Diagnosis and Management of Carpal Tunnel Syndrome in Primary Care

Abstract

Karpālā kanāla sindroms, kas definēts kā vidusnerva kompresija plaukstas līmenī, ir viena no biežākām veselības problēmām, ko ārstē rokas ķirurgi. Šī patoloģija tika identificēta Otrā pasaules kara laikā. Protams, arī pirms tam šī slimība bija plaši pazīstama zem citiem nosaukumiem. [1] Pirmais tipiskos karpālā kanāla sindroma simptomus aprakstīja Džeimss Pedžets 1854.gadā – pacientiem ar distāliem spieķkaula lūzumiem. Pēc 80 gadiem, arī citi ārsti sāka aprakstīt Džeimsa Pedžeta aprakstīto veselības problēmu – tika atklāts, ka spieķkaula lūzums var novest pie vidusnerva kompresijas. 1938. gadā Mēršs pirmais noformulēja jēdzienu “karpālā kanāla sindroms”. [3] Galvenais iemesls, kāpēc nodefinēt karpālā kanāla sindromu bija tik grūti, bija saistīts ar to, ka šai slimībai ir multiplas etioloģijas un ļoti atšķirīgie patofizioloģiskie procesi, tāpēc ne vienmēr ir iespējams atrast saistību. Ar laiku, karpālā kanāla sindroms tika izpētīts sīkāk. Dotajā brīdī rietumu populācijās tiek novērots straujš aroda etioloģijas muskuloskeletālo slimību pieaugums, ko varētu izskaidrot ar lielu fizisko slodzi un atkārtotām roku kustībām. Vairāk kā 60% augšējo ekstremitāšu arodslimību ir saistītas ar karpālā kanāla sindromu. Tēmas aktualitāte: Karpālā kanāla sindromam ir augsta incidence rietumu populācijās. Aktuāls ir jautājums – kā ģimenes ārsts var diagnosticēt šo slimību klīniski un kādas ir karpālā kanāla sindroma klīniskās manifestācijas? Hipotēze: Klīniskie simptomi un pazīmes, kā arī pozitīvie provokācijas testi, ir pietiekoši, lai diagnosticētu karpālā kanāla sindromu primārajā aprūpē. Ģimenes ārstam nav nepieciešams veikt elektrofizioloģiskos izmeklējumus. Materiāli un metodes: Šajā literatūras aprakstā tikka izmantoti avoti kā PubMed, Mayo Clinic, E-žurnāli. Tika izmantoti arī tādi avoti kā Amboss un UpToDate. Rezultāti: Klīniskās pazīmes un simptomi ir pietiekoši, lai diagnosticētu karpālā kanāla sindromu, tomēr pēc klīniskajām pazīmēm vien nav iespējams noteikt, tieši cik nopietns ir bojājums un vai ir polineiropātija. Lai to noteiktu, nepieciešams veikt nervu vadītspējas ātruma testu (NCV).

INTRODUCTION

Carpal tunnel syndrome, defined as the compression of the median nerve at the wrist, is one of the most common conditions surgically treated by hand surgeons. This pathology was specifically identified during and after the years of World War II. Retrospectively, however, this condition did not appear suddenly at that time but was known under a variety of different names in the past. [1] Typical symptoms of CTS were firstly described by Sir James Paget in 1854 in patients who sustained fractures in the distal radius [1]. Around 80 years later, other physicians began to notice what Paget had described. They found the link that a radial fracture leads to a compression of the median nerve. [2] In 1938, the term “carpal tunnel syndrome” (CTS) was coined by Moersch, but it took a couple of articles written by George Phalen at the beginning of the 1950s to establish the name [3]. The reason it took so long to identify that condition was due to the reason that there are quite many aetiologies because the pathophysiology is different for each cause, so finding the connection is not always very obvious. [4] Over the years, the understanding of medicine widened up and led to more connection. Western populations are reporting a rise in the number of occupation-related musculoskeletal disorders. This link can be explained by an increased strain and repetitive movements by individuals. Europe has reported more than 60% of musculoskeletal disorders of upper limbs which were acknowledged and recognized as an occupational related cause for CTS. [5] Topicality of the research: Carpal tunnel syndrome has nowadays shown a high incidence in the western population. The question which is remaining: How can a family doctor diagnose that condition clinically and what are the different clinically manifestations of it. Hypothesis: The clinical features and symptoms, as well as positive signs are sufficient enough to state the diagnosis of CTS in a primary care setting. There is no further electrophysiological examination necessary. Materials and methods: In this literature review the research results are based on PubMed sources, Mayo Clinic, E-journals. As the university provides Internet pages such as Amboss and UpToDate, these sources have been taken into consideration as well, especially for clinical signs and treatment options. Results: The clinical signs and symptoms are enough to diagnose CTS although the clinical signs alone cannot indicate to which extent the damage was made and whether a polyneuropathy is present. For that a neuroconduction study is necessary.