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Carpal tunnel syndrome

Última revisão: 11 Jun 2025
Última atualização: 15 Apr 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presence of risk factors
  • numbness of hand(s)
  • nighttime worsening
  • numbness in median nerve distribution
  • numbness confined to palmar aspect of the first 4 fingers
Detalhes completos

Outros fatores diagnósticos

  • symptoms are intermittent
  • onset is gradual
  • weakness of hand
  • clumsiness
  • aching and pain in arm
  • weakness of thenar muscles (abductor pollicis brevis, or APB, in particular)
  • normal reflexes
  • finger stiffness
  • cold sensitivity
  • atrophy of thenar eminence
Detalhes completos

Fatores de risco

  • age 40-60 years
  • high BMI
  • female sex
  • fractured wrist/carpal bones
  • square wrist
  • rheumatoid arthritis
  • diabetes
  • pregnancy
  • congenital carpal tunnel stenosis
  • occupational exposure
  • tobacco smoking
  • thyroid disorders
  • significant computer use
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • electromyogram (EMG)
Detalhes completos

Investigações a serem consideradas

  • ultrasound of the wrist
  • MRI of the wrist
Detalhes completos

Algoritmo de tratamento

AGUDA

clinical diagnosis of carpal tunnel syndrome (CTS) without electromyogram (EMG) confirmation, or pregnant women

mild or moderate based on EMG findings (nonpregnant)

severe based on EMG findings (nonpregnant)

CONTÍNUA

moderate based on EMG findings + failed splint and corticosteroid injection(s)

refractory to surgery

Colaboradores

Autores

Nigel Ashworth, MBChB, MSc, FRCP(Can)
Nigel Ashworth

Professor

Division of Physical Medicine & Rehabilitation

Faculty of Medicine & Dentistry

University of Alberta

Edmonton

Canada

Declarações

NA is an author of a number of references cited in this topic.

Revisores

Ines C. Lin , MD, MSEd

Associate Professor of Surgery

Division of Plastic Surgery, Department of Surgery, and Department of Orthopaedic Surgery

Perelman School of Medicine at the University of Pennsylvania

Philadelphia

PA

Declarações

ICL declares that she has no competing interests.

Peter C. Amadio, MD

Dean for Research Academic Affairs

Lloyd A. and Barbara A. Amundson Professor of Orthopedic Surgery

Professor of Biomedical Engineering

Mayo Clinic

Rochester

​MN

Declarações

PCA declares that he has no competing interests.

Shawn Marshall, MD, MSc

Associate Professor

University of Ottawa

Ottawa

Ontario

Canada

Declarações

SM declares that he has been primary author and co-author of Cochrane systematic reviews of nonsurgical interventions for treatment of carpal tunnel syndrome.

Tim J. Doherty, MD, PhD

Associate Professor

The University of Western Ontario

London

Ontario

Canada

Declarações

TJD declares that he has no competing interests.

Michael Plant, MD, FRCP

Consultant Rheumatologist

The James Cook University Hospital

South Tees Hospitals NHS Foundation Trust

Middlesbrough

UK

Declarações

MP declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Cartwright MS, Hobson-Webb LD, Boon AJ, et al; American Association of Neuromuscular and Electrodiagnostic Medicine. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug;46(2):287-93. Resumo

Ashworth NL, Bland JDP, Chapman KM, et al. Local corticosteroid injection versus placebo for carpal tunnel syndrome. Cochrane Database Syst Rev. 2023 Feb 1;2(2):CD015148.Texto completo  Resumo

Peters S, Page MJ, Coppieters MW, et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev. 2016 Feb 17;(2):CD004158.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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