Etiologic Study Of The Carpal Tunnel Syndrome

Objective:To summarize the pathogeny of the carpal tunnel syndrome (CTS) recently, in order to supervise the early clinical discovery,diagnosis and treatment of the CTS. Methods: 86 cases with CTS were selected as objective group, who were treated in the hand surgery department of No.1 hospital of Jilin University between May 1997 and March 2007. To explore the etiology of the CTS according to their histories,clinical symptoms,signs,ECGs and what we see in the operation. Results: The objective group is consist of 65 females and 21 males, the ratio of the male and the female is 1:3.The average age of the objective group is 49 years old, and those whose ages are between 40 and 60 years old take 61.6% of all the cases. There are 23 cases that have CTS on their left arms, and 26 cases on right arms, and 37 cases on both arms. The histories of these patients vary from 2 hours to 10 years. There are 27 cases whose histories are within 3 months, 30 cases whose histories are between 3 months and 1 year, 29 cases whose histories are longer than 1 year. Among the 86 patients, 8 of them have a history of trauma. Those 86 cases who took operations, according to what we see in the operation, we got to know that 46 cases are simply because the iterative and physical stimulations which cause the hyperplasia of the transverse carpal ligament and the ectoblasts of the flexors and the median nerve; 17 cases are because the distinct hyperplasia of the synovial menbraneand 4 of the 16 cases is definitely diagnosd by pathological examinations;14 are because the edema of the nerve; 3 cases are because the variation of the anatomy; 4 are because the abnormal wrist; 1 is because hematoma. Discussion: According to the rusult of Statistics, we find that CTS happens more to women than to men, except those who have a history of obvious trama. The age of the most patients who suffer from CTS is between 40 and 60. For people of this age, the tissues and organs of the body begin to have recessive change, and the recessive change of the parenchyma may cause the oppress of the nerve. And women of this age have the higher probability to suffer from the immune and collagenic diseases than others. We should spread the cognition of the CTS to these people, in order to have early diagnosis and early treatment. According to the previous clinical experience and prognosis, we got to know that CTS caused by the factors that mentioned above is not reversible because of no early treatment. The longer the courses of the diseases is, the more obvious the atrophy of muscles is. For those patients who have already suffered from the atrophy of the muscles, even if the median nerve is fully released, the muscles are hard to recover, and some may lose the fuction of the thumb later. To those patients who have a long history and have already lost the function of the thumb, we can only undergo the operation of the reconstruct of the function, and that affect the quality of the patients' life obviously. Thus, the work that to spread the cognition of the disease to those who is more likely to suffer from CTS is very important for the improving of the prognosis. Also, forthese people, especially the female patients, doctors should do more examinations and assays, for example, the sedimentation of the blood cells,rheumatic factors,antibody of the TB, get the details of the courses of the disease, in order to make sure that whether or not these patients are suffered from other diseases that can cause the change of the synovial menbrane, treat aactively to avoid the aggravation and recrudescence. Bahrami's research shows that 17% of the pregnant women suffer from CTS, and among them, 23.5% relate to both hands, 17.5% are diagnosed "severe CTS"[7]. To these patiants, doctors should also spread the cognition of the disease, because severe CTS during pregnance can also cause the atrophy of the muscles and the loss of the function. In our research, 2 cases are acute CTS caused by trauma, all the other patients are engaged in the work that need a lot of movement of their wrists, and the ocupations' difference is related to that whether CTS is on single or double hands. CTS happened on those patients who are engaged in accountant and cadre is on the preponderant hand, and CTS happened on those who are engaged in peasants,workers and housewives are often on both hands, or sometimes can be found on non-preponderant hand. So, CTS has consanquineous relation with the iterative movement of the wrists. Iterative and physical stimulations on the wrists can cause the hyperplasia of the transverse carpal ligament and the ectoblasts of the flexors and the median nerve. For these patients who have a long history of the iterative movement of the wrists, especially for thoseelder people, iterative stimulation may affect the blood supply of the carpale, cause the necrosis of the carpale and the change of the location between the carpales, the cubage of the carpal tunnel decreases, the pressure becomes higher, and the median nerve is oppressed in the wrists. Some researches show that the fracture or the dislocation of the carpale and the metacarpus and some fixation after trauma that press the wrist may cause the acute edema of the parenchyma in carpal tunnel, or the damnification of the parenchyma cause the bleeding, the hematoma change the shape of the carpal tunnel, the cubage of the carpal tunnel decreases, the pressure becomes higher, and cause the CTS[8-12]. For those patients who have a history of trauma, doctors should eliminate the infection of the trauma as early as possible, also we should explore the situation in the carpal tunnel sufficiently, in order to avoid the hematoma or the fracture of the carpale cause CTS. Patients who have a history of trauma in our research didn't have systematic examination and availible and reasonable treatment. For those patients after trauma who may suffer from CTS, doctors should pay attention to the reasonable fixation,early functional exercise and the treatment of the nerve nourishment and stimulation. Thus, the early diagnosis of the CTS is very significative. Some studies show that ultrasonic of high frequency can not only show the osseous structure,parenchyma and other things that consist of the carpal tunnel, but also denifitude the etiology of the CTS and the modal change of the median nerve, so, that is to say,ultrasonic of high frequency is of very importance in the diagnosis and distinguishment of the CTS[36]. Weimin Chen,Yi Wang and some others in Huashan Hospital in Shanghai show that ultrasonic examination can distinguish the CTS both in modality and measurement, it can display the local reason that cause the CTS and the variation of the anatomy, and it apply the help to the choice of the ways of the operation[37]. Also, they show the advantage of the dynamic ultrasonic of real time, that is, it can display the change of the location of the median nerve in the carpal tunnel when the fingers are bending intuisionisticly, the change of the modality, estimate the abnormal nerve and its drgrees according to the increase of the diameter of the nerve before and after the fingers' bending, help to choose the ways of operation[38]. Now that most of the patients can afford the prise of the ultrasonic examination and it can help us to know the etiology well, it makes clinical sense to spread the ultrasonic examination for CTS. Fan Wang and some others did some measurement for 101 patients that suffered from CTS with the microcyber machine that can measure the potence of the muscles, and it provide a significant index to the estimation of the degree and curative effect of CTS[39]. Early discovery,diagnosis and treatment is very important for CTS. Doctors should not only spread the congnition of the CTS to the people, but also do some early examinations for the patients who still don't have clinical symptoms according to the etiology, diagnosis early, in order to improve thequality of the prognosis as well as possible. Conclusion:By analysing the 86 cases, we can summarize the pathogenies of CTS as follows: 1.CTS occurs more in female than in male, the ratio of the male and the female is 1:3. 2. CTS often occurs among those people whose ages are between 40 and 60 years old. 3.CTS has consanquineous relation with the ocupations of the patients, it is often seen on farmers,workers and housewives who always work with their hands. 4.CTS is mainly caused by the iterative and physical stimulations in the wrists, beside that, the edema of the nerve,the pathological changes of the wrist,pathological change of the synovial menbrane and the variation of the anatomy can also cause CTS. 5. Trauma is an very important factor for CTS, and if doctors can treat it properly, it will reduce the chance of happening of CTS after trauma.