Ortega-Santiago R, de-la-Llave-Rincon A I, Laguarta-Val S, Martinez-Perez A, Pareja J A, Fernandez-de-Las-Penas C
Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Universidad Rey Juan Carlos, Madrid, Espana.
Rev Neurol. 2012 Apr 16;54(8):490-6.
Carpal tunnel syndrome (CTS) is considered a simple entrapment of the median nerve at the carpal tunnel. In the last years, several studies have demonstrated the presence of peripheral and central sensitization mechanisms.
To review the basis neurophysiology of peripheral and central sensitization by applying them to CTS and to determine their clinical repercussions.
Several studies have revealed that patients with CTS exhibit somato-sensory changes in areas innervated by the median nerve and also in areas non-related with the median nerve. Individuals with CTS exhibited widespread mechanical and thermal pain hyperalgesia, although they suffered from unilateral symptoms. Further, patients also showed wide-spread impairments in vibration conduction, deficits in fine motor control and changes in the somato-sensory cortex. These evidences support the presence of a complex process of peripheral and central sensitization in patients with CTS which may constitute a negative prognosis factor for the management of these patients.
The advances in neurosciences in the last years support the presence of peripheral and central sensitization mechanisms in CTS. These mechanisms justify the necessity of conceptual changes and in the management, both conservative and surgical, of this syndrome. Additionally, central sensitization can also play a relevant role in the prognosis of CTS since it can constitute a negative prognosis factor for its treatment.
腕管综合征（CTS）被认为是正中神经在腕管处的一种单纯卡压。近年来，多项研究已证实存在外周和中枢敏化机制。
通过将外周和中枢敏化应用于腕管综合征，回顾其基础神经生理学，并确定其临床影响。
多项研究表明，腕管综合征患者在正中神经支配区域以及与正中神经无关的区域均表现出躯体感觉变化。尽管腕管综合征患者有单侧症状，但他们表现出广泛的机械性和热痛觉过敏。此外，患者在振动传导方面也存在广泛损害，精细运动控制存在缺陷，躯体感觉皮层也有变化。这些证据支持腕管综合征患者存在外周和中枢敏化的复杂过程，这可能是这些患者治疗预后不良的一个因素。
近年来神经科学的进展支持腕管综合征中外周和中枢敏化机制的存在。这些机制证明了在该综合征的保守和手术治疗管理中观念改变的必要性。此外，中枢敏化在腕管综合征的预后中也可能起相关作用，因为它可能是其治疗预后不良的一个因素。
