KARPAL TÜNEL SENDROMUNUN NÖRAL TERAPİ İLE TEDAVİSİ: BİR OLGU SUNUMU

Yıl 2015, Cilt: 9 Sayı: 1, 27 - 31, 01.02.2015

Cüneyt Tamam Yusuf Tamam

Öz

GİRİŞ: Karpal tünel sendromu (KTS) median sinirin el bileğinde karpal kanalda transvers karpal ligament tarafından basıya uğraması sonucu gelişen bir tuzak nöropatisidir. Elde güçsüzlük, ağrı, özellikle 1, 2 ve 3 parmakta olmak üzere his kaybı veya karıncalanma şikayetleri ile kendini gösterir. Cerrahi girişimler median sinirin gevşetilmesinde etkili olsalar da risk içermektedirler. Hali hazırda bir çok konservatif tedavi metodu; atelleme, germe egzersizleri, ilaçlar olmasına ragmen hiçbiri kesin sonuç vermemektedir. Bu olguda KTS tedavisi için nöral terapi uyguladık.OLGU: 40 yaşında kadın hasta karpal tünel tanısı ile, kliniğimize başvurdu. KTS tanısı 2 yıl once konulmuş. Ameliyattan çekindiği için kabul etmemiş. Fizik muayenede sol elde Phalen ve Tinnel testi pozitif. El bileğinin tekrarlayan hareketi ile şikayetlerde belirgin artış mevcut. Elektrodiagnostik test ile karpal tünel sendromu düşündüren sinir iletim hızının uzaması saptandı.TEDAVİ: Hastaya tekrarlayan seanslar halinde karpal tünel enjeksiyonu, segment tedavisi, trigeminal sinir enjeksiyonları ve sol kolda aşı skarına enjeksiyon yapıldı. Hastaya 6 seans tedavi yapıldı. Hala takipte olan hastada tam iyileşme izlendi. SONUÇ: Karpal tünel sendromu median sinirin sıkışması sonucu ortaya çıkar. Bu yaşam kalitesi açısından hastaya çeşitli engeller oluşturur. Nöral terapi karpal tünel sendromu tedavisi için non-invaziv olan iyi bir seçenek oluşturmaktadır

Anahtar Kelimeler

Karpal Tünel Sendromu, lokal anestezik, prokain, lidokain, Nöralterapi, enjeksiyon

TREATMENT OF CARPAL TUNNEL SYNDROME BY NEURAL THERAPY: CASE REPORT

Öz

INTRODUCTION: Carpal tunnel syndrome (CTS) is an entrapment neuropathy due to the compression of the median nerve at the wrist in the carpal canal by the transverse carpal ligament. It is characterized by symptoms of hand weakness, pain, numbness or tingling in the hand, especially in the thumb, index and middle fingers.Surgical methods are effective in decompression of the nerve, but are not without risk. Various non-surgical treatments such as splinting, stretching exercises, or the use of medicines are available, but none of them is universally effective. Despite these treatments, many patients may suffer symptoms which are persistent and repetitive, and may last for years. We applied neural therapy as an effective non-surgical treatment for carpal tunnel syndrome. CASE: 40-year-old female patient with a diagnosis of carpal tunnel for 2 years , admitted to our clinic. Physical examination showed positive Phalen’s and Tinnel’s test on her left wrist. There was an increase of symptoms with repetitive movement. Electrodiagnostic test revealed prolongation of nerve conduction velocity thus suggesting carpal tunnel syndrome.TREATMENT: The patient was treated with repeated sessions of segmental injection, trigeminal nerve injection and carpal tunnel injections. Injection to a vaccination scar on her left shoulder was also applied. The patient was treated six sessions. The patient, still under follow up, had full recovery.CONCLUSION: Carpal tunnel syndrome occurs as a result of compression of the median nerve by the structures around it in the carpal tunnel. It causes disabilities in terms of life quality. Neural therapy is a good choice of non-invasive treatment for carpal tunnel syndrome

Anahtar Kelimeler

Carpal tunnel syndrome, CTS, Local anesthetic, procaine, lidocaine, Neural Therapy

Kaynakça

• Phalen GS (1966): The carpal-tunnel syndrome: 17 years experience in diagnosis and treatment of 654 hands. Journal of Bone and Joint Surgery 48A: 211–228
• Gelberman RH, Rydevik BL Pess GM, Szabo RM and Lundburg G (1998): Carpal tunnel syndrome. Orthopedic Clinics of North America 19: 115– 124
• Simovic D and Weinberg DH (2000): Carpal tunnel syndrome. Archives of Neurology 57: 754–755.
• Aroori S, Spence RAJ (2008) Carpal tunnel syndrome. Ulster Med J 77:6– 17
• Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rose´n I (1999) Prevalence of carpal tunnel syndrome in a general popula on. JAMA 282:153–158].
• Horch RE, Allmann KH, Laubenberger J, Langer M, Stark CB. Median nev- re compression can be detected by magne c resonance imaging of the carpal tunnel. Neurosurgery 1997:41(1); 76-83
• Pretorius ES, Ebstein RE, Dalinko MK. MR imaging of the wrist. Radiol clin North Am 1997:26(2):148-153.
• Silver MA, Gelberman RH, Gelman H, Rhoades CE. Carpal Tunnel Syndrome:Associated abnormali es in unlar nevre func on and the ef- fect of carpal tunnel release on these abnormali es. J Hand Surg. 1983: 10A; 71013.
• Kao SY (2003) Carpal tunnel syndrome as an occupa onal disease.J Am Board Fam Pract 16:533–542
• Stevens Jl, Beard CM, O’Fallon WM: Condi ons assosiated with carpal tunnel syndrome. Mayo Clin Proc. 1992: 67(6);541-548.
• Werner RA, Andary M (2002) Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol 113:1373–1381
• Rempel DM, Diao E (2004) Entrapment neuropathies: pathophysiology and pathogenesis. J Electromyogr Kinesiol 14:71–75
• Hirata H, Nagakura T, Tsujii M (2004). The rela onship of VEGF and PGE2 expression to extracellular matrix remodeling of the tenosynovium in the carpal tunnel syndrome J Pathol 204:605–612 .
• Tucci MA, Barbieri RA, Freeland AE (1997) Biochemical and histologi- cal analysis of the fl exor tenosynovium in pa ents with carpal tunnel syndrome. Biomed Sci Instrum 33:246–251.
• Bland JDB (2001) Do nerve conduc on studies predict the outcome of carpal tunnel decompression? Muscle Nerve 24:935–940
• Bland JDB (2005) Carpal tunnel syndrome. Curr Opin Intern Med 4(6):578–582
• Nora DB, Becker J, Ehler JA, Gomes I (2004) Clinical feature of 1, 039 pa ents with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg 107:64–69
• Wi JC, Hentz JG, Stevens JC (2004) Carpal tunnel syndrome with normal nerve conduc on studies. Muscle Nerve 29:515–522].
• Yalçın P, Arasıl T. 40 yas üzeri kadonlarda karpal tünel sendromu insidan- sı.Roma zma 1990: 5(1); 23-33.).
• Koenig RW, Pedro MT, Heinen CPG, Schmidt T, Richter HP, Antoniadis G et al (2009) High-resolu on ultrasonography in evalua ng peripheral nerve entrapment and trauma. Neurosurg Focus 26:1–6
• Ertekin C. Sentral ve Periferik EMG Anatomi-Fizyoloji-Klinik. İzmir: Meta Basım Matbaacılık Hizmetleri, 2006; 403-427.
• Posch JL, Marco e DR: Carpal tunnel syndrome. an analysis of 1, 201 cases. Orthop Rev 1976; 5: 25-35. 6125.
• Phalen GS, Kendrick JI: Compression neuropathy of the median nerve in the carpal tunnel. JAMA 1957;164: 524-30.
• Graham RA: Carpal tunnel syndrome: a sta s cal analysis of 214 cases. Orthopedics 1983; 6:1283-87.
• Zagnoli F, Andre V, Le Dreef P, Garcia JF, Bellard S. İdiopathic carpal tun- nel syndrome: Clinical, electrodiagnos c, and magne c resonance ima- ging correla ons. Rev Rhum 1999; 66(4): 192-200.
• Nazlıkul H.Fibromiyalji Sendromu Barnat 2014;8;2;1-9
• Nazlıkul H.Darm als Störfeld, Vortrag Greiswald 2011
• Nazlıkul H, Acarkan T. Bağırsak ve Enterik sinir sisteminin regülasyondaki önemi. Barnat 2014;8;1;1-7.