中医骨科学外文版 (29).ppt

Carpal Tunnel SyndromeSection II.Overview1.Definition:Carpal tunnel syndrome,also known as carpal tunnel stenosis,refers to a syndrome which mainly presents with pain,numbness and fatigue of the three and half fingers on the radial side caused by that the median nerve is clamped in the carpal tunnel due to the decrease of internal volume of carpal tunnel and the increase of contents in carpal tunnel which makes the pressure in carpal tunnel increase.II Anatomy The carpal tunnel is on the palmar side of wrist and is surrounded by flexor retinaculum and carpal sulcus.There are tendon of flexor digitorum superficialis,tendon of flexor digitorum profundus and median nerve in the carpal tunnel.III.Etiology and Pathology(I)Etiology1.Strain:It may cause chronic damage of tendon,synovium and nerve,resulting in inflammatory edema compression.2.Fracture and dislocation:There can be deformity in healing process,causing a decrease of internal volume of carpal tunnel.3.Endocrine disorder and collagenosis:Cause inflammatory edema of ligament,synovium and tendon.4.Other diseases:Thecal cyst,lipoma,hemangioma,calcinosis,etc.IV.Diagnosis(1)Medical history:History of strain or trauma.(2)Symptoms:Abnormal feelings of the three and half fingers on the radial side of the affected hand,such as tingling,burning pain,numbness,sense of swelling,weakened hand force,clumsy thumb,etc.,but the motor function is not lost.(3)Signs1.Sensory allergy or hypoesthesia of index finger and middle finger(especially fingertips)of the affected hand.2.Cold,pale or cyanotic skin.3.Dry and desquamation of finger skin(nervus vascularis malnutrition).4.Clumsy and weak thumb abduction and palm movement in muscle strength examination.5.Macrothenar muscular atrophy.6.Tinels sign:By percussing the median nerve with fingers at the proximal margin of flexor retinaculum,and the pain and numbness of the affected hand will reappear or worsen.This sign is also called percussion test.7.Positive phalen test:When the median nerve is compressed for 1-2 minutes in phalen test,numbness is aggravated,and pain can occur in the middle finger and index finger.V Treatment(1)Treatment principles Eliminate the causes of oppression;Restore nerve function.(5)Treatment 1.Block therapy:12.5-25 mg of prednisolone plus 2-3 mL of 1%lidocaine can be injected into carpal tunnel at the midpoint of the proximal margin of carpal flexor retinaculum.The acupoints such as Yangxi,Hegu,Laogong will be taken into consideration.2.Acupuncture and moxibustion therapyManipulation:Pressing,kneading,rotating,rolling,rubbing,stretch traction,etc.Operation:1.The patient is sitting,holding out his/her hand and putting his/her palm up on the treatment table,and the doctor presses such acupoints as Qu Ze,Neiguan,Daling and Yuji with thumb;2.Pushing,rolling,pressing or kneading manipulation with one finger should be used for round-trip treatment from forearm to hand along hand-jueyin pericardium meridian,and the treatment should be strengthened on carpal tunnel and thenar muscle.First,the force of manipulation should be light,then it is gradually aggravated.3.The wrist and knuckles should be rotated by rotating manipulation,and the knuckles should be twisted4.Wrist pinching manipulation:The patient is sitting,placing the forearm in the pronation position,and putting the back of the hand up;The doctor holds the palm of the patient with both hands,with his/her right hand on the radial side and his/her left hand on the ulnar side,while his/her thumb lies flat on the back side of the wrist joint.The doctor uses the thumb tip to press the back space of wrist joint and rotates the wrist joint in stubbs stretch traction.Then,the doctor pushes the wrist back to the maximum under the thumb press,then bends and rotates the wrist 2-3 times in different directions.o5.Then the wrist and palm should be rubbed by rubbing manipulation to achieve the purpose of relaxing muscles and tendons,activating blood circulation and removing blood stasisoAfter the operation,the plaster for warming channels and dredging collaterals should be applied externally,and the wrist should be fixed in the rest position with cardboard.After the illness is relieved,it should be washed with Chinese medicine externally or some drugs for relaxing muscles and tendons for external use.VI PrognosisThe disease is easy to recur,and massage treatment can relieve symptoms.If the symptoms recur and worsen gradually,surgery should be performed.