询问城堡Connolly顶级医生：了解腕管综合症，从诊断到治疗

Carpal tunnel syndrome is a pinching or inflammation of the median nerve, the nerve that travels down the front of the forearm and wrist. It’s called a mixed nerve because it supplies sensation to three and a half fingers — typically the thumb, index, long, and ring fingers, and it provides muscle strength to the hand, particularly the thumb.

That nerve travels through a tunnel in the wrist before it goes to the muscles to supply strength and to the fingertips to give sensation. In that tunnel, the nerve can be compressed — it can be squeezed or irritated, and as a result, the nerve doesn't function normally anymore.

当中位神经被压缩或刺激时，功能会丧失，随着时间的流逝，这会变得越来越糟。腕管综合症的人can notice numbness, tingling, weakness, and pain.

It’s also common to lose dexterity when you have carpal tunnel syndrome. You may start to drop objects or have trouble with what we call fine manipulation, which is required for actions such as picking coins off a tabletop or closing a jewelry clasp.

如果您不与医生交谈或寻求治疗，那么问题往往会逐渐恶化，甚至可能变得不可逆转。当发生这种情况时，一个人可能会感到可怕的疼痛或麻木 - 感觉就像您的手在24/7的电插座上。最终，它可能是如此严重，以至于通常由这种神经随着时间的流逝或萎缩而收缩的肌肉实际上枯萎了，这时一个人将留下永久性的残疾。

腕管综合症发生时，腕隧道中的肌腱（将肌肉连接到骨头）肿胀并发炎时，就会发生腕管综合症，从而导致神经的空间较小。它会导致压缩。

Many people think of typing as the main cause of carpal tunnel syndrome, but that’s just one of several reasons someone can develop carpal tunnel syndrome. The most common reason for carpal tunnel syndrome is what we call idiopathic or spontaneous — it just happens.

有一些诱人的因素与患者患腕管综合征的风险增加有关。女性获得腕管综合症的可能性是男性的三倍以上，在更年期和怀孕期间，由于激素的波动如此之多，因此还有其他风险。

Sometimes, there seems to be a hereditary component to carpal tunnel syndrome — sometimes I will treat someone whose mother and grandmother both have it.

Other chronic conditions, including being overweight or obese, underlying inflammatory disease, such asgout，类风湿关节炎，甚至是骨关节炎的中位神经附近，甲状腺功能减退症（（low thyroid levels）和糖尿病都与腕管综合征的风险更高有关。

Some jobs or activities can increase the risk of carpal tunnel syndrome. Any repetitive motions or repetitive stress, including activities such as typing on a keyboard, gripping a steering wheel, or using power tools can cause inflammation of the tendons in the carpal tunnel, which, in turn, can lead to carpal tunnel syndrome.

腕管综合症是一种临床诊断，这意味着没有“是或否”测试，例如验血这可以立即告诉我们一个人是否有。诊断是通过将患者的症状与身体检查一起进行的。考试的一部分包括挑衅性测试 - 它们被称为挑衅性，因为我们试图挑衅symptoms of carpal tunnel syndrome。We do things like tap the inside of the wrist or ask patients to bend their wrist in order to bring about the symptoms that they’re noticing when they’re at home or at work.

After hearing the symptoms and performing the tests, we have a good sense of whether someone has carpal tunnel syndrome or perhaps another problem masquerading as carpal tunnel syndrome. These conditions can include a pinched nerve in the neck or forearm, or something called thoracic outlet syndrome, which is a pinched nerve between the neck and the underarm.

如果我们怀疑某人患有腕管综合征，我们会发送一项称为EMG（肌电图）的电诊断研究。这使用了一个惊人的设备，该设备可在千分之一秒内测量神经信号的速度。EMG测试可以揭示神经穿过手腕时的神经是否在放慢速度，或者脖子和手腕的放慢速度，这被称为双重粉碎综合症。

The test shows us if there’s a “traffic jam” in the signals. Is it harder for the nerve signals to get across the wrist because the nerve isn’t healthy, because it’s pinched, squeezed, or compressed? It’s like a garden hose — if it’s pinched or you step on it, the water in the hose slows down and there’s less water that comes out. In the same way, the nerve signal can get slowed down in carpal tunnel syndrome.

EMG可以确认腕管综合征诊断，确定严重程度的水平，并帮助我们确定哪种治疗方案是最好的。

一种更保守的非手术治疗可能适合仅在某些时间或活动中出现的间歇性问题的人。治疗可能包括诸如改变握持手腕或使用夹板的策略，以使腕部在睡觉或进行某些活动时保持直截了当。

For people with moderate carpal tunnel syndrome, we may need to use anti-inflammatory medicine such asNSAIDSor injectable or oral steroids to reduce inflammation and pain. Occupational therapy can also be used to improve symptoms and inflammation as well.

这些治疗通常在大多数轻度至中度腕管综合症患者中起作用，但有时在更严重的情况下需要手术。

有两种类型的手术 - 原始的开放技术，这是我们切开手腕并切割腕韧带，压在神经上以扩大腕管时。第二种是封闭技术，也称为内窥镜腕管手术。该手术的侵入性较小 - 它只需要使用薄工具和相机的小切口，我们只需切割韧带即可切割韧带，而无需切割所有组织即可触发韧带。

Both operations work well and heal with minimal scarring; by six months, the results of the surgeries are the same. There are advantages to the endoscopic approach — it involves less pain and heals faster, and you’re able to return to doing activities up to five times faster than with the open approach.

我让患者采用替代或非传统方法，例如针灸或脊骨疗法调整。这些治疗可能对轻度腕管综合症有帮助，但通常对更严重的病例没有好处。

新的治疗方法,试图解决腕管syndrome, like platelet rich plasma (PRT), amniotic fluid, or stem cells can be very expensive, and they don’t have the clinical evidence to demonstrate that they really make a difference.

一个人未经治疗的腕管综合症的越长，随着时间的推移会进展或恶化的可能性越大，从而增加了不可逆转或永久损害的风险。听你的身体。如果您开始经历腕管综合症的任何症状，请与您的医生交谈，以便采取适当的措施。好消息是，即使需要手术，在超过90％的情况下，症状得到了改善或完全解决问题。