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Современная стратегия дифференциальной диагностики и лечения компрессионно-ишемической невропатии срединного нерва на уровне карпального канала (клиническое исследование)
Современная стратегия дифференциальной диагностики и лечения компрессионно-ишемической невропатии срединного нерва на уровне карпального канала (клиническое исследование)
Самарцев И.Н., Рашидов Н.А., Живолупов С.А., Воробьева М.Н. Современная стратегия дифференциальной диагностики и лечения компрессионно-ишемической невропатии срединного нерва на уровне карпального канала (клиническое исследование). Consilium Medicum. 2017; 19 (2.2. Неврология и Ревматология): 58–66.
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Аннотация
Синдром карпального канала (СКК) является одним из наиболее часто встречаемых заболеваний периферической нервной системы. Однако, несмотря на широкое распространение (86,7% всех компрессионно-ишемических невропатий), дифференциальная диагностика и лечение данной патологии представляет собой сложную задачу.
Цель исследования – оптимизация диагностики и лечения больных с СКК.
Материалы и методы. 126 пациентов с СКК были разделены на 2 группы. Терапия основной группы (n=60) включала базовую схему (локальная инъекционная терапия с глюкокортикостероидом, ношение ортеза, витамины группы В, габапентин) и антихолинэстеразный препарат ипидакрин (Ипигрикс®). Лечение контрольной группы (n=66) ограничивалось базовой схемой. Общая длительность периода наблюдения составила 60 дней. Оценка эффективности терапии проводилась с учетом анализа интенсивности болевого синдрома по шкале NRS, нарушений функции кисти по опроснику QuickDASH и электронейромиографии (ЭНМГ).
Результаты. Самым специфичным (93,2%) и чувствительным (95,9%) проявлением СКК оказался симптом «встряхивания». Включение в комбинированную терапию ипидакрина (Ипигрикс®) позволило достоверно (р<0,05) снизить выраженность чувствительных и двигательных нарушений на кисти, улучшить функционирование пораженной руки у пациентов с СКК, что коррелировало с положительной динамикой изменений ЭНМГ-параметров (преимущественно по сенсорным волокнам). На основании результатов исследования выявлены клинические предикторы эффективности консервативной терапии (КПЭТ) СКК: длительность заболевания менее 3 нед, отсутствие выраженной гипотрофии тенара, амплитуда моторного ответа n. medianus более 5,5 мс, скорость проведения импульса более 51,6 м/с по двигательным волокнам n. medianus, тотальное нивелирование сенсорных нарушений после 1-го сеанса локальной инъекционной терапии с глюкокортикостероидом, применение ипидакрина. При наличии всех 6 КПЭТ вероятность хорошего эффекта (купирования болевого синдрома и QuickDASH≤10 баллов) от консервативной терапии пациентов с СКК составила около 90%.
Выводы. Для верификации СКК необходимо руководствоваться диагностической ценностью клинических симптомов и тестов. Терапию СКК следует регламентировать КПЭТ и показаниями для хирургического вмешательства. При проведении консервативного лечения СКК в состав базовой терапии должен быть включен антихолинэстеразный препарат ипидакрин (Ипигрикс®).
Ключевые слова: синдром карпального канала, Ипигрикс, локальная инъекционная терапия, клинические предикторы эффективности терапии.
The aim of the study was to optimize the diagnosis and treatment of CTS.
Materials and methods. 126 patients with CTS were divided into 2 groups. Therapy of the main group (n=60) included basic scheme (local steroid injection – LSI, splinting, vitamins B, gabapentin) and cholinesterase inhibitor ipidacrine (Ipigrix®). Therapy of the control group (n=66) was limited by the basic scheme. The total duration of the observation period was 60 days. The effectiveness of treatment was evaluated according to the analysis of NRS, QuickDASH and nerve conduction studies’ (NCS) results.
Results. The “flick sign” turned out to be the most specific (93.2%) and sensitive manifestation of CTS. Ipigrix administration allowed to significantly reduce (р<0.05) severity of sensory of motor disturbances, enhance physical function of the upper limb in patients of CTS which correlated with positive changes of NCS-parameters (predominantly in sensor fibers). We have also estimated the сlinical prediction rules (CRPs): duration of CTS less than 3 mths, lack of severe thenar atrophy, amplitudes of recorded n. medianus motor response >5.5 ms, motor conduction velocity >51.6 m/s, total reduction of sensory disturbances after 1st LSI, ipidacrine administration. The presence of all 6 CRP’s predicts good effect of conservative treatment (lack of pain, QuickDASH≤10 points) in almost 90% of CTS patients.
Conclusions. Verification of CTS should be based on diagnostic value of clinical signs and tests. Therapy of CTS must be regulate by CRP’s and indications for surgery. Ipidacrine (Ipigrix®) should be included in basic scheme of CTS conservative treatment.
Key words: carpal tunnel syndrome, Ipigrix, local steroid injection, clinical prediction rules.
Цель исследования – оптимизация диагностики и лечения больных с СКК.
Материалы и методы. 126 пациентов с СКК были разделены на 2 группы. Терапия основной группы (n=60) включала базовую схему (локальная инъекционная терапия с глюкокортикостероидом, ношение ортеза, витамины группы В, габапентин) и антихолинэстеразный препарат ипидакрин (Ипигрикс®). Лечение контрольной группы (n=66) ограничивалось базовой схемой. Общая длительность периода наблюдения составила 60 дней. Оценка эффективности терапии проводилась с учетом анализа интенсивности болевого синдрома по шкале NRS, нарушений функции кисти по опроснику QuickDASH и электронейромиографии (ЭНМГ).
Результаты. Самым специфичным (93,2%) и чувствительным (95,9%) проявлением СКК оказался симптом «встряхивания». Включение в комбинированную терапию ипидакрина (Ипигрикс®) позволило достоверно (р<0,05) снизить выраженность чувствительных и двигательных нарушений на кисти, улучшить функционирование пораженной руки у пациентов с СКК, что коррелировало с положительной динамикой изменений ЭНМГ-параметров (преимущественно по сенсорным волокнам). На основании результатов исследования выявлены клинические предикторы эффективности консервативной терапии (КПЭТ) СКК: длительность заболевания менее 3 нед, отсутствие выраженной гипотрофии тенара, амплитуда моторного ответа n. medianus более 5,5 мс, скорость проведения импульса более 51,6 м/с по двигательным волокнам n. medianus, тотальное нивелирование сенсорных нарушений после 1-го сеанса локальной инъекционной терапии с глюкокортикостероидом, применение ипидакрина. При наличии всех 6 КПЭТ вероятность хорошего эффекта (купирования болевого синдрома и QuickDASH≤10 баллов) от консервативной терапии пациентов с СКК составила около 90%.
Выводы. Для верификации СКК необходимо руководствоваться диагностической ценностью клинических симптомов и тестов. Терапию СКК следует регламентировать КПЭТ и показаниями для хирургического вмешательства. При проведении консервативного лечения СКК в состав базовой терапии должен быть включен антихолинэстеразный препарат ипидакрин (Ипигрикс®).
Ключевые слова: синдром карпального канала, Ипигрикс, локальная инъекционная терапия, клинические предикторы эффективности терапии.
________________________________________________
The aim of the study was to optimize the diagnosis and treatment of CTS.
Materials and methods. 126 patients with CTS were divided into 2 groups. Therapy of the main group (n=60) included basic scheme (local steroid injection – LSI, splinting, vitamins B, gabapentin) and cholinesterase inhibitor ipidacrine (Ipigrix®). Therapy of the control group (n=66) was limited by the basic scheme. The total duration of the observation period was 60 days. The effectiveness of treatment was evaluated according to the analysis of NRS, QuickDASH and nerve conduction studies’ (NCS) results.
Results. The “flick sign” turned out to be the most specific (93.2%) and sensitive manifestation of CTS. Ipigrix administration allowed to significantly reduce (р<0.05) severity of sensory of motor disturbances, enhance physical function of the upper limb in patients of CTS which correlated with positive changes of NCS-parameters (predominantly in sensor fibers). We have also estimated the сlinical prediction rules (CRPs): duration of CTS less than 3 mths, lack of severe thenar atrophy, amplitudes of recorded n. medianus motor response >5.5 ms, motor conduction velocity >51.6 m/s, total reduction of sensory disturbances after 1st LSI, ipidacrine administration. The presence of all 6 CRP’s predicts good effect of conservative treatment (lack of pain, QuickDASH≤10 points) in almost 90% of CTS patients.
Conclusions. Verification of CTS should be based on diagnostic value of clinical signs and tests. Therapy of CTS must be regulate by CRP’s and indications for surgery. Ipidacrine (Ipigrix®) should be included in basic scheme of CTS conservative treatment.
Key words: carpal tunnel syndrome, Ipigrix, local steroid injection, clinical prediction rules.
Полный текст
Список литературы
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4. Amirlak B et al. Median Nerve Entrapment. 1-11-2010. Internet Communication, 2011. Accessed: 24/10/2011.
5. Atroshi I et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282 (2): 153–8.
6. Bingham RC, Rosecrance JC, Cook TM. Prevalence of abnormal median nerve conduction in applicants for industrial jobs. Am J Ind Med 1996; 30 (3): 355–61.
7. Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991–2001. J Neurol Neurosurg Psychiatry 2003; 74 (12): 1674–9.
8. Burns TM. Mechanisms of acute and chronic compression neuropathy. In: Dyck PJ, Thomas PK Peripheral neuropathy. 4th. Amsterdam: Elsevier, 2005; p. 1391–402.
9. Chang MH et al. Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electro diagnosis of carpal tunnel syndrome. Clin Neurophysiol 2006; 117 (5): 984–91.
10. O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003; 1.
11. Dias JJ, Bhowal B, Wildin CJ, Thompson JR. Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias?
J Bone Joint Surg Br 2001; 83 (2): 235–40.
12. Gelberman RH et al. Carpal tunnel syndrome. A scientific basis for clinical care. Orthop Clin North Am 1988; 19 (1): 115–4.
13. Gerritsen AM et al. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomised controlled trial. JAMA 2002; 288: 1245–51.
14. Harrel FE et al. Regression modelling strategies for improved prognostic prediction. Stat Med 1984; 3(2): 143–152.
15. Hirata H, Nagakura T, Tsujii M. The relationshiot of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol 2004; 205 (5): 606–12.
16. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29 (6): 602–8.
17. Hui AC et al. A randomized controlled trial of surgery vs. steroid injection for carpal tunnel syndrome. Neurology 2005; 64 (12): 2074–8.
18. Katz JN et al. Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg 1995; 20 (4): 549–55.
19. LaBan MM, MacKenzie JR, Zemenick GA. Anatomic observations in carpal tunnel syndrome as they relate to the tethered median nerve stress test. Arch Phys Med Rehabil 1989; 70 (1): 44–6.
20. Lundborg G, Gelberman RH, Minteer-Convery M. Median nerve compression in the carpal tunnel – Functional response to experimentally induced controlled pressure. J Hand Surg 1982; 7 (3): 252–9.
21. Ly-Pen D et al. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum 2005; 52 (2): 612–9.
22. MacDermid JC, Doherty T. Clinical and electrodiagnostic testing of carpal tunnel syndrome: a narrative review. J Orthop Sports Phys Ther 2004; 34 (10): 565–88.
23. Mackinnon SE. Pathophysiology of nerve compression. Hand Clin 2002; 18 (2): 231–41.
24. Millesi H, Zoch G, Rath T. The gliding apparatus of peripheral nerve and its clinical significance. Ann Chir Main Memb Super 1990; 9: 87–97.
25. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002; 58 (2): 289–94.
26. Mondelli V et al. Long term follow-up of carpal tunnel syndrome during pregnancy: a cohort study and review of the literature. Electromyogr Clin Neurophysiol 2007; 47 (6): 259–271.
27. Nathan PA, Meadows KD, Doyle LS. Occupation as a risk factor for impaired sensory conduction of the median nerve at the carpal tunnel. J Hand Surg 1988; 13 (2): 167–70.
28. Phalen GS, Kendrick JI. Compression neuropathy of the median nerve in the carpal tunnel. JAMA 1957; 164: 524–30.
29. Pelmear PL, Taylor W. Carpal tunnel syndrome and hand-arm vibration syndrome. A diagnostic enigma. Arch Neurol 1994; 51 (4): 416–20.
30. Sud V et al. Absorptive properties of synovium harvested from the carpal tunnel. Microsurgery 2002; 22 (7): 316–9.
31. Thoma A, Veltri K, Haines T, Duku E. A systematic review of reviews comparing the effectiveness of endoscopic and open carpal tunnel decompression. Plast Reconstr Surg 2004; 113 (4): 1184–91.
32. Turner A, Kimble F, Gulyas K, Ball J. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg 2010; 80: 50–4.
33. Werner RA, Andary M. Carpal tunnel syndrome pathophysiology and clinical neurophysiology. Clin Neurophysiol 2002; 113 (9): 1373–81.
34. Werner RA, Armstrong TJ. Carpal tunnel syndrome: ergonomic risk factors and intra carpal canal pressure carpal tunnel syndrome. Phys Med Rehabil Clin N Am 1997; 8 (3): 555–69.
35. Yoshii Y et al. The effect of wrist position on the relative motion of tendon nerve and subsynovial connective tissue within the carpal tunnel in a human cadaver model. J Orthop Res 2008; 26 (8): 1153–8.
2. Zhivolupov S.A., Samarcev I.N. Maloinvazivnaja terapija (blokady) v nevrologii. M., 2016. [in Russian]
3. Zhivolupov S.A., Samarcev I.N. Central'nye mehanizmy terapevticheskoj jeffektivnosti nejromidina v lechenii travmaticheskih porazhenij perifericheskih nervov. Zhurn. nevrologii i psihiatrii im. S.S.Korsakova. 2010; 110 (3): 25–30. [in Russian]
4. Amirlak B et al. Median Nerve Entrapment. 1-11-2010. Internet Communication, 2011. Accessed: 24/10/2011.
5. Atroshi I et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282 (2): 153–8.
6. Bingham RC, Rosecrance JC, Cook TM. Prevalence of abnormal median nerve conduction in applicants for industrial jobs. Am J Ind Med 1996; 30 (3): 355–61.
7. Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991–2001. J Neurol Neurosurg Psychiatry 2003; 74 (12): 1674–9.
8. Burns TM. Mechanisms of acute and chronic compression neuropathy. In: Dyck PJ, Thomas PK Peripheral neuropathy. 4th. Amsterdam: Elsevier, 2005; p. 1391–402.
9. Chang MH et al. Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electro diagnosis of carpal tunnel syndrome. Clin Neurophysiol 2006; 117 (5): 984–91.
10. O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003; 1.
11. Dias JJ, Bhowal B, Wildin CJ, Thompson JR. Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias?
J Bone Joint Surg Br 2001; 83 (2): 235–40.
12. Gelberman RH et al. Carpal tunnel syndrome. A scientific basis for clinical care. Orthop Clin North Am 1988; 19 (1): 115–4.
13. Gerritsen AM et al. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomised controlled trial. JAMA 2002; 288: 1245–51.
14. Harrel FE et al. Regression modelling strategies for improved prognostic prediction. Stat Med 1984; 3(2): 143–152.
15. Hirata H, Nagakura T, Tsujii M. The relationshiot of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol 2004; 205 (5): 606–12.
16. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29 (6): 602–8.
17. Hui AC et al. A randomized controlled trial of surgery vs. steroid injection for carpal tunnel syndrome. Neurology 2005; 64 (12): 2074–8.
18. Katz JN et al. Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg 1995; 20 (4): 549–55.
19. LaBan MM, MacKenzie JR, Zemenick GA. Anatomic observations in carpal tunnel syndrome as they relate to the tethered median nerve stress test. Arch Phys Med Rehabil 1989; 70 (1): 44–6.
20. Lundborg G, Gelberman RH, Minteer-Convery M. Median nerve compression in the carpal tunnel – Functional response to experimentally induced controlled pressure. J Hand Surg 1982; 7 (3): 252–9.
21. Ly-Pen D et al. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum 2005; 52 (2): 612–9.
22. MacDermid JC, Doherty T. Clinical and electrodiagnostic testing of carpal tunnel syndrome: a narrative review. J Orthop Sports Phys Ther 2004; 34 (10): 565–88.
23. Mackinnon SE. Pathophysiology of nerve compression. Hand Clin 2002; 18 (2): 231–41.
24. Millesi H, Zoch G, Rath T. The gliding apparatus of peripheral nerve and its clinical significance. Ann Chir Main Memb Super 1990; 9: 87–97.
25. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002; 58 (2): 289–94.
26. Mondelli V et al. Long term follow-up of carpal tunnel syndrome during pregnancy: a cohort study and review of the literature. Electromyogr Clin Neurophysiol 2007; 47 (6): 259–271.
27. Nathan PA, Meadows KD, Doyle LS. Occupation as a risk factor for impaired sensory conduction of the median nerve at the carpal tunnel. J Hand Surg 1988; 13 (2): 167–70.
28. Phalen GS, Kendrick JI. Compression neuropathy of the median nerve in the carpal tunnel. JAMA 1957; 164: 524–30.
29. Pelmear PL, Taylor W. Carpal tunnel syndrome and hand-arm vibration syndrome. A diagnostic enigma. Arch Neurol 1994; 51 (4): 416–20.
30. Sud V et al. Absorptive properties of synovium harvested from the carpal tunnel. Microsurgery 2002; 22 (7): 316–9.
31. Thoma A, Veltri K, Haines T, Duku E. A systematic review of reviews comparing the effectiveness of endoscopic and open carpal tunnel decompression. Plast Reconstr Surg 2004; 113 (4): 1184–91.
32. Turner A, Kimble F, Gulyas K, Ball J. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg 2010; 80: 50–4.
33. Werner RA, Andary M. Carpal tunnel syndrome pathophysiology and clinical neurophysiology. Clin Neurophysiol 2002; 113 (9): 1373–81.
34. Werner RA, Armstrong TJ. Carpal tunnel syndrome: ergonomic risk factors and intra carpal canal pressure carpal tunnel syndrome. Phys Med Rehabil Clin N Am 1997; 8 (3): 555–69.
35. Yoshii Y et al. The effect of wrist position on the relative motion of tendon nerve and subsynovial connective tissue within the carpal tunnel in a human cadaver model. J Orthop Res 2008; 26 (8): 1153–8.
2. Живолупов С.А., Самарцев И.Н. Малоинвазивная терапия (блокады) в неврологии. М., 2016. / Zhivolupov S.A., Samarcev I.N. Maloinvazivnaja terapija (blokady) v nevrologii. M., 2016. [in Russian]
3. Живолупов С.А., Самарцев И.Н. Центральные механизмы терапевтической эффективности нейромидина в лечении травматических поражений периферических нервов. Журн. неврологии и психиатрии им. С.С.Корсакова. 2010; 110 (3): 25–30. / Zhivolupov S.A., Samarcev I.N. Central'nye mehanizmy terapevticheskoj jeffektivnosti nejromidina v lechenii travmaticheskih porazhenij perifericheskih nervov. Zhurn. nevrologii i psihiatrii im. S.S.Korsakova. 2010; 110 (3): 25–30. [in Russian]
4. Amirlak B et al. Median Nerve Entrapment. 1-11-2010. Internet Communication, 2011. Accessed: 24/10/2011.
5. Atroshi I et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282 (2): 153–8.
6. Bingham RC, Rosecrance JC, Cook TM. Prevalence of abnormal median nerve conduction in applicants for industrial jobs. Am J Ind Med 1996; 30 (3): 355–61.
7. Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991–2001. J Neurol Neurosurg Psychiatry 2003; 74 (12): 1674–9.
8. Burns TM. Mechanisms of acute and chronic compression neuropathy. In: Dyck PJ, Thomas PK Peripheral neuropathy. 4th. Amsterdam: Elsevier, 2005; p. 1391–402.
9. Chang MH et al. Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electro diagnosis of carpal tunnel syndrome. Clin Neurophysiol 2006; 117 (5): 984–91.
10. O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003; 1.
11. Dias JJ, Bhowal B, Wildin CJ, Thompson JR. Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias?
J Bone Joint Surg Br 2001; 83 (2): 235–40.
12. Gelberman RH et al. Carpal tunnel syndrome. A scientific basis for clinical care. Orthop Clin North Am 1988; 19 (1): 115–4.
13. Gerritsen AM et al. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomised controlled trial. JAMA 2002; 288: 1245–51.
14. Harrel FE et al. Regression modelling strategies for improved prognostic prediction. Stat Med 1984; 3(2): 143–152.
15. Hirata H, Nagakura T, Tsujii M. The relationshiot of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol 2004; 205 (5): 606–12.
16. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29 (6): 602–8.
17. Hui AC et al. A randomized controlled trial of surgery vs. steroid injection for carpal tunnel syndrome. Neurology 2005; 64 (12): 2074–8.
18. Katz JN et al. Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg 1995; 20 (4): 549–55.
19. LaBan MM, MacKenzie JR, Zemenick GA. Anatomic observations in carpal tunnel syndrome as they relate to the tethered median nerve stress test. Arch Phys Med Rehabil 1989; 70 (1): 44–6.
20. Lundborg G, Gelberman RH, Minteer-Convery M. Median nerve compression in the carpal tunnel – Functional response to experimentally induced controlled pressure. J Hand Surg 1982; 7 (3): 252–9.
21. Ly-Pen D et al. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum 2005; 52 (2): 612–9.
22. MacDermid JC, Doherty T. Clinical and electrodiagnostic testing of carpal tunnel syndrome: a narrative review. J Orthop Sports Phys Ther 2004; 34 (10): 565–88.
23. Mackinnon SE. Pathophysiology of nerve compression. Hand Clin 2002; 18 (2): 231–41.
24. Millesi H, Zoch G, Rath T. The gliding apparatus of peripheral nerve and its clinical significance. Ann Chir Main Memb Super 1990; 9: 87–97.
25. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002; 58 (2): 289–94.
26. Mondelli V et al. Long term follow-up of carpal tunnel syndrome during pregnancy: a cohort study and review of the literature. Electromyogr Clin Neurophysiol 2007; 47 (6): 259–271.
27. Nathan PA, Meadows KD, Doyle LS. Occupation as a risk factor for impaired sensory conduction of the median nerve at the carpal tunnel. J Hand Surg 1988; 13 (2): 167–70.
28. Phalen GS, Kendrick JI. Compression neuropathy of the median nerve in the carpal tunnel. JAMA 1957; 164: 524–30.
29. Pelmear PL, Taylor W. Carpal tunnel syndrome and hand-arm vibration syndrome. A diagnostic enigma. Arch Neurol 1994; 51 (4): 416–20.
30. Sud V et al. Absorptive properties of synovium harvested from the carpal tunnel. Microsurgery 2002; 22 (7): 316–9.
31. Thoma A, Veltri K, Haines T, Duku E. A systematic review of reviews comparing the effectiveness of endoscopic and open carpal tunnel decompression. Plast Reconstr Surg 2004; 113 (4): 1184–91.
32. Turner A, Kimble F, Gulyas K, Ball J. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg 2010; 80: 50–4.
33. Werner RA, Andary M. Carpal tunnel syndrome pathophysiology and clinical neurophysiology. Clin Neurophysiol 2002; 113 (9): 1373–81.
34. Werner RA, Armstrong TJ. Carpal tunnel syndrome: ergonomic risk factors and intra carpal canal pressure carpal tunnel syndrome. Phys Med Rehabil Clin N Am 1997; 8 (3): 555–69.
35. Yoshii Y et al. The effect of wrist position on the relative motion of tendon nerve and subsynovial connective tissue within the carpal tunnel in a human cadaver model. J Orthop Res 2008; 26 (8): 1153–8.
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13. Gerritsen AM et al. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomised controlled trial. JAMA 2002; 288: 1245–51.
14. Harrel FE et al. Regression modelling strategies for improved prognostic prediction. Stat Med 1984; 3(2): 143–152.
15. Hirata H, Nagakura T, Tsujii M. The relationshiot of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol 2004; 205 (5): 606–12.
16. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29 (6): 602–8.
17. Hui AC et al. A randomized controlled trial of surgery vs. steroid injection for carpal tunnel syndrome. Neurology 2005; 64 (12): 2074–8.
18. Katz JN et al. Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg 1995; 20 (4): 549–55.
19. LaBan MM, MacKenzie JR, Zemenick GA. Anatomic observations in carpal tunnel syndrome as they relate to the tethered median nerve stress test. Arch Phys Med Rehabil 1989; 70 (1): 44–6.
20. Lundborg G, Gelberman RH, Minteer-Convery M. Median nerve compression in the carpal tunnel – Functional response to experimentally induced controlled pressure. J Hand Surg 1982; 7 (3): 252–9.
21. Ly-Pen D et al. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum 2005; 52 (2): 612–9.
22. MacDermid JC, Doherty T. Clinical and electrodiagnostic testing of carpal tunnel syndrome: a narrative review. J Orthop Sports Phys Ther 2004; 34 (10): 565–88.
23. Mackinnon SE. Pathophysiology of nerve compression. Hand Clin 2002; 18 (2): 231–41.
24. Millesi H, Zoch G, Rath T. The gliding apparatus of peripheral nerve and its clinical significance. Ann Chir Main Memb Super 1990; 9: 87–97.
25. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002; 58 (2): 289–94.
26. Mondelli V et al. Long term follow-up of carpal tunnel syndrome during pregnancy: a cohort study and review of the literature. Electromyogr Clin Neurophysiol 2007; 47 (6): 259–271.
27. Nathan PA, Meadows KD, Doyle LS. Occupation as a risk factor for impaired sensory conduction of the median nerve at the carpal tunnel. J Hand Surg 1988; 13 (2): 167–70.
28. Phalen GS, Kendrick JI. Compression neuropathy of the median nerve in the carpal tunnel. JAMA 1957; 164: 524–30.
29. Pelmear PL, Taylor W. Carpal tunnel syndrome and hand-arm vibration syndrome. A diagnostic enigma. Arch Neurol 1994; 51 (4): 416–20.
30. Sud V et al. Absorptive properties of synovium harvested from the carpal tunnel. Microsurgery 2002; 22 (7): 316–9.
31. Thoma A, Veltri K, Haines T, Duku E. A systematic review of reviews comparing the effectiveness of endoscopic and open carpal tunnel decompression. Plast Reconstr Surg 2004; 113 (4): 1184–91.
32. Turner A, Kimble F, Gulyas K, Ball J. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg 2010; 80: 50–4.
33. Werner RA, Andary M. Carpal tunnel syndrome pathophysiology and clinical neurophysiology. Clin Neurophysiol 2002; 113 (9): 1373–81.
34. Werner RA, Armstrong TJ. Carpal tunnel syndrome: ergonomic risk factors and intra carpal canal pressure carpal tunnel syndrome. Phys Med Rehabil Clin N Am 1997; 8 (3): 555–69.
35. Yoshii Y et al. The effect of wrist position on the relative motion of tendon nerve and subsynovial connective tissue within the carpal tunnel in a human cadaver model. J Orthop Res 2008; 26 (8): 1153–8.
Авторы
И.Н.Самарцев*, Н.А.Рашидов, С.А.Живолупов, М.Н.Воробьева
ФГБВОУ ВО «Военно-медицинская академия им. С.М.Кирова» Минобороны России. 194044, Россия, Санкт-Петербург, ул. Академика Лебедева, д. 6
*alpinaigor@mail.ru
S.M.Kirov Medical Military Academy of the Ministry of Defence of the Russian Federation. 194044, Russian Federation, Saint Petersburg, ul. Akademika Lebedeva, d. 6
*alpinaigor@mail.ru
ФГБВОУ ВО «Военно-медицинская академия им. С.М.Кирова» Минобороны России. 194044, Россия, Санкт-Петербург, ул. Академика Лебедева, д. 6
*alpinaigor@mail.ru
________________________________________________
S.M.Kirov Medical Military Academy of the Ministry of Defence of the Russian Federation. 194044, Russian Federation, Saint Petersburg, ul. Akademika Lebedeva, d. 6
*alpinaigor@mail.ru
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