carpal tunnel syndrome
Introduction
Introduction to the ulnar tube syndrome The ulnar tube syndrome refers to the symptoms and signs of sensation and motor dysfunction caused by the compression of the ulnar nerve in the ulnar fiber line of the wrist. The ulnar tube, also known as the Guyon tube, is located on the ulnar side of the wrist area and is composed of the transverse ligament of the wrist and the distal part of the volar ligament. The ulnar artery, the ulnar vein and the ulnar nerve pass through the tube. In the tube, the ulnar nerve is divided into a deep branch and a shallow branch, that is, a sports branch and a sensory branch. The upper end of the ulnar tube is surrounded by the proximal edge of the pea bone, the volar ligament of the wrist and the transverse ligament of the wrist; the lower ligament of the ulnar tube is composed of the volar ligament of the wrist, the short palm muscle and the aponeurosis, the ligament of the bean, and the ulnar flexor tendon. And the tendon of the medial muscle of the hand is surrounded. For patients with mild sensory disturbances, patients can be temporarily treated conservatively, and localized and oral neurotrophic drugs are given. The remaining wrist and cannula syndrome should be treated as soon as possible after diagnosis. basic knowledge Sickness ratio: 0.0012% Susceptible people: no special people Mode of infection: non-infectious Complications: carpal tunnel syndrome edema ganglion cyst lipoma xanthomas
Cause
Causes of ulnar tube syndrome
It is currently believed that the incidence of sacral canal syndrome is mainly related to the following factors:
1. Long-term repeated wrist joint extension and deviation, with hook bone as the fulcrum, forming tension posture, causing aseptic inflammation of ligament and synovial membrane, edema hyperplasia, and poor ductility, so the internal pressure is increased, and the ulnar nerve is compressed. Cause local degeneration, thickening of the outer membrane.
2, long-term high load using the right hand, so that the right hand blood vessels thickened, abnormal position, resulting in the small fish muscle tendon arch ulnar nerve compression, because the width of the hypoglossal space of the small fish muscle tendon is greater than the transverse diameter of the vascular nerve bundle, and the longitudinal height It is almost equal to the longitudinal diameter of the vascular nerve bundle, and the abnormal vascular pulsation stimulates the compressed nerve, causing abnormal bioelectrical impulses, causing the sympathetic nerves that innervate the blood vessels to lose control of the vasomotor and dilate and ooze out, and the internal pressure of the ulnar canal is increased. , causing further compression of the ulnar nerve.
3, sacral sheath cysts and other local occupying lesions increase the content of the ruler tube, which is close to the proximal end of the ulnar tube, the ulnar nerve has not been separated into deep, shallow branches, so the lesion caused by sensory dyskinesia.
4, crush injury caused by wrist joint lesions caused by edema in the cannula or changes in the structure of the tube, resulting in local fibrous tissue hyperplasia, scar adhesion, causing ulnar nerve compression.
Prevention
Brachial tube syndrome prevention
Carpal tunnel syndrome can be caused by a variety of causes. Most patients are caused by excessive movement of hands and wrists. It is meaningful for the prevention of patients caused by such causes. The significance is not only pre-morbid prevention, but also symptom relief. After preventing recurrence.
1. When the labor intensity of the hands and wrists is high, pay attention to the rest during the labor period to prevent the central nerve of the wrist from being continuously compressed. The middle-aged women should pay more attention to this in the labor. In addition, relax the wrist before and after labor. Fully active wrist joints help prevent carpal tunnel syndrome.
2. Pay attention to avoid washing cold water in the work, avoid cold stimulation and excessive flexion, pay attention to local warmth.
3. For patients who have already suffered from the disease, if the symptoms are relieved after treatment, it is necessary to pay attention to prevent recurrence, and to avoid activities with long hands and wrist strength.
4. Fractures due to trauma, if the patient with dislocation has numbness and pain, it is necessary to go to the hospital for examination and timely treatment, and good results can be obtained.
Complication
Complications of the ulnar tube syndrome Complications carpal tunnel syndrome edema ganglion cyst lipoma xanthomas
Any cause of squeezing or reducing the volume of the carpal tunnel can compress the median nerve and cause carpal tunnel syndrome, Coles fracture malunion, anterior lumbar dislocation, soft tissue edema caused by infection or trauma, thickened transverse ligament of the wrist, ganglion cyst, lipoma , yellow tumor, systemic diseases such as obesity, diabetes, thyroid dysfunction, amyloidosis or Reynaud disease can sometimes be combined with carpal tunnel syndrome, in the early stage of the lesion is characterized by median nerve edema and congestion, gradually due to oppressive ischemia It causes fibrosis in the nerve, compression of the axons and disappearance of the myelin sheath. Finally, the nerve tissue is transformed into fibrous tissue, and the inner tube disappears and is replaced by collagen tissue, which becomes an irreversible change.
Symptom
Symptoms of the ulnar tube syndrome Common symptoms The feeling of the outside of the shoulder arm... Simple fracture of the finger or arm of the arm... No movement or feeling of impediment... Wrist gun deformity
Since the ulnar nerve is divided into two deep and shallow branches in the ulnar tube, the distal end of the ulnar tube is separated by a bridge-shaped zygomatic arch. Therefore, when the ulnar nerve trunk and its branches are compressed in different parts of the wrist, there will be different clinical manifestations. . In order to facilitate the determination of the compression site of the ulnar nerve based on clinical manifestations, the ulnar tube is divided into three regions (Gross method).
Zone 1: refers to the part of the ulnar nerve that is separated from the deep and shallow branches. After the nerve is compressed, it shows the main injury of the ulnar nerve, which has both dyskinesia and sensory disturbance.
Zone 2: The part of the deep branch of the ulnar nerve that travels inside the tube. After the nerve is compressed, it appears as a simple movement disorder.
Zone 3: The part of the ulnar nerve that travels within the tube. After the nerve is compressed, it mainly manifests as sensory disturbance. Examination can be found that the ulnar side of the ulnar side of the sensation is reduced, or the volar side of the middle finger of the little finger is reduced or disappeared.
Examine
Examination of the ulnar tube syndrome
Local examination : (1) The small fish muscles and interosseous muscles have different degrees of atrophy, and the ulnar side of the large fish muscles atrophy. Muscle strength is weakened or lost, 2 to 5 means adduction, and abduction is limited. (2) Ring, small finger claw-shaped hand deformity. (3) The paper jam test is positive, and the Froment sign is positive.
Diagnosis
Diagnosis and differentiation of ulnar tube syndrome
1, middle-aged men are more common, laborers have a history of traumatic wrist injury, fracture history.
2, such as the ulnar nerve shallow branch involved, the clinical manifestations of the palm ulnar side of the little finger and ring finger ulnar side of the skin sensory, above the wrist joint feeling normal, mild and limited symptoms, no motor dysfunction.
3, such as deep ulnar nerve involvement, clinical manifestations of intramuscular dyskinesia, interosseous muscle atrophy, weakness or paralysis, long-term disease may appear claw-shaped deformity. No sensory disturbances.
4, wrist flexor muscles such as ulnar and tender pain masses, suggesting ganglion cyst or tumor compression.
5, the wrist test can make the ring, little finger numb, tingling, burning sensation worse.
