{"id":1140,"date":"2023-04-07T07:00:14","date_gmt":"2023-04-07T00:00:14","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&#038;p=1140"},"modified":"2023-04-09T00:16:31","modified_gmt":"2023-04-08T17:16:31","slug":"hoi-chung-ong-co-tay","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/hoi-chung-ong-co-tay\/","title":{"rendered":"Carpal tunnel syndrome"},"content":{"rendered":"<h2>OUTLINE<\/h2>\n<h3>Define<\/h3>\n<p>\u1ed0ng c\u1ed5 tay l\u00e0 m\u1ed9t khoang k\u00edn c\u00f3 d\u00e2y <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/di-chung-ton-thuong-than-kinh-ngoai-bien-liet-than-kinh-quay-giua-tru\/\">th\u1ea7n kinh gi\u1eefa<\/a> v\u00e0 9 g\u00e2n g\u1ea5p \u0111i qua. Th\u00e0nh \u1ed1ng c\u1ed5 tay c\u1ee9ng, \u0111\u01b0\u1ee3c t\u1ea1o n\u00ean t\u1eeb x\u01b0\u01a1ng c\u1ed5 tay ph\u00eda sau v\u00e0 ph\u00eda tr\u01b0\u1edbc b\u1edfi d\u00e2y ch\u1eb1ng ngang \u1ed1ng c\u1ed5 tay kh\u00e1 d\u00e0y. Th\u1ec3 t\u00edch c\u1ee7a \u1ed1ng c\u1ed5 tay ch\u1ec9 v\u1eeba \u0111\u1ee7 ch\u1ee9a c\u00e1c th\u00e0nh ph\u1ea7n n\u1eb1m b\u00ean trong n\u00f3 n\u00ean ch\u1ec9 c\u1ea7n s\u1ef1 thu h\u1eb9p c\u1ee7a \u1ed1ng c\u1ed5 tay ho\u1eb7c t\u0103ng th\u00eam m\u1ed9t ph\u1ea7n n\u00e0o \u0111\u00f3 trong \u1ed1ng c\u1ed5 tay s\u1ebd t\u0103ng \u00e1p l\u1ef1c trong \u1ed1ng c\u1ed5 tay.<\/p>\n<p>Carpal tunnel syndrome is a disease that compresses the median nerve in the carpal tunnel causing paresthesia, pain, numbness, and areas innervated by the median nerve. The pathophysiology of the disease is not well understood, but it is thought to be caused by compression of the median nerve in the carpal tunnel.<\/p>\n<h3>Reason<\/h3>\n<ul>\n<li>The exact cause of the disease is unknown.<\/li>\n<li>B\u1ec7nh \u0111\u01b0\u1ee3c xem g\u00e2y ra b\u1edfi s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 di truy\u1ec1n v\u00e0 m\u00f4i tr\u01b0\u1eddng. M\u1ed9t s\u1ed1 c\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng bao g\u1ed3m: b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng, b\u00e9o ph\u00ec, mang thai, suy gi\u00e1p, v\u00e0 c\u00f4ng vi\u1ec7c lao \u0111\u1ed9ng n\u1eb7ng ho\u1eb7c l\u00e0m vi\u1ec7c v\u1edbi c\u00e1c c\u00f4ng c\u1ee5 rung. C\u00e1c r\u1ed1i lo\u1ea1n kh\u00e1c nh\u01b0 vi\u00eam bao ho\u1ea1t d\u1ecbch v\u00e0 <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/viem-gan-calci-hoa-khop-vai\/\">vi\u00eam g\u00e2n<\/a> c\u00f3 li\u00ean quan \u0111\u1ebfn chuy\u1ec3n \u0111\u1ed9ng l\u1eb7p \u0111i l\u1eb7p l\u1ea1i th\u1ef1c hi\u1ec7n trong qu\u00e1 tr\u00ecnh l\u00e0m vi\u1ec7c b\u00ecnh th\u01b0\u1eddng ho\u1eb7c c\u00e1c ho\u1ea1t \u0111\u1ed9ng kh\u00e1c.<\/li>\n<\/ul>\n<p><strong>1. Increased capacity in the wrist, possibly due to<\/strong><\/p>\n<ul>\n<li>Ph\u00f9 ho\u1eb7c d\u00e0y c\u1ee7a bao ho\u1ea1t d\u1ecbch g\u00e2n g\u1ea5p nh\u01b0: <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/benh-ly-viem-bao-gan\/\">vi\u00eam bao g\u00e2n<\/a> g\u1ea5p (vi\u00eam th\u1ea5p, ch\u1ea5n th\u01b0\u01a1ng, lao,\u2026) u s\u1ee5n.<\/li>\n<li>Edema due to trauma, infection, metabolic disorder, etc.<\/li>\n<li>Injury in the space: lymph nodes, forming <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/u-xuong-va-phan-mem\/\">bone tumor<\/a>, abnormal bulges inside or outside the muscle (worm muscle II, superficial flexion II, deep palmar).<\/li>\n<li>Tophy of gout, calcium deposition,\u2026<\/li>\n<li>Hemophilia, leukemia.<\/li>\n<\/ul>\n<p><strong>2. Reducing the size of the carpal tunnel in the body is<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/viem-xuong-tuy\/\">Inflammation of the bone<\/a> joints, semilunar dislocation, Colles fracture, etc.<\/li>\n<li>Wrist fracture<\/li>\n<li>Fracture of the lower end of the radial bone, the bone is displaced anteriorly, or <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/so-cuu-bat-dong-gay-xuong\/\">motionless<\/a> Wrist posture can cause compression of the median nerve<\/li>\n<li>Direct pressure from crutches or canes<\/li>\n<li>The choroid holds the flexor tendon due to: powdery degeneration, acromegaly<\/li>\n<li>Congenital stenosis of the cervical canal<\/li>\n<\/ul>\n<h3>Classify<\/h3>\n<p>There is no specific classification, but according to Acta Neurologica Scandinavica. Carpal tunnel syndrome can be divided into five categories:<\/p>\n<p><strong>table 27.1.\u00a0<\/strong>Classification of carpal tunnel syndrome<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"77\">\n<p><strong>Grading<\/strong><\/p>\n<\/td>\n<td width=\"490\">\n<p><strong>Expression sign<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"77\">\n<p>Very heavy<\/p>\n<\/td>\n<td width=\"490\">\n<p>Loss of motor and sensory responses of the median nerve<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"77\">\n<p>Heavy<\/p>\n<\/td>\n<td width=\"490\">\n<p>Loss of sensory response, abnormal distal dynamic latency (DML)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"77\">\n<p>Medium<\/p>\n<\/td>\n<td width=\"490\">\n<p>Distant dynamic latency (DML) and sensory conduction velocity abnormalities (CNCV)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"77\">\n<p>Light<\/p>\n<\/td>\n<td width=\"490\">\n<p>Normal distal dynamic latency (DML), abnormal sensory conduction velocity (CNCV)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"77\">\n<p>Very light<\/p>\n<\/td>\n<td width=\"490\">\n<p>Abnormal distal to proximal hand ratio, other tests normal<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3>ASSESSMENT OF PATIENTS<\/h3>\n<p><strong><a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/khai-thac-benh-su-va-tien-can-benh-ly-ngoai-chan-thuong\/\">Medical history<\/a><\/strong><\/p>\n<p>T\u00ea tay l\u00e0 d\u1ea5u hi\u1ec7u ch\u1ee7 y\u1ebfu \u0111\u1ea7u ti\u00ean, t\u00ea nhi\u1ec1u hay \u00edt t\u00f9y theo m\u1ee9c \u0111\u1ed9 ch\u00e8n \u00e9p tr\u00ean th\u1ea7n kinh gi\u1eefa. B\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m c\u1ea3m gi\u00e1c \u1edf m\u1eb7t l\u00f2ng c\u00e1c <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-ban-ngon-tay-gay-xuong-ban-tay\/\">ng\u00f3n tay<\/a> c\u00e1i, tr\u1ecf v\u00e0 gi\u1eefa. L\u00fac \u0111\u1ea7u ch\u1ec9 t\u00ea m\u1ed9t l\u00fac v\u00e0o bu\u1ed5i s\u00e1ng sau khi th\u1ee9c d\u1eady, \u0111\u1ea9y c\u00e1c kh\u1ed1i n\u1eb7ng hay l\u00e1i xe g\u1eafn m\u00e1y r\u1ed3i sau \u0111\u00f3 t\u00ea tay li\u00ean t\u1ee5c su\u1ed1t ng\u00e0y, k\u00e8m theo c\u1ea3m gi\u00e1c t\u00ea tay l\u00e0 c\u1ea3m gi\u00e1c kim ch\u00e2m nh\u00e8 nh\u1eb9 \u1edf \u0111\u1ea7u c\u00e1c ng\u00f3n tay. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, b\u1ec7nh nh\u00e2n s\u1ebd m\u1ea5t d\u1ea7n c\u1ea3m gi\u00e1c ti\u1ebfp x\u00fac v\u00e0 nh\u1eadn bi\u1ebft c\u00e1c v\u1eadt th\u1ec3 c\u1ea7m n\u1eafm \u0111\u1ebfn m\u1ee9c l\u00e0m r\u01a1i mu\u1ed7ng, \u0111\u0169a khi \u0103n.<\/p>\n<p>The thumb is gradually weakened due to reduced movement of the maggot muscle group in the counter-finger movements, but in the early stages, the patient does not notice it, and in the later stages, the humerus is clearly atrophied.<\/p>\n<p>Clinical examination<\/p>\n<ul>\n<li>Look for Tinel&#039;s sign on the median nerve at the wrist: taping the median nerve is positive if the patient feels electrical currents in the median nerve supply (spinning or pain), this test is positive. In 15 \u2013 30% cases, negative results cannot rule out carpal tunnel syndrome.<\/li>\n<\/ul>\n<ul>\n<li>Find the feeling of vibration with frequency 256, 128, 32 Hz using tuning fork. The disease is more severe if the sensation is reduced with low frequency.<\/li>\n<li>Look for signs of decreased ability to distinguish two points on the same lobe.<\/li>\n<li>Look for Phallen&#039;s sign: let the patient flex the wrist for 30-60 seconds causing pain or numbness in the neck This test is positive in 70-80% cases.<\/li>\n<\/ul>\n<p>Subclinical<\/p>\n<ul>\n<li>Conduct clinical trials including:<\/li>\n<\/ul>\n<p>+ Capture <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/x-quang-trong-chan-thuong-chinh-hinh\/\">X-ray<\/a>: <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/chan-thuong-cot-song-co\/\">cervical spine<\/a> four postures<\/p>\n<p>+ Electromyography EMG (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromyography\" target=\"_blank\" rel=\"noopener\">electromyography<\/a>):<\/p>\n<ul>\n<li>It is very necessary for patients with suspected carpal tunnel syndrome, it is both valuable in diagnosis, legal, surgical indication and postoperative follow-up.<\/li>\n<li>Normal motor conduction &lt; 4.4 milliseconds\n<ul>\n<li>5 milliseconds: moderate nerve damage<\/li>\n<li>6 milliseconds: surgical indication is required<\/li>\n<\/ul>\n<\/li>\n<li>Sensory conduction is slow, and when sensory action potentials are abundant, the indication is more delicate than motor transmission.<\/li>\n<\/ul>\n<p>Upper limit of normal conduction # 4 milliseconds. Lower limit of normal potential # 8 milliseconds.<\/p>\n<h3>DIAGNOSE<\/h3>\n<p><strong>Defined criteria<\/strong>: clinical examination + electromyography. X-rays of the cervical spine are necessary to rule out carpal tunnel syndrome, where cervical nerve roots are compressed due to foramen stenosis.<\/p>\n<p><strong>Diagnose the cause<\/strong>: usually not needed because the specific cause of carpal tunnel syndrome is unknown.<\/p>\n<p><strong>Differential diagnosis<\/strong><\/p>\n<p>There are diseases, patients also have symptoms similar to carpal tunnel syndrome:<\/p>\n<ul>\n<li>Spine diseases: cervical spondylosis, herniated discs, vertebral body tumors, etc.<\/li>\n<li>Peripheral neuropathy: peripheral neuritis (due to history of diabetes and elevated blood sugar)<\/li>\n<li><a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/viem-xuong-tuy\/\">Arthritis<\/a> Fingers (pain with joint movement)<\/li>\n<li>Rotator cuff tendon bursitis (pain near base of thumb)<\/li>\n<li>Medial nerve compression at the elbow (weak wrist flexion)<\/li>\n<li>Hypothyroidism<\/li>\n<li>Carpal synovial cyst (with tumor of the base of toe I).<\/li>\n<\/ul>\n<h2>TREATMENT<\/h2>\n<h3>Purpose<\/h3>\n<p>Restoring movement and feeling of damaged limbs, in order to bring the highest efficiency to help patients soon recover daily activities with optimal quality of life.<\/p>\n<h3>Rule\u00a0<\/h3>\n<ul>\n<li>Once carpal tunnel syndrome has been identified, it should be treated immediately because if left for too long, the damage to the median nerve is difficult to recover.<\/li>\n<li>Depending on the time of the injury, there is an appropriate treatment method<\/li>\n<li>No further damage.<\/li>\n<\/ul>\n<h3>Specific treatment<\/h3>\n<p>In the early stages, the disease is mild, only need to wear a wrist brace at night for 2 months, the drug only supports the natural recovery including group B vitamins, ATP and calcium.<\/p>\n<p>In the later stages, surgery is required. If the disease is not long, it is enough to open the carpal tunnel, cut the ring ligament and release the median nerve, but if the disease has been around for a long time, especially if there has been atrophy of the female muscles, the nerve sheath is fibrous, it is necessary to peel and cut the outer envelope. The classic incision on the front of the wrist will create an invisible scar as it heals<\/p>\n<p><strong>1. Indications for surgery<\/strong><\/p>\n<ul>\n<li>Symptoms do not reduce with conservative treatment, splints 2-4 weeks, restricts movement for one month<\/li>\n<li>Pain several times a day<\/li>\n<li>Partial atrophy of the gynaecomastia<\/li>\n<li>Suspected tumor compressing the wrist: lipoma or neuromas<\/li>\n<li>Electromyography severity.<\/li>\n<\/ul>\n<p><strong>2. Surgical technique<\/strong><\/p>\n<p>Local anesthetic, garrot. There are two methods of surgery:<\/p>\n<p><em><strong>Open surgery<\/strong><\/em><\/p>\n<p>- The incision: depends on the surgeon. Usually one of the following three incisions is used:<\/p>\n<p>+ Classic skin incision: following the humeral fold down to the wrist crease, bend the ulnar angle to avoid damaging the palmar branch of the median nerve that distributes the palmar surface, this branch is usually located between the palmar long arm and the neck flexion. hand crank, if damage to the branch will reduce the sensation of the mound.<\/p>\n<p>+ Skin incision L: skin incision parallel to the crease of the mound (usually the line between the 3rd and 4th fingers) to the wrist crease, making a horizontal incision of 1 cm inclined the cylinder.<\/p>\n<p>+ The incision across the wrist crease is 1-2 cm depending on the surgeon.<\/p>\n<p>When examining the median nerve, if there is stenosis or surrounding fibrous tissue, the fibrous tissue should be dissected. In most cases, decompression of the median nerve by transverse ligament ablation is sufficient to improve microcirculation. However, in cases of fibrosis, the inner nerve fibers are still compressed in the fiber bundles. Nerve sheath dissection produces a significant injury to the nerve fiber such as microbleeding, edema, scarring, and microcirculation changes.<\/p>\n<p>In addition, it is very easy to cut into the structure that they form bridges between adjacent fiber bundles. Curis and Everomann (1973) recommend sheath dissection when patients have persistent sensory loss and muscle atrophy. According to the author<a href=\"https:\/\/en.wikipedia.org\/wiki\/Fran%C3%A7ois_Braun\" target=\"_blank\" rel=\"noopener\"> F. Marin. Braun<\/a> It is recommended that when there is atrophy of the gynaecomastia, examine the nerve division with a magnifying glass.<\/p>\n<p><em><strong>Endoscopic: <\/strong><\/em>Make a small incision to insert the endoscope to view the transverse ligament and cut.<\/p>\n<p><strong>3. Complications after surgery<\/strong><\/p>\n<ul>\n<li>Injury caused by the physician injuring the median nerve, cutting into the palmar branch or the recurrent branch of the female tissue<\/li>\n<li>Carpal tunnel decompression is not completely prone to recurrence<\/li>\n<li>Surgical wound complications<\/li>\n<\/ul>\n<p>+ Infections<\/p>\n<p>+ Open incision<\/p>\n<p>+ Incision pain due to the dermal branch being attached to the surgical scar, painful keloids, and shrinkage scars from the incisions perpendicular to the wrist crease.<\/p>\n<ul>\n<li>Weakness in handling heavy objects<\/li>\n<li>Stiffness in fingers and wrists<\/li>\n<li>Burning sympathetic dystrophy due to frequent effects from minor trauma of the median nerve<\/li>\n<li>Recurrent carpal tunnel syndrome due to perineural fibrosis and synovial hyperplasia<\/li>\n<li>The flexor tendon loses its fulcrum like the bowstring.<\/li>\n<\/ul>\n<h3>FOLLOW-UP EXAMINATION<\/h3>\n<ul>\n<li>Days 1 and 2: The patient is hospitalized with his arms hanging high until the pain is gone and the edema is reduced, and begins to exercise the fingers.<\/li>\n<li>Weeks 1 and 2: Wrist splint 2 weeks. Should not be left free, tired arms can be removed several times a day and exercise shoulder and elbow exercises.<\/li>\n<li>Weeks 3 and 4: place a firm bandage on the wrist, allowing only light movements.<\/li>\n<li>Weeks 5 and 8: Can do light work without lifting heavy objects or repetitive tasks for up to 3 months.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>","protected":false},"featured_media":1312,"comment_status":"open","ping_status":"closed","template":"","tags":[95],"chuyen-muc":[61],"class_list":["post-1140","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-ong-co-tay","chuyen-muc-benh-ly"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1140","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang"}],"about":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/types\/bai-giang"}],"replies":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/comments?post=1140"}],"version-history":[{"count":0,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1140\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/1312"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=1140"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=1140"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=1140"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}