CLINICAL ANATOMY OF CARPAL TUNNEL AT PRIMARY COMPRESSION OF MEDIAN NERVE (CARPAL TUNNEL SYNDROME)
Causes for primary (idiopathic) compression of median nerve in the carpal tunnel are unknown. There is an idea of possible compression of median nerve in an anatomically narrowed lumen of carpal tunnel, whose walls have a bow shape in the cross section. The bow arc is bounded laterally by the radial eminence of wrist formed by tubercles of scaphoid bone and trapezium and medially by the ulnar eminence of wrist consisting of pisiform bone and hamulus of hamate bone. The bow string is the carpal ligament. To study morphometric parameters of carpal tunnel lumen, we have selected eight patients with diagnosed primary compression of median nerve aged 42-78 with the II stage by R. Szabo (1992). The patients have received preoperative magnetic-resonance imaging of the carpal tunnel with the following measurement of cross-section area of tunnel lumen in cm2 at three levels: entrance, central part, 6 Байтингер А.В., Черданцев Д.В., Перельмутер В.М., Ибраев М.М. № 4 (67) декабрь’ 2018 Вопросы реконструктивной и пластической хирургии and exit from the carpal tunnel. Intraoperatively collected fragments of carpal ligament were subjected to histological and immunohystological analysis. During the magnetic-resonance imaging, in all the patients the cross-sectional area of the carpal tunnel was (1.56 ± 0.02) cm2 at the entrance, (1.58 ± 0.01) cm2 in the central part, and (1.59 ± 0.01) cm2 at the exit. These values did not exceed the anatomical norm. Pathohistological changes of the fibrillary apparatus in the carpal ligament did not lead to its shortening. The data obtained suggest that at the primary compression of median nerve there is no narrowing of carpal tunnel lumen, and so the external compression of nerve at its three levels is lacking. Development of primary compression of median nerve within the carpal tunnel is likely associated with the internal compression by anatomical formations surrounding the nerve or by development of intraneural edema in the nerve itself.
Keywords
синдром запястного канала,
синдром карпального канала,
срединный нерв,
декомпрессия,
кисть,
carpal tunnel syndrome,
median nerve,
decompression,
palmAuthors
| Baytinger A.V. | Krasnoyarsk, Russian Federation | |
| Cherdantsev D.V. | Krasnoyarsk, Russian Federation | |
| Perelmuter V.M. | Tomsk National Research Medical Center of the Russian Academy of Sciences | |
| Ibraev M.M. | Medical Center “Longa Vita” | |
Всего: 4
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