Síndrome do túnel do carpo: aspectos atuais

Abstract

RESUMO -Baseado na experiência eletrofisiológica do autor em 668 pacientes e em dados de literatura, foi realizada revisão sobre síndrome do túnel do carpo (STC) analisando aspectos clínico-epidemiológicos e de conducão nervosa. O nervo mediano sofre desmielinização nodal ou segmentar por compressão no túnel do carpo, 3-4 cm distal à prega do punho. O complexo sintomátíco inclui dormência e fomigamento noturno nas mãos, frequentemente bilateral e mais comum em mulheres na faixa etária de 40-60 anos. São descritos casos familiares em que a herança poderia determinar ligamento transverso do carpo mais espesso. Fatores antropomórficos podem também representar risco adicional porém com pouca significância estatística. Ressonância magnética pode ser útil em casos selecionados e atípicos. São discutidos aspectos do tratamento conservador e controvérsias do tratamento cirúrgico. Na condução nervosa clássica observa-se aumento de latência distal sensitiva (segmentar) e motora do nervo mediano. Métodos adicionais de sensibilização incluem latência palma-punho do mediano (misto), diferença de latência palma-punho mediano/ulnar (misto), diferença de latência mediano/radial e mediano/ulnar (sensitivo), técnica da centimetragem punho-palma com registro no II/III dedos e diferença mediano/ulnar com registro lumbrical/interósseo (motor).PALAVRAS-CHAVES: síndrome do túnel do carpo, nervo mediano, condução nervosa, neuropatia compressiva. Carpal tunnel syndrome: present approachesABSTRACT -A clinical, epidemiological and nerve conduction studies report on carpal tunnel syndrome was done after electrophysiological author's experience on 668 cases and literature review. The median nerve underwent focal (nodal) or segmental demyelination after compression on carpal tunnel, 3-4 distal to wrist fold. The symptomatic complex includes nocturnal hands numbness and paraesthesia, mostly bilateral and between 40-60 years old. Familial cases are described and the gene could encode thick transverse carpal ligament. Anthropomorphic findings could also bring about an additional risk, but with low significance. Magnetic resonance could be a useful tool for selected atypical cases. Conservative treatment and controversies on surgery timing are discussed. Classical conduction studies on median nerve reveal a prolonged distal segmental sensory latency and also on distal motor latency. Increasing sensitivity may be reach using additional methods such as, median mixed mid-palm latency, comparative mid-palm latency median/ulnar, comparative sensory latency median/radial and median/ulnar, inching method from wrist to palm recording on index/middle finger and comparative motor median/ ulnar recording on lumbrical/interosseous muscle.KEY WORDS: carpal tunnel syndrome, median nerve, nerve conduction, compression neuropathy.A síndrome do túnel do carpo (STC) tem sido diagnosticado em número cada vez mais expressivo com o aumento de eletroneuromiografistas que tornaram técnicas eletrofisiológicas de condução nervosa mais acessíveis à população. Contudo, ap...

Liberação do canal do carpo por mini-incisão transversa

“…Other pathologies (such as cervical radiculopathy, brachial plexus lesions, thoracic outlet syndrome, apical pulmonary neoplasia, pronator syndrome, cubital and ulnar tunnel syndromes, and peripheral neuropathies) may cause paresthesia in the hand and should be excluded from the diagnosis. 6,7 A combination of findings from the clinical history and physical examination is more trustworthy than just one separate sign or symptom. CTS is accurately diagnosed in most cases when found in association with nocturnal pain, a positive Tinel's test, painful carpal tunnel compression test (Durkan test) and positive Phalen test.…”

“…It is also a way of documenting the patient's case for legal purposes. 4,7 The treatment may be conservative or surgical, and there are various surgical techniques for decompression. 4 The conservative treatment for CTS includes modification of activities, nocturnal immobilization of the wrist, injection of corticosteroids into the carpal canal, and oral medications.…”

Carpal tunnel syndrome in the elderly: nerve conduction parameters

“…Carpal tunnel syndrome (CTS), the most common entrapment neuropathy in humans, is caused by median nerve compression in the carpal tunnel, just distal to the wrist crease [1][2][3] . The incidence ranges from 99-376 / 100,000, peaking in the early fifties, and also in the seventies in some reports [4][5][6][7][8] .…”

“…The main complaints are intermittent numbness of the hands, nocturnal paresthesia, and pain. In chronic or more severe cases, weakness and thenar atrophy may appear 2,11,12 . In the elderly population, the clinical picture may be atypical, without symptoms, or even rapidly lead to severe forms with thenar atrophy 7,13 .…”

103. Carpal tunnel syndrome: Long-term nerve conduction studies in hands

“…Median nerve is compressed when pass through carpal tunnel about 2 cm distal to the wrist groove together with nine tendons: Flexor Digitorum Superficialis (4), Flexor Digitorum Profundus (4) and Flexor Pollicis Longus (1) forearm muscles 1 . In rochester, Minnesota, USA, the incidence of CTS was progressively higher from each period of five years from 1961-65 till 1975-80 (88, 102, 100 and 125/100,000 persons/year, respectively), and it occurs more frequently in females between 40 and 60 years of age with a peak incidence at 45 to 54 years 2 .…”