Karpal tünel sendromu

Karpal tünel sendromu (KTS) en sık rastlanan tuzak nöropatidir. Median sinir, bilek düzeyinde, karpal tünel içerisinde kompresyona uğrar. Bu kompresyon sonucunda, kan-sinir bariyeri yıkılarak ödem, enflamasyon ve çevre yumuşak dokuda fibrozis gelişir. Sonraki evre sinirdeki myelin örtünün yıkımını takip eden akson hasarıdır. Karpal tünel sendromunun çoğu idiopatiktir. Diğer nedenler ise sistemik bozukluklar, lokal faktörler ve aşırı kullanım/çaba gerektiren faktörlerdir. Öykü, fizik muayene ve elektronöromiyografi tanı için gereklidir. Hastalar çoğunlukla radial taraftaki 3.5 parmakta uyuşma, karıncalanma ve ağrıdan yakınır. Tipik olarak hastalar gece uyuşuk bir el ile uyanırlar. Fizik muayenede, median sinir duysal alanında hipoestezi, provokatif testlerin pozitifliği ve tenar kaslarda güçsüzlük ve atrofi görülebilir. Sinir ileti hızı çalışmasındaki tipik bulgu, uzamış latansdır. Konservatif tedavi istirahat, non steroid antienflamatuvar ilaçlar, nötral pozisyon splintleri ve steriod enjeksiyonunu içerir. Cerrahi tedavi endikasyonları, konservatif tedavinin başarısızlığı veya ciddi KTS’dir. KTS, median sinirin bilekte tuzaklanması ile seyreden en sık fokal nöropati ve özellikle kadınlarda önkol ağrısının önde gelen etkenlerinden olması nedeniyle önemlidir.

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The median nevre is compressed within the carpal tunnel at the wrist. This compression result in disrupt of the blood-nerve barrier causing edema, inflamation and fibrosis of surrounding connective tissue. The next stage is a distruption of the myelin coverage of the nerve followed by damage to the axons. Most carpal tunnel syndromes are idiopathic. Other causes include systemic disorders, local factors and overuse/exertional factors. History, physical examination and electroneuromyography are essential for the diagnosis. Patients usually suffer from numbness, tingling and pain on palmar side in radial 3.5 fingers. Tipically patients are awakened at night by a numb hand. The physical examination may show hypesthesia in median nerve sensory distrubition, positive provocative tests and a weakness and atrophy of the thenar muscles. The typical finding in the nevre conduction velocity is a prolonged latency period. The conservative treatment for CTS include rest, non-steroidal anti-inflamatory drugs, neutral position splints, and steroid injection. The indications for surgical treatment are failure of conservative management or severe CTS. CTS is very important because of entrapment of the median nevre at the wrist is the most frequent focal neuropathy in humans and a common cause of pain in the forearm, particularly in women.

Kaynakça

1. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282: 153-8.

2. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992; 45: 373-6.

3. Franklin GM, Haug J, Heyer N, Checkoway H, Peck N. Occupational carpal tunnel syndrome in Washington State, 1984-1988. Am J Public Health 1991; 81: 741-6.

4. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002; 58: 289-94.

5. Nordstrom DL, DeStefano F, Vierkant RA, Layde PM. Incidence of diagnosed carpal tunnel syndrome in a general population. Epidemiology 1998; 9: 342-5.

6. Rengachary SS. Entrapment neuropathies. In: Wilkins RH, Rengachary SS, editors. Neurosurgery. International ed. The McGraw-HillCompanies; 1996. p. 3073-98.

7. Greenberg MS. Handbook of Neurosurgery; 3rd ed. Florida: Greenberg Graphics. 1994.

8. Frank H. Netter. Atlas of Human Anatomy, Paperback 2nd ed. 1997.

9. Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology: review. Clin Neurophysiol 2002; 113: 1373-81.

10. Lundborg G, Gelberman RH, Minteer-Convery M, Lee YF, Hargens AR. Median nerve compression in the carpal tunnel--functional response to experimentally induced controlled pressure. J Hand Surg [Am] 1982; 7: 252-9.

11. Gelberman RH, Rydevik BL, Pess GM, Szabo RM, Lundborg G. Carpal tunnel syndrome. A scientific basis for clinical care. Orthop Clin North Am 1988; 19: 115-24.

12. Dahlin LB, Shyu BC, Danielsen N, Andersson SA. Effects of nerve compression or ischaemia on conduction properties of myelinated and non-myelinated nerve fibres. An experimental study in the rabbit common peroneal nerve. Acta Physiol Scand 1989; 136: 97-105.

13. Sunderland S. The nerve lesion in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 1976; 39: 615-26.

14. Dekel S, Papaioannou T, Rushworth G, Coates R. Idiopathic carpal tunnel syndrome caused by carpal stenosis. Br Med J 1980; 280: 1297-9.

15. Voitk AJ, Mueller JC, Farlinger DE, Johnston RU. Carpal tunnel syndrome in pregnancy. Can Med Assoc J 1983; 128: 277-81.

16. Lavey EB, Pearl RM. Patent median artery as a cause of carpal tunnel syndrome. Ann Plast Surg 1981; 7: 236-8.

17. Fissette J, Onkelinx A, Fandi N. Carpal and Guyon tunnel syndrome in burns at the wrist. J Hand Surg [Am] 1981; 6: 13-5.

18. Bowles AP Jr, Asher SW, Pickett JB. Use of Tinel's sign in carpal tunnel syndrome. Ann Neurol 1983; 13: 689-90.

19. Seror P. Phalen's test in the diagnosis of carpal tunnel syndrome. J Hand Surg [Br] 1988; 13: 383-5.

20. Ghavanini MR, Haghighat M. Carpal tunnel syndrome: reappraisal of five clinical tests. Electromyogr Clin Neurophysiol 1998; 38: 437-41.

21. Durkan JA. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am 1991; 73: 535-8.

22. 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: 735-7.

23. Tetro AM, Evanoff BA, Hollstien SB, Gelberman RH. A new provocative test for carpal tunnel syndrome. Assessment of wrist flexion and nerve compression. J Bone Joint Surg Br 1998; 80: 493-8.

24. van Dijk MA, Reitsma JB, Fischer JC, Sanders GT. Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review. Clin Chem 2003; 49: 1437-44.

25. Keles I, Karagulle Kendi AT, Aydin G, Zöğ SG, Orkun S. Diagnostic precision of ultrasonography in patients with carpal tunnel syndrome. Am J Phys Med Rehabil 2005; 84: 443-50.

26. Altinok MT, Baysal O, Karakas HM, Firat AK. Sonographic evaluation of the carpal tunnel after provocative exercises. J Ultrasound Med 2004; 23: 1301-6.

27. Buchberger W. Radiologic imaging of the carpal tunnel. Eur J Radiol 1997; 25: 112-7.

28. Kanaan N, Sawaya RA. Carpal tunnel syndrome: modern diagnostic and management techniques. Br J Gen Pract 2001; 51: 311-4.

29. Öge K, Demirkazık FG, Nurlu G, İnci S, Erbengi E. Value of carpal tunnel area measurements in carpal tunnel syndrome. European Association of Neurosurgical Societies Winter Meeting; 1998 Feb 18- 21, İstanbul, Türkiye. EANS Abstract Book 1998. p. 40.

30. Musluoglu L, Celik M, Tabak H, Forta H Clinical, electrophysiological and magnetic resonance imaging findings in carpal tunnel syndrome. Electromyogr Clin Neurophysiol 2004; 44: 161-5.

31. Baba H, Maezawa Y, Uchida K et al. Cervical myeloradiculopathy with entrapment neuropathy: a study based on the double-crush concept. Spinal Cord 1998; 36: 399-404.

32. Rempel DM, Harrison RJ, Barnhart S. Work-related cumulative trauma disorders of the upper extremity. JAMA 1992; 267: 838-42.

33. England JD. Entrapment neuropathies. Curr Opin Neurol 1999; 12: 597-602.

34. Olehnik WK, Manske PR, Szerzinski J. Median nerve compression in the proximal forearm. J Hand Surg [Am] 1994; 19: 121-6.

35. Schmelzer RE, Della Rocca GJ, Caplin DA. Endoscopic carpal tunnel release: a review of 753 cases in 486 patients. Plast Reconstr Surg 2006; 117: 177-85.

36. O'Gradaigh D, Merry P. Corticosteroid injection for the treatment of carpal tunnel syndrome. Ann Rheum Dis 2000; 59: 918-9.

37. Dammers JW, Veering MM, Vermeulen M. Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial. BMJ 1999; 319: 884-6.

38. Linskey ME, Segal R. Median nerve injury from local steroid injection in carpal tunnel syndrome. Neurosurgery 1990; 26: 512-5.

39. Gooch CL, Mitten DJ. Treatment of carpal tunnel syndrome: is there a role for local corticosteroid injection? Neurology 2005; 64: 2006-7.

40. Cokluk C, Senel A, Iyigun O, Celik F, Rakunt C. Open median nerve release using double mini skin incision in patients with carpal tunnel syndrome: technique and clinical results. Neurol Med Chir (Tokyo) 2003; 43:465-8.

Kaynak Göster

  • ISSN: 1309-9833
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2008

339 75

Sayıdaki Diğer Makaleler

Psoriazisli hastalarda kontakt duyarlılığın araştırılması

Nuran UZ, Şebnem AKTAN, Şeniz ERGİN, Şanlı Berna ERDOĞAN, Deniz EVLİYAOĞLU

1 Ocak 2004 – 31 Temmuz 2005 tarihleri arasında Denizli ilinde postmortem inceleme yapılan adli olguların değerlendirilmesi

KEMALETTİN ACAR, BORA BOZ, AYŞE KURTULUŞ DERELİ

Sülfitin ortalama eritrosit hacmi, ortalama eritrosit hemoglobin konsantrasyonu ve eritrosit içi kalsiyum düzeyine in vitro etkisi

Mlek BOR-KÜÇÜKATAY, VURAL KÜÇÜKATAY, Aysel AĞAR, Oğuz Kerim BAŞKURT

Koroner arter baypas cerrahisi sonrasında gecikmiş ekstübasyonun risk faktörleri

Mustafa SAÇAR, Gökhan ÖNEM, Fahri ADALI, İbrahim GÖKŞİN, Derviş VERDİ, Ali Vefa ÖZCAN, Ümit Yaşar TEKELİ, Hülya SUNGURTEKİN, Ahmet BALTALARLI

Hematolojik hastalıklarda acil cerrahi

ZAFER TEKE, Ali N KESK

Karpal tünel sendromu

Yurdal SERARSLAN, İsmet M. MELEK, Taşkın DUMAN

Denizli merkezinde 6-15 yaş grubu çocuklarda obezite sıklığı

Serap SEMİZ, Özmer M.A. ÖZDEMİR, Ayşegül Sözeri ÖZDEMİR

Post travmatik çoklu ilaç dirençli acinetobacter baumannii menenjitli olguda yüksek doz meropenem ile başarılı tedavi

Suzan SAÇAR, Hüseyin TURGUT, Derya Hırçın CENGER, Erdal COŞKUN, ALİ ASAN, İlknur KALELİ

Kutanöz epidermal kistden gelişen pigmente bazal hücreli karsinom: Olgu sunumu ve literatürün gözden geçirilmesi

ZAFER TEKE, Hakan ÖÇSEL, Çallı Neşe DEMİRKAN

Mayıs 2003- Temmuz 2004 tarihleri arasında Pamukkale Üniversitesi Tıp Fakültesi Adli Tıp Anabilim Dalı’na başvuran aile içi şiddet olguları

BORA BOZ, KEMALETTİN ACAR, AYŞE KURTULUŞ DERELİ