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Karpaltunnelsyndrom

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Sakkunnig:
Definition:
Symtom på grund av kompression av nervus medianus i karpaltunneln. Repetitiva rörelser i arbetet och svullnad i handleden predisponerar för tillståndet.
Förekomst:
Den vanligast förekommande perifera neuropatin med en prevalens på cirka 5 % bland vuxna. Vanligare bland kvinnor.
Symtom:
Typiska symtom är domningar och stickningar i handflatan och i de radiala fingrarna.
Kliniska fynd:
Positiva fynd vid Tinels och Phalens test kan styrka misstanken.
Diagnostik:
Diagnosen ställs i första hand genom klinisk undersökning. I oklara fall kan neurofysiologisk utredning (ENeG) behöva göras.
Behandling:
Tillståndet kan spontanläka, och i lindriga till måttliga fall är behandling med skena under 4 veckor som regel förstahandsval. Eventuellt kortisoninjektion. Operation vid svåra eller kvarstående symtom.
  1. Middleton SD, Anakwe RE. Carpal tunnel syndrome. BMJ. 2014;349:g6437. doi: 10.1136/bmj.g6437. DOI  
  2. Horvath A, Westin O, Samuelsson K, Zeba N. ABC om vanliga tillstånd i hand och handled, del 1. Lakartidningen.se 2019-04-09 www.lakartidningen.se lakartidningen.se  
  3. Kleopa KA.. In the Clinic. Carpal Tunnel Syndrome. Ann Intern Med 2015. pmid:26322711 PubMed  
  4. Hughes R. Peripheral nerve diseases: The bare essentials. Practical Neurology 2008; 8: 396-405. PubMed  
  5. American Academy of Orthopaedic Surgeons: Management of Carpal Tunnel Syndrome. Evidence-Based Clinical Practice Guideline 2016.
  6. Jablecki CK, Andary MT, Floeter MK et al. 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 2002; 58: 1589-92. PubMed  
  7. Scott KR, Kothari MJ. Clinical manifestations and diagnosis of carpal tunnel syndrome. UpToDate, last updated May 20, 2010. UpToDate  
  8. Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001. J Neurol Neurosurg Psychiatry 2003; 74: 1674-9. PubMed  
  9. D`Arcy CA, McGee S. Does this patient have carpal tunnel syndrome? JAMA 2000; 283:3110-17. PMID: 10865306 PubMed  
  10. Bland JD. Carpal tunnel syndrome. BMJ 2007; 335: 343-6. British Medical Journal  
  11. Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, MacDermid JC. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review. J Hand Ther 2004; 17: 210-28. PubMed  
  12. Todnem K, Lundemo GH. Symptomer og kliniske forløp ved karpaltunnelsyndrom. Tidsskr Nor Lægeforen 2001; 121: 1489-92.
  13. Neal SL, Fields KB. Peripheral nerve entrapment and injury in the upper extremity. Am Fam Physician 2010; 81: 147-55. American Family Physician  
  14. Ashworth NL. Carpal tunnel syndrome. Medscape, last updated Jul 01, 2015. emedicine.medscape.com  
  15. Vaught MS, Brismée JM, Dedrick GS, et al.. Association of disturbances in the thoracic outlet in subjects with carpal tunnel syndrome: a case-control study. Journal of hand therapy 2011; 24: 44-52.
  16. Duckworth AD, Jenkins PJ, McEachan JE. Diagnosing carpal tunnel syndrome. J Hand Surg Am. 2014 Jul;39(7):1403-7. doi: 10.1016/j.jhsa.2014.03.039. dx.doi.org  
  17. McDonagh C, Alexander M, Kane D. The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology (Oxford). 2015 Jan;54(1):9-19. PMID: 25118315. PubMed  
  18. Shrivastava N, Szabo RM. Decision making in the management of entrapment neuropathies of the upper extremity. J Musculoskeletal Med 2008; 25: 278-89. PubMed  
  19. Piazzini DB, Aprile I, Ferrara PE, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil 2007; 21: 299-314. PubMed  
  20. McClure PS. Evidence-based practice: an example related to the use of splinting in a patient with carpal tunnel syndrome. Hand Ther 2003; 16: 256-63. PubMed  
  21. Burke DT, Burke MM, Steward GW, Cambre A. Splinting for carpal tunnel syndrome: in search of the optimal angle. Arch Phys Med Rehabil 1994; 75: 1241-4. PubMed  
  22. Chesterton LS, Blagojevic-Bucknall M, Burton C, et al. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. Lancet 2018; 392: 1423-33. pmid:30343858 PubMed  
  23. Dammers JW, Veering MM, Vermeulen M. Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial. BMJ 1999 Oct 2; 319:884-6. PubMed  
  24. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome (Cochrane Review). In: The Cochrane Library, Issue 4, 2002. Oxford: Update Software. The Cochrane Library  
  25. Karimzadeh A, Bagheri S, Raeissadat SA, et al. The comparison of the effectiveness between different doses of local methylprednisolone injection versus triamcinolone in Carpal Tunnel Syndrome: a double-blind clinical trial. J Pain Res. 2019; 12: 579-84. PMID: 30787634 PubMed  
  26. Hofer M, Ranstam J, Atroshi I. Extended Follow-up of Local Steroid Injection for Carpal Tunnel Syndrome: A Randomized Clinical Trial. JAMA Netw Open. 2021 Oct 1;4(10):e2130753. doi: 10.1001/jamanetworkopen.2021.30753. PMID: 34677593 PubMed  
  27. Gerritsen AA, de Krom MC, Struijs MA, Scholten RJ, de Vet HC, Bouter LM. Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. J Neurol 2002; 249: 272-80. PubMed  
  28. Keith MW, Masear V, Amadio PC, et al. Treatment of carpal tunnel syndrome. J Am Acad Orthop Surg 2009; 17: 397-405. PubMed  
  29. Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain. Diagnosis, mechanisms, and treatment recommendations. Arch Neurol 2003; 60: 1524-34. PubMed  
  30. Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, issue 4, 2008. The Cochrane Library  
  31. Jarvik JG, Comstock BA, Kliot M, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet 2009; 374: 1074-81. PubMed  
  32. Atroshi I, Larsson G-U, Ornstein E, Hofer M, Johnsson R, Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ 2006; 332: 1473-6. British Medical Journal  
  33. Vasiliadis HS, Georgoulas P, Shrier I, et al. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev. 2014 Jan 31;1:CD008265. doi: 10.1002/14651858.CD008265.pub2. DOI  
  34. Macdermid JC, Richards RS, Roth JH, Ross DC, King GJ. Endoscopic versus open carpal tunnel release: a randomized trial. J Hand Surg Am 2003; 28: 475-80. PubMed  
  35. Saw NL, Jones S, Shepstone L, Meyer M, Chapman PG, Logan AM. Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial. J Hand Surg Br 2003; 28: 444-9. PubMed  
  36. Peters S, Page MJ, Coppieters MW et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev 2016; Feb 17;2: CD004158.. pmid:26884379 PubMed  
  37. Atthakomol P, Manosroi W, Phanphaisarn A, et al. Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2018 Jan 25;19(1):32. doi: 10.1186/s12891-018-1948-3. PMID: 29370788 PubMed  
  38. Wu YT, Ke MJ, Chou YC, et al.. Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial. J Orthop Res 2016 Jun; 34(6): 977-84. pmid:26610183 PubMed  
  39. Rankin IA, Sargeant H, Rehman H, Gurusamy KS. Low-level laser therapy for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD012765. DOI: 10.1002/14651858.CD012765. DOI  
  40. Fatami T, Kobayashi A, Utika T, Endoh T, Fujita T. Carpal tunnel syndrome; its natural history. Hand Surgery 1997; 2 (2): 129-30.
  41. Santosa KB, Chung KC, Waljee JF. . Complications of compressive neuropathy: prevention and management strategies. Hand Clin. 2015; May;31(2): 139-49. pmid:25934192 PubMed  
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet

Tidigare sakkunniga

  • Tor Ansved, docent och specialist, Neurology clinic, Sophiahemmet, Stockholm
  • Ingard Løge, spesialist allmennmedisin (NEL)