Leczenie zespołów cieśni

• Authors: Dariusz J. Jaskólski

Title variants

EN

Management of entrapment neuropathies

• Languages of publication: EN PL

Abstracts

EN

This paper reviews current knowledge on management of entrapment neuropathies. An attempt of conservative therapy is appropriate in patients showing no motor deficit, particularly if entrapment neuropathy is associated with an endocrine disorder, potentially avoidable physical activity or with external compression of the nerve. Even though the natural history of entrapment neuropathies is poorly understood, it is well known that their course is not necessarily progressive and spontaneous remissions are not exceptional. This advocates conservative treatment in patients with mild symptoms in early stages of the disease. Such a treatment must ensure getting rid of the factors responsible for development of the neuropathy and usually includes temporary immobilization of the affected limb. Currently available data do not support the value of local steroid injections. Management problems encountered in patients with diabetes mellitus and in the cases of double or multiple crush syndrome were also discussed. Basing on the most recently published clinical data the author reviews indications to surgical treatment in each of the entrapment neuropathies. Operative techniques and strategies were presented and briefly assessed. Attention was drawn to the possible advantages and disadvantages of endoscopic surgery for carpal tunnel syndrome as compared with the open surgery. The results of operative treatment were looked at pointing out typical side effects and complications.

PL

W pracy przedstawiono aktualną wiedzę na temat leczenia zespołów cieśni. Próba leczenia zachowawczego jest uzasadniona w przypadkach przebiegających bez uszkodzenia włókien ruchowych, zwłaszcza gdy neuropatia wiąże się ze zmianami hormonalnymi, możliwą do uniknięcia aktywnością fizyczną lub uciskiem z zewnątrz. Choć historia naturalna zespołów tunelowych jest słabo poznana, to wiadomo, że ich przebieg nie musi być postępujący, a samoistne remisje nie należą do wyjątków, co rzutuje na wybór terapii u chorych z niezbyt nasilonymi objawami klinicznymi. Leczenie zachowawcze polega na usunięciu czynników odpowiedzialnych za rozwój neuropatii, a jego istotnym elementem jest czasowe unieruchomienie kończyny. Dostępne dane nie potwierdzają wartości leczniczej miejscowych wstrzyknięć steroidów. Omówiono problemy terapeutyczne występujące u chorych z cukrzycą oraz w przypadkach tzw. zespołu podwójnego zmiażdżenia. W oparciu o najnowsze dostępne publikacje omówiono wskazania do leczenia chirurgicznego oraz przedstawiono techniki i strategie operacyjne stosowane w poszczególnych zespołach cieśni. Zwrócono szczególną uwagę na przydatność zabiegów endoskopowych w zespole cieśni nadgarstka i ich porównanie z operacją klasyczną. Zaprezentowano wyniki leczenia chirurgicznego w poszczególnych neuropatiach, uwzględniając możliwe powikłania i ich leczenie.

Keywords

EN

endoscopic surgery in entrapment neuropathies; entrapment neuropathies of the lower extremity; entrapment neuropathies of the median nerve; entrapment neuropathies of the radial nerve; entrapment neuropathies of the ulnar nerve; kończyny dolnej; leczenie zachowawcze zespołów cieśni; local steroid injections; management of entrapment neuropathies; miejscowa steroidoterapia; nerwu promieniowego; thoracic outlet syndrome; zabiegi endoskopowe; zespoły cieśni nerwu pośrodkowego; zespół cieśni nerwu łokciowego; zespół górnego otworu klatki piersiowej

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Aktualności Neurologiczne
• Year: 2006
• Volume: 6
• Issue: 4
• Pages: 267-276

Contributors

author

Dariusz J. Jaskólski

• Klinika Neurochirurgii i Onkologii Układu Nerwowego Uniwersytetu Medycznego w Łodzi, Szpital im. Barlickiego, ul. Kopcińskiego 22, 90-153 Łódź, tel.: [phone], faks: 042 677 67 81

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• Document Type: article