Strohl Adam B, Zelouf David S
Instructor, Philadelphia Hand Center, Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Department of Surgery-Division of Plastic Surgery, Philadelphia, Pennsylvania.
Instr Course Lect. 2017 Feb 15;66:153-162.
In addition to the more common carpal tunnel and cubital tunnel syndromes, orthopaedic surgeons must recognize and manage other potential sites of peripheral nerve compression. The distal ulnar nerve may become compressed as it travels through the wrist, which is known as ulnar tunnel or Guyon canal syndrome. The posterior interosseous nerve may become entrapped in the proximal forearm as it travels through the radial tunnel, which results in a pain syndrome without motor weakness. The median nerve may become entrapped in the proximal forearm, which can result in a variety of symptoms. Spontaneous neuropathy of the anterior interosseous nerve branch of the median nerve can be observed without external compression. Electrodiagnostic and imaging studies may aid surgeons in the diagnosis of these syndromes; however, a thorough physical examination is paramount to localize compressed segments of these nerves. An understanding of the anatomy of each of these nerve areas allows surgeons to appreciate a patient's clinical findings and helps guide surgical decompression.
除了更常见的腕管综合征和肘管综合征外,骨科医生还必须识别和处理周围神经受压的其他潜在部位。尺神经远端在穿过手腕时可能会受到压迫,这被称为尺管综合征或Guyon管综合征。骨间后神经在穿过桡管时可能会在近端前臂被卡压,导致一种无运动无力的疼痛综合征。正中神经可能会在近端前臂被卡压,这可能导致各种症状。正中神经骨间前神经分支可在无外部压迫的情况下出现自发性神经病变。电诊断和影像学检查可能有助于外科医生诊断这些综合征;然而,全面的体格检查对于定位这些神经的受压节段至关重要。了解这些神经区域中每一个的解剖结构,有助于外科医生理解患者的临床发现,并有助于指导手术减压。