Carpal tunnel syndrome

Abstract

Sažetak. Sindrom karpalnog tunela (SKT) dobro je poznata, najčešće dijagnosticirana kompresivna neuropatija i čini 90 % svih neuropatija te je prisutna u 3,8 % opće populacije. Uzrokovana je oštećenjem nervus medianus (NM) u području karpalnog tunela, ograničenog karpalnim kostima i transverzalnim karpalnim ligamentom. SKT se klasificira u idiopatski i sekundarni. Patogeneza SKT-a je kompleksna te uključuje kompresiju i trakciju NM-a u području karpalnog tunela, a još uvijek nije u potpunosti razjašnjena. U dijagnostici su u uporabi brojni klinički testovi, elektromioneurografija (EMNG), ultrazvučna dijagnostika i magnetska rezonancija. Liječenje SKT-a može biti konzervativno i kirurško. Konzervativno liječenje preporučuje se kod pacijenata koji imaju simptome blažeg i umjerenog stupnja, dok se kirurško liječenje (dekompresija NM-a) provodi kod pacijenata s oštećenjem težeg stupnja. Cilj preglednog rada prikazati je najnovije spoznaje vezane uz taj klinički sindrom i motivirati kliničare na što bržu dijagnostiku i liječenje. Prikazane spoznaje temeljene su na najnovijim rezultatima sustavnih pregleda i metaanaliza.

Uporaba računala na radu i sindrom karpalnog kanala

“…Workplace risk factors that lead to the development of CTS are rapid repetitive movements of the wrist and fingers, pressure on the wrist, use of hand strength, distorted wrist position (dorsiflexion, ulnar deviation) and vibrations transmitted to the hands and arms (Newington et al, 2015, Baričić et al, 2019. Repetitive movements of the hand and fingers lead to numerous tendon movements within the canal, microruptures in the subsynovial connective tissue, accumulation of fluid and, over time, the development of inelastic connective tissue.…”

“…Abduction and thumb opposition are also difficult. Precise manual actions (unbuttoning buttons, closing jars) are difficult in this stage (Brinar et al, 2009, Tomić, 2018, Baričić et al, 2019, MSD priručnik, 2014.…”

“…The Tinel test is most commonly used, and performed by percussion of the median nerve in the wrist in the area of the carpal tunnel, and is positive if paresthesias occur in the innervation area of the median nerve. Another test is the Phalen test, where the maximum flexion of the wrist is performed for 60 seconds, and it is positive if paresthesia and pain occur in the innervation area (Baričić et al, 2019). Electromyoneurography (EMNG) is the gold standard in the diagnosis of CTS.…”

“…Electromyoneurography (EMNG) is the gold standard in the diagnosis of CTS. Diagnostic criteria are prolonged motor and sensory latency of the median nerve, and slowed motor and sensory conduction velocity of the median nerve (Baričić et al, 2019). The test is of high specificity (> 95%) and sensitivity (60-85%), and an aid for the exclusion of other pathological conditions in the differential diagnosis (Newington et al, 2015, Tomić, 2018.…”

Estimation of Median Nerve Axonal Degeneration without Needle Electromyography

“…The only way to differentiate the two is to stimulate the median nerve in the palm and compare its amplitude with the wrist stimulation. If the amplitude ratio of the palm to the wrist is greater than 1.6 for sensory and more than 1.2 for the motor, it will be a sign of conduction block [6,7]. However, the needle EMG is often helpful in further characterizing the neuropathic insult in CTS, especially when the CMAP amplitude is reduced because this condition can be a consequence of either distal demyelination or axonal degeneration.…”