Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri.
JAMA. 2022 Jun 28;327(24):2434-2445. doi: 10.1001/jama.2022.8481.
Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability.
Carpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools. The Durkan physical examination maneuver, consisting of firm digital pressure across the carpal tunnel to reproduce symptoms, is 64% sensitive and 83% specific for carpal tunnel syndrome. People with suspected proximal compression or other compressive neuropathies should undergo electrodiagnostic testing, which is approximately more than 80% sensitive and 95% specific for carpal tunnel syndrome. Splinting or steroid injection may temporarily relieve symptoms. Patients who do not respond to conservative therapies may undergo open or endoscopic carpal tunnel release for definitive treatment. Trigger finger, which involves abnormal resistance to smooth flexion and extension ("triggering") of the affected finger, affects up to 20% of adults with diabetes and approximately 2% of the general population. Steroid injection is the first-line therapy but is less efficacious in people with insulin-dependent diabetes. People with diabetes and those with recurrent symptoms may benefit from early surgical release. de Quervain tenosynovitis, consisting of swelling of the extensor tendons at the wrist, is more common in women than in men. People with frequent mobile phone use are at increased risk. The median age of onset is 40 to 59 years. Steroid injections relieve symptoms in approximately 72% of patients, particularly when combined with immobilization. People with recurrent symptoms may be considered for surgical release of the first dorsal extensor compartment. Thumb carpometacarpal joint arthritis affects approximately 33% of postmenopausal women, according to radiographic evidence of carpometacarpal arthritis. Approximately 20% of patients require treatment for pain and disability. Nonsurgical interventions (immobilization, steroid injection, and pain medication) relieve pain but do not alter disease progression. Surgery may be appropriate for patients unresponsive to conservative treatments.
Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and thumb carpometacarpal joint arthritis can be associated with significant disability. First-line treatment for each condition consists of steroid injection, immobilization, or both. For patients who do not respond to noninvasive therapy or for progressive disease despite conservative therapy, surgical treatment is safe and effective.
腕管综合征、扳机指、德奎文氏腱鞘炎和拇指基底（腕掌）关节炎可导致显著的残疾。
腕管综合征的特征是拇指和食指、中指和环指以及桡侧有麻木和刺痛感，严重时拇指对掌无力。它在女性和肥胖、糖尿病患者以及从事需要使用键盘、电脑鼠标、重型机械或振动手动工具的职业的人群中更为常见。德奎文氏体格检查操作为在腕管上施加坚实的数字压力以重现症状，其对腕管综合征的敏感性为 64%，特异性为 83%。疑似近端压迫或其他压迫性神经病的患者应接受电诊断测试，该测试对腕管综合征的敏感性约为 80%，特异性为 95%。夹板或类固醇注射可能暂时缓解症状。对保守治疗无反应的患者可能需要进行开放式或内镜下腕管松解术以进行确定性治疗。扳机指涉及受影响手指的平滑弯曲和伸展（“扳机”）的异常阻力，影响多达 20%的糖尿病患者和约 2%的普通人群。类固醇注射是一线治疗方法，但在胰岛素依赖型糖尿病患者中效果较差。糖尿病患者和有复发性症状的患者可能受益于早期手术松解。德奎文氏腱鞘炎由手腕伸肌腱肿胀引起，在女性中比男性更为常见。频繁使用手机的人风险增加。发病的中位年龄为 40 至 59 岁。类固醇注射可缓解约 72%患者的症状，尤其是与固定相结合时。有复发性症状的患者可能需要考虑进行第一背侧伸肌间隔的手术松解。拇指腕掌关节炎根据腕掌关节炎的放射学证据，影响约 33%的绝经后妇女。大约 20%的患者需要治疗疼痛和残疾。非手术干预（固定、类固醇注射和止痛药物）可缓解疼痛，但不能改变疾病进展。对于对保守治疗无反应的患者，手术可能是合适的。
腕管综合征、扳机指、德奎文氏腱鞘炎和拇指腕掌关节炎可导致显著的残疾。每种疾病的一线治疗方法包括类固醇注射、固定或两者兼施。对于对非侵入性治疗无反应或尽管进行了保守治疗但疾病仍在进展的患者，手术治疗是安全有效的。
