腕管注射引起的正中神经损伤。
Median nerve injuries caused by carpal tunnel injections.
作者信息
Kim Hyun Jung, Park Sang Hyun
机构信息
Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea.
出版信息
Korean J Pain. 2014 Apr;27(2):112-7. doi: 10.3344/kjp.2014.27.2.112. Epub 2014 Mar 28.
Abstract
Local steroid injections are widely used for diagnostic and therapeutic purposes in the management of carpal tunnel syndrome. The median nerve injury is the most serious complication in association with carpal tunnel injections although the incidence is low. A median nerve injury will be presented with shooting pain at the injection time along with other sensory distortion, motor weakness and muscle atrophy. The management includes a conservative treatment and a surgical exploration. Carpal tunnel injections should be used at a minimum only. If such steroid injection is required, an appropriate needle positioning is vital for the nerve injury prevention. The patient should not be heavily sedated and should be encouraged to inform experiences of numbness/paresthesia during the procedure immediately.
摘要
局部类固醇注射在腕管综合征的治疗中被广泛用于诊断和治疗目的。正中神经损伤是腕管注射相关的最严重并发症，尽管其发生率较低。正中神经损伤在注射时会出现刺痛，并伴有其他感觉异常、运动无力和肌肉萎缩。治疗方法包括保守治疗和手术探查。应尽量少用腕管注射。如果需要进行此类类固醇注射，正确的进针位置对于预防神经损伤至关重要。患者不应过度镇静，应鼓励其在操作过程中立即告知有无麻木/感觉异常的情况。
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Clin Neurophysiol. 2014 Jul;125(7):1479-84. doi: 10.1016/j.clinph.2013.11.010. Epub 2013 Nov 23.
2
Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: A single-blind randomized prospective study.超声引导与盲法类固醇注射治疗腕管综合征的对比：一项单盲随机前瞻性研究。
Am J Phys Med Rehabil. 2013 Nov;92(11):999-1004. doi: 10.1097/PHM.0b013e31829b4d72.
3
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4
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Rheumatology (Oxford). 2012 Aug;51(8):1447-54. doi: 10.1093/rheumatology/kes053. Epub 2012 Mar 30.
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6
7
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10
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