Entrapment neuropathies are commonly seen in rheumatologic diseases, due to the mechanical compression of the peripheral nerves as a result of joint deformities and inflammation of the synovium, ligaments, tendons and bursae. Although clinical findings, diagnosis and treatments are similar to those without rheumatologic disease, pain and joint limitations may cause difficulties in clinical examination and differential diagnosis. Commonly seen entrapment neuropathies in rheumatologic diseases are carpal tunnel syndrome, tarsal tunnel syndrome, cubital tunnel syndrome and Morton’s neuroma. Clinical findings and electrophysiological investigations are essential for diagnosis and differential diagnosis. Magnetic Resonance Imaging and Ultrasonography are also helpful. Polyneuropathies, plexopathies and radiculopathies should be mainly considered in differential diagnosis.
Awerbuch MS, Shephard E, Vernon-Roberts B. Morton’s metatarsalgia due to Intermetatarsophalangeal bursitis as an early manifestation of rheumatoid arthritis. Clin Orthop Relat Res 1982; 167 (1): 214-21.
Vainio K (1979) Morton’s metatarsalgia in rheumatoid arthritis. Clin Orthop Relat Res 1979; 142 (3): 85-9.
Özçete ZA, On AY. Ulnar Sinir Tuzak Nöropatileri. Turk J Phys Med Rehab 2010;56(2):190-5
deAndrade JR, Casagrande PA. Ulnar nerve entrapment in rheumatoid arthritis: a case report. Arthritis Rheum 1965;8 (1): 294-301.
Helliwell P. Clinical features of the foot in rheumatoid arthritis. In: Helliwell P, Woodburn J, Redmond A, Turner D, Davys H (eds). The foot and ankle in rheumatoid arthritis. 1st ed. Edinburgh: Churchill Livingstone/Elsevier; 2007: 5774.
Nakano K. Entrapment neuropathy from Baker's cyst. JAMA 1978; 239 (2): 135.
Ishikawa H, Hirohata K. Posterior insterosseous nerve syndrome assoicated with rheumatoid synovial cysts of the elbow joint. Clin Orthop 1990; 254 (3): 134-9.
Létourneau L, Dessureault M, Carette S. Rheumatoid iliopsoas bursitis presenting as unilateral femoral nerve palsy. J Rheumatol 1991; 8 (1): 462-3.
Ogawa H, Akaike A, Ishimaru D. Posterior interosseous nerve palsy related to rheumatoid synovitis of the elbow. Mod Rheumatol 2007;17 (2): 327-9.
Agarwal V, Singh R, Wiclaf, et al. A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol 2008; 27 (7): 841-4.
Good AE, Christopher RP, Koepke GH, Bender LF, Tarter MF. Peripheral neuropathy associated with rheumatoid arthritis. A clinical and electrodiagnostic study of 70 consecutive rheumatoid arthritis patients. Ann Intern Med 1965; 63 (1): 87-99.
Salvarani C, Cantini F, Macchioni P, et al. Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum 1998; 41 (7): 1221-6.
Salvarani C, Hunder GG. Musculoskeletal manifestations in a population‐based cohort of patients with giant cell arteritis. Arthritis Rheum 1999; 42 (6): 1259-66.
Said G. Necrotizing peripheral nerve vasculitis. Neurol Clin 1997;15 (4): 835-48.
Omdal R, Mellgren SI, Husby G. Clinical neuropsychiatric and neuromuscular manifestations in systemic lupus erythematosus. Scand J Rheumatol 1988; 17 (2): 113-7.
Sivri A, Hasçelik Z, Çeliker R, Basgöze O. Early detection of neurological involvement in systemic lupus erythematosus. Electromyogr Clin Neurophysiol 1995; 35 (2): 195-9.
İrdesel J. Median sinir tuzak nöropatileri. In: Sarıdoğan M (ed). Üst Ekstremite Tuzak Nöropatileri. 1. Baskı. Ankara: Türkiye Klinikleri; 2019: 11-21.
Bacle G, Marteau E, Corcia P, Garaud P, Laulan J. Are carpal tunnel syndrome and regional degenerative osteoarthritis linked? Results of a case-control study. J Hand Surg Asian Pac 2018; 23 (1): 41-6.
MacDermid JC, Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther 2004; 17 (3): 309-19.
Yagiz A, Efendi H, Hepgüler S. Karpal tünel sendromunda kullanılan klinik testlerin tanısal değerleri. Nörol Bil Derg 1995;12 (3): 59-65.
Gellman H, Gelberman RH, Tan AM, Botte MJ. Carpal tunnel syndrome. An evaluation of the provocative diagnostic tests. J Bone Joint Surg Am 1986; 68 (5): 735-7.
Phalen GS. The carpal-tunnel syndrome. Clinical evaluation of 598 hands. Clin Orthop Relat Res. 1972; 83 (3): 29-40.
Werner RA, Bir C, Armstrong TJ. Reverse Phalen’s maneuver as an aid in diagnosing carpal tunnel syndrome. Arch Phys Med Rehabil. 1994; 75 (7): 783-6.
Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve. 1997; 20 (12): 1477-86.
Akyüz M, Karataş G. Üst ekstremite tuzak nöropatilerinde elektrofizyolojik değerlendirme. In: Sarıdoğan M (ed). Üst Ekstremite Tuzak Nöropatileri. 1. Baskı. Ankara: Türkiye Klinikleri; 2019: 46-57.
Barnes CG, Currey HL. Carpal tunnel syndrome in rheumatoid arthritis. A clinical and electrodiagnostic survey. Ann Rheum Dis 1967; 26 (1): 226-33.
Lanzillo B, Pappone N, Crisci C, di Girolamo C, Massini R, Caruso G. Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum 1998; 41(4): 1196-202.
Sivri A, Guler‐Uysal F. The electroneurophysiological findings in rheumatoid arthritis patients. Electromyogr Clin Neurophysiol 1999; 39 (3): 387-91.
Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve. 2000; 23 (8): 1280-3.
Palamar D. Tuzak nöropatilerinde ultrasonografik inceleme. In: Sarıdoğan M (ed). Üst Ekstremite Tuzak Nöropatileri. 1. Baskı. Ankara: Türkiye Klinikleri 2019: 58-68.
Kaymak B, Özçakar L, Çetin A, Çetin MC, Akıncı A, Hasçelik Z. A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome. Arch Phys Med Rehabil 2008; 89 (4): 743-8.
On AY. Travmatik periferik sinir yaralanmaları. In: Beyazova M, Kutsal YG (Eds). Fiziksel Tıp ve Rehabilitasyon. Ankara: Güneş Tıp Kitabevleri: 2016: 2449-64.
Novak CB, Lee GW, Mackinnon SE, Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg Am 1994; 19 (4): 817-20.
Kuschner SH, Ebramzadeh E, Mitchell S. Evalution of elbow flexion and Tinel tests for cubital tunnel syndrome in asymptomatic individuals. Orthopedics 2006; 29 (1): 305-8.
Campbell WW. Guidelines in electrodiagnostic medicine. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow. Muscle Nerve Suppl 1999;8: 171-205.
Korkmaz M, On AY, Caliş FA. Reference data for ulnar nerve short segment conduction studies at the elbow. Muscle Nerve. 2011; 44 (5): 783-8.
Yalcinkaya S, Atamaz Calis F, Ozdemir O, Kucuk L, Gunay H, On AY. The value of short segment conduction studies in localizing ulnar neuropathy of the elbow. Hand Microsurg 2017; 6 (3): 68-74.
Mondelli M, Morana P, Padua L. An electrophysiological severity scale in tarsal tunnel syndrome. Acta Neurol Scand 2004; 109 (3): 284–9.
Oh SJ, Sarala PK, Kuba T, Elmore RS.Tarsal tunnel syndrome; electrophysiological study. Ann Neurol 1979; 5 (3): 32 7-30.
Abouelela AA, Zohiery AK. The triple compression stress test for diagnosis of tarsal tunnel syndrome. Foot (Edinb) 2012; 22 (3): 146-9.
On AY, Erer F, Akşit R. Morton’s metatarsalji elektrofizyolojik tanısında invaziv olmayan yeni bir teknik. J Rheum Med Rehab 1999; 10 (2): 127-32.
Ata AM. Onat ŞŞ Özçakar L. Ultrasound-guided diagnosis and treatment of Morton's neuroma. Pain Physician 2016; 19 (2): E355-8.
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Romatolojik hastalıklarda tuzak nöropatileri: Epidemiyoloji, tanı ve ayırıcı tanı
Year 2021,
Volume: 60 Suppl:1 (Rheumatology), 1 - 8, 20.01.2021
Romatolojik hastalıklarda sinovyum, ligament, tendon ve bursaların inflamasyonuna ve eklem deformitelerine bağlı olarak, periferik sinirlerin mekanik kompresyona uğramaları nedeniyle tuzak nöropatileri sıklıkla görülmektedir. Klinik, tanı ve tedavi romatolojik hastalığı olmayan bireylerle benzer olmakla birlikte, ağrı ve eklem kısıtlılıkları klinik muayene ve ayırıcı tanıda güçlüklere yol açabilmektedir. En sık görülen tuzak nöropatileri karpal tünel sendromu, tarsal tünel sendromu, kübital tünel sendromu ve Morton metatarsaljisidir. Tanıda klinik bulgular ve elektrofizyolojik incelemeler esastır. Manyetik Rezonans ve Ultrasonografik görüntüleme de yardımcıdır. Ayırıcı tanıda başlıca polinöropatiler, pleksopatiler ve radikülopatiler akla gelmelidir.
Awerbuch MS, Shephard E, Vernon-Roberts B. Morton’s metatarsalgia due to Intermetatarsophalangeal bursitis as an early manifestation of rheumatoid arthritis. Clin Orthop Relat Res 1982; 167 (1): 214-21.
Vainio K (1979) Morton’s metatarsalgia in rheumatoid arthritis. Clin Orthop Relat Res 1979; 142 (3): 85-9.
Özçete ZA, On AY. Ulnar Sinir Tuzak Nöropatileri. Turk J Phys Med Rehab 2010;56(2):190-5
deAndrade JR, Casagrande PA. Ulnar nerve entrapment in rheumatoid arthritis: a case report. Arthritis Rheum 1965;8 (1): 294-301.
Helliwell P. Clinical features of the foot in rheumatoid arthritis. In: Helliwell P, Woodburn J, Redmond A, Turner D, Davys H (eds). The foot and ankle in rheumatoid arthritis. 1st ed. Edinburgh: Churchill Livingstone/Elsevier; 2007: 5774.
Nakano K. Entrapment neuropathy from Baker's cyst. JAMA 1978; 239 (2): 135.
Ishikawa H, Hirohata K. Posterior insterosseous nerve syndrome assoicated with rheumatoid synovial cysts of the elbow joint. Clin Orthop 1990; 254 (3): 134-9.
Létourneau L, Dessureault M, Carette S. Rheumatoid iliopsoas bursitis presenting as unilateral femoral nerve palsy. J Rheumatol 1991; 8 (1): 462-3.
Ogawa H, Akaike A, Ishimaru D. Posterior interosseous nerve palsy related to rheumatoid synovitis of the elbow. Mod Rheumatol 2007;17 (2): 327-9.
Agarwal V, Singh R, Wiclaf, et al. A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol 2008; 27 (7): 841-4.
Good AE, Christopher RP, Koepke GH, Bender LF, Tarter MF. Peripheral neuropathy associated with rheumatoid arthritis. A clinical and electrodiagnostic study of 70 consecutive rheumatoid arthritis patients. Ann Intern Med 1965; 63 (1): 87-99.
Salvarani C, Cantini F, Macchioni P, et al. Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum 1998; 41 (7): 1221-6.
Salvarani C, Hunder GG. Musculoskeletal manifestations in a population‐based cohort of patients with giant cell arteritis. Arthritis Rheum 1999; 42 (6): 1259-66.
Said G. Necrotizing peripheral nerve vasculitis. Neurol Clin 1997;15 (4): 835-48.
Omdal R, Mellgren SI, Husby G. Clinical neuropsychiatric and neuromuscular manifestations in systemic lupus erythematosus. Scand J Rheumatol 1988; 17 (2): 113-7.
Sivri A, Hasçelik Z, Çeliker R, Basgöze O. Early detection of neurological involvement in systemic lupus erythematosus. Electromyogr Clin Neurophysiol 1995; 35 (2): 195-9.
İrdesel J. Median sinir tuzak nöropatileri. In: Sarıdoğan M (ed). Üst Ekstremite Tuzak Nöropatileri. 1. Baskı. Ankara: Türkiye Klinikleri; 2019: 11-21.
Bacle G, Marteau E, Corcia P, Garaud P, Laulan J. Are carpal tunnel syndrome and regional degenerative osteoarthritis linked? Results of a case-control study. J Hand Surg Asian Pac 2018; 23 (1): 41-6.
MacDermid JC, Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther 2004; 17 (3): 309-19.
Yagiz A, Efendi H, Hepgüler S. Karpal tünel sendromunda kullanılan klinik testlerin tanısal değerleri. Nörol Bil Derg 1995;12 (3): 59-65.
Gellman H, Gelberman RH, Tan AM, Botte MJ. Carpal tunnel syndrome. An evaluation of the provocative diagnostic tests. J Bone Joint Surg Am 1986; 68 (5): 735-7.
Phalen GS. The carpal-tunnel syndrome. Clinical evaluation of 598 hands. Clin Orthop Relat Res. 1972; 83 (3): 29-40.
Werner RA, Bir C, Armstrong TJ. Reverse Phalen’s maneuver as an aid in diagnosing carpal tunnel syndrome. Arch Phys Med Rehabil. 1994; 75 (7): 783-6.
Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve. 1997; 20 (12): 1477-86.
Akyüz M, Karataş G. Üst ekstremite tuzak nöropatilerinde elektrofizyolojik değerlendirme. In: Sarıdoğan M (ed). Üst Ekstremite Tuzak Nöropatileri. 1. Baskı. Ankara: Türkiye Klinikleri; 2019: 46-57.
Barnes CG, Currey HL. Carpal tunnel syndrome in rheumatoid arthritis. A clinical and electrodiagnostic survey. Ann Rheum Dis 1967; 26 (1): 226-33.
Lanzillo B, Pappone N, Crisci C, di Girolamo C, Massini R, Caruso G. Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum 1998; 41(4): 1196-202.
Sivri A, Guler‐Uysal F. The electroneurophysiological findings in rheumatoid arthritis patients. Electromyogr Clin Neurophysiol 1999; 39 (3): 387-91.
Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve. 2000; 23 (8): 1280-3.
Palamar D. Tuzak nöropatilerinde ultrasonografik inceleme. In: Sarıdoğan M (ed). Üst Ekstremite Tuzak Nöropatileri. 1. Baskı. Ankara: Türkiye Klinikleri 2019: 58-68.
Kaymak B, Özçakar L, Çetin A, Çetin MC, Akıncı A, Hasçelik Z. A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome. Arch Phys Med Rehabil 2008; 89 (4): 743-8.
On AY. Travmatik periferik sinir yaralanmaları. In: Beyazova M, Kutsal YG (Eds). Fiziksel Tıp ve Rehabilitasyon. Ankara: Güneş Tıp Kitabevleri: 2016: 2449-64.
Novak CB, Lee GW, Mackinnon SE, Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg Am 1994; 19 (4): 817-20.
Kuschner SH, Ebramzadeh E, Mitchell S. Evalution of elbow flexion and Tinel tests for cubital tunnel syndrome in asymptomatic individuals. Orthopedics 2006; 29 (1): 305-8.
Campbell WW. Guidelines in electrodiagnostic medicine. Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow. Muscle Nerve Suppl 1999;8: 171-205.
Korkmaz M, On AY, Caliş FA. Reference data for ulnar nerve short segment conduction studies at the elbow. Muscle Nerve. 2011; 44 (5): 783-8.
Yalcinkaya S, Atamaz Calis F, Ozdemir O, Kucuk L, Gunay H, On AY. The value of short segment conduction studies in localizing ulnar neuropathy of the elbow. Hand Microsurg 2017; 6 (3): 68-74.
Mondelli M, Morana P, Padua L. An electrophysiological severity scale in tarsal tunnel syndrome. Acta Neurol Scand 2004; 109 (3): 284–9.
Oh SJ, Sarala PK, Kuba T, Elmore RS.Tarsal tunnel syndrome; electrophysiological study. Ann Neurol 1979; 5 (3): 32 7-30.
Abouelela AA, Zohiery AK. The triple compression stress test for diagnosis of tarsal tunnel syndrome. Foot (Edinb) 2012; 22 (3): 146-9.
On AY, Erer F, Akşit R. Morton’s metatarsalji elektrofizyolojik tanısında invaziv olmayan yeni bir teknik. J Rheum Med Rehab 1999; 10 (2): 127-32.
Ata AM. Onat ŞŞ Özçakar L. Ultrasound-guided diagnosis and treatment of Morton's neuroma. Pain Physician 2016; 19 (2): E355-8.
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