방아쇠수지가 손목터널증후군 환자의 악력, 통증 및 상지기능에 미치는 영향: 단면적 연구

김명권 ( Myoung-kwon Kim ),윤다은 ( Da-eun Yun ) 대한물리의학회 2021 대한물리의학회지 Vol.16 No.1

PURPOSE: The purpose of this study was to investigate the effects of trigger finger on pain, muscle strength and function in carpal tunnel syndrome (CTS) patients. METHODS: A total of 60 subjects (30 carpal tunnel syndrome with trigger finger and 30 carpal tunnel syndrome without trigger finger) were assessment for pain, muscle strength (power grip, key pinch , tip to tip pinch, three jaw pinch) and function. The effect sizes of the two groups were compared, and the correlation between the trigger finger and each variable was analyzed. RESULTS: The results showed that there were significantly difference in the pain, muscle strength excluding three jaw pinch and function (p < .05). The results also showed correlation between trigger finger and pain (r = .552), muscle strength excluding three jaw pinch (power grip r = -.296, key pinch r = -.260, tip to tip pinch r = -.285), and function (r = .375). The function of carpal tunnel syndrome patients was related to pain (r = .550) and power grips (r = -.324) of muscle strength. CONCLUSION: In carpal tunnel syndrome patients with trigger finger compared to carpal tunnel syndrome, muscle weakness, pain increase, and function reduction were shown. In addition, trigger finger are correlated with muscle strength, pain and function, and muscle weakness and increased pain affect the daily living of carpal tunnel syndrome patients with triggers finger. Therefore, physical therapy interventions of carpal tunnel syndrome patients with trigger finger should be combined with treatment for muscle strength enhancement as well as pain reduction.

한 콘돔공장근로자들의 수근관증후군에 관한 연구

강중구,백도명,이윤정,마효일,손미아,이홍기,최정근,Kang, Joong-Koo,Paek, Do-Myung,Lee, Young-Jung,Ma, Hyeo-Il,Son, Mi-A,Lee, Hong-Ki,Choi, Jung-Keun 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.3

The objectives of this study are to investigate the prevalence of occupation related carpal tunnel syndrome(CTS) among workers in a condom industry : to analyse the sensitivity and specificity of clinical signs or symptoms such as hand diagram, Tinel's sign and Phalen's sign in carpal tunnel syndrome : and to test vibration threshold test using audiometry as a technically easy and noninvasive method in the diagnosis of carpal tunnel syndrome in stead of nerve conduction velocity (NCV). The study group was divided into exposed group(39 cases) and non-exposed group(48 cases) based on whether or not excessive use of wrist movements exsist. 1. There are stastically significant differences in symptoms and signs of carpal tunnel syndrome such as hand diagram, Tinel's sign and Phalen's sign between exposed and non-exposed group(p<0.05). 2. Six cases(9 hands) were comfirmed as carpal tunnel syndrome by NCV. Five cases(7 hands) belonged to exposed group, 1 case(2 hands) to nonexposed group. As there are significant differences in prevalence of carpal tunnel syndrome between two groups(p<0.05), excessive use of wrist in occupation is a risk factor of carpal tunnel syndrome. 3. When we use NCV as a gold standard in the diagnosis of carpal tunnel syndrome, sensitivity and specificity of hand diagram, Tinel's sign and Phalen's sign is as followed; hand diagram , sensitivity 88.9%, specificity 84.2% Tinel's sign ; sensitivity 55.6%, specificity 72.8% Phalen's sign ; sensitivity 14.3%, specificity 88.4%. Among above clinical signs and symptoms, hand diagram is the best clinical screening test. 4. The differences of vibration threshold between median and ulnar nerve at the same time are useful in the diagnosis of carpal tunnel syndrome but the time change of vibration threshold of median nerve over time are not sensitive enough. It is concluded that vibration threshold between median and ulnar nerve at the same time can be used as a supplementary or alternative criterion to indicate that the nerve dysfunction is located in the carpal tunnel.

모 사업장 포장부서 근로자들에서 발생한 수근터널증후군에 대한 조사연구

이원진,이은일,차철환,Lee, Won-Jin,Lee, Eun-Il,Cha, Chul-Whan 대한예방의학회 1992 예방의학회지 Vol.25 No.1

반복작업에 종사하는 모 사업장 포장부서 근로자 42명을 대상으로 수근터널증후군에 대한 중상, 이학적 검사 및 근전도 검사를 1991년 11월부터 1992년 3월까지 실시하였다. 양손 모두에서 근전도상 이상소견을 보인 경우가 4명, 오른쪽 손에만 이상소견을 보인 경우가 4명 그리고 왼손이 1명 등 총 9명으로서 21.4%의 높은 유병률을 나타내었다. 임상중상은 전체 42명중 66.7%에 해당되는 28명에서 나타났다. Tinel과 Phalen sign 등 이학적 검사에서 이상소견을 보인 경우는 14명으로 전체의 33.3%를 차지하였다. 그리고 키와 임신 횟수를 제외한 수근터널증후군에 대한 다른 일반적 위험요인은 환자군과 비환자군에서 유의한 차이는 없었다. 근전도 검사를 기준으로 하였을 때 임상증상에 대한 민감도는 0.89, 특이도는 0.39이었고 Tinel sign에서는 각각 0.33, 0.88 그리고 Phalen sign에서는 0.56, 0.82 등이었다. 임상증상이 있고 Tinel과 Phalen sign에서 어느 하나 양성으로 나타나는 것을 선별기준으로 하였을 경우의 민감도와 특이도는 0.57, 0.76이었다. The carpal tunnel syndrome is one of the most common peripheral nerve entrapment syndromes. The typical symptoms are pain, numbness and paresthesia in the median nerve territory of the hand. Recently, it is widely recognized that occupational factor is regarded as the important cause of the carpal tunnel syndrome. Clinical study is performed in the 42 female workers who is repetitively working at packing department in a rayon manufacturing factory from November 1991 till March 1992. The study included a questionnaire, physical examinations, and the neurophysiological test. The summary of the results obtained was as follows : 1. Among 42 packing workers, 9 workers(21.4%) were diagnosed as carpal tunnel syndrome by electromyography. The affected side was bilateral in 4 workers(9.5%), right in 4 workers(9.5%), and left in one worker(2.4%). 2. Among 42 subjects, 28 workers(66.7%) complained the clinical symptoms related to carpal tunnel syndrome, 11 workers(26.2%) showed positive Phalen sign, and 7 workers(16.7%) showed positive Tinel sign. 3. Researchers regard electromyographic finding as the gold standard for diagnosis of carpal tunnel syndrome. The sensitivity and specificity of the clinical symptoms to diagnose the carpal tunnel syndrome were 0.89, 0.39 respectively. If the carpal tunnel syndrome is diagnosed by the combination of the positive findings of the symptoms and the physical examinations, either Tinel or Phalen sign, the sensitivity and specificity were 0.67 and 0.76 respectively. Considering above results, though this small number of workers is not adequate for epidemiologic conclusions, carpal tunnel syndrome seems to be an important occupational disorder among packing workers in a rayon manufacturing factory.

수근관증후군에 대한 도침치료의 효과: 체계적 문헌 고찰과 메타분석

정재민,설재욱,김선종,선윤권,최지민,노희정,최진봉 한방재활의학과학회 2022 한방재활의학과학회지 Vol.32 No.3

Objectives The objective of this study was to assess the effectiveness of acupotomy for carpal tunnel syndrome. Methods Based on seven domestic and foreign databases. We analyzed the randomized controlled trials using acupotomy for carpal tunnel syndrome. The treatment group was treated with acupotomy and the control group was no restrictions on treatment methods. Results In this study, the effect of acupuncture treatment for carpal tunnel syndrome was investigated. Each study reported that acupotomy could be an effective treatment for carpal tunnel syndrome. However, as a result of meta-analysis of Levine carpal tunnel syndrome questionnaire scores, visual analog scale, and sensory nerve conduction velocity, the results were more clinically significant than those of the control group. Due to the small number of randomized controlled trial studies and the nature of acupotomy treatment, blinding of interventions was impossible, resulting in a high risk of bias. Conclusions In this regard, it is thought that well-planned randomized controlled studies on patients with carpal tunnel syndrome are needed in the future to secure the clinical evidence for acupotomy treatment.

손가락굽힘근 힘줄의 통풍결절 침착에 의해 발생한 손목터널증후군

권세웅 ( Se Woong Kwon ),김지혜 ( Ji Hye Kim ),강원찬 ( Won Chan Kang ),김수정 ( Soo Jung Kim ),김호연 ( Ho Yeon Kim ),김해림 ( Hae Rim Kim ),이상헌 ( Sang Heon Lee ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.1

Carpal tunnel syndrome is the most common peripheral entrapment neuropathy. We report on the first Korean case of carpal tunnel syndrome induced by tophaceous deposition in flexor digitorum tendons of a patient with chronic gout. A 63-year-old male suffered from numbness, decreased sensation over both median nerve distribution, and weakness of thenar muscle for 3 years. Physical examinations revealed positive Tinel’s sign and Phalen’s test and thenar qjmuscle atrophy was found on both hands. In nerve conduction study, there was no action potential of the sensory and motor of the bilateral median nerve. Ultrasonography showed increased cross-sectional area of median nerve due to tophaceous deposition in flexor digitorum tendons in the carpal tunnel. Dual-energy computed tomography showed diffuse multifocal green color coding tophaceous deposition within the carpal tunnel. His neuropathic symptoms improved after injection of triamcinolone into the carpal tunnel and administration of oral medication including non-steroidal anti-inflammatory drugs and colchicine. (J Rheum Dis 2015;22:29-33)

경도와 초경도 수근관 증후군 환자의 초음파 검사 소견

박기영,배정호,이소영,오정섭,임정근,손대구 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.1

Objective: To assess the clinical usefulness of ultrasonography for the diagnosis of mild and very mild carpal tunnel syndrome. Method: Ultrasonographic evaluation was performed in 39 hands of 29 patients with mild and very mild carpal tunnel syndrome according to Bland's neurophysiologic grading scale. Controls included 41 hands of 34 subjects without electrophysiologic evidence of carpal tunnel syndrome. Ultrasonographic findings were evaluated quantitatively with regard to the cross-sectional area, the flattening ratio, the swelling ratio of the median nerve, and palmar displacement of the flexor retinaculum. The analysis of differences between controls and patients group were done by independent t-test. Cut-off values using receiver operation characteristic, were calculated. Results: Patients had significantly increased cross sectional area and flattening ratio of the median nerve at proximal carpal area, palmar displacement of the flexor retinaculum at proximal carpal area. A critical value of equal or higher to 8.5 mm2 for cross-sectional area at the pisiform level showed a sensitivity 79.5%, a specificity of 95.1%, which had most diagnostic value compared with the value of cross-sectional area at the distal radius level, flattening ratio at the pisiform level and palmar displacement. Conclusion: Ultrasonography was useful in the diagnosis of mild and very mild carpal tunnel syndrome.

진행된 수근관 증후군에서 횡수근 인대 절개술과 동시에 시행한 제4수지 천수지 굴곡건을 이용한 대립 성형술

이영석,천호준,김영우,우상현 대한수부외과학회 2017 대한수부외과학회지 Vol.22 No.1

Purpose: To analyze the clinical outcome for primary ring flexor digitorum superficialis transfer with open carpal tunnel release in extreme carpal tunnel syndrome. Methods: Ring flexor digitorum superficialis transfer with open release of the transverse carpal ligament was performed on 23 patients who were diagnosed with extreme carpal tunnel syndrome between September 2008 and August 2013. All patients had visibly severe atrophies, with no sign of compound muscle action potential (CMAP) of abductor pollicis brevis from electromyography. They wanted simultaneous reconstruction of the function of the hand as well as recovery of the numbness. We evaluated the clinical results using key-pinch, hand grip abilities, disability of the arm, shoulder and hand (DASH) scores, Kapandji scores. Results: Key-pinch and hand grip abilities had no significant difference after the surgery compared with before, but DASH scores were significantly different, averaging 18.6 after, compared with 39.8 before surgery. And Kapandji scores increased significantly from 4.8 before, to 9.3 after the surgery. Numbness and pain in hands were also markedly improved with a different score on VAS each. Conclusion: Primary ring flexor digitorum superficialis opponensplasty with open carpal tunnel release is a very practical and useful way of treating extreme carpal tunnel syndrome in thenar weakness. 목적: 무지구 근육의 위축을 동반한 진행된 수근관 증후군에서 횡수근 인대의 절개술과 동시에 제4수지의 천수지 굴곡건 이전술을 이용한 대립 성형술을 시행하였고, 그 임상적 결과를 평가하였다. 방법: 2008년 9월부터 2013년 8월까지 총 23명의 진행된 수근관 증후군 환자를 대상으로 횡수근 인대의 절개술과 동시에 무지 대립 성형술을 시행하였다. 모든 환자들에서 심한 무지구 근육의 위축이 있었으며, 근전도 검사에서 복합 근육 활동 전압이 전혀 관찰되지 않았다. 환자들은 손저림의 치료뿐만 아니라 손의 기능 회복을 동시에 원하였다. 수술전후의 손저림의 정도, 통증, 엄지와 집게 손가락의 집기 능력, 손의 악력과 상지 근골격계 기능(disability of the arm, shoulder and hand, DASH)을 평가하였다. 결과: 집기 능력과 악력은 수술 전후 유의한 차이를 보이지 않았다. 상지 근골격계 장애 점수는 수술 전 평균 39.8에서수술 후에는 18.6으로 유의하게 호전되었다. Kapandji 점수는 수술 전 4.8에서 수술 후 9.3으로, 대립 기능이 향상되었다. 손저림과 통증 또한 수술 이후에 유의하게 호전되었다. 결론: 수근관 증후군에서 횡수근 인대의 절개와 동시에 시행한 제4수지의 천수지 굴곡건을 이용한 대립 성형술은 진행된 수근관 증후군에서 약해진 대립 기능의 회복에 매우 유용한 수술 방법이었다.

Predictive Variables for Sonographically Guided Corticosteroid Injection in Mild-to-Moderate Carpal Tunnel Syndrome

정성윤,곽정민,강석,손성호,김재두,윤준식 대한재활의학회 2018 Annals of Rehabilitation Medicine Vol.42 No.2

Objective To assess the predictive variables after sonographically guided corticosteroid injection in carpal tunnel syndrome. Methods A prospective, observational study was carried out on 25 wrists of 20 consecutive patients with carpal tunnel syndrome, confirmed by the American Association of Neuromuscular and Electrodiagnostic Medicine criteria, which includes clinical history, symptoms, and evidence of slowing of distal median nerve conduction. Visual analogue scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) were asked to the patients before and 4 weeks after the procedure. On a basis of VAS difference before and after the procedure, we divided the patients into two groups: more than 50% of VAS improving (good response group) and less than 50% of VAS improving (poor response group). Also, nerve conduction studies and ultrasound evaluations were performed prior to sonographically guided corticosteroid injection and at 4 weeks after the procedure. The cross-sectional area (CSA) of median nerve at maximal swelling point around wrist was measured by manual tracing using ultrasonography. With assessments mentioned above, we tried to assess predictive variables for prognosis after sonographically guided corticosteroid injection in carpal tunnel syndrome. Results The CSA of median nerve at wrist measured before the procedure was significantly larger in good response group than in poor response group. Furthermore, the CSA of median nerve at wrist, symptom severity scale of BCTQ, motor/sensory latency and sensory amplitude were correlated with VAS improving. Conclusion The CSA of median nerve at wrist is the strongest predictive value for sonographically guided corticosteroid injection in mild-to-moderate carpal tunnel syndrome.

내시경을 이용한 손목 터널 증후군의 치험례

안성봉,정성균,김창현,임성열 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.3

For many years the standard surgical treatment for carpal tunnel syndrome has been division of the transverse carpal ligament under direct vision through a palm incision. Although the effectiveness and patient acceptability of the conventional open carpal tunnel release are good, disability from a painful palm, cutaneous neuroma, and prolonged swelling are reported. Endoscopic carpal tunnel release seems to result in less postoperative morbidity, and minimal serious complications. Because endoscopic carpal tunnel release leaves the overlying skin, the subcutaneous fat, and the palmar fascia and its attachments to the thenar and hypothenar musculature intact, its proponents maintain that their patient have less scar tenderness, quicker recovery of grip strength, and earlier to return activities of daily living and work. The endoscopic approach(Agee single portal technique), which includes specific localization of the hook of hamate, flexor retinaculum, and the superficial palmar arch utilizing topographical landmarks, avoids entry into Guyon's canal and common digital nerves. We experienced four cases of carpal tunnel syndrome. In four cases, patients with carpal tunnel syndrome have been performed endoscopic carpal tunnel release with minor complication.

Traditional Korean Medicine Therapy for Treating Carpal Tunnel Syndrome in Patients with Wrist Pain: A Systematic Review

김정현,송호섭 대한침구의학회 2015 대한침구의학회지 Vol.27 No.3

Objectives : This study aims to evaluate current clinical evidence of traditional Korean medicine treatment on wrist pain with carpal tunnel syndrome. Methods : Ten Korean databases were searched for prospective clinical trials of traditional Korean medicine therapy on wrist pain with carpal tunnel syndrome from the time of their inception to February, 2015. Studies conducted in Korean, Chinese and English were searched. Risk of bias in included non-randomized controlled trials was assessed by the Cochrane handbook procedure. Results : Four non-randomized controlled trials were included. A high risk of bias was observed in all trials. All of the included studies reported favorable effects being experienced by an intervention group compared to a baseline or control group. Included studies never described any occurrence of adverse events. Conclusions : There is no evidence that traditional Korean medicine treatments are effective for treating wrist pain associated with carpal tunnel syndrome. All of the included studies lacked appropriate methodological qualities and internal validity. Future well-designed clinical trials that evaluate the effects and safety of traditional Korean medicine treatment for patients with carpal tunnel syndrome are needed.