Harinesan Nimalan, Silsby Matthew, Simon Neil G
Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
Northern Beaches Clinical School, Macquarie University, Sydney, NSW, Australia.
Handb Clin Neurol. 2024;201:61-88. doi: 10.1016/B978-0-323-90108-6.00005-3.
Median neuropathy at the wrist, commonly referred to as carpal tunnel syndrome (CTS), is the most common entrapment neuropathy. It is caused by chronic compression of the median nerve at the wrist within the space-limited carpal tunnel. Risk factors that contribute to the etiology of compression include female gender, obesity, work-related factors, and underlying medical conditions, such as hypothyroidism, pregnancy, and amyloidosis. The diagnosis is made on clinical grounds, although these can be confounded by anatomical variations. Electrodiagnostic studies, which are specific and sensitive in diagnosing CTS, support the diagnosis; however, a subgroup may present with normal results. The advent of imaging techniques, including ultrasound and MRI, further assists the diagnostic process. The management of CTS is divided into the nonsurgical approaches that include hand therapy, splinting and corticosteroid injection, and surgical decompression of the carpal tunnel. Although several surgical techniques have been developed, no one method is more effective than the other. Each of these management approaches are effective at providing symptom relief and are utilized at different severities of the condition. There is, however, a lack of consensus on standardized diagnostic criteria, as well as when and to whom to refer patients for surgery.
腕部正中神经病变，通常称为腕管综合征（CTS），是最常见的卡压性神经病变。它是由正中神经在腕部空间有限的腕管内受到慢性压迫所致。导致压迫病因的危险因素包括女性、肥胖、工作相关因素以及潜在的疾病，如甲状腺功能减退、妊娠和淀粉样变性。尽管解剖变异可能会混淆诊断，但诊断仍基于临床依据。电诊断研究在诊断CTS方面具有特异性和敏感性，可支持诊断；然而，有一个亚组可能结果正常。包括超声和MRI在内的成像技术的出现进一步辅助了诊断过程。CTS的治疗分为非手术方法，包括手部治疗、夹板固定和皮质类固醇注射，以及腕管手术减压。尽管已经开发了几种手术技术，但没有一种方法比另一种更有效。这些治疗方法中的每一种在缓解症状方面都有效，并在病情的不同严重程度下使用。然而，在标准化诊断标准以及何时将患者转诊手术和转诊给谁方面缺乏共识。
