{"id":2069,"date":"2023-07-04T10:00:48","date_gmt":"2023-07-04T03:00:48","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&#038;p=2069"},"modified":"2023-07-31T18:25:11","modified_gmt":"2023-07-31T11:25:11","slug":"di-chung-ton-thuong-than-kinh-ngoai-bien-liet-than-kinh-quay-giua-tru","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/di-chung-ton-thuong-than-kinh-ngoai-bien-liet-than-kinh-quay-giua-tru\/","title":{"rendered":"D\u1ecb ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i bi\u00ean, li\u1ec7t th\u1ea7n kinh quay-gi\u1eefa-tr\u1ee5"},"content":{"rendered":"<h2><strong>DEFINE<\/strong><\/h2>\n<p>Di ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean l\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng <a href=\"https:\/\/bsvothanhtoan.com\/en\/gioi-thieu\/\">th\u1ea7n kinh ngo\u1ea1i bi\u00ean<\/a> ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb hay \u0111i\u1ec1u tr\u1ecb kh\u00f4ng hi\u1ec7u qu\u1ea3 \u0111\u1ec3 l\u1ea1i c\u00e1c khi\u1ebfm khuy\u1ebft v\u1ec1 v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c sau 3 th\u00e1ng (k\u1ec3 t\u1eeb l\u00fac t\u1ed5n th\u01b0\u01a1ng).<\/p>\n<h2><strong>DIAGNOSE<\/strong><\/h2>\n<h3><strong>clinical<\/strong><\/h3>\n<ul>\n<li>H\u1ecfi b\u1ec7nh<\/li>\n<\/ul>\n<p>+ <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/khai-thac-benh-su-va-tien-can-benh-ly-ngoai-chan-thuong\/\">Reason for admission<\/a>: r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c? Li\u1ec7t? Teo c\u01a1?<\/p>\n<p>+ <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/khai-thac-benh-su-va-tien-can-benh-ly-ngoai-chan-thuong\/\">Medical history<\/a>: th\u1eddi gian xu\u1ea5t hi\u1ec7n b\u1ec7nh, tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean, t\u00ednh ch\u1ea5t tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u0169, ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh, t\u00ecnh tr\u1ea1ng hi\u1ec7n t\u1ea1i<\/p>\n<p>+ Ti\u1ec1n s\u1eed: \u0111\u1eb7c \u0111i\u1ec3m ngh\u1ec1 nghi\u1ec7p, th\u00f3i quen sinh ho\u1ea1t, ti\u1ec1n s\u1eed ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n<ul>\n<li>V\u1eadn \u0111\u1ed9ng<\/li>\n<\/ul>\n<p>+ Y\u1ebfu hay li\u1ec7t c\u00e1c c\u01a1 v\u00f9ng th\u1ea7n kinh chi ph\u1ed1i + S\u1ee9c c\u01a1 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u1eeb M0 \u0111\u1ebfn M5.<\/p>\n<ul>\n<li>C\u1ea3m gi\u00e1c<\/li>\n<\/ul>\n<p>+ Gi\u1ea3m, r\u1ed1i lo\u1ea1n hay m\u1ea5t c\u1ea3m gi\u00e1c v\u00f9ng th\u1ea7n kinh chi ph\u1ed1i<\/p>\n<p>+ C\u1ea3m gi\u00e1c \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u1eeb S0 \u0111\u1ebfn S4 (theo Hi\u1ec7p h\u1ed9i Ph\u1eabu thu\u1eadt th\u1ea7n kinh Hoa K\u1ef3). &#8211;\u00a0 Kh\u00e1m d\u1ea5u Tinel.<\/p>\n<p>X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed th\u1ea7n kinh b\u1ecb t\u1ed5n th\u01b0\u01a1ng hay x\u00e1c \u0111\u1ecbnh s\u1ef1 ph\u1ee5c h\u1ed3i lu\u1ed3ng th\u1ea7n kinh sau kh\u00e2u n\u1ed1i.<\/p>\n<h3><strong>Subclinical<\/strong><\/h3>\n<ul>\n<li><a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/x-quang-trong-chan-thuong-chinh-hinh\/\">X-ray<\/a>: gi\u00fap ph\u00e1t hi\u1ec7n <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-kin\/\">fracture<\/a>, can x\u01b0\u01a1ng ho\u1eb7c c\u00e1c b\u1ea5t th\u01b0\u1eddng kh\u00e1c c\u1ee7a x\u01b0\u01a1ng g\u00e2y ch\u00e8n \u00e9p th\u1ea7n kinh<\/li>\n<li>MRI: trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, MRI gi\u00fap ph\u00e1t hi\u1ec7n m\u1ed9t s\u1ed1 t\u1ed5 ch\u1ee9c kh\u00f4ng c\u1ea3n quang t\u00ecnh tr\u1ea1ng ch\u00e8n \u00e9p th\u1ea7n kinh (u m\u1ee1, u h\u1ea1ch, ph\u00ecnh m\u1ea1ch,\u2026)<\/li>\n<li>Kh\u1ea3o s\u00e1t ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n: \u0111i\u1ec7n c\u01a1 \u0111\u1ed3 (EMG) v\u00e0 kh\u1ea3o s\u00e1t d\u1eabn truy\u1ec1n th\u1ea7n kinh gi\u00fap x\u00e1c \u0111\u1ecbnh th\u1ea7n kinh b\u1ecb t\u1ed5n th\u01b0\u01a1ng, \u0111\u1ecbnh khu v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng v\u00e0 gi\u00fap theo d\u00f5i qu\u00e1 tr\u00ecnh h\u1ed3i ph\u1ee5c c\u1ee7a th\u1ea7n kinh. Th\u01b0\u1eddng k\u1ebft qu\u1ea3 kh\u1ea3o s\u00e1t ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n v\u1eabn b\u00ecnh th\u01b0\u1eddng trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a b\u1ec7nh.<\/li>\n<\/ul>\n<h3><strong>L\u01b0\u1ee3ng gi\u00e1 ch\u1ee9c n\u0103ng<\/strong><\/h3>\n<p>L\u01b0\u1ee3ng gi\u00e1 ch\u1ee9c n\u0103ng chi tr\u00ean c\u1ee7a b\u1ec7nh nh\u00e2n b\u1eb1ng b\u1ed9 c\u00e2u h\u1ecfi DASH (Disabilities of Arm, Shoulder and Hand). B\u1ed9 c\u00e2u h\u1ecfi n\u00e0y \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng sinh ho\u1ea1t h\u1eb1ng ng\u00e0y c\u00f3 s\u1eed d\u1ee5ng tay v\u00e0 m\u1ee9c \u0111\u1ed9 \u1ea3nh h\u01b0\u1edfng c\u1ee7a tay b\u1ec7nh \u0111\u1ebfn c\u00f4ng vi\u1ec7c v\u00e0 c\u00e1c ho\u1ea1t \u0111\u1ed9ng th\u1ec3 thao, ngh\u1ec7 thu\u1eadt. B\u1ec7nh nh\u00e2n tr\u1ea3 l\u1eddi c\u00e1c c\u00e2u h\u1ecfi d\u1ef1a v\u00e0o c\u00e1c ho\u1ea1t \u0111\u1ed9ng th\u1ef1c t\u1ebf c\u1ee7a h\u1ecd trong 1 tu\u1ea7n tr\u01b0\u1edbc \u0111\u00f3. M\u1ed7i ho\u1ea1t \u0111\u1ed9ng s\u1ebd \u0111\u01b0\u1ee3c cho \u0111i\u1ec3m t\u1eeb 1 \u0111\u1ebfn 5 t\u00f9y v\u00e0o m\u1ee9c \u0111\u1ed9 kh\u00f3 kh\u0103n khi th\u1ef1c hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng \u0111\u00f3. S\u1eed d\u1ee5ng c\u00f4ng th\u1ee9c cho s\u1eb5n \u0111\u1ec3 t\u00ednh ch\u1ec9 s\u1ed1 DASH, t\u1eeb \u0111\u00f3 l\u01b0\u1ee3ng gi\u00e1 \u0111\u01b0\u1ee3c m\u1ee9c \u0111\u1ed9 gi\u1ea3m kh\u1ea3 n\u0103ng s\u1eed d\u1ee5ng chi tr\u00ean c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<h3><strong>Ph\u00e2n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng<\/strong><\/h3>\n<p>C\u00e1c di ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i bi\u00ean th\u01b0\u1eddng g\u1eb7p:<\/p>\n<ul>\n<li>C\u0103ng gi\u00e3n th\u1ea7n kinh<\/li>\n<li>Ch\u00e8n \u00e9p th\u1ea7n kinh<\/li>\n<li>\u0110\u1ee9t th\u1ea7n kinh \u0111i\u1ec1u tr\u1ecb kh\u00f4ng hi\u1ec7u qu\u1ea3 hay ch\u01b0a \u0111i\u1ec1u tr\u1ecb<\/li>\n<li>M\u1ea5t \u0111o\u1ea1n th\u1ea7n kinh<\/li>\n<li>D\u1eadp nh\u1ed5 ngu\u1ed3n th\u1ea7n kinh \u1edf \u0111\u1ea7u g\u1ea7n th\u1ea7n kinh b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/li>\n<\/ul>\n<h4>Ph\u00e2n lo\u1ea1i c\u1ee7a Seddon: ba m\u1ee9c \u0111\u1ed9<\/h4>\n<ul>\n<li>\u0110\u1ed9 1: M\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh<\/li>\n<li>\u0110\u1ed9 2: \u0110\u1ee9t s\u1ee3i tr\u1ee5c th\u1ea7n kinh- \u0110\u1ed9 3: \u0110\u1ee9t d\u00e2y th\u1ea7n kinh.<\/li>\n<\/ul>\n<h4>Ph\u00e2n lo\u1ea1i theo Sunderland: n\u0103m m\u1ee9c \u0111\u1ed9<\/h4>\n<ul>\n<li>\u0110\u1ed9 1: M\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh<\/li>\n<li>\u0110\u1ed9 2: \u0110\u1ee9t s\u1ee3i tr\u1ee5c th\u1ea7n kinh<\/li>\n<li>\u0110\u1ed9 3: \u0110\u1ee9t d\u00e2y th\u1ea7n kinh, bao b\u00f3 s\u1ee3i c\u00f2n nguy\u00ean<\/li>\n<li>\u0110\u1ed9 4: \u0110\u1ee9t d\u00e2y th\u1ea7n kinh, bao b\u00f3 s\u1ee3i c\u0169ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng- \u0110\u1ed9 5: D\u00e2y th\u1ea7n kinh b\u1ecb \u0111\u1ee9t ho\u00e0n to\u00e0n.<\/li>\n<\/ul>\n<h4>So s\u00e1nh ph\u00e2n lo\u1ea1i Seddon v\u00e0 Sunderland<\/h4>\n<p><strong>B\u1ea3ng 23.1. <\/strong>So s\u00e1nh ph\u00e2n lo\u1ea1i Seddon v\u00e0 Sunderland<\/p>\n<table width=\"592\">\n<tbody>\n<tr>\n<td width=\"399\">\n<p><strong>Seddon<\/strong><\/p>\n<\/td>\n<td width=\"194\">\n<p><strong>Sunderland<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"399\">\n<p>M\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh<\/p>\n<\/td>\n<td width=\"194\">\n<p>I<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"399\">\n<p>\u0110\u1ee9t s\u1ee3i tr\u1ee5c th\u1ea7n kinh<\/p>\n<\/td>\n<td width=\"194\">\n<p>II<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><strong>SYMPTOMS<\/strong><\/h2>\n<ul>\n<li>Wound infection<\/li>\n<li>Bung ch\u1ec9 n\u1ed1i th\u1ea7n kinh<\/li>\n<li>Kh\u00f4ng ph\u1ee5c h\u1ed3i th\u1ea7n kinh<\/li>\n<li>Bung ch\u1ec9 kh\u00e2u g\u00e2n c\u01a1<\/li>\n<li>C\u01a1 chuy\u1ec3n b\u1ecb y\u1ebfu hay qu\u00e1 c\u0103ng.<\/li>\n<\/ul>\n<p>S\u01a0 \u0110\u1ed2\u00a0<\/p>\n<h2>NGUY\u00caN T\u1eaeC PH\u1ee4C H\u1ed2I CH\u1ee8C N\u0102NG V\u00c0 \u0110I\u1ec0U TR\u1eca<\/h2>\n<h3><strong>The principles of treatment <\/strong><\/h3>\n<p>&#8211; T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i bi\u00ean n\u00f3i chung \u0111\u01b0\u1ee3c chia th\u00e0nh ba m\u1ee9c \u0111\u1ed9 n\u1eb7ng kh\u00e1c nhau theo Seddon. Th\u00e1i \u0111\u1ed9 x\u1eed tr\u00ed ph\u1ee5 thu\u1ed9c nhi\u1ec1u v\u00e0o m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng:<\/p>\n<p>+ \u0110\u1ed9 1: \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, th\u01b0\u1eddng h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n<\/p>\n<p>+ \u0110\u1ed9 2: \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n l\u00e0 l\u1ef1a ch\u1ecdn ban \u0111\u1ea7u. N\u1ebfu kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u ph\u1ee5c h\u1ed3i th\u1ea7n kinh sau m\u1ed9t th\u1eddi gian \u0111i\u1ec1u tr\u1ecb th\u00ec ngh\u0129 \u0111\u1ebfn ph\u1eabu thu\u1eadt th\u0103m d\u00f2 v\u00e0 \u0111i\u1ec1u tr\u1ecb. Th\u01b0\u1eddng b\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c kh\u00f4ng ho\u00e0n to\u00e0n<\/p>\n<p>+ \u0110\u1ed9 3: Ph\u1eabu thu\u1eadt l\u00e0 b\u1eaft bu\u1ed9c. Th\u1ea7n kinh s\u1ebd kh\u00f4ng h\u1ed3i ph\u1ee5c n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt n\u1ed1i th\u1ea7n kinh. Qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i ph\u1ee5 thu\u1ed9c nhi\u1ec1u v\u00e0o ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt v\u00e0 kh\u1ea3 n\u0103ng t\u00e1i ph\u00e2n ph\u1ed1i th\u1ea7n kinh sau ph\u1eabu thu\u1eadt.<\/p>\n<h3><strong>Nguy\u00ean t\u1eafc ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng \u0111\u1ed1i v\u1edbi th\u1ea7n kinh b\u1ecb t\u1ed5n th\u01b0\u01a1ng do ch\u1ea5n th\u01b0\u01a1ng<\/strong><\/h3>\n<p>&#8211; Giai \u0111o\u1ea1n c\u1ea5p: ngay sau ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c sau ph\u1eabu thu\u1eadt:<\/p>\n<p>+ <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/so-cuu-bat-dong-gay-xuong\/\">Motionless<\/a> chi t\u1ed5n th\u01b0\u01a1ng: th\u1eddi gian t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt<\/p>\n<p>+ V\u1eadn \u0111\u1ed9ng: t\u1ea7n su\u1ea5t v\u00e0 c\u01b0\u1eddng \u0111\u1ed9 t\u1eadp c\u0169ng ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt<\/p>\n<p>+ Mang m\u00e1ng th\u1ea7n kinh nh\u1eb1m d\u1ef1 ph\u00f2ng bi\u1ebfn d\u1ea1ng<\/p>\n<p>+ T\u01b0 v\u1ea5n cho b\u1ec7nh nh\u00e2n bi\u1ebft c\u00e1ch b\u1ea3o v\u1ec7 an to\u00e0n cho v\u00f9ng th\u01b0\u01a1ng t\u1ed5n, \u0111\u1eb7c bi\u1ec7t l\u00e0 sau ph\u1eabu thu\u1eadt n\u1ed1i th\u1ea7n kinh. Tr\u00e1nh g\u00e2y t\u1ed5n th\u01b0\u01a1ng cho v\u00f9ng chi b\u1ecb m\u1ea5t c\u1ea3m gi\u00e1c &#8211; Giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c: khi c\u00f3 d\u1ea5u hi\u1ec7u t\u00e1i chi ph\u1ed1i th\u1ea7n kinh:<\/p>\n<p>+ T\u00e1i r\u00e8n luy\u1ec7n v\u1eadn \u0111\u1ed9ng: t\u1eadp m\u1ea1nh c\u01a1 theo ch\u01b0\u01a1ng tr\u00ecnh t\u0103ng ti\u1ebfn<\/p>\n<p>+ Gi\u1ea3m t\u00ecnh tr\u1ea1ng t\u0103ng c\u1ea3m gi\u00e1c: qu\u00e1 tr\u00ecnh t\u00e1i chi ph\u1ed1i th\u1ea7n kinh th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi t\u00ecnh tr\u1ea1ng t\u0103ng c\u1ea3m gi\u00e1c. Cho b\u1ec7nh nh\u00e2n ti\u1ebfp x\u00fac v\u1edbi nhi\u1ec1u v\u1eadt l\u00e0m b\u1eb1ng ch\u1ea5t li\u1ec7u kh\u00e1c nhau \u0111\u1ec3 gi\u1ea3m t\u00ecnh tr\u1ea1ng tr\u00ean<\/p>\n<p>+ T\u00e1i r\u00e8n luy\u1ec7n c\u1ea3m gi\u00e1c: gi\u00fap b\u1ec7nh nh\u00e2n h\u1ecdc c\u00e1ch nh\u1eadn bi\u1ebft \u0111\u1ed3 v\u1eadt khi s\u1edd.<\/p>\n<p>&#8211; Giai \u0111o\u1ea1n m\u1ea1n t\u00ednh: qu\u00e1 tr\u00ecnh t\u00e1i chi ph\u1ed1i th\u1ea7n kinh \u0111\u00e3 \u0111\u1ea1t \u0111\u1ec9nh, m\u1ed9t s\u1ed1 ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i th\u00eam \u0111\u01b0\u1ee3c n\u1eefa.<\/p>\n<p>+ Ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5 ch\u1ec9nh h\u00ecnh \u0111\u1ec3 d\u1ef1 ph\u00f2ng co r\u00fat g\u00e2n c\u01a1<\/p>\n<p>+ S\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5 tr\u1ee3 gi\u00fap cho chi tr\u00ean trong c\u00e1c ho\u1ea1t \u0111\u1ed9ng sinh ho\u1ea1t h\u1eb1ng ng\u00e0y + D\u1ef1 ph\u00f2ng t\u1ed5n th\u01b0\u01a1ng cho v\u00f9ng chi b\u1ecb gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c.<\/p>\n<h2><strong>\u0110I\u1ec0U TR\u1eca PH\u1eaaU THU\u1eacT<\/strong><\/h2>\n<p>T\u00f9y theo nguy\u00ean nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh m\u00e0 c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u00e0y th\u01b0\u1eddng khi m\u1ed5 ph\u1eabu thu\u1eadt vi\u00ean m\u1edbi quy\u1ebft \u0111\u1ecbnh \u0111\u01b0\u1ee3c. Do \u0111\u00f3, c\u1ea7n chu\u1ea9n b\u1ecb v\u00e0i ph\u01b0\u01a1ng \u00e1n tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb.<\/p>\n<h3><strong>Gi\u1ea3i c\u0103ng th\u1ea7n kinh, chuy\u1ec3n \u0111\u01b0\u1eddng \u0111i th\u1ea7n kinh \u0111\u1ec3 gi\u1ea3m \u0111\u1ed9 c\u0103ng<\/strong><\/h3>\n<p>Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u00e1p d\u1ee5ng cho c\u00e1c t\u1ed5n th\u01b0\u01a1ng l\u00e0m c\u0103ng d\u00e2y th\u1ea7n kinh nh\u01b0 v\u1eb9o khu\u1ef7u ra ngo\u00e0i do di ch\u1ee9ng g\u00e3y tr\u00ean hai l\u1ed3i c\u1ea7u, ch\u00e8n \u00e9p x\u01b0\u01a1ng g\u00e3y hay can x\u01b0\u01a1ng, \u0111\u01b0a \u0111\u1ebfn r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n, n\u1eb7ng n\u1ec1 h\u01a1n l\u00e0m x\u01a1 bao s\u1ee3i th\u1ea7n kinh.<\/p>\n<h3><strong>Gi\u1ea3i \u00e9p th\u1ea7n kinh b\u1ecb ch\u00e8n \u00e9p<\/strong><\/h3>\n<p>Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u00e1p d\u1ee5ng cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1ea7n kinh b\u1ecb ch\u00e8n \u00e9p t\u1eeb c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu b\u00ean ngo\u00e0i nh\u01b0 d\u00e2y ch\u1eb1ng, can x\u01b0\u01a1ng, s\u1eb9o co r\u00fat,\u2026<\/p>\n<h3><strong>Kh\u00e2u n\u1ed1i l\u1ea1i th\u1ea7n kinh<\/strong><\/h3>\n<p>S\u1eed d\u1ee5ng cho c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u1ee9t th\u1ea7n kinh ch\u01b0a n\u1ed1i hay \u0111\u00e3 n\u1ed1i r\u1ed3i nh\u01b0ng sau th\u1eddi gian theo d\u00f5i kh\u00f4ng th\u1ea5y hi\u1ec7u qu\u1ea3.<\/p>\n<h3><strong>Gh\u00e9p th\u1ea7n kinh<\/strong><\/h3>\n<p>D\u00f9ng m\u1ed9t \u0111o\u1ea1n th\u1ea7n kinh c\u1ea3m gi\u00e1c c\u1ee7a c\u01a1 th\u1ec3 hay \u0111\u1ed3ng lo\u1ea1i gh\u00e9p n\u1ed1i v\u00e0o c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1ea5t \u0111o\u1ea1n th\u1ea7n kinh.<\/p>\n<h3><strong>Chuy\u1ec3n gh\u00e9p th\u1ea7n kinh<\/strong><\/h3>\n<p>T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i bi\u00ean m\u00e0 \u0111\u1ea7u g\u1ea7n th\u1ea7n kinh t\u1ed5n th\u01b0\u01a1ng b\u1ecb nh\u1ed5 \u0111\u1ee9t hay kh\u00f4ng t\u00ecm \u0111\u01b0\u1ee3c. M\u1ed9t ngu\u1ed3n th\u1ea7n kinh \u0111\u1ea7u g\u1ea7n kh\u00e1c s\u1ebd \u0111\u01b0\u1ee3c thay th\u1ebf \u0111\u1ec3 gh\u00e9p, n\u1ed1i v\u00e0o \u0111\u1ea7u xa th\u1ea7n kinh t\u1ed5n th\u01b0\u01a1ng nh\u01b0 chuy\u1ec3n gh\u00e9p th\u1ea7n kinh XI v\u00e0o th\u1ea7n kinh vai tr\u00ean.<\/p>\n<h3><strong>Chuy\u1ec3n g\u00e2n c\u01a1<\/strong><\/h3>\n<p>Khi t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh v\u01b0\u1ee3t qu\u00e1 th\u1eddi gian ph\u1ee5c h\u1ed3i v\u1eadn \u0111\u1ed9ng c\u01a1 th\u00ec t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh kh\u00f4ng th\u1ec3 kh\u00e2u n\u1ed1i. C\u00e1c c\u01a1 ph\u1ee5 c\u00f2n l\u1ea1i b\u00ean c\u1ea1nh \u00edt ch\u1ee9c n\u0103ng s\u1ebd \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ec3 <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/phuc-hoi-chuc-nang-benh-nhan-cut-chi\/\">Rehabilitation<\/a> c\u01a1 do th\u1ea7n kinh t\u1ed5n th\u01b0\u01a1ng chi ph\u1ed1i, v\u00ed d\u1ee5 chuy\u1ec3n g\u00e2n trong li\u1ec7t th\u1ea7n kinh quay.<\/p>\n<h3><strong>Thu\u1ed1c v\u00e0 d\u1ee5ng c\u1ee5 sau kh\u00e2u n\u1ed1i ph\u1ee5c h\u1ed3i th\u1ea7n kinh<\/strong><\/h3>\n<h4>Thu\u1ed1c<\/h4>\n<ul>\n<li>Mecobalamin ti\u00eam v\u00e0 u\u1ed1ng (Methylcobal, Kononaz,\u2026)<\/li>\n<li>ATP<\/li>\n<li>Calci<\/li>\n<li>Gabapentin<\/li>\n<li>Galantamin (Nivalin)<\/li>\n<li>Acid folic<\/li>\n<li>Vitamin A, D<\/li>\n<li>Kh\u00e1ng vi\u00eam<\/li>\n<li>Pain relief<\/li>\n<li>Kh\u00e1ng sinh sau m\u1ed5.<\/li>\n<\/ul>\n<h4>D\u1ee5ng c\u1ee5<\/h4>\n<ul>\n<li>K\u00ednh hi\u1ec3n v\u1ecb ph\u1eabu thu\u1eadt 1 hay 2 ng\u01b0\u1eddi l\u00e0m vi\u1ec7c, \u0111\u1ed9 ph\u00f3ng \u0111\u1ea1i 5 \u2013 20<\/li>\n<li>K\u00ednh hi\u1ec3n vi c\u00f3 trang b\u1ecb ph\u1eabu thu\u1eadt Laser<\/li>\n<li>Ch\u1ec9 kh\u00e2u <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/vi-phau-thuat-va-vat-da\/\">vi ph\u1eabu<\/a> t\u1eeb 7.0 \u0111\u1ebfn 10.0<\/li>\n<li>Keo sinh h\u1ecdc d\u00e1n th\u1ea7n kinh<\/li>\n<li>M\u00e1y k\u00edch th\u00edch \u0111i\u1ec7n th\u1ea7n kinh trong ph\u1eabu thu\u1eadt- M\u00e1y k\u00edch th\u00edch \u0111i\u1ec7n \u0111i\u1ec1u tr\u1ecb v\u1eadt l\u00fd tr\u1ecb li\u1ec7u.<\/li>\n<\/ul>\n<h4><strong>5.8. Theo d\u00f5i, t\u00e1i kh\u00e1m<\/strong><\/h4>\n<ul>\n<li>T\u00e1i kh\u00e1m m\u1ed7i 2 tu\u1ea7n sau ph\u1eabu thu\u1eadt<\/li>\n<li>N\u1eb9p b\u1ea5t \u0111\u1ed9ng t\u1eeb 5 \u2013 6 tu\u1ea7n sau n\u1ed1i gh\u00e9p th\u1ea7n kinh<\/li>\n<li>V\u1eadt l\u00fd tr\u1ecb li\u1ec7u: n\u1eb9p b\u1ea5t \u0111\u1ed9ng, gi\u1ea3m \u0111au, gi\u1ea3m s\u01b0ng, k\u00edch th\u00edch \u0111i\u1ec7n &#8211; Theo d\u00f5i s\u1ef1 ph\u1ee5c h\u1ed3i th\u1ea7n kinh, c\u01a1 tr\u00ean l\u00e2m s\u00e0ng v\u00e0 EMG.<\/li>\n<\/ul>\n<h2><strong>LI\u1ec6T TH\u1ea6N KINH QUAY, GI\u1eeeA, TR\u1ee4<\/strong><\/h2>\n<h3><strong>T\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh quay (n. radialis)<\/strong><\/h3>\n<p><strong><em>\u1eb7c \u0111i\u1ec3m gi\u1ea3i ph\u1eabu <\/em><\/strong>&#8211; Nguy\u00ean \u1ee7y:<\/p>\n<p>D\u00e2y th\u1ea7n kinh quay xu\u1ea5t ph\u00e1t t\u1eeb b\u00f3 sau c\u1ee7a \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay, \u0111i ph\u00eda sau \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay.<\/p>\n<ul>\n<li>\u1ede c\u00e1nh tay:<\/li>\n<\/ul>\n<p>+ Th\u1ea7n kinh quay c\u00f9ng v\u1edbi \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay s\u00e2u chui qua l\u1ed7 tam gi\u00e1c c\u00e1nh tay tam \u0111\u1ea7u ra v\u00f9ng c\u00e1nh tay sau, r\u1ed3i ch\u1ea1y trong r\u00e3nh th\u1ea7n kinh quay \u1edf m\u1eb7t sau x\u01b0\u01a1ng c\u00e1nh tay (v\u00ec v\u1eady, khi g\u00e3y 1\/3 gi\u1eefa x\u01b0\u01a1ng c\u00e1nh tay th\u01b0\u1eddng hay t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh quay). Ra kh\u1ecfi r\u00e3nh, d\u00e2y quay ch\u1ecdc qua v\u00e1ch gian c\u01a1 ngo\u00e0i \u0111\u1ec3 ra tr\u01b0\u1edbc, r\u1ed3i v\u00e0o r\u00e3nh nh\u1ecb \u0111\u1ea7u ngo\u00e0i c\u1ee7a h\u1ed1 khu\u1ef7u<\/p>\n<p>+ \u1ede v\u00f9ng c\u00e1nh tay sau, trong r\u00e3nh quay, d\u00e2y quay cho c\u00e1c nh\u00e1nh v\u1eadn \u0111\u1ed9ng \u0111\u1ebfn c\u01a1 tam \u0111\u1ea7u c\u00e1nh tay v\u00e0 c\u00e1c nh\u00e1nh c\u1ea3m gi\u00e1c \u0111\u1ebfn da v\u00f9ng c\u00e1nh tay ngo\u00e0i v\u00e0 sau.<\/p>\n<ul>\n<li>LIVE <a href=\"https:\/\/vi.wikipedia.org\/wiki\/Khu%E1%BB%B7u_tay\" target=\"_blank\" rel=\"noopener\">khu\u1ef7u tay:<\/a><\/li>\n<\/ul>\n<p>Trong r\u00e3nh nh\u1ecb \u0111\u1ea7u ngo\u00e0i, \u1edf ngang m\u1ee9c n\u1ebfp khu\u1ef7u th\u00ec th\u1ea7n kinh quay chia l\u00e0m hai ng\u00e0nh c\u00f9ng xu\u1ed1ng c\u1eb3ng tay: nh\u00e1nh n\u00f4ng c\u1ea3m gi\u00e1c v\u00e0 nh\u00e1nh s\u00e2u v\u1eadn \u0111\u1ed9ng.<\/p>\n<ul>\n<li>\u1ede c\u1eb3ng tay:<\/li>\n<\/ul>\n<p>+ Nh\u00e1nh n\u00f4ng: \u0111\u1ed3ng h\u00e0nh v\u1edbi \u0111\u1ed9ng m\u1ea1ch quay \u1edf 1\/3 gi\u1eefa c\u1eb3ng tay v\u00e0 \u0111\u01b0\u1ee3c c\u01a1 c\u00e1nh tay<\/p>\n<p>quay che ph\u1ee7, c\u01a1 n\u00e0y \u0111\u01b0\u1ee3c xem l\u00e0 c\u01a1 t\u00f9y h\u00e0nh c\u1ee7a th\u1ea7n kinh quay. \u0110\u1ebfn kho\u1ea3ng 3 cm tr\u00ean m\u1ecfm tr\u00e2m quay th\u00ec d\u00e2y quay r\u1eddi kh\u1ecfi \u0111\u1ed9ng m\u1ea1ch quay, ch\u1ea1y v\u00f2ng ra sau quanh b\u1edd ngo\u00e0i x\u01b0\u01a1ng quay \u1edf d\u01b0\u1edbi g\u00e2n c\u01a1 c\u00e1nh tay quay, xuy\u00ean qua m\u1ea1c v\u00e0 chia th\u00e0nh 4 \u2013 5 th\u1ea7n kinh mu <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-ban-ngon-tay-gay-xuong-ban-tay\/\">ng\u00f3n tay<\/a> \u0111\u1ec3 c\u1ea3m gi\u00e1c cho n\u1eefa ngo\u00e0i mu tay v\u00e0 hai ng\u00f3n r\u01b0\u1ee1i ho\u1eb7c ba ng\u00f3n r\u01b0\u1ee1i c\u00e1c ng\u00f3n tay ngo\u00e0i:<\/p>\n<ul>\n<li>Nh\u00e1nh th\u1ee9 nh\u1ea5t v\u00e0o b\u1edd ngo\u00e0i ng\u00f3n tay I v\u00e0 v\u00f9ng m\u00f4 c\u00e1i li\u1ec1n k\u1ec1<\/li>\n<li>Nh\u00e1nh th\u1ee9 hai v\u00e0o b\u1edd trong ng\u00f3n tay I<\/li>\n<li>Nh\u00e1nh th\u1ee9 ba v\u00e0o b\u1edd ngo\u00e0i ng\u00f3n tay II<\/li>\n<li>Nh\u00e1nh th\u1ee9 t\u01b0 v\u00e0o c\u00e1c b\u1edd k\u1ec1 nhau c\u1ee7a ng\u00f3n tay II v\u00e0 III.<\/li>\n<\/ul>\n<p>Tr\u1eeb ng\u00f3n c\u00e1i, c\u00e1c th\u1ea7n kinh mu ng\u00f3n tay ch\u1ec9 chi ph\u1ed1i cho ph\u1ea7n g\u1ea7n c\u1ee7a mu c\u00e1c ng\u00f3n tay v\u00ec ph\u1ea7n xa c\u1ee7a c\u00e1c ng\u00f3n tay \u0111\u01b0\u1ee3c chi ph\u1ed1i b\u1edfi c\u00e1c nh\u00e1nh gan ng\u00f3n tay c\u1ee7a c\u00e1c th\u1ea7n kinh gi\u1eefa v\u00e0 th\u1ea7n kinh tr\u1ee5.<\/p>\n<p>+ Nh\u00e1nh s\u00e2u: \u0111i gi\u1eefa hai l\u1edbp c\u01a1 ng\u1eeda, ch\u1ea1y v\u00f2ng quanh c\u1ed5 x\u01b0\u01a1ng quay \u0111\u1ec3 ra v\u00f9ng c\u1eb3ng tay sau. Th\u1ea7n kinh ph\u00e2n nh\u00e1nh v\u00e0o c\u01a1 ng\u1eeda v\u00e0 khi tho\u00e1t ra \u1edf b\u1edd d\u01b0\u1edbi c\u01a1 n\u00e0y th\u00ec chia nhi\u1ec1u nh\u00e1nh \u1edf gi\u1eefa hai l\u1edbp c\u01a1 v\u00f9ng c\u1eb3ng tay sau \u0111\u1ec3 v\u1eadn \u0111\u1ed9ng c\u00e1c c\u01a1 v\u00f9ng n\u00e0y: c\u01a1 du\u1ed7i c\u00e1c ng\u00f3n tay, c\u01a1 du\u1ed7i ng\u00f3n tay \u00fat, c\u01a1 du\u1ed7i c\u1ed5 tay tr\u1ee5,\u2026 L\u00fac \u0111\u1ea7u, th\u1ea7n kinh ch\u1ea1y sau c\u00e1c c\u01a1 d\u1ea1ng ng\u00f3n c\u00e1i d\u00e0i v\u00e0 du\u1ed7i ng\u00f3n c\u00e1i ng\u1eafn, sau \u0111\u00f3 chui ra tr\u01b0\u1edbc \u00e1p s\u00e1t m\u1eb7t sau m\u00e0ng gian c\u1ed1t n\u00ean ph\u1ea7n n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 th\u1ea7n kinh gian c\u1ed1t sau, \u0111i xu\u1ed1ng d\u1ecdc theo \u0111\u1ed9ng m\u1ea1ch gian c\u1ed1t sau. Th\u1ea7n kinh chia nh\u00e1nh v\u00e0o t\u1ea5t c\u1ea3 c\u00e1c c\u01a1 l\u1edbp s\u00e2u c\u1ee7a c\u1eb3ng tay sau (tr\u1eeb c\u01a1 c\u00e1nh tay quay v\u00e0 c\u01a1 du\u1ed7i c\u1ed5 tay quay d\u00e0i do nh\u00e1nh b\u00ean c\u1ee7a th\u1ea7n kinh quay chi ph\u1ed1i) v\u00e0 t\u1eadn c\u00f9ng nh\u01b0 m\u1ed9t nh\u00e1nh t\u1edbi kh\u1edbp c\u1ed5 tay.<\/p>\n<h4>6.1.2. Ch\u1ee9c n\u0103ng sinh l\u00fd<\/h4>\n<ul>\n<li>V\u1eadn \u0111\u1ed9ng c\u00e1c c\u01a1: th\u00e2n d\u00e2y th\u1ea7n kinh cho nh\u00e1nh \u0111i\u1ec1u khi\u1ec3n:<\/li>\n<\/ul>\n<p>+ \u1ede h\u00f5m n\u00e1ch: c\u01a1 tam \u0111\u1ea7u c\u00e1nh tay<\/p>\n<p>+ Trong r\u00e3nh nh\u1ecb \u0111\u1ea7u ngo\u00e0i: c\u01a1 ng\u1eeda, c\u01a1 quay th\u1ee9 nh\u1ea5t.<\/p>\n<p>Nh\u00e1nh sau \u0111i\u1ec1u khi\u1ec3n c\u00e1c c\u01a1 sau: quay th\u1ee9 hai, ng\u1eeda ng\u1eafn, tr\u1ee5 sau, du\u1ed7i c\u00e1c ng\u00f3n, du\u1ed7i ng\u00f3n \u00fat, d\u1ea1ng ng\u00f3n c\u00e1i d\u00e0i, du\u1ed7i ng\u00f3n c\u00e1i ng\u1eafn, du\u1ed7i ng\u00f3n \u00fat ng\u1eafn, du\u1ed7i ng\u00f3n tr\u1ecf.<\/p>\n<ul>\n<li>V\u00f9ng c\u1ea3m gi\u00e1c:<\/li>\n<\/ul>\n<p>+ M\u1eb7t sau c\u00e1nh tay<\/p>\n<p>+ Ph\u1ea7n gi\u1eefa m\u1eb7t sau c\u1eb3ng tay<\/p>\n<p>+ B\u1edd ngo\u00e0i (b\u1edd quay) m\u1eb7t mu b\u00e0n tay, m\u1eb7t mu ng\u00f3n c\u00e1i v\u00e0 \u0111\u1ed1t 1, 2 c\u1ee7a ng\u00f3n tr\u1ecf, n\u1eeda ngo\u00e0i \u0111\u1ed1t 1 ng\u00f3n gi\u1eefa.<\/p>\n<h4>Diagnose<\/h4>\n<p><em>Kh\u00e1m v\u00e0 l\u01b0\u1ee3ng gi\u00e1 ch\u1ee9c n\u0103ng <\/em>&#8211; Quan s\u00e1t:<\/p>\n<p>+ D\u1ea5u hi\u1ec7u \u201cb\u00e0n tay r\u0169 c\u1ed5 c\u00f2\u201d (tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh)<\/p>\n<p>+ T\u00ecnh tr\u1ea1ng teo c\u01a1, rung th\u1edb c\u01a1 ph\u00eda tay b\u00ean li\u1ec7t so v\u1edbi b\u00ean l\u00e0nh trong giai \u0111o\u1ea1n mu\u1ed9n c\u1ee7a b\u1ec7nh.<\/p>\n<ul>\n<li>Kh\u00e1m v\u1eadn \u0111\u1ed9ng:<\/li>\n<\/ul>\n<p>+ C\u01a1 l\u1ef1c: li\u1ec7t ho\u1eb7c y\u1ebfu c\u00e1c nh\u00f3m c\u01a1 do th\u1ea7n kinh quay chi ph\u1ed1i bao g\u1ed3m c\u00e1c c\u01a1 du\u1ed7i khu\u1ef7u, ng\u1eeda c\u1eb3ng tay, du\u1ed7i c\u1ed5 tay v\u00e0 du\u1ed7i c\u00e1c ng\u00f3n. V\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh quay c\u00e0ng cao th\u00ec s\u1ed1 c\u01a1 b\u1ecb li\u1ec7t c\u00e0ng nhi\u1ec1u + Tr\u01b0\u01a1ng l\u1ef1c c\u01a1: gi\u1ea3m.<\/p>\n<ul>\n<li>Kh\u00e1m c\u1ea3m gi\u00e1c: m\u1ea5t ho\u1eb7c gi\u1ea3m c\u1ea3m gi\u00e1c m\u1eb7t sau c\u00e1nh tay, c\u1eb3ng tay v\u00e0 m\u1eb7t ngo\u00e0i mu tay. V\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh quay c\u00e0ng cao th\u00ec v\u00f9ng m\u1ea5t c\u1ea3m gi\u00e1c c\u00e0ng r\u1ed9ng. \u1ede b\u1ec7nh nh\u00e2n b\u1eaft \u0111\u1ea7u h\u1ed3i ph\u1ee5c th\u1ea7n kinh sau ch\u1ea5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 c\u00f3 t\u00ecnh tr\u1ea1ng t\u0103ng c\u1ea3m gi\u00e1c.<\/li>\n<li>Kh\u00e1m ph\u1ea3n x\u1ea1: m\u1ea5t ho\u1eb7c gi\u1ea3m ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1 tam \u0111\u1ea7u c\u00e1nh tay v\u00e0 ph\u1ea3n x\u1ea1 tr\u00e2m quay.<\/li>\n<\/ul>\n<p><em>Implementing the quadrants<\/em><\/p>\n<ul>\n<li>Li\u1ec7t c\u00e1c nh\u00f3m c\u01a1 do th\u1ea7n kinh quay chi ph\u1ed1i: du\u1ed7i khu\u1ef7u, ng\u1eeda c\u1eb3ng tay, du\u1ed7i c\u1ed5 tay, du\u1ed7i c\u00e1c ng\u00f3n. D\u1ea5u hi\u1ec7u \u201cb\u00e0n tay r\u0169 c\u1ed5 c\u00f2\u201d<\/li>\n<li>M\u1ea5t c\u1ea3m gi\u00e1c m\u1eb7t sau c\u00e1nh tay, c\u1eb3ng tay, m\u1eb7t ngo\u00e0i mu tay<\/li>\n<li>M\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1 tam \u0111\u1ea7u c\u00e1nh tay, ph\u1ea3n x\u1ea1 tr\u00e2m quay<\/li>\n<li>K\u1ebft qu\u1ea3 kh\u1ea3o s\u00e1t ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n ph\u00f9 h\u1ee3p v\u1edbi t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh quay.<\/li>\n<\/ul>\n<p><em>Differential diagnosis<\/em><\/p>\n<ul>\n<li>Pathological <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/chan-thuong-cot-song-co\/\">cervical spine<\/a> g\u00e2y ch\u00e8n \u00e9p r\u1ec5 C6, C7<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay<\/li>\n<li>M\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd kh\u00e1c c\u1ee7a n\u00e3o ho\u1eb7c t\u1ee7y s\u1ed1ng c\u00f3 g\u00e2y li\u1ec7t chi tr\u00ean. V\u00ed d\u1ee5: t\u1ed5n th\u01b0\u01a1ng v\u1ecf n\u00e3o h\u1ed3i tr\u01b0\u1edbc trung t\u00e2m, b\u1ec7nh x\u01a1 c\u1ee9ng c\u1ed9t b\u00ean teo c\u01a1,\u2026<\/li>\n<\/ul>\n<p><em>Diagnose the cause<\/em><\/p>\n<ul>\n<li>T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh quay \u0111o\u1ea1n t\u1eeb n\u00e1ch \u0111\u1ebfn khu\u1ef7u:<\/li>\n<\/ul>\n<p>+ <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-chi-tren\/\">G\u00e3y x\u01b0\u01a1ng c\u00e1nh tay<\/a> m\u1edbi ho\u1eb7c c\u0169<\/p>\n<p>+ H\u1ed9i ch\u1ee9ng li\u1ec7t t\u1ed1i th\u1ee9 B\u1ea3y + \u0110i n\u1ea1ng n\u00e1ch kh\u00f4ng \u0111\u00fang k\u1ef9 thu\u1eadt + H\u1ea1ch n\u00e1ch, ph\u00ecnh m\u1ea1ch ch\u00e8n \u00e9p.<\/p>\n<ul>\n<li>T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh quay \u0111o\u1ea1n t\u1eeb khu\u1ef7u \u0111\u1ebfn c\u1ed5 tay:<\/li>\n<\/ul>\n<p>Th\u01b0\u1eddng g\u1eb7p \u201cH\u1ed9i ch\u1ee9ng th\u1ea7n kinh gian c\u1ed1t sau\u201d do nh\u00e1nh gian c\u1ed1t sau c\u1ee7a th\u1ea7n kinh quay b\u1ecb \u0111\u00e8 \u00e9p b\u1edfi m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n sau:<\/p>\n<p>+ G\u00e3y x\u01b0\u01a1ng, can x\u01b0\u01a1ng, tr\u1eadt \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng quay<\/p>\n<p>+ U m\u1ee1, u x\u01a1 th\u1ea7n kinh, u t\u1ebf b\u00e0o Schwan, d\u1ecb d\u1ea1ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch g\u00e2y \u0111\u00e8 \u00e9p<\/p>\n<p>+ Ngh\u1ec1 nghi\u1ec7p li\u00ean quan \u0111\u1ebfn c\u00e1c ho\u1ea1t \u0111\u1ed9ng s\u1ea5p ng\u1eeda li\u00ean t\u1ee5c c\u1eb3ng tay nh\u01b0 nh\u1ea1c tr\u01b0\u1edfng, ng\u01b0\u1eddi \u0111\u00e1nh \u0111\u00e0n violin,\u2026<\/p>\n<h3><strong>T\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh gi\u1eefa (n. medialis)<\/strong><\/h3>\n<h4>\u0110\u1eb7c \u0111i\u1ec3m gi\u1ea3i ph\u1eabu<\/h4>\n<p>Th\u1ea7n kinh gi\u1eefa (ti\u1ebfng Anh: median nerve; ti\u1ebfng Ph\u00e1p: le nerf m\u00e9dian) l\u00e0 th\u1ea7n kinh ph\u00e2n b\u1ed1 \u1edf v\u00f9ng chi tr\u00ean ng\u01b0\u1eddi v\u00e0 m\u1ed9t s\u1ed1 \u0111\u1ed9ng v\u1eadt. \u0110\u00e2y l\u00e0 m\u1ed9t trong n\u0103m d\u00e2y th\u1ea7n kinh ch\u00ednh b\u1eaft ngu\u1ed3n t\u1eeb \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay.<\/p>\n<p>Th\u1ea7n kinh gi\u1eefa c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb b\u00f3 ngo\u00e0i v\u00e0 b\u00f3 trong c\u1ee7a \u0111\u00e1m r\u1ed1i c\u00e1nh tay, ch\u1ee9a c\u00e1c s\u1ee3i \u1edf r\u1ec5 b\u1ee5ng C5 \u2013 C7 (b\u00f3 ngo\u00e0i) v\u00e0 C8 v\u00e0 T1 (b\u00f3 trong).<\/p>\n<p>Th\u1ea7n kinh gi\u1eefa l\u00e0 d\u00e2y th\u1ea7n kinh duy nh\u1ea5t \u0111i qua <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/hoi-chung-ong-co-tay\/\">carpal tunnel<\/a>. H\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay l\u00e0 t\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt do th\u1ea7n kinh gi\u1eefa b\u1ecb ch\u00e8n \u00e9p trong \u1ed1ng c\u1ed5 tay.<\/p>\n<p>\u0110\u01b0\u1eddng \u0111i, li\u00ean quan, chi ph\u1ed1i<\/p>\n<p>Th\u1ea7n kinh gi\u1eefa xu\u1ea5t ph\u00e1t do c\u00e1c s\u1ee3i c\u1ee7a b\u00f3 ngo\u00e0i v\u00e0 b\u00f3 trong c\u1ee7a \u0111\u00e1m r\u1ed1i c\u00e1nh tay, qua ph\u1ea7n tr\u01b0\u1edbc c\u00e1nh tay, c\u1eb3ng tay v\u00e0 b\u00e0n tay, t\u1eadn c\u00f9ng l\u00e0 c\u00e1c s\u1ee3i th\u1ea7n kinh chi ph\u1ed1i c\u01a1 b\u00e0n tay.<\/p>\n<ul>\n<li>\u1ede c\u00e1nh tay:<\/li>\n<\/ul>\n<p>+ Sau khi h\u00ecnh th\u00e0nh nh\u1edd c\u00e1c s\u1ee3i c\u1ee7a b\u00f3 ngo\u00e0i v\u00e0 b\u00f3 trong c\u1ee7a \u0111\u00e1m r\u1ed1i c\u00e1nh tay h\u1ee3p l\u1ea1i, th\u1ea7n kinh gi\u1eefa \u0111i v\u00e0o c\u00e1nh tay t\u1eeb n\u00e1ch \u1edf r\u00eca d\u01b0\u1edbi c\u01a1 tr\u00f2n l\u1edbn. Sau \u0111\u00f3, d\u00e2y gi\u1eefa \u0111i ch\u1ebfch xu\u1ed1ng d\u01b0\u1edbi v\u00e0 ra ngo\u00e0i, \u1edf tr\u01b0\u1edbc ngo\u00e0i \u0111\u1ed9ng m\u1ea1ch n\u00e1ch. Th\u1ea7n kinh ti\u1ebfp t\u1ee5c theo \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay, \u0111i gi\u1eefa c\u01a1 nh\u1ecb \u0111\u1ea7u c\u00e1nh tay (\u1edf tr\u00ean) v\u00e0 c\u01a1 c\u00e1nh tay (\u1edf d\u01b0\u1edbi). L\u00fac \u0111\u1ea7u, n\u1eb1m b\u00ean ngo\u00e0i \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay; sau \u0111\u00f3, b\u1eaft <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/ton-thuong-day-chang-cheo\/\">front cross<\/a> t\u1ea1o th\u00e0nh h\u00ecnh ch\u1eef X k\u00e9o d\u00e0i. T\u1edbi v\u00f9ng khu\u1ef7u tr\u01b0\u1edbc, th\u1ea7n kinh ch\u1ea1y v\u00e0o r\u00e3nh nh\u1ecb \u0111\u1ea7u trong, \u1edf trong \u0111\u1ed9ng m\u1ea1ch. B\u00ean trong r\u00e3nh, th\u1ea7n kinh gi\u1eefa \u0111i \u1edf ph\u00eda trong \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay. Th\u1ea7n kinh gi\u1eefa cho nh\u00e1nh c\u01a1 \u0111\u1ebfn v\u00f9ng khu\u1ef7u v\u00e0 m\u1ed9t nh\u00e1nh chi ph\u1ed1i v\u1eadn \u0111\u1ed9ng c\u01a1 s\u1ea5p tr\u00f2n.<\/p>\n<ul>\n<li>\u1ede c\u1eb3ng tay:<\/li>\n<\/ul>\n<p>+ Th\u1ea7n kinh gi\u1eefa \u1edf r\u00e3nh nh\u1ecb \u0111\u1ea7u trong, ph\u00eda trong \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay, \u0111i qua \u1edf gi\u1eefa hai \u0111\u1ea7u c\u01a1 s\u1ea5p tr\u00f2n, chui s\u00e2u \u1edf m\u1ea1c c\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u c\u00e1nh tay, ra ngo\u00e0i c\u01a1 c\u00e1nh tay. Th\u1ea7n kinh \u0111i qua \u0111\u1ed9ng m\u1ea1ch tr\u1ee5 (m\u1ed9t trong hai nh\u00e1nh t\u1eadn c\u1ee7a \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay) khi l\u00e1ch gi\u1eefa hai \u0111\u1ea7u c\u01a1 s\u1ea5p tr\u00f2n. Sau \u0111\u00f3, th\u1ea7n kinh di chuy\u1ec3n gi\u1eefa c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n tay n\u00f4ng (\u1edf tr\u00ean) v\u00e0 c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n tay s\u00e2u (\u1edf d\u01b0\u1edbi). Th\u1ea7n kinh \u0111i c\u00f9ng v\u1edbi \u0111\u1ed9ng m\u1ea1ch gi\u1eefa (m\u1ed9t nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch gian c\u1ed1t tr\u01b0\u1edbc). Sau \u0111\u00f3, kho\u1ea3ng 5 cm ph\u00eda tr\u00ean m\u1ea1c c\u01a1 g\u1ea5p (c\u1ed5 tay), th\u1ea7n kinh \u0111i gi\u1eefa c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n tay n\u00f4ng (\u1edf trong) v\u00e0 c\u01a1 g\u1ea5p c\u1ed5 tay quay (ngo\u00e0i) v\u00e0o tay.<\/p>\n<p>+ Th\u00e2n ch\u00ednh c\u1ee7a th\u1ea7n kinh gi\u1eefa chi ph\u1ed1i c\u00e1c nh\u00f3m c\u01a1 n\u00f4ng v\u00e0 s\u00e2u \u1edf khoang tr\u01b0\u1edbc c\u1eb3ng tay, ngo\u1ea1i tr\u1eeb c\u01a1 g\u1ea5p c\u1ed5 tay tr\u1ee5. C\u1ee5 th\u1ec3:<\/p>\n<ul>\n<li>C\u00e1c nh\u00e1nh c\u01a1 t\u00e1ch ra trong r\u00e3nh nh\u1ecb \u0111\u1ea7u trong, chi ph\u1ed1i c\u01a1 g\u1ea5p c\u1ed5 tay quay, c\u01a1 gan tay d\u00e0i v\u00e0 c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n tay n\u00f4ng<\/li>\n<li>Th\u1ea7n kinh gian c\u1ed1t tr\u01b0\u1edbc c\u1eb3ng tay t\u00e1ch ra \u1edf ph\u1ea7n tr\u00ean c\u1ee7a c\u1eb3ng tay, li\u00ean quan v\u1edbi \u0111\u1ed9ng m\u1ea1ch gian c\u1ed1t tr\u01b0\u1edbc v\u00e0 n\u1eeda ngo\u00e0i c\u1ee7a c\u01a1 g\u1ea5p ng\u00f3n c\u00e1i d\u00e0i v\u00e0 n\u1eeda b\u00ean c\u1ee7a c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n tay s\u00e2u (n\u1eeda c\u01a1 n\u00e0y ph\u00eda g\u1ea7n x\u01b0\u01a1ng tr\u1ee5 th\u00ec \u0111\u01b0\u1ee3c th\u1ea7n kinh tr\u1ee5 chi ph\u1ed1i). Cu\u1ed1i c\u00f9ng, th\u1ea7n kinh chi ph\u1ed1i c\u01a1 s\u1ea5p vu\u00f4ng. Ngo\u00e0i vi\u1ec7c chi ph\u1ed1i c\u01a1 b\u1eafp, th\u1ea7n kinh n\u00e0y c\u00f2n chi ph\u1ed1i kh\u1edbp quay \u2013 tr\u1ee5 v\u00e0 kh\u1edbp c\u1ed5 tay.<\/li>\n<li>Th\u1ea7n kinh gi\u1eefa c\u0169ng chi ph\u1ed1i c\u1ea3m gi\u00e1c c\u1eb3ng tay. Nh\u00e1nh gan b\u00e0n tay c\u1ee7a th\u1ea7n kinh gi\u1eefa t\u00e1ch ra \u1edf ph\u1ea7n xa c\u1eb3ng tay. Nh\u00e1nh n\u00e0y cho c\u1ea3m gi\u00e1c cho \u00f4 m\u00f4 c\u00e1i v\u00e0 cho trung t\u00e2m l\u00f2ng b\u00e0n tay. C\u00e1c nh\u00e1nh kh\u1edbp t\u00e1ch ra, \u0111\u1ebfn chi ph\u1ed1i <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/trat-khop-vai-khuyu-hang\/\">elbow joint<\/a> tay v\u00e0 kh\u1edbp quay \u2013 tr\u1ee5. C\u00e1c nh\u00e1nh \u0111\u1ebfn m\u1ea1ch m\u00e1u chi ph\u1ed1i \u0111\u1ed9ng m\u1ea1ch quay v\u00e0 tr\u1ee5. C\u00f3 m\u1ed9t nh\u00e1nh n\u1ed1i v\u00e0o th\u1ea7n kinh tr\u1ee5.<\/li>\n<\/ul>\n<ul>\n<li>B\u00e0n tay:<\/li>\n<\/ul>\n<p>+ Th\u1ea7n kinh gi\u1eefa qua \u1ed1ng c\u1ed5 tay \u0111i v\u00e0o b\u00e0n tay, theo g\u00e2n c\u1ee7a c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n tay n\u00f4ng, c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n tay s\u00e2u v\u00e0 c\u01a1 g\u1ea5p ng\u00f3n c\u00e1i d\u00e0i. T\u1eeb \u0111\u00f3, th\u1ea7n kinh chia th\u00e0nh c\u00e1c nh\u00e1nh c\u01a1 qu\u1eb7t ng\u01b0\u1ee3c v\u00e0 nh\u00e1nh b\u00ec chi ph\u1ed1i c\u1ea3m gi\u00e1c c\u00e1c ng\u00f3n tay:<\/p>\n<ul>\n<li>Nh\u00e1nh c\u01a1 (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 nh\u00e1nh qu\u1eb7t ng\u01b0\u1ee3c) chi ph\u1ed1i c\u00e1c c\u01a1 (c\u01a1 \u0111\u1ed1i chi\u1ebfu ng\u00f3n tay c\u00e1i, c\u01a1 d\u1ea1ng ng\u00f3n tay c\u00e1i ng\u1eafn v\u00e0 \u0111\u1ea7u n\u00f4ng c\u1ee7a c\u01a1 g\u1ea5p ng\u00f3n tay c\u00e1i ng\u1eafn)<\/li>\n<li>Nh\u00e1nh b\u00ec chi ph\u1ed1i c\u1ea3m gi\u00e1c c\u00e1c ng\u00f3n tay: nh\u00e1nh gan ng\u00f3n tay ri\u00eang v\u00e0 ba nh\u00e1nh gan ng\u00f3n tay chung: nh\u00e1nh gan ng\u00f3n tay ri\u00eang chi ph\u1ed1i m\u1eb7t gan tay c\u1ee7a ba ng\u00f3n tay r\u01b0\u1ee1i \u1edf ph\u00eda ngo\u00e0i k\u1ec3 t\u1eeb ng\u00f3n c\u00e1i v\u00e0 c\u1ea3 m\u1eb7t mu \u0111\u1ed1t II v\u00e0 \u0111\u1ed1t III c\u1ee7a c\u00e1c ng\u00f3n \u0111\u00f3. Ngo\u00e0i ra, th\u1ea7n kinh c\u00f2n chi ph\u1ed1i c\u01a1 giun I v\u00e0 II.<\/li>\n<\/ul>\n<h4><strong>Ch\u1ee9c n\u0103ng sinh l\u00fd <\/strong>&#8211; V\u1eadn \u0111\u1ed9ng c\u00e1c c\u01a1:<\/h4>\n<p>+ \u1ede c\u1eb3ng tay: s\u1ea5p tr\u00f2n, gan tay l\u1edbn, b\u00e9, g\u1ea5p c\u00e1c ng\u00f3n n\u00f4ng, g\u1ea5p c\u00e1c ng\u00f3n s\u00e2u, g\u1ea5p ng\u00f3n c\u00e1i d\u00e0i, s\u1ea5p vu\u00f4ng<\/p>\n<p>+ \u1ede b\u00e0n tay: d\u1ea1ng ng\u00f3n c\u00e1i ng\u1eafn, \u0111\u1ed1i ng\u00f3n c\u00e1i, g\u1ea5p ng\u00f3n ng\u1eafn, c\u01a1 giun 1 v\u00e0 2 &#8211; V\u00f9ng c\u1ea3m gi\u00e1c:<\/p>\n<p>+ N\u1eeda ngo\u00e0i gan b\u00e0n tay<\/p>\n<p>+ M\u1eb7t gan c\u00e1c ng\u00f3n c\u00e1i, tr\u1ecf, gi\u1eefa v\u00e0 n\u1eeda ngo\u00e0i ng\u00f3n nh\u1eabn<\/p>\n<p>+ M\u1eb7t mu c\u1ee7a \u0111\u1ed1t hai; ba ng\u00f3n tr\u1ecf, gi\u1eefa v\u00e0 n\u1eeda ngo\u00e0i ng\u00f3n nh\u1eabn.<\/p>\n<h4>Diagnose<\/h4>\n<p><em>Kh\u00e1m v\u00e0 l\u01b0\u1ee3ng gi\u00e1 ch\u1ee9c n\u0103ng<\/em><\/p>\n<p>&#8211; Quan s\u00e1t:<\/p>\n<p>+ Tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh:<\/p>\n<ul>\n<li>D\u1ea5u hi\u1ec7u \u201cb\u00e0n tay kh\u1ec9\u201d: teo c\u01a1 \u00f4 m\u00f4 c\u00e1i, ng\u00f3n c\u00e1i n\u1eb1m c\u00f9ng m\u1eb7t ph\u1eb3ng v\u1edbi c\u00e1c ng\u00f3n kh\u00e1c, m\u1ea5t \u0111\u1ed9ng t\u00e1c d\u1ea1ng v\u00e0 \u0111\u1ed1i ng\u00f3n c\u00e1i<\/li>\n<li>D\u1ea5u hi\u1ec7u \u201cb\u00e0n tay gi\u1ea3ng \u0111\u1ea1o\u201d: m\u1ea5t \u0111\u1ed9ng t\u00e1c g\u1ea5p ng\u00f3n 1, 2 v\u00e0 m\u1ed9t ph\u1ea7n ng\u00f3n 3; c\u00e1c ng\u00f3n 4, 5 v\u1eabn g\u1ea5p \u0111\u01b0\u1ee3c b\u00ecnh th\u01b0\u1eddng.<\/li>\n<li>Kh\u00e1m v\u1eadn \u0111\u1ed9ng:<\/li>\n<\/ul>\n<p>+ C\u01a1 l\u1ef1c: li\u1ec7t c\u00e1c c\u01a1 do th\u1ea7n kinh gi\u1eefa chi ph\u1ed1i. M\u1ea5t \u0111\u1ed9ng t\u00e1c g\u1ea5p, d\u1ea1ng v\u00e0 \u0111\u1ed1i ng\u00f3n c\u00e1i. N\u1ebfu t\u1ed5n th\u01b0\u01a1ng cao c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ea5p c\u1eb3ng tay v\u00e0 g\u1ea5p c\u1ed5 tay y\u1ebfu.<\/p>\n<ul>\n<li>C\u00e1c nghi\u1ec7m ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay:<\/li>\n<\/ul>\n<p>+ Nghi\u1ec7m ph\u00e1p Tinel: g\u00f5 nh\u1eb9 li\u00ean t\u1ee5c v\u00f9ng \u1ed1ng c\u1ed5 tay trong 30 \u2013 60 gi\u00e2y. D\u1ea5u hi\u1ec7u d\u01b0\u01a1ng t\u00ednh: t\u00ea ho\u1eb7c c\u1ea3m gi\u00e1c ch\u00e2m ch\u00edch v\u00f9ng c\u1ea3m gi\u00e1c th\u1ea7n kinh gi\u1eefa chi ph\u1ed1i<\/p>\n<p>+ Nghi\u1ec7m ph\u00e1p Phalen: b\u1ec7nh nh\u00e2n g\u1ea5p c\u1ed5 tay hai b\u00ean 90<sup>o<\/sup>, \u00e1p mu hai b\u00e0n tay v\u00e0o nhau v\u00e0 duy tr\u00ec t\u01b0 th\u1ebf n\u00e0y trong 30 \u2013 60 gi\u00e2y. D\u1ea5u hi\u1ec7u d\u01b0\u01a1ng t\u00ednh: t\u00ea ho\u1eb7c c\u1ea3m gi\u00e1c ch\u00e2m ch\u00edch v\u00f9ng c\u1ea3m gi\u00e1c th\u1ea7n kinh gi\u1eefa chi ph\u1ed1i.<\/p>\n<p>+ Tr\u01b0\u01a1ng l\u1ef1c c\u01a1: gi\u1ea3m.<\/p>\n<ul>\n<li>Kh\u00e1m c\u1ea3m gi\u00e1c: m\u1ea5t c\u1ea3m gi\u00e1c c\u00e1c ng\u00f3n 1, 2, 3 v\u00e0 \u00bd ngo\u00e0i ng\u00f3n 4 \u1edf gan tay v\u00e0 \u0111\u1ed1t t\u1eadn c\u00f9ng c\u1ee7a c\u00e1c ng\u00f3n tr\u00ean \u1edf mu tay.<\/li>\n<\/ul>\n<p><em>Implementing the quadrants<\/em><\/p>\n<ul>\n<li>D\u1ea5u hi\u1ec7u \u201cb\u00e0n tay kh\u1ec9\u201d, \u201cb\u00e0n tay gi\u1ea3ng \u0111\u1ea1o\u201d<\/li>\n<li>M\u1ea5t \u0111\u1ed9ng t\u00e1c g\u1ea5p, d\u1ea1ng v\u00e0 \u0111\u1ed1i ng\u00f3n c\u00e1i. S\u1ea5p c\u1eb3ng tay v\u00e0 g\u1ea5p c\u1ed5 tay y\u1ebfu n\u1ebfu t\u1ed5n th\u01b0\u01a1ng cao<\/li>\n<li>M\u1ea5t c\u1ea3m gi\u00e1c c\u00e1c ng\u00f3n 1, 2, 3 v\u00e0 \u00bd ngo\u00e0i ng\u00f3n 4 \u1edf gan tay v\u00e0 \u0111\u1ed1t t\u1eadn c\u00f9ng c\u1ee7a c\u00e1c ng\u00f3n tr\u00ean \u1edf mu tay<\/li>\n<li>Nghi\u1ec7m ph\u00e1p Tinel v\u00e0 Phalen d\u01b0\u01a1ng t\u00ednh trong h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay<\/li>\n<li>K\u1ebft qu\u1ea3 kh\u1ea3o s\u00e1t ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n ph\u00f9 h\u1ee3p v\u1edbi t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh gi\u1eefa.<\/li>\n<\/ul>\n<p><em>Differential diagnosis<\/em><\/p>\n<p>B\u1ec7nh l\u00fd ch\u00e8n \u00e9p r\u1ec5 C6, C7.<\/p>\n<pre><em>Diagnose the cause<\/em><\/pre>\n<ul>\n<li>B\u1ec7nh l\u00fd ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa \u1edf c\u1eb3ng tay (h\u1ed9i ch\u1ee9ng th\u1ea7n kinh gian c\u1ed1t tr\u01b0\u1edbc)<\/li>\n<\/ul>\n<p>+ Ngh\u1ec1 nghi\u1ec7p li\u00ean quan \u0111\u1ebfn g\u1ea5p khu\u1ef7u v\u00e0 s\u1ea5p c\u1eb3ng tay qu\u00e1 nhi\u1ec1u, x\u00e1ch \u0111\u1ed3 v\u1eadt qu\u00e1 n\u1eb7ng, <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/bo-bot\/\">cast<\/a> c\u1eb3ng tay, g\u00e3y x\u01b0\u01a1ng c\u1eb3ng tay, \u0111\u1ea1n b\u1eafn,\u2026<\/p>\n<ul>\n<li>B\u1ec7nh l\u00fd ch\u00e8n \u00e9p th\u1ea7n kinh gi\u1eefa \u1edf c\u1ed5 tay (h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay):<\/li>\n<\/ul>\n<p>+ C\u1ea5p t\u00ednh: ch\u1ea5n th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m v\u00f9ng c\u1ed5 tay, g\u00e3y x\u01b0\u01a1ng c\u1ed5 tay, <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/bong-nguoi-lon\/\">burn<\/a><\/p>\n<p>+ M\u1ea1n t\u00ednh: mang \u0111ai c\u1ed5 tay ho\u1eb7c g\u0103ng tay b\u00f3 ch\u1eb7t, b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u1eabu c\u00e1c th\u00e0nh ph\u1ea7n trong \u1ed1ng c\u1ed5 tay, s\u1eb9o c\u0169 do \u0111\u00e3 t\u1eebng m\u1ed5 \u1ed1ng c\u1ed5 tay<\/p>\n<p>+ Ngh\u1ec1 nghi\u1ec7p v\u00e0 th\u00f3i quen sinh ho\u1ea1t: g\u1ea5p du\u1ed7i c\u1ed5 tay l\u1eb7p \u0111i l\u1eb7p l\u1ea1i, n\u1eafm ch\u1eb7t, l\u00e0m vi\u1ec7c v\u1edbi m\u00e1y t\u00ednh, l\u00e0m vi\u1ec7c v\u1edbi c\u00e1c d\u1ee5ng c\u1ee5 rung l\u1eafc m\u1ea1nh.<\/p>\n<ul>\n<li>Ngo\u00e0i ra, th\u1ea7n kinh gi\u1eefa c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u1edf b\u1ea5t c\u1ee9 v\u1ecb tr\u00ed n\u00e0o tr\u00ean \u0111\u01b0\u1eddng \u0111i c\u1ee7a n\u00f3 do hung kh\u00ed hay c\u00e1c v\u1eadt s\u1eafc nh\u1ecdn kh\u00e1c g\u00e2y ra.<\/li>\n<\/ul>\n<h4>Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng v\u00e0 \u0111i\u1ec1u tr\u1ecb: t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh gi\u1eefa trong h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay<\/h4>\n<p>Nhi\u1ec1u b\u1ec7nh nh\u00e2n b\u1ecb h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n n\u1ebfu \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm. Mang m\u00e1ng n\u00e2ng \u0111\u1ee1 c\u1ed5 tay, gi\u1eef \u1edf t\u01b0 th\u1ebf trung t\u00ednh, mang khi ng\u1ee7 v\u00e0 khi th\u1ef1c hi\u1ec7n nh\u1eefng ho\u1ea1t \u0111\u1ed9ng \u0111\u00f2i h\u1ecfi s\u1ef1 v\u1eadn \u0111\u1ed9ng c\u1ed5 tay nhi\u1ec1u. S\u1eed d\u1ee5ng th\u00eam kh\u00e1ng vi\u00eam NSAIDs \u0111\u01b0\u1eddng u\u1ed1ng. Kho\u1ea3ng 90% b\u1ec7nh nh\u00e2n b\u1ecb h\u1ed9i ch\u1ee9ng \u1ed1ng c\u1ed5 tay nh\u1eb9 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n sau 4 \u2013 6 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb, sau \u0111\u00f3 duy tr\u00ec ti\u1ebfp \u00edt nh\u1ea5t 2 th\u00e1ng n\u1eefa.<\/p>\n<ul>\n<li>N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng h\u1ec1 c\u00f3 \u0111\u00e1p \u1ee9ng khi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n v\u1edbi m\u00e1ng n\u1eb9p c\u1ed5 tay th\u00ec l\u1ef1a ch\u1ecdn ti\u1ebfp theo l\u00e0 ti\u00eam steroid v\u00e0o \u1ed1ng c\u1ed5 tay. Th\u01b0\u1eddng gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng sau m\u0169i ti\u00eam th\u1ee9 nh\u1ea5t, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p cho ph\u00e9p ti\u00eam \u0111\u1ebfn 3 m\u0169i, c\u00e1ch nhau 3 \u2013 6 tu\u1ea7n. Khi ti\u00eam \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111\u00fang k\u1ef9 thu\u1eadt \u0111\u1ec3 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng, t\u1ed5n th\u01b0\u01a1ng g\u00e2n, t\u1ed5n th\u01b0\u01a1ng hay t\u1ea1o s\u1eb9o cho d\u00e2y th\u1ea7n kinh<\/li>\n<li>Thay \u0111\u1ed5i t\u01b0 th\u1ebf v\u00e0 c\u00f3 ch\u1ebf \u0111\u1ed9 ngh\u1ec9 ng\u01a1i h\u1ee3p l\u00fd khi l\u00e0m vi\u1ec7c \u0111\u1ec3 tr\u00e1nh l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng b\u1ec7nh<\/li>\n<li>Ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi vi\u1ec7c mang m\u00e1ng n\u1eb9p, u\u1ed1ng thu\u1ed1c kh\u00e1ng vi\u00eam NSAIDs v\u00e0 ti\u00eam steroid v\u00e0o \u1ed1ng c\u1ed5 tay ho\u1eb7c khi b\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m \u0111\u00e1ng k\u1ec3 c\u00e1c ho\u1ea1t \u0111\u1ed9ng sinh ho\u1ea1t h\u1eb1ng ng\u00e0y ho\u1eb7c c\u00f3 t\u00ecnh tr\u1ea1ng teo c\u01a1 r\u00f5. Ph\u1eabu thu\u1eadt c\u1eaft d\u00e2y ch\u1eb1ng ngang gi\u1ea3i ph\u00f3ng th\u1ea7n kinh gi\u1eefa c\u00f3 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng cao v\u00e0 giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c sau m\u1ed5 c\u0169ng nhanh.<\/li>\n<li>Ch\u01b0\u01a1ng tr\u00ecnh ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng sau ph\u1eabu thu\u1eadt \u1ed1ng c\u1ed5 tay gi\u1ea3i ph\u00f3ng th\u1ea7n kinh gi\u1eefa:<\/li>\n<\/ul>\n<p>+ Tu\u1ea7n 1: t\u1eadp ngay sau m\u1ed5. G\u1ea5p du\u1ed7i c\u1ed5 tay nh\u1eb9 nh\u00e0ng, c\u00e1c ng\u00f3n g\u1ea5p du\u1ed7i t\u1ed1i \u0111a. Mang n\u1eb9p c\u1ed5 tay h\u1ed7 tr\u1ee3<\/p>\n<p>+ Tu\u1ea7n 2: c\u1eaft ch\u1ec9 v\u00e0 ch\u0103m s\u00f3c s\u1eb9o m\u1ed5. B\u1eaft \u0111\u1ea7u t\u1eadp m\u1ea1nh c\u01a1 v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng sinh ho\u1ea1t h\u1eb1ng ng\u00e0y<\/p>\n<p>+ Tu\u1ea7n 3 \u2013 4: ti\u1ebfp t\u1ee5c t\u1eadp m\u1ea1nh c\u01a1. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e9p th\u1ef1c hi\u1ec7n nh\u1eefng ho\u1ea1t \u0111\u1ed9ng m\u1ea1nh h\u01a1n v\u00e0 quay tr\u1edf l\u1ea1i l\u00e0m vi\u1ec7c.<\/p>\n<h3><strong>T\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh tr\u1ee5 (n. ulnaris)<\/strong><\/h3>\n<h4><strong>\u0110\u1eb7c \u0111i\u1ec3m gi\u1ea3i ph\u1eabu<\/strong><\/h4>\n<p>&#8211; Nguy\u00ean u\u1ef7:<\/p>\n<p>D\u00e2y th\u1ea7n kinh tr\u1ee5 xu\u1ea5t ph\u00e1t t\u1eeb b\u00f3 trong c\u1ee7a \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay, \u0111i ph\u00eda trong \u0111\u1ed9ng m\u1ea1ch c\u00e1nh tay trong \u1ed1ng c\u00e1nh tay.<\/p>\n<ul>\n<li>\u1ede c\u00e1nh tay<\/li>\n<\/ul>\n<p>\u0110\u1ebfn 1\/3 gi\u1eefa c\u00e1nh tay, th\u1ea7n kinh tr\u1ee5 c\u00f9ng v\u1edbi \u0111\u1ed9ng m\u1ea1ch b\u00ean tr\u1ee5 tr\u00ean ch\u1ecdc qua v\u00e1ch gian c\u01a1 trong ra v\u00f9ng c\u00e1nh tay sau v\u00e0 \u00e1p s\u00e1t m\u1eb7t sau v\u00e1ch gian c\u01a1 trong. Sau \u0111\u00f3, \u0111i v\u00e0o r\u00e3nh th\u1ea7n kinh tr\u1ee5 \u1edf v\u00f9ng khu\u1ef7u sau.<\/p>\n<ul>\n<li>\u1ede c\u00e1nh tay d\u00e2y tr\u1ee5 kh\u00f4ng cho nh\u00e1nh b\u00ean n\u00e0o &#8211; \u1ede khu\u1ef7u tay:<\/li>\n<\/ul>\n<p>+ R\u00e3nh th\u1ea7n kinh tr\u1ee5 h\u1eb9p v\u00e0 s\u00e2u, n\u1eb1m \u1edf ph\u00eda trong v\u00f9ng khu\u1ef7u sau<\/p>\n<p>+ Trong r\u00e3nh, d\u00e2y tr\u1ee5 \u0111i gi\u1eefa hai b\u00f3 c\u1ee7a c\u01a1 g\u1ea5p c\u1ed5 tay tr\u1ee5 l\u00e0 c\u01a1 t\u00f9y h\u00e0nh c\u1ee7a th\u1ea7n kinh tr\u1ee5 v\u00e0 xung quanh l\u00e0 v\u00f2ng n\u1ed1i gi\u1eefa \u0111\u1ed9ng m\u1ea1ch b\u00ean tr\u1ee5 tr\u00ean v\u00e0 \u0111\u1ed9ng m\u1ea1ch qu\u1eb7t ng\u01b0\u1ee3c tr\u1ee5 sau.<\/p>\n<ul>\n<li>\u1ede c\u1eb3ng tay:<\/li>\n<\/ul>\n<p>+ Th\u1ea7n kinh tr\u1ee5 \u0111i t\u1eeb ph\u00eda sau m\u1ecfm tr\u00ean l\u1ed3i c\u1ea7u trong \u0111\u1ebfn ph\u00eda ngo\u00e0i x\u01b0\u01a1ng \u0111\u1eadu, n\u00f3 n\u1eb1m tr\u01b0\u1edbc c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n s\u00e2u v\u00e0 sau c\u01a1 g\u1ea5p c\u1ed5 tay tr\u1ee5<\/p>\n<p>+ \u0110\u1ed9ng m\u1ea1ch tr\u1ee5 \u0111i ph\u00eda ngo\u00e0i th\u1ea7n kinh tr\u1ee5 \u1edf 2\/3 d\u01b0\u1edbi<\/p>\n<p>+ \u0110\u1ebfn tr\u00ean c\u1ed5 tay, th\u1ea7n kinh tr\u1ee5 cho nh\u00e1nh v\u1eadn \u0111\u1ed9ng m\u1ed9t c\u01a1 r\u01b0\u1ee1i: c\u01a1 g\u1ea5p c\u1ed5 tay tr\u1ee5 v\u00e0 hai b\u00f3 trong c\u01a1 g\u1ea5p c\u00e1c ng\u00f3n s\u00e2u (ng\u00f3n 4 v\u00e0 5).<\/p>\n<ul>\n<li>\u1ede b\u00e0n tay:<\/li>\n<\/ul>\n<p>Th\u1ea7n kinh tr\u1ee5 \u0111i v\u00e0o b\u00e0n tay gi\u1eefa x\u01b0\u01a1ng \u0111\u1eadu v\u00e0 x\u01b0\u01a1ng m\u00f3c, \u1edf ph\u00eda tr\u01b0\u1edbc m\u1ea1c gi\u1eefa g\u00e2n g\u1ea5p, ph\u00eda sau c\u01a1 gan tay ng\u1eafn v\u00e0 chia l\u00e0m 2 nh\u00e1nh: n\u00f4ng v\u00e0 s\u00e2u.<\/p>\n<p>+ Nh\u00e1nh n\u00f4ng:<\/p>\n<ul>\n<li>Cho nh\u00e1nh v\u1eadn \u0111\u1ed9ng c\u01a1 gan tay ng\u1eafn<\/li>\n<li>Ph\u00e2n ph\u1ed1i c\u1ea3m gi\u00e1c cho m\u1ed9t ng\u00f3n r\u01b0\u1ee1i b\u00ean trong qua c\u00e1c th\u1ea7n kinh gan ng\u00f3n chung v\u00e0 c\u00e1c th\u1ea7n kinh gan ng\u00f3n tay. Th\u1ea7n kinh gan ng\u00f3n tay \u0111i v\u00e0o b\u1edd trong ng\u00f3n \u00fat. Th\u1ea7n kinh gan ng\u00f3n chung chia th\u00e0nh 2 th\u1ea7n kinh gan ng\u00f3n ri\u00eang cho c\u00e1c b\u1edd k\u1ec1 nhau c\u1ee7a c\u00e1c ng\u00f3n tay IV v\u00e0 V<\/li>\n<li>Th\u1ea7n kinh gan ng\u00f3n chung c\u00f2n t\u00e1ch ra nh\u00e1nh t\u1edbi n\u1ed1i v\u1edbi th\u1ea7n kinh gi\u1eefa.<\/li>\n<\/ul>\n<p>+ Nh\u00e1nh s\u00e2u:<\/p>\n<ul>\n<li>Nh\u00e1nh s\u00e2u \u0111i k\u00e8m theo cung \u0111\u1ed9ng m\u1ea1ch gan tay s\u00e2u. Cho nh\u00e1nh v\u1eadn \u0111\u1ed9ng 3 c\u01a1 c\u1ee7a m\u00f4 \u00fat (c\u01a1 d\u1ea1ng ng\u00f3n \u00fat, c\u01a1 g\u1ea5p ng\u00f3n \u00fat ng\u1eafn, c\u01a1 du\u1ed7i ng\u00f3n \u00fat). Sau \u0111\u00f3 v\u00f2ng qua b\u1edd d\u01b0\u1edbi m\u00f3c x\u01b0\u01a1ng m\u00f3c \u0111\u1ec3 \u0111i s\u00e2u v\u00e0o b\u00e0n tay, cho nh\u00e1nh v\u1eadn \u0111\u1ed9ng h\u1ea7u h\u1ebft c\u00e1c c\u01a1 c\u1ee7a gan tay: c\u00e1c c\u01a1 gian c\u1ed1t, c\u00e1c c\u01a1 giun trong v\u00e0 m\u1ed9t c\u01a1 r\u01b0\u1ee1i c\u1ee7a m\u00f4 c\u00e1i (c\u01a1 kh\u00e9p ng\u00f3n c\u00e1i, \u0111\u1ea7u s\u00e2u c\u01a1 g\u1ea5p ng\u00f3n c\u00e1i ng\u1eafn), ngo\u1ea1i tr\u1eeb n\u0103m c\u01a1 do d\u00e2y th\u1ea7n kinh gi\u1eefa v\u1eadn \u0111\u1ed9ng.<\/li>\n<\/ul>\n<h4>Ch\u1ee9c n\u0103ng sinh l\u00fd<\/h4>\n<ul>\n<li>V\u1eadn \u0111\u1ed9ng c\u00e1c c\u01a1<\/li>\n<\/ul>\n<p>+ M\u00f4 \u00fat: gan tay ng\u1eafn, d\u1ea1ng ng\u00f3n \u00fat, \u0111\u1ed1i ng\u00f3n \u00fat, g\u1ea5p ng\u00f3n \u00fat ng\u1eafn<\/p>\n<p>+ C\u00e1c c\u01a1 gian c\u1ed1t<\/p>\n<p>+ C\u01a1 giun 3 v\u00e0 4<\/p>\n<p>+ Kh\u00e9p ng\u00f3n c\u00e1i<\/p>\n<p>+ B\u00f3 s\u00e2u v\u00e0 c\u01a1 g\u1ea5p ng\u00f3n c\u00e1i.<\/p>\n<ul>\n<li>V\u00f9ng c\u1ea3m gi\u00e1c<\/li>\n<\/ul>\n<p>M\u1eb7t gan n\u1eeda trong (n\u1eeda tr\u1ee5) b\u00e0n tay, ng\u00f3n \u00fat, n\u1eeda trong ng\u00f3n nh\u1eabn, n\u1eeda trong mu b\u00e0n tay.<\/p>\n<h4>Diagnose<\/h4>\n<p><em>Kh\u00e1m v\u00e0 l\u01b0\u1ee3ng gi\u00e1 ch\u1ee9c n\u0103ng<\/em><\/p>\n<p>&#8211; Quan s\u00e1t:<\/p>\n<p>Tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh:<\/p>\n<p>+ D\u1ea5u hi\u1ec7u \u201cb\u00e0n tay vu\u1ed1t tr\u1ee5\u201d: teo c\u00e1c c\u01a1 gian c\u1ed1t v\u00e0 c\u01a1 giun b\u00e0n tay; du\u1ed7i kh\u1edbp b\u00e0n ng\u00f3n v\u00e0 g\u1ea5p c\u00e1c kh\u1edbp li\u00ean \u0111\u1ed1t t\u1ea1o t\u01b0 th\u1ebf vu\u1ed1t, r\u00f5 r\u1ec7t \u1edf ng\u00f3n 4, 5<\/p>\n<p>+ C\u00e1c ng\u00f3n tay h\u01a1i d\u1ea1ng ra, \u00f4 m\u00f4 \u00fat teo nh\u1ecf, b\u1eb9t xu\u1ed1ng, khe gian c\u1ed1t l\u00f5m xu\u1ed1ng \u0111\u1ec3 l\u1ed9 r\u00f5 x\u01b0\u01a1ng b\u00e0n tay.<\/p>\n<ul>\n<li>Kh\u00e1m v\u1eadn \u0111\u1ed9ng: C\u01a1 l\u1ef1c: li\u1ec7t c\u00e1c c\u01a1 do th\u1ea7n kinh tr\u1ee5 chi ph\u1ed1i. V\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh tr\u1ee5 c\u00e0ng cao th\u00ec s\u1ed1 c\u01a1 b\u1ecb li\u1ec7t c\u00e0ng nhi\u1ec1u.<\/li>\n<\/ul>\n<p>+ C\u00e1c nghi\u1ec7m ph\u00e1p:<\/p>\n<ul>\n<li>Y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n n\u1eafm b\u00e0n tay: ng\u00f3n 4, 5 v\u00e0 m\u1ed9t ph\u1ea7n ng\u00f3n 3 g\u1ea5p kh\u00f4ng h\u1ebft<\/li>\n<li>Kh\u00f4ng g\u1ea5p \u0111\u01b0\u1ee3c \u0111\u1ed1t cu\u1ed1i ng\u00f3n 5: b\u1ec7nh nh\u00e2n kh\u00f4ng g\u00e3i \u0111\u01b0\u1ee3c ng\u00f3n \u00fat tr\u00ean m\u1eb7t b\u00e0n trong khi gan b\u00e0n tay \u00e1p ch\u1eb7t xu\u1ed1ng m\u1eb7t b\u00e0n<\/li>\n<li>Nghi\u1ec7m ph\u00e1p Froment: b\u1ec7nh nh\u00e2n k\u1eb9p t\u1edd gi\u1ea5y gi\u1eefa ng\u00f3n c\u00e1i v\u00e0 ng\u00f3n tr\u1ecf, do li\u1ec7t c\u01a1 kh\u00e9p ng\u00f3n c\u00e1i n\u00ean kh\u00f4ng th\u1ec3 k\u1eb9p t\u1edd gi\u1ea5y b\u1eb1ng ng\u00f3n c\u00e1i du\u1ed7i th\u1eb3ng m\u00e0 ph\u1ea3i g\u1ea5p ng\u00f3n c\u00e1i \u1edf kh\u1edbp li\u00ean \u0111\u1ed1t \u0111\u1ec3 gi\u1eef t\u1edd gi\u1ea5yl\u1ea1i.<\/li>\n<\/ul>\n<p>+ Tr\u01b0\u01a1ng l\u1ef1c c\u01a1: gi\u1ea3m<\/p>\n<ul>\n<li>Kh\u00e1m c\u1ea3m gi\u00e1c: m\u1ea5t c\u1ea3m gi\u00e1c \u1edf ng\u00f3n tay \u00fat, m\u00f4 \u00fat v\u00e0 1\/2 ng\u00f3n nh\u1eabn &#8211; Kh\u00e1m ph\u1ea3n x\u1ea1: m\u1ea5t ph\u1ea3n x\u1ea1 tr\u1ee5 s\u1ea5p.<\/li>\n<\/ul>\n<pre><em>Implementing the quadrants<\/em><\/pre>\n<ul>\n<li>Bi\u1ebfn d\u1ea1ng \u201cb\u00e0n tay vu\u1ed1t tr\u1ee5\u201d<\/li>\n<li>M\u1ea5t \u0111\u1ed9ng t\u00e1c d\u1ea1ng v\u00e0 kh\u00e9p c\u00e1c ng\u00f3n, kh\u00e9p ng\u00f3n c\u00e1i, g\u1ea5p \u0111\u1ed1t xa ng\u00f3n 4 \u2013 5<\/li>\n<li>M\u1ea5t c\u1ea3m gi\u00e1c \u1edf ng\u00f3n tay \u00fat, m\u00f4 \u00fat v\u00e0 1\/2 ng\u00f3n nh\u1eabn<\/li>\n<li>M\u1ea5t ph\u1ea3n x\u1ea1 tr\u1ee5 s\u1ea5p<\/li>\n<li>K\u1ebft qu\u1ea3 kh\u1ea3o s\u00e1t ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n ph\u00f9 h\u1ee3p v\u1edbi t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh tr\u1ee5.<\/li>\n<\/ul>\n<pre><em>Differential diagnosis<\/em><\/pre>\n<p>T\u1ed5n th\u01b0\u01a1ng r\u1ec5 C8, T1 ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i \u0111o\u1ea1n th\u00e2n d\u01b0\u1edbi, b\u00f3 trong: y\u1ebfu m\u1ed9t s\u1ed1 c\u01a1 kh\u00f4ng do th\u1ea7n kinh tr\u1ee5 chi ph\u1ed1i. V\u00ed d\u1ee5: C8 c\u0169ng chi ph\u1ed1i th\u1ea7n kinh cho c\u00e1c c\u01a1 g\u1ea5p ng\u00f3n c\u00e1i d\u00e0i, d\u1ea1ng ng\u00f3n c\u00e1i ng\u1eafn, \u0111\u1ed1i ng\u00f3n c\u00e1i trong khi \u0111\u00f3 th\u1ea7n kinh tr\u1ee5 th\u00ec kh\u00f4ng. \u0110o \u0111i\u1ec7n c\u01a1 g\u00f3p ph\u1ea7n gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t.<\/p>\n<pre><em>Diagnose the cause<\/em><\/pre>\n<ul>\n<li>T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh tr\u1ee5 \u1edf khu\u1ef7u tay:<\/li>\n<\/ul>\n<p>+ B\u1ea5t th\u01b0\u1eddng c\u00e1c c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu, g\u00e3y x\u01b0\u01a1ng c\u0169 ho\u1eb7c m\u1edbi, b\u1ec7nh l\u00fd kh\u1edbp vi\u00eam t\u1ea1i v\u00f9ng khu\u1ef7u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn th\u1ea7n kinh tr\u1ee5 b\u1ecb ch\u00e8n \u00e9p<\/p>\n<p>+ Duy tr\u00ec t\u01b0 th\u1ebf g\u1ea5p khu\u1ef7u trong th\u1eddi gian d\u00e0i ho\u1eb7c l\u1eb7p \u0111i l\u1eb7p l\u1ea1i \u0111\u1ed9ng t\u00e1c g\u1ea5p du\u1ed7i khu\u1ef7u<\/p>\n<p>+ B\u1ec7nh phong.<\/p>\n<ul>\n<li>T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh tr\u1ee5 \u1edf c\u1ed5 tay: th\u01b0\u1eddng g\u1eb7p h\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p th\u1ea7n kinh tr\u1ee5 \u1edf k\u00eanh Guyon:<\/li>\n<\/ul>\n<p>+ Nh\u1eefng ng\u01b0\u1eddi l\u00e0m ngh\u1ec1 \u0111\u00f2i h\u1ecfi v\u1eadn \u0111\u1ed9ng c\u1ed5 tay nhi\u1ec1u<\/p>\n<p>+ Ti\u1ec1n s\u1eed ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng c\u1ed5 tay + U bao ho\u1ea1t d\u1ecbch c\u1ed5 tay.<\/p>\n<ul>\n<li>Ngo\u00e0i ra, th\u1ea7n kinh tr\u1ee5 c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u1edf b\u1ea5t c\u1ee9 v\u1ecb tr\u00ed n\u00e0o tr\u00ean \u0111\u01b0\u1eddng \u0111i c\u1ee7a n\u00f3 do hung kh\u00ed hay c\u00e1c v\u1eadt s\u1eafc nh\u1ecdn kh\u00e1c g\u00e2y ra.<\/li>\n<\/ul>\n<h4>Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/h4>\n<pre><em>\u0110\u1ed1i v\u1edbi th\u1ea7n kinh tr\u1ee5 b\u1ecb ch\u00e8n \u00e9p \u1edf khu\u1ef7u<\/em><\/pre>\n<ul>\n<li>H\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n tr\u00e1nh c\u00e1c \u0111\u1ed9ng t\u00e1c sinh ho\u1ea1t l\u00e0m \u0111\u00e8 \u00e9p hay k\u00e9o c\u0103ng th\u1ea7n kinh tr\u1ee5. S\u1eed d\u1ee5ng mi\u1ebfng \u0111\u1ec7m v\u00f9ng khu\u1ef7u, b\u1ecdc n\u1ec7m cho tay gh\u1ebf, tr\u00e1nh \u0111\u1ed9ng t\u00e1c g\u1ea5p khu\u1ef7u l\u00e2u trong sinh ho\u1ea1t. S\u1eed d\u1ee5ng n\u1eb9p \u0111\u00eam h\u1ed7 tr\u1ee3 \u0111\u1ec3 tr\u00e1nh t\u01b0 th\u1ebf g\u1ea5p khu\u1ef7u k\u00e9o d\u00e0i khi ng\u1ee7.<\/li>\n<li>Xem x\u00e9t \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt \u0111\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng sau 2 \u2013 3 th\u00e1ng \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c li\u00ean t\u1ee5c ho\u1eb7c c\u00f3 teo, y\u1ebfu c\u01a1. Th\u01b0\u1eddng ph\u1eabu thu\u1eadt gi\u1ea3i ch\u00e8n \u00e9p \u0111\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p th\u1ea7n kinh tr\u1ee5 b\u1ecb ch\u00e8n t\u1ea1i \u0111\u01b0\u1eddng h\u1ea7m th\u1ea7n kinh tr\u1ee5. Trong khi \u0111\u00f3 \u0111\u1ed1i v\u1edbi th\u1ea7n kinh tr\u1ee5 b\u1ecb ch\u00e8n \u00e9p t\u1ea1i r\u00e3nh th\u1ea7n kinh tr\u1ee5 th\u00ec ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c ch\u1ecdn l\u00e0 chuy\u1ec3n v\u1ecb tr\u00ed th\u1ea7n kinh tr\u1ee5. N\u1ebfu tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh k\u00e9o d\u00e0i ch\u01b0a qu\u00e1 1 n\u0103m v\u00e0 ch\u01b0a c\u00f3 teo c\u01a1 th\u00ec k\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt th\u01b0\u1eddng kh\u1ea3 quan.<\/li>\n<\/ul>\n<pre><em>\u0110\u1ed1i v\u1edbi th\u1ea7n kinh tr\u1ee5 b\u1ecb ch\u00e8n \u00e9p \u1edf k\u00eanh Guyon<\/em><\/pre>\n<ul>\n<li>\u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n \u0111\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9 b\u1eb1ng c\u00e1ch tr\u00e1nh c\u00e1c \u0111\u1ed9ng t\u00e1c l\u00e0m ch\u1ea5n th\u01b0\u01a1ng th\u00eam, mang n\u1eb9p c\u1ed5 tay h\u1ed7 tr\u1ee3<\/li>\n<li>N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n th\u00ec ngh\u0129 \u0111\u1ebfn ph\u1eabu thu\u1eadt. Th\u01b0\u1eddng ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf m\u1ecfm m\u00f3c c\u1ee7a x\u01b0\u01a1ng m\u00f3c k\u1ebft h\u1ee3p v\u1edbi gi\u1ea3i ph\u00f3ng th\u1ea7n kinh tr\u1ee5 b\u1ecb ch\u00e8n \u00e9p. Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 u bao ho\u1ea1t d\u1ecbch hay m\u1ed9t t\u1ed5 ch\u1ee9c g\u00ec kh\u00e1c \u1edf trong hay g\u1ea7n k\u00eanh Guyon g\u00e2y ch\u00e8n \u00e9p th\u1ea7n kinh tr\u1ee5 th\u00ec c\u0169ng c\u1ea7n ph\u1ea3i ph\u1eabu thu\u1eadt.<\/li>\n<li style=\"list-style-type: none;\">\u00a0<\/li>\n<\/ul>","protected":false},"featured_media":2283,"comment_status":"open","ping_status":"closed","template":"","tags":[183,182],"chuyen-muc":[61],"class_list":["post-2069","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-liet-than-kinh","tag-ton-thuong-than-kinh-ngoai-bien","chuyen-muc-benh-ly"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2069","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=2069"}],"version-history":[{"count":0,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/2069\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/2283"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=2069"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=2069"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=2069"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}