小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 手部麻木
- 夜间恶化
- 正中神经分布区麻痹
- 前 4 指掌侧麻木
其他诊断因素
- 症状呈间歇性
- 症状逐渐加重
- 手部无力
- 笨拙
- 手臂疼痛
- 鱼际肌无力，尤其是拇短展肌（APB）
- 正常反射
- 手指僵硬
- 畏冷
- 鱼际萎缩
危险因素
- 年龄40 - 60 岁
- 体重指数较高
- 女性
- 手腕/腕骨骨折
- 方形手腕
- 类风湿关节炎
- 糖尿病
- 妊娠
- 先天性腕管狭窄
- 职业暴露
- 吸烟
- 甲状腺疾病
- 大量使用计算机
诊断性检查
首要检查
- 肌电图（EMG）
需考虑的检查
- 腕部超声检查
- 腕部核磁共振成像
治疗流程
未经肌电图（electromyogram, EMG）确认而临床诊断为腕管综合征（carpal tunnel syndrome, CTS）的患者，或孕妇
基于肌电图检查结果的轻度或中度腕管综合征（非妊娠妇女）
基于肌电图检查结果的重度腕管综合征（非妊娠妇女）
基于 EMG 检查结果的中度腕管综合征＋夹板疗法和皮质类固醇注射无效
手术难治性腕管综合征
撰稿人
作者
Nigel Ashworth, MBChB, MSc, FRCP(Can)
Professor
Division of Physical Medicine & Rehabilitation
Faculty of Medicine & Dentistry
University of Alberta
Edmonton
Canada
利益声明
NA is an author of a number of references cited in this topic.
同行评议者
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 PennsylvaniaPhiladelphia
PA
利益声明
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
利益声明
PCA declares that he has no competing interests.
Shawn Marshall, MD, MSc
Associate Professor
University of Ottawa
Ottawa
Ontario
Canada
利益声明
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
利益声明
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
利益声明
MP declares that he has no competing interests.
鉴别诊断
- 骨关节炎（Osteoarthritis, OA）
- 急性卒中
- C6 神经根病
更多 鉴别诊断指南
- 手、腕和前臂疾病指南
- ACR 适用性标准：慢性手腕疼痛
更多 指南患者教育信息
腕管综合征
更多 患者教育信息
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