Carragee E J, Hentz V R
Orthopaedic Surgery, Stanford University, California.
Orthop Clin North Am. 1988 Jan;19(1):157-64.
Repetitive movement of the upper extremity, whether recreational or occupational, may result in various neuropathies, the prototype of which is the median nerve neuropathic in the carpal canal. The pathophysiology of this process is incompletely understood but likely involves both mechanical and ischemic features. Experimentally increased pressures within the carpal canal produced reproducible progressive neuropathy. Changes in vibratory (threshold-type) sensibility appears to be more sensitive than two-point (innervation density-type) sensibility. The specific occupational etiologies of carpal neuropathy are obscured by methodologic and sociological difficulties, but clearly some occupations have high incidences of CTS. History and physical examination are usually sufficient for the diagnosis, but diagnostic assistance when required is available through electrophysiological testing, CT scanning, and possibly MRI. Each of these tests has limitations in both sensitivity and specificity. Treatment by usual conservative means should be combined with rest from possible provocative activities. Surgical release of the carpal canal is helpful in patients failing conservative therapy. Occupational modifications are important in both treatment and prevention of median neuropathy due to repetitive trauma.
上肢的重复性运动，无论是娱乐性的还是职业性的，都可能导致各种神经病变，其中典型的是腕管内的正中神经病变。这一过程的病理生理学尚未完全了解，但可能涉及机械和缺血特征。实验表明，腕管内压力增加会导致可重复性的进行性神经病变。振动（阈值型）感觉的变化似乎比两点（神经支配密度型）感觉更敏感。由于方法学和社会学方面的困难，腕管神经病变的具体职业病因尚不明确，但显然有些职业的腕管综合征发病率很高。病史和体格检查通常足以做出诊断，但必要时可通过电生理测试、CT扫描，可能还有MRI来辅助诊断。这些检查在敏感性和特异性方面都有局限性。常规保守治疗应结合避免可能引发症状的活动进行休息。对于保守治疗无效的患者，手术松解腕管是有帮助的。职业调整在治疗和预防因重复性创伤导致的正中神经病变方面都很重要。
