaluations of three types of peripheral entrapment mononeuropathies were identified in four countries. Our findings showed that surgery was the most cost-effective therapy followed by same cost efficacy of infiltrative therapy and conservative therapy for peripheral entrapment mononeuropathies. However, the fact that surgery was the most common comparator (n = 6) in our selected studies cannot be neglected.Expert opinion: Due to huge methodological variability, the finding of surgery as the cost-effective treatment strategy remains tentative and the decision about the most suitable clinical and cost-effective therapy should be individualized from case to case. Moreover, the economic evaluation of all possible treatment strategies for peripheral entrapment mononeuropathies over alonger period of analysis is required in future studies.
Collapse
Affiliation(s)
- Safeer Khan
- Department of Pharmacy Services, Al-Taaluf National Group of Polyclinics, Makkah, Kingdom of Saudi Arabia
| | - Nauman Qamar
- Department of Production, Frontier Dextrose Limited, Industrial Estate, Haripur, Khyber Pakthunkhwa, Pakistan
| | - Ihsan Ullah
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| |
Collapse
|
|
21
|
Agarwal P, Sharma D. Our experience of reinnervation of sole in diabetic sensorimotor polyneuropathy: A chance to change the natural history of disease. J Clin Orthop Trauma 2021; 17:25-29. [PMID: 33717968 PMCID: PMC7920140 DOI: 10.1016/j.jcot.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 12/23/2022] Open
Abstract
Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy which leads to insensate sole, diabetic foot ulcers (DFU) and its complications. We share our experience in recovery of sensation in the sole after prophylactic surgery such as nerve decompression (ND) or sensory neurotization by nerve transfer (NT) in patients having Diabetic sensorimotor polyneuropathy DSPN. 32 patients (46 feet) were selected for either nerve decompression or sensory neurotization depending upon presence or absence of Tinel's sign at tarsal tunnel. At 6 month post-operatively perception of touch and pain recovered in all feet; temperature and pressure perception recovered in ∼95% feet; average vibration perception threshold returned to normal range and 2-Point Discrimination came down significantly. There were no ulcers or amputation in operated limbs during follow up period of 6 months. Prophylactic surgery in the form of ND and NT can be offered with minimal complications which significantly improve sensations in the sole in selected cases of DSPN. These have the potential to improve the quality of life of patient and change the natural course of disease.
Collapse
Affiliation(s)
- Pawan Agarwal
- Professor, and in Charge Plastic Surgery Unit, NSCB Government Medical College, Jabalpur MP, 482003, India
- Corresponding author. 292/293, Napier Town, Jabalpur, 482001, MP, India.
| | - Dhananjaya Sharma
- Professor and Head, Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
| |
Collapse
|
|
22
|
Pelosi L, Yong V, Blumhardt LD. Utility of nerve ultrasound in ulnar neuropathy with abnormal non-localizing electrophysiology in diabetes mellitus. Neurophysiol Clin 2020; 50:387-390. [PMID: 32994094 DOI: 10.1016/j.neucli.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022] Open
Abstract
We studied the utility of ultrasound in the diagnostic workup of ulnar neuropathy with abnormal non-localizing electrophysiology (NL-UN) in patients with diabetes. Eighteen ulnar nerves (15 patients) were scanned from wrist to mid-upper arm. Ultrasound showed: (a) focal nerve enlargement at the elbow (8/18 nerves), either alone (6) or superimposed upon diffuse nerve abnormality (2); (b) diffuse nerve enlargement without focal abnormality (8/18); (c) segmental abnormality in upper-arm or forearm without extrinsic nerve compression (2/18). This study shows a pivotal role for ultrasound in the classification of NL-UN in patients with diabetes, which can facilitate critical therapeutic decisions.
Collapse
Affiliation(s)
- Luciana Pelosi
- Departments of Neurology and Neurophysiology, Bay Of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand.
| | - Vivien Yong
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
| | - Lance D Blumhardt
- University Department of Clinical Neurology, Nottingham, United Kingdom
| |
Collapse
|
|
23
|
Patel K, Horak H, Tiryaki E. Diabetic neuropathies. Muscle Nerve 2020; 63:22-30. [DOI: 10.1002/mus.27014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/20/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Kamakshi Patel
- Department of Neurology, University of Texas Medical Branch Galveston Texas USA
| | - Holli Horak
- Department of Neurology, University of Arizona Tucson Arizona USA
| | - Ezgi Tiryaki
- Department of Neurology, University of Minnesota Minneapolis Minnesota USA
| |
Collapse
|
|
24
|
Croxson S. Diabetes vignette. Weak left hand – query stroke in a diabetic double amputee. PRACTICAL DIABETES 2020. [DOI: 10.1002/pdi.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
|
25
|
Agarwal P, Sharma B, Sharma D. Tarsal tunnel release restores sensations in sole for diabetic sensorimotor polyneuropathy. J Clin Orthop Trauma 2020; 11:442-447. [PMID: 32405206 PMCID: PMC7211905 DOI: 10.1016/j.jcot.2019.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy. Loss of sensations in sole leads to diabetic foot ulcers (DFU) and its complications. Surgical decompression has been used in the treatment of diabetic peripheral neuropathy, however; its effectiveness has been questioned.Purpose of this study was to evaluate the sensory recovery in sole after tarsal tunnel decompression (TTD) in patients having DSPN. METHODS Thirteen patients (Age28-70 years, average 35.57 years; 7 Males, 6 Females; 20 feet) with DSPN and positive Tinel's sign over the tarsal tunnel were included in the study. Pre and post-operative sensory tests performed on the sole included tests for touch, pain, temperature, pressure, vibration perception threshold (VPT) and two-point discrimination (2-PD). Results were classified as per British Medical Research Council (MRC) scoring system. RESULTS -Sixteen feet were followed-up for 6 months. In all feet perception of touch, pain and pressure recovered. Temperature perception recovered in 75% feet. VPT came to normal range (16.81V) from 40.37 V and 2-PD came down to average of 6.0 mm from preoperative average of11.2 mm.MRC scale improved from S0 in 5 feet and S2 in 15 feet to S3+ in all 16 feet.There were no ulcers or amputation in operated limbs during follow up period of 6 months. CONCLUSIONS TTD improves plantar sensations in diabetic neuropathy and prevents ulcers and its related complications.
Collapse
Affiliation(s)
- Pawan Agarwal
- Charge Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Bashudev Sharma
- Resident Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
| |
Collapse
|
|
26
|
Moon HI, Shin J, Kim YW, Chang JS, Yoon S. Diabetic polyneuropathy and the risk of developing carpal tunnel syndrome: A nationwide, population‐based study. Muscle Nerve 2020; 62:208-213. [DOI: 10.1002/mus.26901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/14/2020] [Accepted: 04/19/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Hyun Im Moon
- Department of Rehabilitation MedicineBundang Jesaeng General Hospital Gyeonggi‐do Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine and Public HealthAjou University, School of Medicine Suwon Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation MedicineYonsei University College of Medicine Seoul Republic of Korea
| | - Jee Suk Chang
- Department of Radiation OncologyYonsei University College of Medicine Seoul Republic of Korea
| | - SeoYeon Yoon
- Department of Rehabilitation MedicineBundang Jesaeng General Hospital Gyeonggi‐do Republic of Korea
| |
Collapse
|
|
27
|
|
|
28
|
|
|
29
|
Hammond EA, Pitz M, Lambert P, Shay B. Quantitative sensory profiles of upper extremity chemotherapy induced peripheral neuropathy: Are there differences in sensory profiles for neuropathic versus nociceptive pain? Can J Pain 2019; 3:169-177. [PMID: 35005406 PMCID: PMC8730657 DOI: 10.1080/24740527.2019.1665992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aims: The aim of this study was to define the sensory phenotypes of taxane-induced peripheral neuropathy (TIPN) between neuropathic and nonneuropathic symptoms in a breast cancer population to identify future targets for mechanism-based pain management. Methods: Participants (n = 48) with stage I–III breast cancer. Self-report questionnaires and quantitative sensory testing were used to assess sensory symptoms. The self-report version of the Leeds Assessment for Neuropathic Symptoms and Signs (S-LANSS) divided the groups into neuropathic and nonneuropathic sensory phenotypes. In total, five visits over approximately 8 months assessed each participant from pre-chemotherapy to 6 months post-chemotherapy. Results: Out of 191 nerve assessments, 150 had an S-LANSS <12 defined as “nonneuropathic” and 41 scored >12, which was defined as “neuropathic.” Numeric Pain Rating Scale (NPRS) was analyzed based on percentages of those experiencing 1+ pain (graded 1/10 or higher) versus no pain. The neuropathic group had 82.9% of 1+ pain vs. 28.7% in the nonneuropathic group (odds ratio = 7.49; 95% confidence interval, 2.76–20.3; P = 0.001). The neuropathic group reported impaired function on the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire (P = 0.002). Heat pain threshold resulted in statistical differences for the left hand but not the right hand in the neuropathic group (P = 0.05). No other quantitative data on warm/cool or cold or vibration demonstrated sensory differences between the groups. Conclusions: Few differences in sensory profiles measured using quantitative sensory testing (QST) were found. Heat pain thresholds were normalized, possibly suggesting that the neuropathic group retained C-fiber and transient potential vanilloid 1 (TRPV1) function. Participants with neuropathic pain demonstrated significant differences with increased pain and decreased function.
Collapse
Affiliation(s)
- Elizabeth Andersen Hammond
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marshall Pitz
- Internal Medicine, Rady Faculty of Health Sciences, Medical Oncologist, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pascal Lambert
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Barbara Shay
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
|
30
|
Abstract
PURPOSE OF REVIEW Diabetic peripheral neuropathy eventually affects nearly 50% of adults with diabetes during their lifetime and is associated with substantial morbidity including pain, foot ulcers, and lower limb amputation. This review summarizes the epidemiology, risk factors, and management of diabetic peripheral neuropathy and related lower extremity complications. RECENT FINDINGS The prevalence of peripheral neuropathy is estimated to be between 6 and 51% among adults with diabetes depending on age, duration of diabetes, glucose control, and type 1 versus type 2 diabetes. The clinical manifestations are variable, ranging from asymptomatic to painful neuropathic symptoms. Because of the risk of foot ulcer (25%) and amputation associated with diabetic peripheral neuropathy, aggressive screening and treatment in the form of glycemic control, regular foot exams, and pain management are important. There is an emerging focus on lifestyle interventions including weight loss and physical activity as well. The American Diabetes Association has issued multiple recommendation statements pertaining to diabetic neuropathies and the care of the diabetic foot. Given that approximately 50% of adults with diabetes will be affected by peripheral neuropathy in their lifetime, more diligent screening and management are important to reduce the complications and health care burden associated with the disease.
Collapse
Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Halsted 668, Baltimore, MD, 21287, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA.
| |
Collapse
|
|
31
|
Rinkel WD, Aziz MH, Van Neck JW, Cabezas MC, van der Ark LA, Coert JH. Development of grading scales of pedal sensory loss using Mokken scale analysis on the Rotterdam Diabetic Foot Study Test Battery data. Muscle Nerve 2019; 60:520-527. [PMID: 31281987 PMCID: PMC6852564 DOI: 10.1002/mus.26628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Loss of sensation due to diabetes-related neuropathy often leads to diabetic foot ulceration. Several test instruments are used to assess sensation, such as static and moving 2-point discrimination (S2PD, M2PD), monofilaments, and tuning forks. METHODS Mokken scale analysis was applied to the Rotterdam Diabetic Foot Study data to select hierarchies of tests to construct measurement scales. RESULTS We developed 39-item and 31-item scales to measure loss of sensation for research purposes and a 13-item scale for clinical practice. All instruments were strongly scalable and reliable. The 39 items can be classified into 5 hierarchically ordered core clusters: S2PD, M2PD, vibration sense, monofilaments, and prior ulcer or amputation. DISCUSSION Guided by the presented scales, clinicians may better classify the grade of sensory loss in diabetic patients' feet. Thus, a more personalized approach concerning individual recommendations, intervention strategies, and patient information may be applied.
Collapse
Affiliation(s)
- Willem D Rinkel
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive, and Hand Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Hosein Aziz
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan W Van Neck
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine/Centre for Diabetes, Endocrinology and Vascular Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - L Andries van der Ark
- Faculty of Social and Behavioural Sciences, Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - J Henk Coert
- Department of Plastic, Reconstructive, and Hand Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
|
32
|
Sriraksa N, Kongsui R, Thongrong S, Duangjai A, Hawiset T. Effect of Azadirachta indica flower extract on functional recovery of sciatic nerve crush injury in rat models of DM. Exp Ther Med 2019; 17:541-550. [PMID: 30651834 DOI: 10.3892/etm.2018.6931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/26/2018] [Indexed: 01/29/2023] Open
Abstract
Chronic hyperglycemia causes nerves to be more susceptible to compression, which often occurs as a result of hyperglycemia-induced oxidative stress. Oxidative stress impairs nerve function and delays nerve recovery. Azadirachta indica, a herb from Thailand, possesses antioxidant and antidiabetic properties. The aim of the present study was therefore to investigate the effect of A. indica flower extract on the functional recovery of a sciatic nerve crush injury in rat models of diabetes mellitus (DM). Male Wistar rats were randomly assigned into seven groups including the control rats, rats with DM subjected to sham surgery and treated with vehicle, and rats with DM subjected to the crush surgery and treated with vehicle or A. indica flower extract at a dose of 250, 500 or 750 mg/kg animal body weight, or with vitamin C. DM was induced using a single intraperitoneal injection of streptozotocin (55 mg/kg animal body weight). Rats subjected to a sciatic nerve crush injury or sham surgery were orally treated with either vehicle, A. indica flower extract or vitamin C for 21 days. Functional recovery was assessed every 3 days using a walking track analysis, foot withdrawal reflex test and rotarod test. At the end of the study, the rats were sacrificed and their left sciatic nerves were harvested in order to determine malondialdehyde levels, superoxide dismutase activity and axon density. The treatment with A. indica flower extract significantly improved functional recovery, especially motor and sensory functions. The extract significantly decreased malondialdehyde levels, and increased superoxide dismutase activity and axon density. The results of the current study indicate that the mechanism underlying the enhanced functional recovery of the sciatic nerve following treatment with A. indica flower extract may be associated with an antioxidative effect. However, further studies are required to confirm the current results.
Collapse
Affiliation(s)
- Napatr Sriraksa
- Division of Physiology, School of Medical Sciences, University of Phayao, Mueang, Phayao 56000, Thailand
| | - Ratchaniporn Kongsui
- Division of Physiology, School of Medical Sciences, University of Phayao, Mueang, Phayao 56000, Thailand
| | - Sitthisak Thongrong
- Division of Anatomy, School of Medical Sciences, University of Phayao, Mueang, Phayao 56000, Thailand
| | - Acharaporn Duangjai
- Division of Physiology, School of Medical Sciences, University of Phayao, Mueang, Phayao 56000, Thailand
| | - Thaneeya Hawiset
- School of Medicine, Mae Fah Luang University, Mueang, Chiang Rai 57100, Thailand
| |
Collapse
|
|
33
|
Tony AA, Tony EA, Selim YA, Saad E. Carpal tunnel syndrome in patients with and without diabetes mellitus in Upper Egypt: The impact of electrophysiological and ultrasonographical studies. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Abeer A. Tony
- Departments of Neurology, Faculty of Medicine, Aswan University, Aswan, Egypt
| | | | | | - Ehab Saad
- Rheumatology and Rehablitation, South-Vally University, Qena, Egypt
| |
Collapse
|
|
34
|
Validity of the Tinel Sign and Prevalence of Tibial Nerve Entrapment at the Tarsal Tunnel in Both Diabetic and Nondiabetic Subjects. Plast Reconstr Surg 2018; 142:1258-1266. [DOI: 10.1097/prs.0000000000004839] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
|
35
|
Rinkel WD, Rizopoulos D, Aziz MH, Van Neck JW, Cabezas MC, Coert JH. Grading the loss of sensation in diabetic patients: A psychometric evaluation of the rotterdam diabetic foot study test battery. Muscle Nerve 2018; 58:559-565. [PMID: 30028522 PMCID: PMC6646912 DOI: 10.1002/mus.26192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 12/22/2022]
Abstract
Introduction: Static‐ and moving 2‐point discrimination (S2PD, M2PD), 10‐g monofilaments‐ and tuning fork are validated outcome measures of clinical manifestations of diabetes‐related neuropathy. No modern statistical techniques have been used to investigate how well these instruments combine to measure sensory loss. Methods: To grade sensory loss at the feet, we fitted parametric forms of Item Response Theory models to the data of these instruments. Results: The fit statistics indicate that the loss of sensation is gradable, with readily available instruments. S2PD and M2PD are lost first, followed by vibration sense, the 10‐g monofilament and the ability to feel a cold stimulus. Conclusions: This test battery appears to provide sound measurement properties in a group of diabetic patients with diverse amounts of sensory loss. This approach may be used in clinical practice to grade sensory loss reliably and quickly, with instruments that are easy to use. Muscle Nerve58: 559–565, 2018
Collapse
Affiliation(s)
- Willem D Rinkel
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - M Hosein Aziz
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands
| | - Johan W Van Neck
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine/Centre for Diabetes, Endocrinology and Vascular Medicine, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - J Henk Coert
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Utrecht University Medical Center, Utrecht, the Netherlands
| |
Collapse
|
|
36
|
Kotb MA, Bedewi MA, Aldossary NM, Mahmoud G, Naguib MF. Sonographic assessment of carpal tunnel syndrome in diabetic patients with and without polyneuropathy. Medicine (Baltimore) 2018; 97:e11104. [PMID: 29901629 PMCID: PMC6024071 DOI: 10.1097/md.0000000000011104] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The objective of this study is to determine whether the cross sectional area (CSA) measurement of the median nerve at the wrist differ between carpal tunnel syndrome (CTS) in diabetic patients with and without diabetic polyneuropathy (DPN).This study included 44 patients with type II diabete millitus (DM) with CTS, 32 patients with CTS and DPN, 46 patients with idiopathic CTS, and 42 healthy subjects. Ultrasonographic measurement of the CSA of the median nerve was made at the level of the wrist, together with nerve conduction studies.The median CSA at the wrist was significantly larger in all patient groups compared with healthy subjects. The median nerve CSA was significantly larger in diabetic patients with CTS than patients with idiopathic CTS. The median nerve CSA at wrist was significantly smaller in patients with CTS and DPN compared with diabetic patients with CTS only.The median nerve CSA at the wrist was larger in diabetic patients with CTS than patients with idiopathic CTS and CTS with DPN. Median nerve CSA can help to differentiate between diabetic patients with CTS with and without DPN.
Collapse
Affiliation(s)
- Mamdouh Ali Kotb
- College of Medicine, Prince Sattam bin Abdulaziz University, Al-kharj, Kingdom of Saudi Arabia
- Neurology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Nasser M. Aldossary
- College of Medicine, Prince Sattam bin Abdulaziz University, Al-kharj, Kingdom of Saudi Arabia
| | - Gehan Mahmoud
- College of Medicine, Prince Sattam bin Abdulaziz University, Al-kharj, Kingdom of Saudi Arabia
| | | |
Collapse
|
|
37
|
Abstract
This study investigated the effects of diabetes mellitus (DM) on dynamical coordination of hand intrinsic muscles during precision grip. Precision grip was tested using a custom designed apparatus with stable and unstable loads, during which the surface electromyographic (sEMG) signals of the abductor pollicis brevis (APB) and first dorsal interosseous (FDI) were recorded simultaneously. Recurrence quantification analysis (RQA) was applied to quantify the dynamical structure of sEMG signals of the APB and FDI; and cross recurrence quantification analysis (CRQA) was used to assess the intermuscular coupling between the two intrinsic muscles. This study revealed that the DM altered the dynamical structure of muscle activation for the FDI and the dynamical intermuscular coordination between the APB and FDI during precision grip. A reinforced feedforward mechanism that compensates the loss of sensory feedbacks in DM may be responsible for the stronger intermuscular coupling between the APB and FDI muscles. Sensory deficits in DM remarkably decreased the capacity of online motor adjustment based on sensory feedback, rendering a lower adaptability to the uncertainty of environment. This study shed light on inherent dynamical properties underlying the intrinsic muscle activation and intermuscular coordination for precision grip and the effects of DM on hand sensorimotor function.
Collapse
|
|
38
|
|
|
39
|
|
|
40
|
Abstract
BACKGROUND There is still debate regarding whether the surgical release of entrapped lower extremity nerves reduces complaints of associated neuropathy and results in gain of sensory function. The aim of this study was to investigate which factors are associated with a favorable surgical outcome, by follow-up of patients previously participating in a randomized controlled trial. METHODS The authors evaluated the 5-year follow-up of diabetic patients previously participating in the Lower Extremity Nerve Entrapment Study (LENS). Visual analogue pain scores, satisfaction, complaints, quality of life (i.e., 36-Question Short-Form Health Survey and EuroQol 5 Dimensions instrument), sensory function, and incident ulceration and amputation were assessed. Differences between patients who underwent unilateral versus bilateral decompressions were investigated. RESULTS Thirty-one of the original 42 LENS participants were measured, of which eight patients underwent additional decompression of the contralateral leg, after 12-month LENS follow-up. At 5 years, bilateral surgical patients (n = 8) had significantly lower pain scores and higher quality of life compared with unilateral surgical patients (n = 23), were younger, had a lower age when diagnosed with diabetes, and had a lower body mass index at baseline. Pain scores of the additional decompressed leg decreased in a manner similar to that of the initial decompressed leg during follow-up. Patients with severe preoperative sensory loss did worse; 41.2 percent of the LENS Follow-Up Study subjects underwent or considered undergoing contralateral surgery. CONCLUSION The authors' results suggest that the beneficial effects of lower extremity nerve decompression surgery are reserved for a select group of patients, of which preoperative nerve damage, age, duration of diabetes, and body mass index are important effect modifiers. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
|
|
41
|
Nickerson DS. Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence? Diabet Foot Ankle 2017; 8:1367209. [PMID: 28959382 PMCID: PMC5613909 DOI: 10.1080/2000625x.2017.1367209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
External neurolysis of the nerve at fibro-osseous tunnels has been proprosed to treat or prevent signs, symptoms, and complications in the lower extremity of diabetes patients with sensorimotor polyneuropathy. Nerve decompression is justified in the presence of symptomatic compressed nerves in the several fibro-osseous tunnels of the extremities, which are known to be frequent in diabetes. Quite a body of literature has accumulated reporting results after such nerve decompression in the leg, describing pain relief and sensibility improvement, as well as balance recovery, diabetic foot ulcer prevention, curtailed ulcer recurrence risk, and amputation avoidance. Historical academic hesitance to endorse surgical treatments for pain and numbness in diabetes was based primarily on the early retrospective reports' potential for bias and placebo effects, and that the hypothetical basis for surgery lies outside the traditional etiology paradigm of length-dependent axonopathy. This reticence is here critiqued in view of recent studies using objective, measured outcome protocols which nullify such potential confounders. Pain relief is now confirmed with Level 1 studies, and Level 2 prospective information suggests protection from initial diabetic foot ulceration and most neuropathic ulcer recurrences. In view of the potential for nerve decompression to be useful in addressing some of the more difficult, expensive, and life altering complications of diabetic neuropathy, this secondary compression thesis and operative treatment methodology may deserve reassessment.
Collapse
|
|
42
|
Liao C. Letter: Decompressive Surgery for Diabetic Neuropathy: Waiting for Incontrovertible Proof. Neurosurgery 2017; 81:E33-E34. [PMID: 28419341 DOI: 10.1093/neuros/nyx192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chenlong Liao
- Department of Neurosurgery XinHua Hospital, School of Medicine Shanghai JiaoTong University Shanghai, P.R. China
| |
Collapse
|
|
43
|
Abstract
BACKGROUND Exercise is highly beneficial for persons with diabetes. Similar to many other patients, those with diabetes may be reluctant to exercise given a lack of motivation and proper instruction regarding an exercise prescription. In general, medical providers are poorly equipped to develop an exercise prescription and furnish motivation. Attempts to find activities that not only provide effective aerobic challenges but also are enjoyable to participate in are fraught with difficulty. Hiking as a potential option for a safe and enjoyable activity is discussed, including the possible downsides. METHODS Multiple publications were reviewed using key words. RESULTS A review of the literature uncovered limited publications or controlled trials that discussed the use of hiking per se as an activity for the management of diabetes. Newer studies reviewing weightbearing exercise and diabetic polyneuropathy and those discussing the advantages of trekking poles for balance and proprioception are cited in support of the recommendation for hiking as an activity for those with diabetes. CONCLUSIONS Exercise has been shown to substantially benefit individuals with diabetes, but convincing patients with diabetes to exercise is daunting. Hiking, unlike other, more tedious exercise programs, may be an exercise option that persons with diabetes might find enjoyable. Hiking may encourage balance training and reduced ground reaction forces. These benefits may be augmented by trekking poles, which may likewise counter the concerns of the uneven surfaces that present challenges to the hiker with diabetes.
Collapse
Affiliation(s)
- David W. Jenkins
- Arizona Podiatric Medicine Program, College of Health Sciences, Midwestern University, Glendale, AZ
| | - Alexander Jenks
- Arizona School of Podiatric Medicine, Glendale, AZ. Dr. Jenks is now with West Houston Medical Center, Houston, TX
| |
Collapse
|
|
44
|
Richards A, McLaren T, Paech M, Nathan E, Beattie E, McDonnell N. Immediate postpartum neurological deficits in the lower extremity: a prospective observational study. Int J Obstet Anesth 2017; 31:5-12. [DOI: 10.1016/j.ijoa.2017.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
|
|
45
|
Singh M, Gupta S, Singh KD, Kumar A. Normative Data for Median Nerve Conduction in Healthy Young Adults from Punjab, India. J Neurosci Rural Pract 2017; 8:S83-S88. [PMID: 28936077 PMCID: PMC5602268 DOI: 10.4103/jnrp.jnrp_94_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Nerve conduction studies (NCSs) are essential for diagnosing various kinds of focal and diffuse neuropathies. Due to the paucity of local NCS data, electrodiagnostic laboratories in Punjab rely on values from Western and other Indian studies. AIM This study was conducted to provide normative data for median nerve conduction parameters (motor and sensory) in Punjabi populace. MATERIALS AND METHODS A cross-sectional study was done on 290 participants (150 males and 140 females), aged 17-21 years, as per standardized protocol. The data were analyzed separately for both genders using SPSS version 20. It consisted of distal latencies and conduction velocities of motor and sensory divisions of median nerve. Student's unpaired t-test was used for statistical analysis. RESULTS There was no effect of gender on any of the median nerve conduction parameters. Height and weight had nonsignificant negative and positive correlation, respectively (P > 0.05), with conduction velocity in both motor and sensory median nerves. For median motor nerve, the values of distal latency and conduction velocity in males were 2.9 ± 0.16 ms and 60.25 ± 2.99 m/s, respectively, whereas, in females, they were 2.6 ± 0.43 ms and 59.83 ± 2.82 m/s. Similarly, for median sensory nerve, the latency and velocity values in males were 2.8 ± 0.56 ms and 54.81 ± 3.70 m/s, whereas, in females, they were 2.4 ± 0.33 ms and 54.56 ± 3.65 m/s, respectively. CONCLUSION The data in this study compared favorably with already existing data. It would help the local electrodiagnostic laboratories in assessing the median nerve abnormalities with greater accuracy in this population subset.
Collapse
Affiliation(s)
- Manjinder Singh
- Department of Physiology, Gian Sagar Medical College, Patiala, Punjab, India
| | - Sharat Gupta
- Department of Physiology, Kalpana Chawla Government Medical College, Karnal, Haryana, India
| | - Kamal Dev Singh
- Department of Physiology, Government Medical College, Patiala, Punjab, India
| | - Avnish Kumar
- Department of Physiology, Government Medical College, Patiala, Punjab, India
| |
Collapse
|
|
46
|
Menting J, Tack CJ, Knoop H. Prevalence and correlates of pain in fatigued patients with type 1 diabetes. J Psychosom Res 2017; 95:68-73. [PMID: 28314551 DOI: 10.1016/j.jpsychores.2017.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/16/2017] [Accepted: 02/17/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the prevalence, location and severity of pain, as well as its association with psychosocial and clinical variables and its impact on functional impairment in fatigued patients with type 1 diabetes. METHODS 120 severely fatigued patients with type 1 diabetes completed questionnaires on pain (McGill Pain Questionnaire, MPQ; Short Form Health Survey subscale bodily pain, SF-36), fatigue severity (Checklist Individual Strength subscale fatigue severity, CIS), depressive symptoms (Beck Depression Inventory Primary Care, BDI-PC) and functional impairment (Sickness Impact Profile-8, SIP-8). HbA1c and diabetes-related complications were assessed, and physical activity was measured using actigraphy. RESULTS 72% of patients reported pain. Muscle, joint and back pain, and headache were most common. Patients with pain were more often female (69 vs. 44%, p=0.013), reported more complications (mean number: 0.7 vs. 0.3, p=0.009) and scored higher on the BDI-PC measuring depressive symptoms (mean score: 3.8 vs. 2.3, p=0.002), compared to patients without pain. Pain was associated with diabetes duration, the number of complications, fatigue severity, depressive symptoms and functional impairment, but not with HbA1c or physical activity. Of patients with pain, 26% reported a high impact of pain. Both pain (β=-0.31, t(117)=-3.39, p=0.001) and fatigue severity (β=0.18, t(117)=2.04, p=0.044) contributed to functional impairment. CONCLUSION Pain was highly prevalent in fatigued patients with type 1 diabetes, although pain impact and severity were relatively low, and the location of some pain symptoms was similar to the location of those in the general population. As pain is related to fatigue and contributes independently to functional impairment, fatigue interventions should address pain.
Collapse
Affiliation(s)
- Juliane Menting
- Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands; Department of Medical Psychology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Hans Knoop
- Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands; Academic Medical Center (AMC), University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| |
Collapse
|
|
47
|
Gibbons CH. Treatment induced neuropathy of diabetes-Long term implications in type 1 diabetes. J Diabetes Complications 2017; 31:715-720. [PMID: 28159476 DOI: 10.1016/j.jdiacomp.2017.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/20/2016] [Accepted: 01/15/2017] [Indexed: 11/22/2022]
Abstract
AIMS/HYPOTHESIS Aggressive glucose control can result in treatment induced neuropathy of diabetes (TIND) if glycemic control is achieved too quickly. The aim of the present study is to describe the 8-year follow-up data on a cohort of individuals with type 1 diabetes who developed TIND. METHODS Twenty-six individuals with type 1 diabetes and TIND were followed longitudinally for 8years with regular quantitative measurement of pain, neurological examinations and evaluation of microvascular complications. Comprehensive neurological testing was performed after TIND and 7-8years later. RESULTS Among the 26 individuals with TIND, 19/26 had stable glycemic control and 7/26 had unstable glycemic control in long-term follow up. Those 19/26 with stable glycemic control had improvement in neuropathy, pain and microvascular complications while the 7/26 with unstable glycemic control had significant worsening of neuropathy, pain and microvascular complications (P<0.01, all tests). CONCLUSION/INTERPRETATION TIND is a poorly understood iatrogenic complication of aggressive glycemic control, although individuals with stable glycemic control tended to improve, while those with unstable glycemic control worsened. Additional studies of TIND are required to understand potential outcomes in an era of medical 'metrics' where physician reimbursement may be tied to achievement of excessively rapid glycemic control.
Collapse
Affiliation(s)
- Christopher H Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
|
48
|
Bin-Jaliah IM, Shariff M, Nayar PS, Chandramoorthy HC. Elevated basal cytosolic calcium of endothelial cells influences the post-surgical outcome in diabetic CTS. Physiol Int 2017; 103:469-480. [PMID: 28229630 DOI: 10.1556/2060.103.2016.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Type 2 diabetes mellitus (T2DM)-induced neuropathy and ischemia-reperfusion post-surgery prolong carpal tunnel syndrome (CTS) pathology, but the effect of T2DM on the prognostic outcome of carpal tunnel (CT) release surgery needs to be investigated. Materials and methods A total of 64 individuals with CTS underwent CT release surgery. HbA1c levels identified their diabetic status. The individual prognostic outcomes were measured by nerve conduction velocity (NCV), amplitude, and latency. Measurement of [Ca2+]c and reactive oxygen species (ROS) from isolated endothelial cells (ECs) revealed the oxidative burden of the normal and diabetic CTS phenotypes. Results CTS individuals with HbA1c > 7 showed decreased NCV (≈22 m/s) and amplitude (≈4.2 mV) with increased latency (≈6 ms), compared to groups with HbA1c ≤ 7. Further to CT release surgery, the reversal of the nerve conduction to normalcy was greatly influenced by the diabetic profile of the individuals. Our results showed elevated basal [Ca2+]c and corresponding high cytosolic ROS in the ECs isolated from individuals with HbA1c > 7 compared to the diabetic and healthy control groups. Conclusion The individuals with diabetic index showed suboptimal neuronal performance pre- and post-CT release surgery. Oxidative stress mediated by high [Ca2+]c and ROS of ECs dissipates to adjoining cells worsening the pathology of the untreated CTS.
Collapse
Affiliation(s)
- I M Bin-Jaliah
- 1 Department of Physiology, College of Medicine, King Khalid University , Abha, Saudi Arabia
| | - Mea Shariff
- 1 Department of Physiology, College of Medicine, King Khalid University , Abha, Saudi Arabia.,2 Department of Orthopedics, Jubilee Mission Medical College , Thrissur, Kerala, India
| | - P S Nayar
- 2 Department of Orthopedics, Jubilee Mission Medical College , Thrissur, Kerala, India
| | - H C Chandramoorthy
- 3 Department of Microbiology and Parasitology, College of Medicine, King Khalid University , Abha, Saudi Arabia
| |
Collapse
|
|
49
|
Neuropatia nei diabetici. Neurologia 2017. [DOI: 10.1016/s1634-7072(16)81776-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
|
50
|
Rota E, Morelli N. Entrapment neuropathies in diabetes mellitus. World J Diabetes 2016; 7:342-353. [PMID: 27660694 PMCID: PMC5027001 DOI: 10.4239/wjd.v7.i17.342] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/18/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
Neuropathy is a common complication of diabetes mellitus (DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies (EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmark of peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. This remarkable frequency of EN in diabetes is underlain by a peculiar pathophysiological background. Due to the metabolic alterations consequent to abnormal glucose metabolism, the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage, making them more prone to entrapment in anatomically constrained channels. This review discusses the most common and relevant EN encountered in diabetic patient in their epidemiological, pathophysiological and diagnostic features.
Collapse
|