Neurological Surgery 脳神経外科49巻6号

2021年11月発行

特集 脊髄脊椎・末梢神経外科ことはじめ Ⅴ　末梢神経絞扼性障害の基本

必ず遭遇する手根管症候群—見分け方と治療法は？

著者： 國保倫子¹ 金景成¹

所属機関： ¹日本医科大学千葉北総病院脳神経外科／脳神経センター

ページ範囲：P.1306 - P.1316

Point
・手根管症候群の症状は，第1〜4指橈側のしびれ，夜間〜早朝にかけての増悪，ring finger splittingが特徴的である．
・診断は，臨床症状とPhalenテストやTinel様徴候などの身体所見，電気生理検査を組み合わせて行う．
・手術療法は有用であり，局所麻酔下に顕微鏡を用いて低侵襲に行える．

参考文献

1）Morimoto KW, et al：Cross-sectional area of the carpal canal proximal and distal to the wrist flexion crease. J Hand Surg Am 30：487-492, 2005

2）de Krom MC, et al：Carpal tunnel syndrome：prevalence in the general population. J Clin Epidemiol 45：373-376, 1992

3）Katz JN, et al：The carpal tunnel syndrome：diagnostic utility of the history and physical examination findings. Ann Intern Med 112：321-327, 1990

4）Atroshi I, et al：Prevalence of carpal tunnel syndrome in a general population. JAMA 282：153-158, 1999

5）Bland JD, Rudolfer SM：Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001. J Neurol Neurosurg Psychiatry 74：1674-1679, 2003

6）English JH, Gwynne-Jones DP：Incidence of carpal tunnel syndrome requiring surgical decompression：a 10.5-year review of 2,309 patients. J Hand Surg Am 40：2427-2434, 2015

7）Roh YH, et al：Incidence of clinically diagnosed and surgically treated carpal tunnel syndrome in Korea. J Hand Surg Am 35：1410-1417, 2010

8）Phalen GS：Spontaneous compression of the median nerve at the wrist. J Am Med Assoc 145：1128-1133, 1951

9）Kuschner SH, et al：Tinel's sign and Phalen's test in carpal tunnel syndrome. Orthopedics 15：1297-1302, 1992

10）Dyck PJ, et al：The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort：the Rochester Diabetic Neuropathy Study. Neurology 43：817-824, 1993

11）日本透析医学会統計調査委員会：わが国の慢性透析療法の現況．透析会誌 51：699-766, 2018

12）Shiri R, Falah-Hassani K：Computer use and carpal tunnel syndrome：a meta-analysis. J Neurol Sci 349：15-19, 2015

13）井須豊彦，金　景成（編）：脳神経外科医，整形外科医，ペインクリニック医のための「超」入門 手術で治すしびれと痛み．メディカ出版，大阪，2016

14）桑原　聡：脊髄・脊椎疾患における手の症候学：筋萎縮性側索硬化症におけるSplit Hand. 脊髄外科 25 248-251, 2011

15）Atroshi I, et al：Symptoms, disability, and quality of life in patients with carpal tunnel syndrome. J Hand Surg Am 24：398-404, 1999

16）Kokubo R, et al：Quality of life effects of pain from para-lumbar- and lower extremity entrapment syndrome and carpal tunnel syndrome and comparison of the effectiveness of surgery. Acta Neurochir（Wien）162：1431-1437, 2020

17）Sansone JM, et al：Jules Tinel（1879-1952）and Paul Hoffmann（1884-1962）. Clin Med Res 4：85-8, 2006

18）Basiri K, Katirji B：Practical approach to electrodiagnosis of the carpal tunnel syndrome：a review. Adv Biomed Res 4：50, 2015

19）McDonagh C, et al：The role of ultrasound in the diagnosis and management of carpal tunnel syndrome：a new paradigm. Rheumatology（Oxford）54：9-19, 2015

20）Jablecki CK, et al；American Association of Electrodiagnostic Medicine；American Academy of Neurology；American Academy of Physical Medicine and Rehabilitation：Practice parameter：electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 58：1589-1592, 2002

21）Fowler JR, et al：The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome：a meta-analysis. Clin Orthop Relat Res 469：1089-1094, 2011

22）Graham B, et al：The American Academy of Orthopaedic Surgeons evidence-based clinical practice guideline on：management of carpal tunnel syndrome. J Bone Joint Surg Am 98：1750-1754, 2016

23）Ghasemi-Esfe AR, et al：Combination of high-resolution and color Doppler ultrasound in diagnosis of carpal tunnel syndrome. Acta Radiol 52：191-197, 2011

24）Jarvik JG, et al：Diagnosis of carpal tunnel syndrome ：electrodiagnostic and MR imaging evaluation. Neuroimaging Clin N Am 14：93-102, 2004

25）Hui AC, et al：Oral steroid in the treatment of carpal tunnel syndrome. Ann Rheum Dis 60：813-814, 2001

26）Herskovitz S, et al：Low-dose, short-term oral prednisone in the treatment of carpal tunnel syndrome. Neurology 45：1923-1925, 1995

27）Huisstede BM, et al：Carpal tunnel syndrome. Part Ⅰ：effectiveness of nonsurgical treatments--a systematic review. Arch Phys Med Rehabil 91：981-1004, 2010

28）Luchetti R, et al：Serial overnight recordings of intracarpal canal pressure in carpal tunnel syndrome patients with and without wrist splinting. J Hand Surg Br 19：35-37, 1994

29）Huisstede BM, et al；European HANDGUIDE Group：Carpal tunnel syndrome：hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline—results from the European HANDGUIDE Study. Arch Phys Med Rehabil 95：2253-2263, 2014

30）長岡正宏，他：手根管症候群と保存的治療．末梢神経 12：61-64, 2002

31）宇佐美聡，他：手根管症候群の保存療法とリハビリテーション．Orthopaedics 33：44-52, 2020

32）MacDonald RI, et al：Complications of surgical release for carpal tunnel syndrome. J Hand Surg Am 3：70-76, 1978

33）森田明夫（編）：新NS NOW 16—Neurosurgical Re-Operations脳神経外科における再手術・再治療．メジカルビュー社，東京，2018

34）Kokubo R, et al：Rare distribution of the palmar cutaneous branch of the median nerve：a case report. J Clin Case Rep 9：12, 2019

35）Tountas CP, et al：Variations of the median nerve in the carpal canal. J Hand Surg Am 12（5Pt1）：708-712, 1987

36）Lanz U：Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am 2：44-53, 1977

37）Atroshi I, et al：Extended follow-up of a randomized clinical trial of open vs endoscopic release surgery for carpal tunnel syndrome. JAMA 314：1399-1401, 2015

38）Sayegh ET, Strauch RJ：Open versus endoscopic carpal tunnel release：a meta-analysis of randomized controlled trials. Clin Orthop Relat Res 473：1120-1132, 2015

39）Michelotti B, et al：Prospective, randomized evaluation of endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome：an interim analysis. Ann Plast Surg 73（Suppl 2）：S157-S160, 2014

40）Chen L, et al：Effectiveness and safety of endoscopic versus open carpal tunnel decompression. Arch Orthop Trauma Surg 134：585-593, 2014

41）Nakagawa M, et al：Carpal tunnel syndrome：a common initial symptom of systemic wild-type ATTR（ATTRwt）amyloidosis. Amyloid 23：58-63, 2016

42）矢﨑正英，樋口京一：老人性全身性アミロイドーシス．Brain Nerve 66：817-826, 2014