Carpal Tunnel Syndrome

Česká verzia

Authors: E. Kurča
Authors place of work: Neurologická klinika JLF UK a MFN, Martin
Published in the journal: Cesk Slov Neurol N 2009; 72/105(6): 499-510
Category: Minimonografie

Summary

This work contains detailed information concerning Carpal Tunnel Syndrome (CTS). The epidemiology of CTS is discussed in the introduction while the epidemiological relationship to the professional aspect of CTS is the subject of another chapter. In the parts describing anatomy and pathogenesis, the focus is on an entire series of anatomical variations concerning carpal tunnel as well as on the fact that the clinical picture of CTS significantly relies upon the motor innervation distribution between n. medianus (the medianus nerve) and n. ulnaris (the ulnar nerve) in the area of the palm. All local and systematic causes that could lead to or partially cause the development of CTS are listed enumeratively, as well. Following a detailed description of the clinical picture of CTS, the following chapter describes the diagnostics of CTS; attention is focused not only on the ever attractive so‑ called provocation tests of the electromyogram (EMG) but to a significant degree on the ultrasound (US) as well. The chapter concerning therapy describes the maximum possibilities of conservative therapy of CTS, about the timing of surgical treatment as well as the selection of optimal surgical procedures between conventional procedures and the use of endoscopic techniques. We also offer a special discussion on problems concerning local administration of pharmaceuticals to the carpal tunnel.

Key words:
carpal tunnel syndrome – conduction studies – ultrasonography – surgery

Zdroje

1. Ehler E, Ambler Z. Mononeuropatie. Praha: Galén 2002.

2. Keller O. Syndrom karpálního tunelu a jeho léčba. Pracov Lék 2001; 53(1): 21– 23.

3. Tanaka S, Wild DK, Seligman PJ, Behrens V, Cameron L, Putz- Anderson V. The US prevalence of self‑ reported carpal tunnel syndrome: 1988 National Health Interview Survey data. Am J Public Health 1994; 84(11): 1846– 1848.

4. Palmer DH, Hanrahan LP. Social and economic costs of carpal tunnel surgery. Instr Course Lect 1995; 44: 167– 172.

5. Stevens JC, Sun S, Beard CM, O‘Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology 1988; 38(1): 134– 138.

6. Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991– 2001. J Neurol Neurosurg Psychiatry 2003; 74(12): 1674– 1679.

7. Leffler CT, Gozani SN, Cros D. Median neuropathy at the wrist: Diagnostic utility of clinical findings and an automated electrodiagnostic device. J Occup Environ Med 2000; 42(4): 398– 409.

8. Dufek J. Profesionální syndrom karpálního tunelu. Neurol Prax 2006; 7(5): 254– 256.

9. Melhorn JM. CTD: carpal tunnel syndrome, the facts and myths. Kans Med 1994; 95(9): 189– 192.

10. Stewart JD. Focal peripheral neuropathies. 3rd ed. Philadelphia: Lippincott Williams & Wilkins 2000.

11. Aroori S, Spence Roy AJ. Carpal tunnel syndrome. Ulster Med J 2008; 77(1): 6– 17.

12. Smrčka M, Vybíhal V, Němec M. Syndrom karpálního tunelu. Neurol Prax 2007; 8(4): 240– 243.

13. Tucci MA, Barbieri RA, Freeland AE. Biochemical and histological analysis of the flexor tenosynovium in patients with carpal tunnel syndrome. Biomed Sci Instrum 1997; 33: 246– 251.

14. Brhel P, Říhová A, Dufek J, Benešová E, Streitová H. Profesionální syndrom karpálního tunelu. Pracov Lék 1999; 51(3): 123– 129.

15. Yamaguchi DM, Lipscomb PR, Soule EH. Carpal tunnel syndrome. Minn Med 1965; 48: 22– 33.

16. Kendall WW. Results of treatment of severe carpal tunnel syndrome without internal neurolysis of the median nerve. J Bone Joint Surg Am 1988; 70(1): 151.

17. Szabo RM, Slater RR jr, Farver TB, Stanton DB, Sharman WK. The value of diagnostic testing in carpal tunnel syndrome. J Hand Surg Am 1999; 24(4): 704– 714.

18. Kurča E, Kučera P. Syndróm karpálneho tunela – patogenéza, diagnostika a liečba. Neurol Prax 2004; 5(2): 24– 28.

19. Mondelli M, Passero S, Giannini F. Provocative tests in different stages of carpal tunnel syndrome. Clin Neurol Neurosurg 2001; 103(3): 178– 183.

20. Kurča E, Cibulčík F. Klinické využitie troch indexov charakterizujúcich vedenie distálnym úsekom nervus medianus v diagnostike syndrómu karpálneho tunela. Neurol Prax 2003; 4(1)1: 34– 37.

21. Kadaňka Z, Dufek J, Hromada J. Standard elektrofyziologického vyšetření syndromu karpálního tunelu pro potřeby hlášení choroby z povolání. Doporučené postupy 2005. [online] 2005 April. Dostupné z URL: http:/ / www.czech- neuro.cz/ index.php?act=detail&idTXT=4.

22. Dufek J. Návrh jednotného postupu elektrodiagnostiky syndromu karpálního tunelu pro pracovní lékařství. Pracov Lék 2000; 52(2): 104– 106.

23. Hladká M, Kurča E. Vyšetrenie karpálneho tunela ultrazvukom. Slov Radiol 2000; 1(7): 4– 9.

24. Kroutil M, Dryml R, Novotný J. Možnosti zobrazovacích vyšetřovacích metod v diagnostice syndromu karpálního tunelu. Cesk Slov Neurol N 1998; 61/ 94(4): 219– 221.

25. Kurca E, Nosal V, Grofik M, Sivak S, Turcanova Koprusakova M, Kucera P. Single parameter wrist ultrasonography as a first‑line screening examination in suspected carpal tunnel syndrome patients. Bratisl Lek Listy 2008; 109(4): 177– 179.

26. Brian WR, Wright AD. Spontaneous compression of both median nerves in the carpal tunnel. Lancet 1947; 1: 277– 282.

27. Silverstein BA, Fine LJ, Armstrong TJ. Occupational factors and carpal tunnel syndrome. Am J Ind Med 1987; 11(3): 343– 358.

28. Rempel D, Bach JM, Gordon L, So Y. Effects of forearm pronation/ supination on carpal tunnel pressure. J Hand Surg Am 1998; 23(1): 38– 42.

29. Putz- Anderson V, Bernard BP, Burt SE, Cole LL, Fairfield- Estill C, Fine LJ et al. Musculoskeletal disorders and workplace factors: A critical review of epidemiologic evidence for work‑related musculoskeletal disorders of the neck, upper extremity and low back. Cincinnati, NIOSH 1997.

30. Gerr F, Letz R. Risk factors for carpal tunnel syndrome in industry: blaming the victim? J Occup Med 1992; 34(11): 1117– 1119.

31. Nathan PA, Meadows KD, Doyle LS. Occupation as a risk factor for impaired sensory conduction of the median nerve at the carpal tunnel. J Hand Surg Br 1988; 13(2): 167– 170.

32. Nathan PA, Istvan JA, Meadows KD. A longitudinal study of predictors of research defined carpal tunnel syndrome in industrial workers: findings in 17 years. J Hand Surg Br 2005; 30(6): 593– 598.

33. Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med Lond 2007; 57(1): 57– 66.

34. Okutsu I, Ninomiya S, Natsuyama M, Takatori Y, Inanami H, Kuroshima N et al. Subcutaneous operation and examination under the universal endoscope. Nippon Seikeigeka Gakkai Zasshi 1987; 61(5): 491– 498.

35. Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM. Splinting vs surgery in the treatment of carpal tunnel syndrome. A randomized controlled trial. JAMA 2002; 288(10): 1245– 1251.

36. Amirjani N, Ashworth NL, Watt MJ, Gordon T, Chan KM. Corticosteroid iontophoresis to treat carpal tunnel syndrome: a double‑blind randomized controlled trial. Muscle Nerve 2009; 39(5): 627– 633.

37. Dakowicz A, Latosiewicz R. The value of iontophoresis combined with ultrasound in patients with the carpal tunnel syndrome. Rocz Akad Med Bialymst 2005; 50 (Suppl 1): 196– 198.

38. O’Connor D, Marshall S, Massy- Westropp N. Non- surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003; 1: CD003219.

39. Racasan O, Dubert T. The safest location for steroid injection in the treatment of carpal tunnel syndrome. J Hand Surg Br 2005; 30(4): 421– 414.

40. Ly- Pen D, Andreu JL, de Blas G, Sanchez- Olaso A, Millan I. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum 2005; 52(2): 612– 619.

41. Agarwal V, Singh R, Sachdev A, Wiclaff, Shekhar S,Goel D. A prospective study of the long term efficacy of local methyl prednisolone acetate injection in the management of mild carpal tunnel syndrome. Rhematology (Oxford) 2005; 44(5): 647–– 650.

42. Kanta M, Ehler E, Laštovička D, Dankova C, Adamkov J, Rehak S. Možnosti chirurgické léčby syndromu karpálního tunelu. Neurol Prax 2006; 7(3): 153– 157.

43. Kanta M, Ehler E, Kremláček J, Lastovicka D, Adamkov J, Rehak S et al. Využití měření tlaků v karpálním tunelu během operace syndromu karpálního tunelu. Rozhl Chir 2007; 86(11): 588– 592.

44. Kanta M, Ehler E, Kremláček J, Lastovicka D, Adamkov J, Rehak S. Efekt endoskopické a klasické operace pro syndrom karpálního tunelu. Cesk Slov Neurol N 2008; 71/ 104(2): 173– 179.