Professional Documents
Culture Documents
PERSPECTIVA HISTRICA
Carpal tunnel syndrome: a historical perspective. Sam L. Loa, Kevin Raskin, MDb, Harriet Lester, MDc, Benisse
Lester. HAND CLINICS 2002
Paget J. Lectures on Surgical Pathology. Philadelphia: Lindsay & Blakiston, 1854.
ANATOMA
Definicin
Lmites
Medidas
Estructuras
Practical anatomy of the carpal tunnell Mitchell B. Rotman, MDa,*, James P. Donovan, MS(R)b. HAND CLINICS 2002
ANATOMA
LIGAMENTO TRANSVERSO DEL
CARPO(LTC)
Origen
Medidas
Secciones
Cobb T, Dalley B, Posteraro R, Lewis R. Anatomyof the flexor retinaculum. J HandSurg 1993;18:919.
Practical anatomy of the carpal tunnell Mitchell B. Rotman, MDa,*, James P. Donovan, MS(R)b. HAND CLINICS 2002
ANATOMA
NERVIO MEDIANO
Tipo de nervio
Origen
Recorrido
Terminales .
ANATOMA
Lanz estudio 246 manos
Grupo O: extraligamentosa 46%.
Grupo I:
Ulnar (IC).
Supraligamentoso (ID):
Grupo II: 7%
Grupo III: 3%
IIIA: ausente
IIIB: a. mediana
IIIC: lumbrical
Grupo IV: 1.6%
IVA:
IVB:
Demircay E, et al: Anatomic Variations of the Median Nerve. Turkish Neurosurgery 2011, Vol: 21, No: 3, 388-396
Lanz U. 1977. Anatomical variations of the median nerve of the carpal tunnel. J Hand Surg [Am] 2:4453.
ANATOMA
COMUNICACIONES ENTRE EL ULNAR Y MEDIANO
Demircay E, et al: Anatomic Variations of the Median Nerve. Turkish Neurosurgery 2011, Vol: 21, No: 3, 388-396
ANATOMA
MARCAS TOPOGRFICAS
FISIOPATOLOGA
FALLO DELA BARRERA
HEMATONEURAL
DEGENERACION AXONAL
EDEMA ENDONEURAL
DESMIELINIZACIN DIFUSA
DESMIELINIZACIN LOCALIZADA
Upton AR, McComas AJ (1973) The double crush in thenerve entrapment syndromes. Lancet 2: 359
Lundborg G (1970) Ischemic nerve injury. Experimentalstudies on intraneural Microvascular pathophysiology and nerve function in a limb
sujected to temporary circulatory arrest. Scand J Plast Reconstr Surg, Suppl 6
EPIDEMIOLOGA
Neuropata compresiva ms comn.
prevalencia de 0.1% a 10%.
Incidencia : 95-148/100000.
Relacin hombre : mujer 1:3.
Bilateralidad de 65% a 84% .
Edad 40 a 60 aos.
Prdida laboral 25 das por ao.
500.000 cirugas al ao.
2 billones al ao
Hales TR, Bernard BP. Epidemiology of work-related musculoskeletal disorders. Ortho Clin N Amer 27(4):679-709, 1996.
Hagberg M et al. Impact of occupations and job tasks on the prevalence of carpal tunnel syndrome. Scand J Work Environ Health 18:337-45, 1992.
ETIOLOGA Y CLASIFICACON
Idioptico
40-50 aos
Condiciones inflamatorias
Condiciones hemorrgicas
Neuropatas
Infeccin
Anatmico
Anomalas
Tumores
Trauma
Ocupacional (Vibraciones )
Agudo
Crnico
DIAGNSTICO
Parestesias - Disestesias
nocturno o en la madrugada
actividades manuales.
Mejora de los sntomas con sacudir las manos.
Dolor
Diagrama de Katz y Stirrat.
Debilidad de la musculatura intrnseca
Wilder-Smith EP, Seet RC, Lim EC. Diagnosing carpal tunnel syndrome clinical criteria and ancillary tests. Nat Clin Pract Neurol
2006;2:36674.
Rempel D et al. Consensus Criteria for the Classification of Carpal Tunnel Syndrome in Epidemiologic Studies. Am J Public Health.
1998 Oct;88(10):1447-51
EXAMEN FSICO
SENSIBILIDAD.
Prueba de Weber
Prueba de Van Frey
Vibracin
Clinical Diagnosis of tunnel carpal syndrome.M. Ceruso, R. Angeloni, G. Lauri, G. Checcucci. 2002. JHS
EXAMEN FSICO
PRUEBAS DE
PROVOCACIN
Tinnel S: 64% E: 71%
Phalen S:75% E:62%
Combinados S: 90%
Clinical Diagnosis of tunnel carpal syndrome.M. Ceruso, R. Angeloni, G. Lauri, G. Checcucci. 2002. JHS
EXAMEN FSICO
EVALUACIN MOTORA.
Clinical Diagnosis of tunnel carpal syndrome.M. Ceruso, R. Angeloni, G. Lauri, G. Checcucci. 2002. JHS
IMGENES DIAGNSTICAS
RADIOGRAFA
TOMOGRAFA
ECOGRAFA
RESONANCIA MAGNTICA
ELECTRODIAGNSTICO
VELOCIDAD DE CONDUCCIN
S: 84 % E:95%
Sensitivas
Motoras
Mixtas
ELECTROMIOGRAFA
Relajacin, Insercin, contraccin
P. Fibrilacin Denervacin activa
P. M. polifsicos Denervacin con
reinervacin
D.C. repetitivas Denervacin crnica
TRATAMIENTO
Mdico
Frula
Medicacin oral
Corticosteroides
Otras modalidades:
- Cambios ergonmicos
- Ultrasonido
- Ejercicios
- Laser
- iontoforesis
Quirrgico
Abierto
Mnimamente invasiva
Endoscpico
C. Sabin Cranford, MD, et al. Journal of the American Academy of Orthopaedic Surgeons. Volume 15, Number 9, September
2007
FRULA
Posicin neutra
2+- 9extension
2 +- 6desviacin ulnar
80% mejoran
J.S. Brault .Conservative Care for Carpal Tunnel Syndrome 2002. JHS
MEDICACIN
AINES
DIURETICOS
PIRIDOXINA
CORTICOSTEROIDES
C. Sabin Cranford, MD, et al. Journal of the American Academy of Orthopaedic Surgeons. Volume 15, Number 9, September
2007
INFILTRACIN
Tradicionalmente
20 mg triamcinolona con o
sin lidocana
Aguja calibre 25
1,25
Dexametasona
C. Sabin Cranford, MD, et al. Journal of the American Academy of Orthopaedic Surgeons. Volume 15, Number 9, September
2007
Green's Operative Hand Surgery: 2-VolumeScott W. Wolfe, Robert N. Hotchkiss, William C.Pederson, Scott H. Kozin
C. Sabin Cranford, MD, et al. Journal of the American Academy of Orthopaedic Surgeons. Volume 15, Number 9, September
2007
C. Sabin Cranford, MD, et al. Journal of the American Academy of Orthopaedic Surgeons. Volume 15, Number 9, September
2007
P. Di Giuseppe. The Mini-Invasive Technique for Carpal Tunnel Release: Open Approach with Converse
Fiberoptic Light Retractor
LIBERACIN ENDOSCPICA
Chow JCY (1989) Endoscopic Release of the Carpal Ligament:A New Technique for Carpal Tunnel Syndrome;
Arthroscopy5:19-24
TRATAMIENTO
ABIERTO VS ENDOSCPICO
GRACIAS.