Morton's metatarsalji elektrofizyolojik tanısında invaziv olmayan yeni bir teknik
Küçük Resim Yok
Tarih
1999
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Motron's metatarsalji, metatarsal başlar arasında yer alan plantar digital sinirlerin, derin transvers ligament tarafından sıkıştırılması sonucunda ortaya çıkan bir tuzak nöropatisidir. Tanı genellikle sübjektif yakınmalar ve klinik bulgularla konur. Ancak bazı olgularda klinik bulguların elektrofizyolojik bulgularla desteklenmesi gerekmektedir. Morton metatarsaljili hastalarda, etkilenen plantar interdigital sinirlerin ortodromik duysal iletim hızında belirgin yavaşlama olduğu gösterilmiştir. Ancak uygulanan teknikte kayıtlayıcı ve uyarıcı olarak iğne elektrodlar kullanılması, incelemenin hastalar için çok ağrılı olmasına yol açmaktadır. Bu çalışmada, plantar interdigital sinirlerin ortodromik duysal iletimleri yüzeyel elektrodlar kullanılarak gerçekleştirilmiştir. Çalışmanın ilk aşamasında, tipik Morton's metatarsalji kliniği olan 8, herhangi bir yakınması olmayan 8 ayakta her iki teknik uygulanmış, her iki grupta da latans, iletim hızı ve amplitud değerleri açısından iki yöntem arasında istatistiksel anlamlı fark bulunmamıştır. Çalışmanın ikinci aşamasında 24 nor¬mal ayakta yüzeyel elektrodlarla gerçekleştirilen ileti çalışmaları değerlendirilmiştir 2/3,3/4 ve 4/5 aralıklarındaki sinirlerin latans ve iletim hızları 1/2 aralığmdaki sinirin latans ve iletim hızları arasındaki farklılıklar hesaplanmıştır. Referans değerinin 2 standart sapma dışında yer alan farklılıklar patolojik kabul edilmiştir. Çalışmanın son aşamasında, iletim çalışmaları Morton's metatarsalji kliniği olan 12 ayakta değerlendirilmiş, etkilenen interdigital sinirlerin iletimlerinde 1/2 aralığmdaki sinirlerin iletimine göre anormal yavaşlama saptanmıştır. Bulgularımız, interdigital sinir iletim çalışmalarında ağrılı olan iğne elektrodlar yerine yüzeyel elektrodlarm kullanılabileceğini göstermiştir.
Mortons metatarsalgia is an entrapment neuropathy caused by pinching of the plantar digital nerve between the metatarsal heads by the deep transverse ligament. The diagnosis is usually based on'subjective symptoms and clinical findings. Occasionally, however, theclinial findings should be supported by vlectrophysiological findings. The orthodromic conduction velocities of the affected interdigital nerves have beeen shown to be ab¬normally slow in the patients with Morton's metatar¬salgia. In that technique however, needle electrodes were used for stimulating and recording which made the in¬vestigation very painful for the patients. In this study, the orthodromic sensory conduction studies of the interdigital nerves were performed by using surface elec¬trodes. As the first step of the study, both techniques were used in 8 normal feet and in 8 feet with the typical clinical findings of Morton's metatarsalgia, and no sta¬tistically significant difference was found in latency, amplitude and conduction velocity values between the two techniques in both groups. As the second step of the study, interdigital nerve conduction studies per¬formed by surface electrodes were evaluated in 24 nor¬mal feet. The differences between the latency and con¬duction velocity values of the nerves in the 2/3,3/4 and 4/5 spaces and those of the nerve in the 1/2 space were calculated. The differences were considered pathologic if they deviated 2 standard deviation from the reference values. As the last step, the conduction studies were evaluated in 12 feet with the clinical findings of Morton's metatarsalgia, and the conduction velocities of the af¬fected interdigital nerves were found to be abnormally slow comparing with those obtained from the 1/2 interdigital spaces. The findings of this study suggest that surface electrodes could be used in interdigital nerve conduction studies instead of needle electrodes which is more painful for the patients.
Mortons metatarsalgia is an entrapment neuropathy caused by pinching of the plantar digital nerve between the metatarsal heads by the deep transverse ligament. The diagnosis is usually based on'subjective symptoms and clinical findings. Occasionally, however, theclinial findings should be supported by vlectrophysiological findings. The orthodromic conduction velocities of the affected interdigital nerves have beeen shown to be ab¬normally slow in the patients with Morton's metatar¬salgia. In that technique however, needle electrodes were used for stimulating and recording which made the in¬vestigation very painful for the patients. In this study, the orthodromic sensory conduction studies of the interdigital nerves were performed by using surface elec¬trodes. As the first step of the study, both techniques were used in 8 normal feet and in 8 feet with the typical clinical findings of Morton's metatarsalgia, and no sta¬tistically significant difference was found in latency, amplitude and conduction velocity values between the two techniques in both groups. As the second step of the study, interdigital nerve conduction studies per¬formed by surface electrodes were evaluated in 24 nor¬mal feet. The differences between the latency and con¬duction velocity values of the nerves in the 2/3,3/4 and 4/5 spaces and those of the nerve in the 1/2 space were calculated. The differences were considered pathologic if they deviated 2 standard deviation from the reference values. As the last step, the conduction studies were evaluated in 12 feet with the clinical findings of Morton's metatarsalgia, and the conduction velocities of the af¬fected interdigital nerves were found to be abnormally slow comparing with those obtained from the 1/2 interdigital spaces. The findings of this study suggest that surface electrodes could be used in interdigital nerve conduction studies instead of needle electrodes which is more painful for the patients.
Açıklama
Anahtar Kelimeler
Rehabilitasyon, Romatoloji
Kaynak
Romatoloji ve Tıbbi Rehabilitasyon Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
10
Sayı
3
