中區防治中心網絡醫院聯合討論會

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1、Work-relatedCarpalTunnelSyndrome王賢和MD.PhD職業醫學科Case-M/48季xxCC:referralhereundertheimpressionofworkrelatedcarpaltunnelsyndrome.職業病的診斷原則疾病的證據職業暴露的證據符合時序性符合人類流行病學已知的證據排除其他可能的致病因素3罹病的證據SymptomsSignsTestsSYMPTOMSNumbness,TinglingpaininthevolaraspectsofhandsWeaknessinlefthandgripp

2、ingEspeciallynotedafterworkoratnightShakinghandstorelievethepainsNosleepdisturbanceyetSignsTinel'ssign(+/-):tappingoverthemediannerveatthewristcausesparesthesiasorpainradiatingfromthewristtothethumbandtheindex,themiddleandhalftheringfingers.Phalen‘stest(+/-):bendingthewristf

3、orwardallthewayfor60secondsresultsinnumbness,tingling,orweaknessinamediannervedistributionAtrophyofthethenarmuscles(-)PresentillnessNumbness,tinglingpainandweaknessofhandsfor3yearsPaincouldtemporarilyrelievedbytheanalgesics,traditionalmassages,herbmedicinesandlocalsteroidinj

4、ection.Carpaltunnelsyndromewasdiagnosedatthe賢德hospitalon2011/01/07.Referralundertheimpressionofworkrelateddisease.MotorNerveConductionStudyNormalamplitudeDelayeddistallatenciesofbilateralmediannerves.ProlongFlatenciesofbilateralmediannervesinFwavestudyNormalresultsofulnar,pe

5、ronealandtibialnerves.FwavestudySupra-maximalstimulationOrtho-dromicstimulusMwave:musclecontraction.Anti-dromicstimulusthemotorneuroncellbodiesbackfiredowntowardsthemusclesmallFwave.F-wavestudyD=thelengthfromthestimulation(wristcrease)tothespine(C7)(formediannerve).F-M=t

6、helatencydifferencebetweenmeanFandMDelay=1millisecondConductionvelocity=2D/(F-M-1).SensoryConductionStudySlowinginthepalm-wristconductionofbilateralmediannervesNormalresultsofulnarandsuralnerves.NerveConductionStudy(NCS)MotorNCSSensoryNCSF-wavestudy(initiallyrecordedinthefoo

7、tmuscles)H(Hoffmann)-reflexstudyF-wavestudyvs.MotorandSensorycoductionstudiesTheF-wavelatencycanbeusedtoderivetheconductionvelocityofnervebetweenthelimbandspine,whereasthemotorandsensorynerveconductionstudiesevaluateconductioninthesegmentofthelimb.F-wavestudyisnotareflex.Hre

8、flexmonosynapticreflexelectricallystimulatingthetibialnerve(Iaafferentsfrom