The 2004 Annual Meeting (January 14-20, 2004) of OASYS_NEW

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Early Diagnosis of Diabetic Entrapment Neuropathy Management with Quantitative Sensory-Motor Testing

Siemionow M, Ozmen S, Demir Y, and Zielinski MS. Department of Plastic Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave. , A60, Cleveland, OH, USA

Introduction: Neuropathy is a very common complication of diabetes mellitus and is the major cause of morbidity that may be devastating and contribute to the mortality. Anatomically diabetic neuropathies may be grouped as diffuse and focal neuropathies. Entrapment neuropathy is a subgroup of focal neuropathies. Diabetic entrapment neuropathy can benefit from surgical therapy. Quantitative-Sensory-Testing (QST) offers comparison of quantitative data in early stages of neuropathy. Creation of standards for screening, monitoring and timing of the operation will decrease morbidity rate associated with diabetic entrapment neuropathy. Materials and Methods: Diabetic patients are being evaluated prospectively using QST, clinical tests questionnaire, and computerized risk factors analysis. Onset of the entrapment is defined as asymmetrical changes found in any method of diagnosis. Results: Preliminary results of 32 patients demonstrated higher (72%) sensitivity of QST than clinical testing for early detection of sensory impairment. Patient with nerve entrapment in comparison with those with diffused nerve changes were characterized by younger age (53.25 vs. 66.57;p<0.05) and shorter disease duration (5.23 vs.15.52) and higher number of females (20 vs.12). The severity of the changes correlated with diabetes duration (5.23 vs.15.52 years) and was dependent on age of patient (54.45 vs.67.17) and glucose level (136.32 vs.138.57). Frequencies of nerve entrapments were 40% in upper extremities (Median 27%, Radial 40%, Ulnar 33%) and 60% in lower extremities (Peroneal 43%, Tibial 57%). Conclusion: Statistical analysis suggests that entrapment may precede diffused neuropathy in diabetes. Preliminary results confirmed the validity of QST for early detection and monitoring of superimposed entrapment neuropathy.