Síndrome do túnel do carpo: estudo retrospectivo de 106 casos e complicações

Oliveira, M. A.; Araújo, J. F. M.; Balbo, R. J.

doi:10.1590/S0004-282X1993000400016

Resumos

Fazemos breve revisão das bases anatômicas e fisiopatológicas da síndrome do túnel do carpo, seu tratamento cirúrgico e suas complicações. Relatamos os casos de duas pacientes que desenvolveram alterações simpáticas como edema da mão e problemas vasculares (fenômeno de Raynaud) para as quais ensaiamos uma explicação, por nós denominada «denervação simpática». Essa complicação, única em nossa série, ocorreu no período pós-operatório imediato, coincidindo com a retirada da imobilização do punho no 22« dia pós-operatório.

síndrome do túnel do carpo; nervo mediano; complicação pós-operatória

The authors present a short review of anatomic and pathophysiological bases of the carpal tunnel syndrome, and its surgical treatment and complications. They report the cases of two patients who developed sympathetic alterations with hand edema and vascular changes (Raynaud phenomenon), and propose an explanation which they name «sympathetic denervation». This is the only complication of their series and it occurred during the immediate post-operative period, coinciding with removal of immobilization of the wrist on the 22nd post-operative day.

carpal tunnel syndrome; median nerve; post-operative complication

M. A. Oliveira^I; J. F. M. Araújo^I; R. J. Balbo^II

^IProfessor Assistente e Neurocirurgião do HVC/HMMG; Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas (FCM) da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Cirurgia do Hospital Vera Cruz (HVC) e Hospital Municipal Dr. Mario Gatti (HMMG), Campinas

^IIProfessor Adjunto e Diretor do Departamento de Neurocirurgia do HVC. Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas (FCM) da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Cirurgia do Hospital Vera Cruz (HVC) e Hospital Municipal Dr. Mario Gatti (HMMG), Campinas

RESUMO

Fazemos breve revisão das bases anatômicas e fisiopatológicas da síndrome do túnel do carpo, seu tratamento cirúrgico e suas complicações. Relatamos os casos de duas pacientes que desenvolveram alterações simpáticas como edema da mão e problemas vasculares (fenômeno de Raynaud) para as quais ensaiamos uma explicação, por nós denominada «denervação simpática». Essa complicação, única em nossa série, ocorreu no período pós-operatório imediato, coincidindo com a retirada da imobilização do punho no 22« dia pós-operatório.

Palavras-chave: síndrome do túnel do carpo, nervo mediano, complicação pós-operatória.

SUMMARY

The authors present a short review of anatomic and pathophysiological bases of the carpal tunnel syndrome, and its surgical treatment and complications. They report the cases of two patients who developed sympathetic alterations with hand edema and vascular changes (Raynaud phenomenon), and propose an explanation which they name «sympathetic denervation». This is the only complication of their series and it occurred during the immediate post-operative period, coinciding with removal of immobilization of the wrist on the 22nd post-operative day.

Key words: carpal tunnel syndrome, median nerve, post-operative complication.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Aceite: 12-março-1903.

Dr. Mauro Augusto de Oliveira Departamento de Neurocirurgia, Hospital Vera Cruz - Av. Andrade Neves 402 - 13013-900 Campinas SP - Brasil.

1. Barbieri CH, Cisneros RR, Audi AF. Síndrome do túnel carpal. Rev Bras Ortop 1985, 20:255-260.
2. Bezerra AJ, Carvalho VC, Nucci A. An anatomical study of the palmar cutaneous branch of median nerve. Surg Radiol Anat 1986, 8:183-188.
3. Blair SJ, Avoiding complication of surgery for nerve compression syndrome. Orthop Clin North Am 1988, 19:125-130.
4. Calvário JS. Síndrome compressiva do nervo mediano no túnel do carpo; análise de 15 casos. Arq Bras Neurocir 1990, 9:35-40.
5. Cannon WB. A law of denervation. Am J Sci 1939, 198:737-750.
6. Dahlin LB. Aspects on pathophysiology of nerve entrapments and nerve compression injuries. Neurosurg Clin North Am 1991, 2:21-29.
7. Farage MF, Oliveira AMJ. Síndrome do túnel do carpo: tratamento. Neurocir Cont Bras 1990, 1:4.
8. Gelberman RH, Pfeffer GB, Galbraith TR, Szabo RM, Rydevik B, Dimick M. Results of treatment of several carpal tunnel syndrome without internal neurolysis of median nerve. J Bone Joint Surg 1987, 69A: 896-903.
9. Gelberman RH, Rydevik B, Szabo RM, Lundborg G. Carpal tunnel syndrome: a scientific basis for clinical care. Orthp Clin North Am 1988, 19:115-124.
10. Kemp LG. Operative neurosurgery. Berlin : Springer-Verlag, 1968, Vol 2, p 181-194.
11. Linskey ME, Segal R. Median nerve injury from local steroid injection in carpal tunnel syndrome. Neurosurgery 1990, 26:312-315.
12. Louis DS, Greene TL, Noenert RC. Complications of the carpal tunnel surgery. J Neurosurg 1985, 62:352-356.
13. MacKinnon SE. Secondary carpal tunnel syndrome. Neurosurg Clin North Am 1991, 2: 75-91.
14. Marie P, Foix C. Atrophie de l'eminence thénar d'origine névritique: rôle le du ligament annulaire antérieur du carpe dans la pathogénie de la lésion. Rev Neurol 1913, 21:647-649.
15. Moles GD, Mezzadri JJM. Sindrome del tunel carpiano: análisis de 80 intervenciones (con sugerencias para evitar complicaciones). Rev Arg Neurocir 1991, 6:40-43.
16. Oliveira MA, Balbo RJ. Síndrome do túnel do carpo. Arq Bras Neurocir 1993, 12:39-45.
17. Phalen GS. The carpal tunnel syndrome: seventheen years experience in diagnosis and treatment of six hundred and fifty four hands. J Bone Joint Surg 1966, 48:211-228.
18. Phalen GS. Reflections on 21 years experience with the carpal tunnel syndrome. JAMA 1970, 212:1365-1367.
19. Pagnanelli DM, Barrer SJ. Carpal tunnel syndrome: surgical treatment using the Paine retinaculatome. J Neurosurg 1991, 75:77-81.
20. Porlawski ZJ, Wiley AM, Murray JF. Post-traumatic dystrophy of the extremites. J Bone Joint Surg 1983, 65A:642-654.
21. Rockwood Jr CA, Green DR. Fracture in adults. Philadelphia: Lippincott, 1975, Vol 1, p 258-271.
22. Schutzer SF, Gossling HR. The treatment of reflex sympathetic dystrophy. J Bone Joint Surg 1984, 66A:625-629.
23. Spillane JD, Spillane JA. An atlas of clinical neurology. London: Oxford Univ Press, 1982.
24. Spinner M. Injuries to the major branches or peripheral nerves of the forearm. Philadelphia: 1972, p76.
25. Spinner RJ, Bachman JW, Amadio RC. The many face of tunnel carpal syndrome. Mayo Clin Proc 1989, 64:829-836.
26. Stolke D, Seidel BU. Das Karpaltunnelsyndrom: Ergebnisse katamnestischer Untersunchungen nach Spaltung des Ligamentum carpale. Neurochirurgia (Stuttgart) 1981, 24:84-86.
27. Sunderland S. Nerves and nerves injury. Ed 2. Edinburgh: Churchill & Livingstone, 1978, p 716.
28. Sunderland S. Nervios periféricos y sus lesiones. Pillar Latorre Murilo. Ed 2. Barcelona: Salvat 1985, pp 465-469, 477-485, 722-738.

Síndrome do túnel do carpo: estudo retrospectivo de 106 casos e complicações

The carpal tunnel syndrome: retrospective study of 106 eases and complications

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Nov 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Barbieri CH, Cisneros RR, Audi AF. Síndrome do túnel carpal. Rev Bras Ortop 1985, 20:255-260.

[2] 2. Bezerra AJ, Carvalho VC, Nucci A. An anatomical study of the palmar cutaneous branch of median nerve. Surg Radiol Anat 1986, 8:183-188.

[3] 3. Blair SJ, Avoiding complication of surgery for nerve compression syndrome. Orthop Clin North Am 1988, 19:125-130.

[4] 4. Calvário JS. Síndrome compressiva do nervo mediano no túnel do carpo; análise de 15 casos. Arq Bras Neurocir 1990, 9:35-40.

[5] 5. Cannon WB. A law of denervation. Am J Sci 1939, 198:737-750.

[6] 6. Dahlin LB. Aspects on pathophysiology of nerve entrapments and nerve compression injuries. Neurosurg Clin North Am 1991, 2:21-29.

[7] 7. Farage MF, Oliveira AMJ. Síndrome do túnel do carpo: tratamento. Neurocir Cont Bras 1990, 1:4.

[8] 8. Gelberman RH, Pfeffer GB, Galbraith TR, Szabo RM, Rydevik B, Dimick M. Results of treatment of several carpal tunnel syndrome without internal neurolysis of median nerve. J Bone Joint Surg 1987, 69A: 896-903.

[9] 9. Gelberman RH, Rydevik B, Szabo RM, Lundborg G. Carpal tunnel syndrome: a scientific basis for clinical care. Orthp Clin North Am 1988, 19:115-124.

[10] 10. Kemp LG. Operative neurosurgery. Berlin : Springer-Verlag, 1968, Vol 2, p 181-194.

[11] 11. Linskey ME, Segal R. Median nerve injury from local steroid injection in carpal tunnel syndrome. Neurosurgery 1990, 26:312-315.

[12] 12. Louis DS, Greene TL, Noenert RC. Complications of the carpal tunnel surgery. J Neurosurg 1985, 62:352-356.

[13] 13. MacKinnon SE. Secondary carpal tunnel syndrome. Neurosurg Clin North Am 1991, 2: 75-91.

[14] 14. Marie P, Foix C. Atrophie de l'eminence thénar d'origine névritique: rôle le du ligament annulaire antérieur du carpe dans la pathogénie de la lésion. Rev Neurol 1913, 21:647-649.

[15] 15. Moles GD, Mezzadri JJM. Sindrome del tunel carpiano: análisis de 80 intervenciones (con sugerencias para evitar complicaciones). Rev Arg Neurocir 1991, 6:40-43.

[16] 16. Oliveira MA, Balbo RJ. Síndrome do túnel do carpo. Arq Bras Neurocir 1993, 12:39-45.

[17] 17. Phalen GS. The carpal tunnel syndrome: seventheen years experience in diagnosis and treatment of six hundred and fifty four hands. J Bone Joint Surg 1966, 48:211-228.

[18] 18. Phalen GS. Reflections on 21 years experience with the carpal tunnel syndrome. JAMA 1970, 212:1365-1367.

[19] 19. Pagnanelli DM, Barrer SJ. Carpal tunnel syndrome: surgical treatment using the Paine retinaculatome. J Neurosurg 1991, 75:77-81.

[20] 20. Porlawski ZJ, Wiley AM, Murray JF. Post-traumatic dystrophy of the extremites. J Bone Joint Surg 1983, 65A:642-654.

[21] 21. Rockwood Jr CA, Green DR. Fracture in adults. Philadelphia: Lippincott, 1975, Vol 1, p 258-271.

[22] 22. Schutzer SF, Gossling HR. The treatment of reflex sympathetic dystrophy. J Bone Joint Surg 1984, 66A:625-629.

[23] 23. Spillane JD, Spillane JA. An atlas of clinical neurology. London: Oxford Univ Press, 1982.

[24] 24. Spinner M. Injuries to the major branches or peripheral nerves of the forearm. Philadelphia: 1972, p76.

[25] 25. Spinner RJ, Bachman JW, Amadio RC. The many face of tunnel carpal syndrome. Mayo Clin Proc 1989, 64:829-836.

[26] 26. Stolke D, Seidel BU. Das Karpaltunnelsyndrom: Ergebnisse katamnestischer Untersunchungen nach Spaltung des Ligamentum carpale. Neurochirurgia (Stuttgart) 1981, 24:84-86.

[27] 27. Sunderland S. Nerves and nerves injury. Ed 2. Edinburgh: Churchill & Livingstone, 1978, p 716.

[28] 28. Sunderland S. Nervios periféricos y sus lesiones. Pillar Latorre Murilo. Ed 2. Barcelona: Salvat 1985, pp 465-469, 477-485, 722-738.