Fernández-de-Las-Peñas César, Arias-Buría José L, Ortega-Santiago Ricardo, De-la-Llave-Rincón Ana I
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
F1000Res. 2020 Jun 15;9. doi: 10.12688/f1000research.22570.1. eCollection 2020.
Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity, and it is traditionally considered a peripheral neuropathy associated with a localized compression of the median nerve just at the level of the carpal tunnel. Surgery and physiotherapy are treatment approaches commonly used for this condition; however, conflicting clinical outcomes suggest that carpal tunnel syndrome may be more complex. There is evidence supporting the role of peripheral nociception from the median nerve in carpal tunnel syndrome; however, emerging evidence also suggests a potential role of central sensitization. The presence of spreading pain symptoms (e.g. proximal pain), widespread sensory changes, or bilateral motor control impairments in people presenting with strictly unilateral sensory symptoms supports the presence of spinal cord changes. Interestingly, bilateral sensory and motor changes are not directly associated with electrodiagnostic findings. Other studies have also reported that patients presenting with carpal tunnel syndrome exhibit neuroplastic brainstem change supporting central sensitization. Current data would support the presence of a central sensitization process, mediated by the peripheral drive originating in the compression of the median nerve, in people with carpal tunnel syndrome. The presence of altered nociceptive gain processing should be considered in the treatment of carpal tunnel syndrome by integrating therapeutic approaches aiming to modulate long-lasting nociceptive barrage into the central nervous system (peripheral drive) and strategies aiming to activate endogenous pain networks (central drive).
腕管综合征是上肢最常见的神经压迫性疾病，传统上被认为是一种与正中神经在腕管水平处局部受压相关的周围神经病变。手术和物理治疗是常用于治疗该疾病的方法；然而，相互矛盾的临床结果表明腕管综合征可能更为复杂。有证据支持正中神经的外周伤害感受在腕管综合征中的作用；然而，新出现的证据也表明中枢敏化可能起作用。在仅有单侧感觉症状的患者中出现扩散性疼痛症状（如近端疼痛）、广泛的感觉变化或双侧运动控制障碍，支持脊髓发生了改变。有趣的是，双侧感觉和运动变化与电诊断结果并无直接关联。其他研究也报道，患有腕管综合征的患者表现出支持中枢敏化的神经可塑性脑干变化。目前的数据支持在腕管综合征患者中存在由起源于正中神经受压的外周驱动介导的中枢敏化过程。在治疗腕管综合征时，应考虑到伤害性感受增益处理的改变，将旨在调节传入中枢神经系统的持久伤害性传入（外周驱动）的治疗方法与旨在激活内源性疼痛网络（中枢驱动）的策略相结合。
