Löppönen Pekka, Hulkkonen Sina, Ryhänen Jorma
Department of Orthopedics and Traumatology, Seinäjoki Central Hospital, FI-60220 Seinäjoki, Finland.
Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland.
J Clin Med. 2022 Jul 9;11(14):3988. doi: 10.3390/jcm11143988.
Carpal tunnel syndrome (CTS) is the most common median nerve compression neuropathy. Its symptoms and clinical presentation are well known. However, symptoms at median nerve distribution can also be caused by a proximal problem. Pronator syndrome (PS) and anterior interosseous nerve syndrome (AINS) with their typical characteristics have been thought to explain proximal median nerve problems. Still, the literature on proximal median nerve compressions (PMNCs) is conflicting, making this classic split too simple. This review clarifies that PMNCs should be understood as a spectrum of mild to severe nerve lesions along a branching median nerve, thus causing variable symptoms. Clear objective findings are not always present, and therefore, diagnosis should be based on a more thorough understanding of anatomy and clinical testing. Treatment should be planned according to each patient's individual situation. To emphasize the complexity of causes and symptoms, PMNC should be named proximal median nerve syndrome.
腕管综合征（CTS）是最常见的正中神经受压性神经病。其症状和临床表现广为人知。然而，正中神经分布区域的症状也可能由近端问题引起。旋前圆肌综合征（PS）和骨间前神经综合征（AINS）具有典型特征，一直被认为可以解释近端正中神经问题。尽管如此，关于近端正中神经受压（PMNC）的文献存在矛盾之处，使得这种经典的分类过于简单。本综述阐明，PMNC应被理解为沿着正中神经分支出现的一系列从轻度到重度的神经病变，从而导致各种不同症状。并非总是存在明确的客观体征，因此，诊断应基于对解剖结构更深入的了解和临床检查。治疗应根据每个患者的具体情况进行规划。为强调病因和症状的复杂性，PMNC应称为近端正中神经综合征。
