腕管综合征

1、List the clinical manifestations of this condition.

请列出该病可能的临床表现

2. What is a positive Tinel’s sign? What is a Phalen’s test?

什么是Tinel征阳性？什么是Phalen实验？

3. List some magnetic resonance imaging findings.

该病的MRI表现?

4. Which observation on magnetic resonance imaging is most specific?

MRI上什么征象最具特征性？

概述

  Carpal Tunnel Syndrome

1、Noctural hand discomfort, paresthesia in the thumb and second, third, and radial side of the fourth fingers, and weakness and atrophy of the thenar musculature.

夜间手部不适，拇指、第二、三指及第四指桡侧感觉异常，大鱼际肌的萎缩、无力。

2. Tingling in the digits supplied by the median nerve.Flex both wrists for 60 seconds—numbness in the median nerve distribution should occur within 60 seconds in the presence of carpal tunnel syndrome.

Tinel征阳性指正中神经支配的手指出现麻木刺痛感。

Phalen实验指腕关节弯曲，60秒内出现正中神经支配区麻木提示腕管综合征。

3. Compression, diffuse flattening, or an abrupt change in the morphology of the median nerve,edema of the nerve, or enhancement with gadolinium administration.

正中神经受压、扁平，或形态出现突然变化，神经水肿或增强扫描出现强化。

4. Abrupt change in morphology.

正中神经形态出现突然变化是最为特征性的变化。

References

Andreisek G, Crook DW, Burg D, et al: Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics26:1267–1287, 2006.

Yu JS: Magnetic resonance imaging of the wrist.Orthopedics17:1041–1048, 1994.

Cross-Reference

Musculoskeletal Imaging: THE REQUISITES, 3rd ed, p 157.

Comment

Carpal tunnelsyndrome is a common neuropathy of the upper extremity caused by compression ofthe median nerve in the carpal tunnel. It typically involves middle age womenand presents as a bilateral condition in nearly one half of those affected.Several common causes of carpal tunnel syndrome include tenosynovitis, masses (ganglion or neuroma), synovial proliferation, anddiminished girth of the carpal channel from post-traumatic osseous changes andfibrosis. Chronic hypoxia has also been suggested as a potential precipitatingevent. Most cases of carpal tunnel syndrome, however, are idiopathic and arelikely the result of a normal aging process.

Magnetic resonanceimaging is useful for confirming the diagnosis of carpal tunnel syndrome inpatients exhibiting symptoms. Characteristic findings are depicted on truetransaxial images of the wrist. Observations diagnostic of this conditioninclude compression and flattening of the median nerve, increased signalintensity in the median nerve on T2W images (as seen in this patient), bowingof the flexor retinaculum, loss of the normal fat between the carpal bones andthe tendons, and/or an abrupt change of the diameter of the median nerve.

腕管综合征是指正中神经在腕管内受压引起的上肢神经卡压性疾病，好发于中年女性，近一半患者表现为双侧发病。腕管综合征的常见原因包括腱鞘炎、肿块（神经节或神经瘤）、滑膜增生、及外伤后骨化纤维化导致的腕管缩小。慢性缺氧也可能是发作的诱因之一，但腕管综合征大部分仍为自发性，表现为与年龄增大相关。当出现类似症状时，MRI对腕管综合征的确诊有一定意义，横轴位图像最为典型，可以观察到正中神经的受压扁平，T2WI信号增高（本例图中可显示），屈肌支持带弯曲，腕骨和肌腱之间的脂肪间隙消失，和/或正中神经的直径突然改变。