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A Guide to Carpal Tunnel and Other Nerve Conditions

2024/8/24
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Gavin Diamond: 我是一名上肢骨科医生,经常遇到周围神经疾病。我想了解你如何评估周围神经疾病,以及你思考过程中的想法。 Jessica Hafner: 首先要考虑症状的模式,这有助于判断问题的严重程度,并区分周围神经系统和中枢神经系统疾病。常见的模式包括局限于手的腕管综合征(通常夜间出现)以及对称性足部症状(由于最长神经最易受损)。在检查中,要确认体征与周围神经系统问题相符,而不是中枢神经系统问题。症状分布(如单侧肢体症状)和发病速度(快速进展提示紧急情况)也很重要。周围神经疾病的危险信号包括快速进展的症状、不对称性症状、早期运动受累、剧烈疼痛和早期自主神经功能受累。中枢神经系统疾病的危险信号也包括快速进展的症状,以及提示特定病灶位置的症状分布(如单侧肢体症状、共济失调或脑神经受累)。帕森内-特纳综合征和格林-巴利综合征都是自身免疫性炎症性疾病,由免疫反应触发,导致严重疼痛和运动无力。 诊断周围神经病变需结合病史、体格检查和神经传导研究,以确定病因,并区分不同类型的周围神经病变。常见的全身性周围神经病变的常见原因包括糖尿病、维生素B12缺乏、甲状腺功能障碍和酒精滥用。神经传导研究对于鉴别不同类型的周围神经病变(如糖尿病性神经病变和炎症性神经病变)至关重要。神经传导研究通过电刺激神经并记录冲动传导速度和幅度来评估神经功能。神经传导研究可以帮助确定神经传导障碍是由于轴突损伤还是髓鞘损伤。神经传导研究报告中的数值反映了神经冲动传导的速度和幅度,可以帮助鉴别不同类型的周围神经病变。肌电图检查通过细针电极记录肌肉电活动,可以帮助检测肌肉纤维的异常活动,如纤维颤动和正锐波。肌电图检查中,纤维颤动和正锐波提示神经支配丧失,是神经损伤的标志。对于局灶性神经病变(如腕管综合征),影像学检查(如超声或MRI)可以帮助确认诊断。体格检查(如Tinel征和Phalen征)对于腕管综合征的诊断非常有用。轻度腕管综合征患者可采用保守治疗(如夜间腕部夹板固定);中重度腕管综合征患者可考虑皮质类固醇注射或手术治疗。即使进行手术治疗,轴突受损的腕管综合征患者也可能存在残留症状或复发。下肢局灶性神经卡压的常见部位包括腓总神经(常因习惯性跷二郎腿)和股外侧皮神经(常因体重变化)。全身性神经病变的治疗取决于病因,包括控制血糖、补充维生素B12、治疗甲状腺疾病和戒酒等。全身性神经病变的治疗包括补充维生素B12(肌内注射更有效)、治疗甲状腺疾病、戒酒以及针对慢性炎症性脱髓鞘性多发性神经病的免疫治疗。某些药物(如化疗药物、某些抗生素和胺碘酮)可能导致周围神经病变,尤其是在患者已存在神经病变的情况下。维生素B6过量也可能导致周围神经病变,应注意避免补充剂过量。早期发现和识别周围神经病变的危险信号对于预防并发症(如跌倒)和及时干预至关重要。

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Ever wondered how to distinguish between peripheral and central nervous system disorders, or what red flag symptoms necessitate urgent medical attention? This episode offers critical insights as Dr Gavin Nimon) ( Orthopaedic Surgeon and Host) interviews Dr. Jessica Hafner, a Consultant Neurologist at the Queen Elizabeth Hospital, as she unpacks the complexities of peripheral neuropathy. From common causes like carpal tunnel syndrome and diabetic neuropathy to the nuances of symptom patterns and tempos, Dr. Hafner provides valuable guidance for medical professionals aiming for precise diagnoses and effective management of these conditions.Explore the world of autoimmune neuropathies, including conditions like Parsonage-Turner syndrome and Guillain-Barre syndrome, which are triggered by immune responses and cause severe pain and motor weakness. Dr. Hafner elucidates the importance of nerve conduction studies for accurate diagnosis, explaining how such tests differentiate between various neuropathies. The episode also covers a broad spectrum of peripheral neuropathy causes, such as diabetes, B12 deficiency, thyroid dysfunction, and alcohol excess, emphasizing the significance of understanding these diverse etiologies.Finally, get equipped with practical strategies for evaluating and treating nerve entrapments and generalized neuropathies. Learn about the intricacies of diagnosing carpal tunnel syndrome, the utility of clinical tests like Tinel's and Phalen's, and the effectiveness of different treatment methods, including surgical options. Dr. Hafner delves into the multifaceted causes and treatments of generalized neuropathies, discussing the role of chronic conditions, medication side effects, and the necessity of thorough evaluations. This comprehensive discussion is a must-listen for anyone involved in the care of patients with peripheral nerve disorders.

Aussie Med Ed is sponsored by OPC Health, an Australian supplier of prosthetics, orthotics, clinic equipment, compression garments, and more. Rehabilitation devices for doctors, physiotherapists, orthotists, podiatrists, and hand therapists. If you'd like to know what OPC Health offers.

Visit opchealth. com. au )and view their range online.

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