1、腕管综合征 carpal tunnel syndrome (CTS),林江豪 LIM CHIANG HOU 22/8/2013,腕管综合征（carpal tunnel syndrome，CTS）是周围神经卡压中最常见的一种。,Carpal tunnel syndrome (CTS) is distribution at the wrist in the carpal tunnel, median entrapment neuropathy, that causes paresthesia, pain, numbness, and other symptoms。 腕管综合症（CTS）指其压缩在腕
2、部在腕管内的正中神经卡压，导致感觉异常，疼痛，麻木，等症状。,Carpal portion form by eight carpal bones 腕部共有8块腕骨 Arranged in two rows, proximal row of carpal and distal radius form the wrist joint. 排列成两行，由近排腕骨与桡骨远端构成桡腕关节 Distal ulna separated by the triangular cartilage and wrist尺骨远端由三角软骨与腕关节隔开,腕部解剖Wrist Anatomy,She :Scaphoid手舟骨
3、Looks :Lunate月骨 Too : Triquertrum三角骨 Pretty :Pisiform 豆骨 Try :Trapezium大多角骨 To :Trapezoid 小多角骨 Catch :Capitate 头状骨 Her :Hamate 钩骨,The bottom and sides of carpal tunnel are formed by wrist (carpal) bones. 底部和两侧的腕管是由腕关节（腕）骨头组成。The top of the carpal tunnel is covered by a connective tissue called the t
4、ransverse carpal ligament. 腕骨隧道顶部的覆盖由结缔组织形成称为腕横韧带,The carpal tunnel is a narrow, tunnel-like structure in the wrist. 腕管是一种狭隘的，隧道形的腕管状结构。,The median nerve travels from the forearm into the hand through carpal tunnel in the wrist. 正中神经从前臂的手通过手腕到腕管。,The median nerve controls feeling in the palm side of
5、 the thumb, index finger, long and radial half of the ring finger. 正中神经控制在手掌一侧的拇指，食指，中指和径向半无名指的感觉。,Causes-local factors,Anatomical factors 解剖因素 congenital predisposition - the carpal tunnel is smaller.先天性倾向 - 腕隧道较小。 trauma or injury to the wrist that cause swelling, such as sprain or fracture外伤或引起肿胀
6、的手腕受伤，如扭伤或骨折,Local factors,Activity factor活动因素 repetitive and forceful movements of the hand and wrist 重复性和有力动作易伤手和手腕 bursitis and tendonitis have been associated with repeated motions performed in the course of normal work or other activities. 滑囊炎，肌腱炎，与在工作或其他活动的过程中进行的重复性的动作。,Systemic factors,Neurog
7、enic factors like diabetic nerve damage, nerve damage alcoholism 神经源性因素如 糖尿病性神经损害，酒精中毒性神经损害,Infection and non infectious inflammatory reactions such as purulent or tuberculous arthritis, rheumatoid arthritis, gout, and other nonspecific tenosynovitis. 感染与非感染性炎性反应 如化脓性或结核性关节炎，类风湿关节炎，痛风，非特异性腱鞘炎等。,Clin
8、ical sign,Wrist, palm radial side， the thumb, index finger, middle finger and ring finger radial side numbness, pain may radiate to the elbow, shoulder. .腕部、手掌面桡侧、拇指、示指、中指和环指桡侧麻、痛，可放射到肘、肩部。 Symptoms aggravated at night or early in the morning; activities and walk away after mitigation. 症状多在夜间或清晨加重；活
9、动及甩手后减轻。,Clinical sign,The area feels diminished or disappeared. Thumb abduction, flexion and palm muscle weakness. Oppression carpal can aggravate symptoms.上述区域感觉减弱或消失。拇指外展、屈曲和对掌肌力减弱。压迫腕掌侧可加重症状。 long duration injury, can be found thenar muscle atrophy, paralysis.病程久者，可见鱼际肌萎缩、瘫痪。,Clinical sign,The a
10、rea feels diminished or disappeared. Thumb abduction, flexion and palm muscle weakness. Oppression carpal can aggravate symptoms.上述区域感觉减弱或消失。拇指外展、屈曲和对掌肌力减弱。压迫腕掌侧可加重症状。 long duration injury, can be found thenar muscle atrophy, paralysis.病程久者，可见鱼际肌萎缩、瘫痪。,Clinical sign,Wrist flexion test and neural ste
11、m percussion test (Tinel sign) were positive. 屈腕试验和神经干叩击试验 （征）均阳性。,According to the speed of onset, can be divided into acute carpal tunnel syndrome and chronic carpal tunnel syndrome. 根据起病的快慢，可分为急性腕管综合征和慢性腕管综合征。 Acute carpal tunnel syndrome: mostly for post-traumatic reactions. The pathophysiologic
12、al process of change is r the tissue within the carpal tunnel acute edema or fluid accumulation in acute gap 急性腕管综合征：多为创伤后反应。其病理生理变化为腕管内组织急性水肿或急性间隙内液体积聚,Chronic carpal tunnel syndrome: slow onset occur, is chronic increased pressure within the carpal tunnel. 慢性腕管综合征：起病缓慢隐匿，是慢性的腕管内压增高。According to di
13、fferent causes, divided into pathological type of carpal tunnel syndrome and dynamic type carpal tunnel syndrome 根据病因不同，分为病理型腕管综合征与动力型腕管综合征。,Diagnosis,1 Wrist and thumb and middle finger numbness, pain, paresthesia, thumb opposition is limited, thenar muscle atrophy.腕和拇、示、中指麻、痛，感觉异常，拇对掌受限，大鱼际肌萎缩。2 O
14、ppression carpal symptoms压迫腕掌侧症状加重3 Wrist flexion test and Tinel sign were positive. 屈腕试验和征均阳性。,4 Carpal tunnel symptoms subsided after closure.腕管封闭后症状明显消退。5 EMG showed median nerve conduction velocity has changed. 肌电图检查示正中神经传导速度有改变。6 Cervical spine X-ray did not change.颈椎线片无改变。,Differential Diagnos
15、is,Cervical disease颈椎病common in the elderly为中老年人多见nerve root type cervical spondylosis show symptoms of confusion, C5, 6,7 nerve root compression appears radial side of the hand numbness, pain, sensory loss 神经根型颈椎病的临床表现易与周围神经的症状相混淆，C5,6,7神经根受压会出现手部桡侧的麻木、疼痛、感觉减退,not appear thenar muscle atrophy不应出现鱼际
16、肌萎缩no history of nighttime waking disease may be associated with neck discomfort.无夜间病醒史，可伴有颈部不适 cervical spine X-ray, EMG can help distinguish between the two. ： 颈椎X线片、肌电图有助于两者的鉴别。,Pronator teres syndrome旋前圆肌综合征 no pain at night woke history无夜间痛醒史 proximal forearm pain and tenderness有前臂近端的疼痛和压痛 flex
17、or muscle strength, muscle strength decreased forearm rotation.有屈指肌力、前臂旋转肌力的下降 EMG helps to distinguish between the two. 肌电图检查有助于两者的鉴别。,Diabetic nerve damage糖尿病的神经损害 distribution hand, foot glove, sock-like feeling of loss, mainly due to damage to the nerve endings, sports damage is not obvious. 分布为
18、手、足部的手套、袜套样感觉减退，主要是神经末梢的损害所致，运动方面的损害不明显。,Thenar branch entrapment syndrome鱼际肌支卡压综合征 thenar muscle atrophy鱼际肌萎缩thenar branch of the median nerve at the point into the muscle tenderness, local may have small neuroma, thumb limited mobility, but the thumb feels normal. 正中神经鱼际肌支入肌点处有压痛，局部可有小神经瘤，拇指活动受限，但
19、拇指感觉正常。,Treatment,treatment of the primary cause lead to carpal tunnel syndrome 首先治疗原发病 对造成腕管综合征的病因进行治疗。,Immobilized固定,Injury patient , available use two plywood wrist fixed in a bit-week. 损伤者，可用两块夹板将腕关节固定于功能位三周。 Avoid wrist flexion, increased median nerve entrapment,避免屈曲腕关节加重正中神经的卡压 improving hand
20、venous return, reduce carpal tunnel synovial edema, reducing nerve entrapment, relieve symptoms.改善手部的静脉回流，减少腕管内滑膜的水肿,减轻对神经的卡压，缓解症状。,Exercise 练功疗法,Wrist range of motion Flexion Extension Side to side Wrist stretch Mid-trap exercise Pectoralis stretch Scalene stretch Thoracic extension Scapular squeeze Wrist extension Grip strengthening,Exercise 练功疗法,Stretching Exercises to Help Prevent Carpal Tunnel Syndrome,Prayer stretch,
