腕管综合征与支具

腕部正中神经卡压引起神经支配区域手指麻木或麻刺感、疼痛、感觉异常、拇短展肌或拇对掌肌乏力或萎缩、出现Ｐｈａｌｅｎ征阳性、Ｔｉｎｎｅｌ征阳性等一系列临床症候群即腕管综合征(ｃａｒｐａｌｔｕｎｎｅｌｓｙｎｄｒｏｍｅ ,ＣＴＳ) ,ＣＴＳ患者通常采用手术减压治疗、药物治疗及物理治疗等。ＣＴＳ支具制动治疗目前已引起临床康复工作者广泛的关注 ,并进行了深入研究。ＣＴＳ的成因与机制手反复紧张工作 ,尤其是处于静态的不合适位置 ,容易使腕管压力 (ｃａｒｐａｌｔｕｎｎｅｌｐｒｅｓｓｕｒｅ ,ＣＴＰ)长时间维持高压状态 ,易形成…     

高频超声在诊断腕管综合征中的应用

腕管综合征（carpal tunnel syndrome，CTS）是正中神经在腕管内受压而表现出支配区功能障碍的一组症状和体征，也是最常见的周围神经嵌压综合征之一，通常根据其特征性临床和电生理所见即可做出诊断。虽然目前电生理检查被认为是诊断CTS的金标准，但它不能显示正中神经周围的毗邻结构，不能为进一步明确病因和手术提供更多的信息。现将近年来关于超声诊断CTS的应用进行综述。     

高频超声在腕管综合征诊断中的应用探讨

【目的】探讨高频超声在诊断腕管综合征（CTS）中的应用价值,并进一步分析神经增粗与神经传导速度及病程的相关性,并证实高频超声在诊断CTS中的临床价值。【方法】对100例健康志愿者及63例经临床和电生理检查确诊的CST进行高频超声腕管内正中神经的检查,并记录神经的横截面积（CSA）,并作CSA与神经电生理及病程的相关性分析。【结果】对照组腕管内正中神经的CSA为（8．60±2．25）mm^2,CST组CSA为（15．61±4．60）mm^2,两组相比较有显著差异（P〈0．01）。CST组CSA与神经电生理（感觉传导速速）的相关系数为-0．74（P〈0．01）,与CTS病程的相关系数为0．79（P〈0．01）。【结论】高频超声在CTS的诊断有重要应用价值,其可作为CTS及周围神经检查新的形态学诊断方法。     

腕管综合征神经电生理诊断

目的:探讨神经电生理检测对非典型腕管综合征(CTS)的诊断价值。方法:对16例CTS患者测定双侧正中神经运动传导速度(MCV)和感觉传导速度(SCV),其中14例用微移法(inchingtechnique)检测腕部正中神经,13例行肌电图(EMG)检查。结果:16例CTS患者中,15例正中神经末端运动潜伏期(DML)延长(≥4.5ms);14例SCV减慢(<46m/s);14例微移法检测患者均有腕部正中神经传导阻滞(≥0.5ms/cm);13例肌电图检测患者中8例有神经源性肌电改变。正中神经微移法检测是4项检查中最为敏感的指标。结论:在临床症状不明显时,神经电生理检查是发现和诊断CTS最有效的方法之一。     

Riche-Cannieu吻合支对腕管综合征诊断的影响

目的了解Riche-Cannieu吻合支（尺神经深支与正中神经返支在手掌中的变异吻合支）对腕管综合征诊断的影响。方法总结12例腕管综合征合并存在Riche-Cannieu吻合支的病例，其中男2例，女10例，平均年龄49.8岁，就其解剖基础、临床表现、电生理表现以及诊断进行讨论。结果由于存在Riche-Cannieu吻合支，腕管综合征患者的拇短展肌得以保留部分甚至全部功能，导致其腕管综合征病变程度与其临床表现、电生理表现不符。结论充分了解Riche-Cannieu吻合支这一解剖变异的特点，对临床诊断和治疗腕管综合征具有重要的意义，同时也可避免错误地解释腕管综合征患者的电生理检测结果。     

腕管综合征25例电生理分析

腕管综合征是正中神经在腕管内受压而表现出的一组症状和体征,以引起手指感觉异常为主要的特征。以中年女性多见,如为男性患者,则常有职业病史。本病有时双侧发病,其中绝经期妇女占双侧发病者的90％以上。现对腕管综合征25例电生理分析如下。     

腕管综合征的诊断研究进展

腕管综合征（CTS）是最常见的正中神经病变,占所有神经病变的90%。欧洲的流行病学调查研究显示,特别是在40~60岁之间的正常人的患病率为4%~5%。女性患病率（9.2%）高于男性（6%）。CTS是正中神经通过腕横韧带下方腕管处受压所致。腕管是连接前臂与手的骨性纤维结构,缺乏伸缩性,其内容物排列较紧密,故当这个区域内的压力增加时,就会发生CTS。CTS通常发生于过度用手及反复的职业损伤所致。例如在执行重复性动作的人,比如打字或处理振动工具,还可见于肢端肥大症、肥胖、肾功能衰竭和甲状腺功能减退的患者。本文将对CTS目前的诊断方法做一综述。     

腕管综合征

１引言腕管综合征（ｃａｒｐａｌｔｕｎｎｅｌｓｙｎｄｒｏｍｅ,ＣＴＳ）是最常见的一种嵌压外周神经病,主要为各种原因致腕管内压力增高,正中神经在腕管内受卡压而产生其相应支配区的神经功能障碍的综合征。２腕管的解剖特点腕管位于掌根部,由骨和韧带构成了一个隧道样结构。其底及两侧由腕骨组成,顶为纤维性的、致密坚固的腕横韧带横跨其上,缺乏弹性,其尺侧附于豌豆骨和钩骨,桡侧为舟骨结节和大多角骨嵴。腕管内有１条拇长屈肌腱、８条指浅、深屈肌腱和正中神经及其伴行的血管通过。正中神经位置最浅,在肌腱和腕横韧带之间,腕管…     

Carpal Tunnel Syndrome

ABSTRACT

Questions from patients about analgesic pharmacotherapy and responses from the authors are presented to help educate patient sand make them more effective self-advocates. The topics addressed in this issue are the signs and symptoms of carpal tunnel syndrome and its treatment.     

Carpal Tunnel Syndrome

The incidence of carpal tunnel syndrome (CTS) appears to be increasing since the advent of computers in the workplace. People performing repetitive wrist movements over periods of time appear to be at particular risk for this syndrome. Prevention of this common entrapment neuropathy can increase the productivity of the workplace as well as avoid needless human suffering. Nurse practitioners play a key role in the education of the client who is at risk, and in the diagnosis and treatment of CTS itself. The author addresses these issues in this overview of diagnosis, treatment, and education of the client with CTS.     

19. Carpal Tunnel Syndrome

Abstract: Carpal tunnel syndrome (CTS) is a common disorder. In the majority of cases, patients with CTS can be diagnosed by means of appropriate history taking. Nerve conduction examination of the nervus medianus is the most important additional diagnostic test and is the best predictor of symptom severity and functional status in idiopathic CTS. Treatment option depends on the severity of the symptoms and the degree of functional daily limitations. If few limitations are present, splinting or corticosteroid injections are preferred. Surgical interventions are reserved for the more severe conditions resulting in significant disability. Interventional pain treatment such as pulsed radiofrequency could be an addition to the future treatment options for CTS.     

Idiopathic Carpal Tunnel Syndrome: Evaluation of the Depth of the Carpal Tunnel by Ultrasonography

The objective of the work described here was to evaluate the depth of the carpal tunnel (DCT) in patients with idiopathic carpal tunnel syndrome (CTS) and healthy volunteers by ultrasonography (US), through measurement of the distance from the flexor retinaculum to the surface of the capitate bone at the carpal tunnel outlet, and compare it with other ultrasonographic and electrophysiologic parameters in CTS. The study was conducted in 60 non-diabetic patients with idiopathic carpal tunnel syndrome (unilateral n = 37, bilateral n = 23) evidenced by electrophysiologic diagnosis according to the criteria of the American Association of Electrodiagnostic Medicine (AAEM). Furthermore, 40 hands from 20 healthy volunteers were examined. Median nerve cross-sectional area (CSA); flattening ratio (FR), the ratio of the length to the width of the median nerve; and DCT at the canal outlet were measured for all participants. The mean age was 35.6 ± 9.48 y. The female-to-male ratio was 47:13 in the CTS patients. The sensitivity and specificity were 82% and 95% for CSA, 75% and 60% for FR and 75% and 87.5% for DCT, respectively. Differences between patients and healthy controls were significant for all three parameters, greatest for DCT, followed by CSA and then FR. We conclude that DCT increased in CTS and this new parameter is comparable in sensitivity and specificity to CSA and FR. DCT increased independently of the cause of the CTS (decrease in size of canal or increase in contents).