Karpal tünel sendromu
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Tarih
2008
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info:eu-repo/semantics/openAccess
Özet
Karpal tünel sendromu (KTS) en sık rastlanan tuzak nöropatidir. Median sinir, bilek düzeyinde, karpal tünel içerisinde kompresyona uğrar. Bu kompresyon sonucunda, kan-sinir bariyeri yıkılarak ödem, enflamasyon ve çevre yumuşak dokuda fibrozis gelişir. Sonraki evre sinirdeki myelin örtünün yıkımını takip eden akson hasarıdır. Karpal tünel sendromunun çoğu idiopatiktir. Diğer nedenler ise sistemik bozukluklar, lokal faktörler ve aşırı kullanım/çaba gerektiren faktörlerdir. Öykü, fizik muayene ve elektronöromiyografi tanı için gereklidir. Hastalar çoğunlukla radial taraftaki 3.5 parmakta uyuşma, karıncalanma ve ağrıdan yakınır. Tipik olarak hastalar gece uyuşuk bir el ile uyanırlar. Fizik muayenede, median sinir duysal alanında hipoestezi, provokatif testlerin pozitifliği ve tenar kaslarda güçsüzlük ve atrofi görülebilir. Sinir ileti hızı çalışmasındaki tipik bulgu, uzamış latansdır. Konservatif tedavi istirahat, non steroid antienflamatuvar ilaçlar, nötral pozisyon splintleri ve steriod enjeksiyonunu içerir. Cerrahi tedavi endikasyonları, konservatif tedavinin başarısızlığı veya ciddi KTS’dir. KTS, median sinirin bilekte tuzaklanması ile seyreden en sık fokal nöropati ve özellikle kadınlarda önkol ağrısının önde gelen etkenlerinden olması nedeniyle önemlidir.
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The median nevre is compressed within the carpal tunnel at the wrist. This compression result in disrupt of the blood-nerve barrier causing edema, inflamation and fibrosis of surrounding connective tissue. The next stage is a distruption of the myelin coverage of the nerve followed by damage to the axons. Most carpal tunnel syndromes are idiopathic. Other causes include systemic disorders, local factors and overuse/exertional factors. History, physical examination and electroneuromyography are essential for the diagnosis. Patients usually suffer from numbness, tingling and pain on palmar side in radial 3.5 fingers. Tipically patients are awakened at night by a numb hand. The physical examination may show hypesthesia in median nerve sensory distrubition, positive provocative tests and a weakness and atrophy of the thenar muscles. The typical finding in the nevre conduction velocity is a prolonged latency period. The conservative treatment for CTS include rest, non-steroidal anti-inflamatory drugs, neutral position splints, and steroid injection. The indications for surgical treatment are failure of conservative management or severe CTS. CTS is very important because of entrapment of the median nevre at the wrist is the most frequent focal neuropathy in humans and a common cause of pain in the forearm, particularly in women.
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The median nevre is compressed within the carpal tunnel at the wrist. This compression result in disrupt of the blood-nerve barrier causing edema, inflamation and fibrosis of surrounding connective tissue. The next stage is a distruption of the myelin coverage of the nerve followed by damage to the axons. Most carpal tunnel syndromes are idiopathic. Other causes include systemic disorders, local factors and overuse/exertional factors. History, physical examination and electroneuromyography are essential for the diagnosis. Patients usually suffer from numbness, tingling and pain on palmar side in radial 3.5 fingers. Tipically patients are awakened at night by a numb hand. The physical examination may show hypesthesia in median nerve sensory distrubition, positive provocative tests and a weakness and atrophy of the thenar muscles. The typical finding in the nevre conduction velocity is a prolonged latency period. The conservative treatment for CTS include rest, non-steroidal anti-inflamatory drugs, neutral position splints, and steroid injection. The indications for surgical treatment are failure of conservative management or severe CTS. CTS is very important because of entrapment of the median nevre at the wrist is the most frequent focal neuropathy in humans and a common cause of pain in the forearm, particularly in women.
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