DOI QR코드

DOI QR Code

Carpal Tunnel Syndrome in Stroke Patients According to the Degree of Spasticity in Median Nerve Cross-Sectional Area and Nerve Conduction Velocity and Comparison of Upper Extremity Function

수근관증후군 뇌졸중 환자에서 경직정도에 따른 정중신경 단면적과 신경전도속도 및 상지기능의 비교

  • 김태곤 (동신대학교 물리치료학과 대학원) ;
  • 정대인 (광주보건대학교 물리치료과) ;
  • 김경윤 (동신대학교 물리치료학과)
  • Received : 2013.08.23
  • Accepted : 2013.09.26
  • Published : 2013.11.28

Abstract

The purpose of this study were carpal tunnel syndrome in stroke patients according to the degree of spasticity in the median nerve cross-sectional area, nerve conduction velocity, and to evaluate differences in upper extremity function. The subjects of this study was in adult patients with stroke 42 patients from 21 patients CTS group and 21 patients Non-CTS group were selected. Measurement of median nerve-cross sectional area, nerve conduction velocity, GST, FMAS, CTS-FSS was measured. The study results were each group between the unaffected side and the affected side CTS and Non-CTS group in each grade between groups unaffected side(p<.001), and affected side(p<.001) median nerve-cross sectional area, median motor and sensory nerve onset latency, there was a statistically significant difference. CTS and Non-CTS group between groups in each grade GST(p<.05), FMAS(p<.05), CTS-FSS(p<.001), there was a statistically significant difference. In this study, the carpal tunnel pathokinesiology ever presented by the contents of upper extremity functional training in stroke patients is one of the information that you need to consider when presented.

본 연구의 목적은 수근관증후군 뇌졸중 환자에서 경직정도에 따른 정중신경 단면적, 신경전도속도 및 상지기능 차이를 알아보고자 하였다. 연구대상은 성인 뇌졸중 환자 42명에서 CTS군 21명과 Non-CTS군 21명으로 선정하였다. 측정방법으로는 정중신경 단면적, 신경전도속도, GST, FMAS, CTS-FSS로 측정하였다. 연구결과, CTS군과 Non-CTS군 간 각 등급에서 정상측(p<.001)과 마비측(p<.001)의 정중신경 단면적, 정중 운동신경과 감각신경 기시잠시는 통계학적으로 유의한 차이가 있었다. CTS군과 Non-CTS군 간 각 등급에서 GST(p<.05), FMAS(p<.05), CTS-FSS(p<.001)는 통계학적으로 유의한 차이가 있었다. 본 연구는 수근관에 대한 병리역학적 내용을 제시함으로서 뇌졸중 환자의 상지기능훈련 시 고려해야할 내용 중 하나임을 제시하였다.

Keywords

References

  1. P. Burvill, G. Johnson, K. Jamrozik, C. Anderson, and E. Stewart-Wynne, "Risk factors for post -stroke depression," Int J Geriatr Psychiatry, Vol.12, No.2, pp.219-226, 1997. https://doi.org/10.1002/(SICI)1099-1166(199702)12:2<219::AID-GPS581>3.0.CO;2-E
  2. M. C. Cirstea, A. Ptito, and M. F. Levin, "Arm reaching improvements with short-term practice depend on the severity of the motor deficit in stroke," Exp Brain Res, Vol.152, No.4, pp.476-488, 2003. https://doi.org/10.1007/s00221-003-1568-4
  3. A. Shumway-Cook and M. H. Woollacott, Motor Control : Theory and practical applications 2nd Ed., Baltimore, Lippincott Williams & Wilkins, 2000.
  4. K. H. Tasi, C. Y. Yeh, H. Y. Chang, and J. J. Chen, "Effects of a single session of prolonged muscle stretch on spastic muscle of stroke patients," Proc Natl Sci Counc Repub China B, Vol.25, No.2, pp.76-81, 2001.
  5. B. B. Bhakta, "Management of spasticity in stroke," Br Med Bull, Vol.56, No.2, pp.476-485, 2000. https://doi.org/10.1258/0007142001903111
  6. D. J. Twist, "Effects of wrapping technique on passive range of motion in a spastic upper extremity," Phys Ther, Vol.65, No.3, pp.299-304, 1985. https://doi.org/10.1093/ptj/65.3.299
  7. G. S. Phalen, "The carpal-tunnel syndrome. Seventeen year's experiece in diagnosis and treatment of six hundred fifty-four hands," J Bone Join Surg Am, Vol.48, No.2, pp.211-228, 1966. https://doi.org/10.2106/00004623-196648020-00001
  8. G. S. Phalen, "The carpal-tunnel syndrome. Clinical evaluation of 598 hand," Clin Orthop Relat Res, Vol.83, pp.29-40, 1972. https://doi.org/10.1097/00003086-197203000-00007
  9. 정세희, 백남종, 방문석, 한태륜, "수근관증후군 관련 임상척도와 전기생리학척도 간 비교", 대한근전도 전기진단의학회지, 제7권, 제2호, pp.79-89, 2005.
  10. N. Kotevoglu and S. Gülbahce-Saglam, "Ultrasound imaging in the diagnosis of carpal tunnel syndrome and its relevance to clinical evaluation," Joint Bone Spine, Vol.72, No.2, pp.142-145, 2005. https://doi.org/10.1016/j.jbspin.2004.03.012
  11. 수근관증후군작성위원회, "표준적 신경치료", 일본신경치료학회, 제25권, 제1호, pp.65-84, 2008.
  12. M. L. Bleecker, "Medical surveillance for carpal tunnel syndrome in workers," J Hand Surg AM, Vol.12, No.5, Pt 2, pp.845-848, 1987. https://doi.org/10.1016/S0363-5023(87)80246-0
  13. D. T. Burke, M. A. Burke, R. Bell, G. W. Stewart, R. S. Mehdi, and H. J. Kim, "Subjective swelling: a new sign for carpal tunnel syndrome," AM J Phys Med Rehabil, Vol.78, No.6, pp.504-508, 1999. https://doi.org/10.1097/00002060-199911000-00002
  14. W. Buchberger, "Radiologic imaging of the carpal tunnel," Eur J Radiol, Vol.25, No.2, pp.112-117, 1997. https://doi.org/10.1016/S0720-048X(97)00038-7
  15. Y. Sato, M. Kaji, T. Tsuru, and K. Oizumi, "Carpal tunnel syndrome involving unaffected limbs of stroke patients," Stroke, Vol.30, No.2, pp.414-418, 1999. https://doi.org/10.1161/01.STR.30.2.414
  16. K. Nakamichi and S. Tachibana, "The use of ultrasonography in detection of synovitis in carpal tunnel syndrome," J Hand Surg Br, Vol.18, No.2, pp.176-179, 1993. https://doi.org/10.1016/0266-7681(93)90100-T
  17. C. Hug, H. Huber, F. Terrier, H. J. Häuselmann, W. Aue, P. Vock, P. Schlapbach, and N. J. Gerber, "Detection of flexor tenosynovitis by magnetic resonance imaging: its relationship to diurnal variation of symptoms," J Rheumatol, Vol.18, No.7, pp.1055-1059, 1991.
  18. 박기영, 배정호, 이소영, 오정섭, 임정근, 손대구, "경도와 초경도 수근관 증후군 환자의 초음파 검사 소견", 대한재활의학회지, 제32권, 제1호, pp.67-72, 2008.
  19. A. Yesildag, S. Kutluhan, N. Sengul, H. R. Koyuncuoglu, O. Oyar, K. Guler, and U. K. Gulsoy, "The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome," Clin Radiol, Vol.59, No.10, pp.910-915, 2004. https://doi.org/10.1016/j.crad.2004.03.020
  20. J. W. Albers, M. B. Brown, A. A. Sima, and D. A. Greene, "Frequency of median mononeropathy in patients with mild diabetic neuropathy in the early diabetes intervention trial(EDIT). Tolrestat Study Group For Edit(Early Diabetes Intervention Trial)," Muscle Nerve, Vol.19, No.2, pp.140-146, 1996. https://doi.org/10.1002/(SICI)1097-4598(199602)19:2<140::AID-MUS3>3.0.CO;2-E
  21. 안미경, 김세주, "수근관증후군 진단법으로서 충양근과 골간근의 정중-척골 신경전도 차이의 의의", 대한재활의학회지, 제18권, 제1호, pp.35-44, 1998.
  22. 윤영대, 심제명, 박민철, 김형수, "정중신경가동 기법이 수근관증후군 환자의 악력과 통증에 미치는영향", 대한물리의학회지, 제4권, 제2호, pp.107-115, 2009.
  23. W. Buchberger, W. Judmaier, G. Birbamer, M. Lener, and C. Schmidauer, "Carpal tunnel syndrome: diagnosis with high-resolution sonography," Am J Roentgenol, Vol.159, No.4, pp.793-798, 1992. https://doi.org/10.2214/ajr.159.4.1529845
  24. L. Sarria, T. Cabada, R. Cozcolluela, T. Martinez-Berganza, and G. Garcia, "Carpal tunnel syndrome: usefulness of sonography," Eur Radiol, Vol.10, No.12, pp.1920-1925, 2000. https://doi.org/10.1007/s003300000502
  25. 김정한, 수근관 증후군 환자에서 임상 소견을 기준으로한 근전도 검사소견의 예측 가능성에 관한 연구, 단국대학교 의학대학원 석사학위논문, 2003.
  26. D. W. Levine, B. P. Simmons, M. J. Koris, L. H. Daltroy, G. G. Hohl, A. H. Fossel, and J. N. Katz, "A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome," J Bone Joint Surg Am, Vol.75, No.11, pp.1585-1592, 1993. https://doi.org/10.2106/00004623-199311000-00002
  27. 마상렬, 공원태, 강영숙, "정형의학적 마사지가 수근관증후군 환자의 통증, 악력, 기능적 평가의 등급에 미치는 영향", 한국데이터정보과학회지, 제20권, 제1호, pp.97-107, 2009.