Karpaltunnelsyndrom
Senast uppdaterad: Senast reviderad:
Sakkunnig:Anna Nager
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.
- Middleton SD, Anakwe RE. Carpal tunnel syndrome. BMJ. 2014;349:g6437. doi: 10.1136/bmj.g6437. DOI
- 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
- Kleopa KA.. In the Clinic. Carpal Tunnel Syndrome. Ann Intern Med 2015. pmid:26322711 PubMed
- Hughes R. Peripheral nerve diseases: The bare essentials. Practical Neurology 2008; 8: 396-405. PubMed
- American Academy of Orthopaedic Surgeons: Management of Carpal Tunnel Syndrome. Evidence-Based Clinical Practice Guideline 2016.
- 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
- Scott KR, Kothari MJ. Clinical manifestations and diagnosis of carpal tunnel syndrome. UpToDate, last updated May 20, 2010. UpToDate
- 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
- D`Arcy CA, McGee S. Does this patient have carpal tunnel syndrome? JAMA 2000; 283:3110-17. PMID: 10865306 PubMed
- Bland JD. Carpal tunnel syndrome. BMJ 2007; 335: 343-6. British Medical Journal
- 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
- Todnem K, Lundemo GH. Symptomer og kliniske forløp ved karpaltunnelsyndrom. Tidsskr Nor Lægeforen 2001; 121: 1489-92.
- Neal SL, Fields KB. Peripheral nerve entrapment and injury in the upper extremity. Am Fam Physician 2010; 81: 147-55. American Family Physician
- Ashworth NL. Carpal tunnel syndrome. Medscape, last updated Jul 01, 2015. emedicine.medscape.com
- 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.
- 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
- 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
- Shrivastava N, Szabo RM. Decision making in the management of entrapment neuropathies of the upper extremity. J Musculoskeletal Med 2008; 25: 278-89. PubMed
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Keith MW, Masear V, Amadio PC, et al. Treatment of carpal tunnel syndrome. J Am Acad Orthop Surg 2009; 17: 397-405. PubMed
- Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain. Diagnosis, mechanisms, and treatment recommendations. Arch Neurol 2003; 60: 1524-34. PubMed
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Fatami T, Kobayashi A, Utika T, Endoh T, Fujita T. Carpal tunnel syndrome; its natural history. Hand Surgery 1997; 2 (2): 129-30.
- 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)