Carpal Tunnel Syndrome Guidelines 腕隧道症候群 (2016)

這次的基層透析協會年會請到台南成大醫院骨科部 周一鳴 主任，主講「腕隧道症候群 外科治療」，演講中展示了許多用門診手術處理成功的carpal tunnel syndrome (CTS) 病人，令人印象深刻。

剛好又看到，「MANAGEMENT OF CARPAL TUNNEL SYNDROME EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE」Adopted by the American Academy of Orthopaedic Surgeons，February 29, 2016

所以和大家分享一下，有關carpal tunnel syndrome

1) 診斷：The group does NOT recommend routinely using magnetic resonance imaging or ultrasound.

The following are Recommended: a thorough patient history, certain physical examination maneuvers, observation, and specific diagnostic tests, such as the hand-held nerve conduction study device. The authors emphasize that no single element should be used alone to make a diagnosis.

Thenar Atrophy is associated with carpal tunnel syndrome, but the syndrome cannot be ruled out in the absence of thenar atrophy.

2) 治療：The group recommends immobilization, oral or injectable steroids, and ketoprofen phonophoresis gel. It also recommends surgery to release the transverse carpal ligament to help restore hand function and ease symptoms.

至於透析是否是CTS risk factor？只有limited evidence。
C. Limited evidence supports that the following factors are associated with the increased risk of developing carpal tunnel syndrome (CTS):
a. Dialysis
Strength of Recommendation: Limited Evidence

而反覆性手/手腕的活動，才是strong risk factor：
INCREASED RISK OF CTS
A. Strong evidence supports that BMI and high hand/wrist repetition rate are associated with the increased risk of developing carpal tunnel syndrome (CTS).
Strength of Recommendation: Strong Evidence

以下有原文PDF供下載
http://www.aaos.org/ctsguideline