Carpal Tunnel Syndrome (CTS), terkait dengan gejala dan tanda, yang disebabkan oleh kompresi saraf median perjalanan melewati terowongan karpal Carpal Tunnel Syndrome. Mempengaruhi tangan karena merupakan neuropati ekstremitas atas bahwa hasil di motor dan gangguan sensorik dari saraf median. Kondisi ini mempengaruhi individu dengan menyebabkan rasa sakit, parestesi, dan kadang-kadang kelemahan dalam distribusi saraf median. Mereka yang didiagnosis dengan Carpal Tunnel Syndrome mungkin mengalami nyeri, mati rasa dan kesemutan di lengan sensasi, yang mungkin mencakup area bahu dan leher; perasaan ini lebih menonjol pada malam hari karena berbagai posisi tidur. Untuk membantu dalam pencegahan Carpal Tunnel Syndrome, latihan peregangan dari pergelangan tangan, tangan, dan jari-jari telah digunakan untuk melawan terhadap rasa sakit dan mati rasa yang disebabkan oleh tindakan repetitif. Selain menggunakan peregangan direkomendasikan dan latihan, perawatan berguna untuk CTS meliputi penggunaan splints malam, suntikan kortikosteroid dan akhirnya dengan operasi. Kebanyakan kasus Carpal Tunnel Syndrome telah ditemukan tanpa sebab tertentu dan individu tertentu mungkin secara genetik cenderung kondisi ini.
Etiologi
Terowongan carpal yang sempit selain dilalui oleh nervus medianus juga dilalui oleh beberapa tendon flexor. Setiap kondisi yang mengakibatkan semakin padatnya terowongan ini dapat menyebabkan terjadinya penekanan pada nerves medianus sehingga timbul carpal tunnel syndrome. Carpal tunnel syndrom dapat dibagi menjadi dua yaitu akut dan kronis, namun pada sebagian kasus etiologinya tidak diketahui ( idiopatik ), terutama pada penderita lanjut usia. Selain itu gerakan yang berulang-ulang pada pergelangan tangan dapat menambah resiko carpal tunnel syndrom. Pada keadaan lain lain nerves medianus dapat terjebak juga di carpal tunnel itu. Secara sekunder, carpal tunnel sindrom dapat timbul pada penderita dengan osteoartitis, diabetes mellitus, miksedema, akromegali, atau wanita hamil. Etiologi lain pada kasus carpal tunnel sindrom antara lain:
(1) Herediter (nuropati herediter yang cenderung menjadi pressure palsy),
(2) Trauma (dislokasi, fraktur colles atau hematom pada lengan bawah, sprain pergelangan tangan, trauma langsung pada pergelangan tangan, pekerjaan dengan gerakan mengetuk atau flexi dan ekstensi pergelangan tangan yang berulang,
(3) Infeksi (tenosinovitis, tuberculosis),
(4) Metabolik (amiloidesis, gout),
(5) Endokrin (terapi estrogen dan androgen, diabetes mellitus, kahamilan).
(6) Neoplasma (Kista ganglion, lipoma, infiltrsi metastase, mieloma)
(7) Penyakit kolagen vaskuler ( artitis rematoid, polimialgia reumatika),
(8) Degenerasi (osteoartitis),
(9) Tumor.
Patologi
Carpal tunnel syndrom dapat dikategorikan menjadi dua yaitu akut dan kronis. Ada beberapa hipotesa mengenai patogenesis dari carpal tunnel syndrom. Sebagian berpendapat bahwa faktor mekanik clan vaskuler memegang peranan penting dalam terjadinya carpal tunnel syndrom. Tapi pada umumnya Carpal tunnel syndrome ini terjadi secara kronis dimana terjadi penebalan flexor retinakulum, yang menyebabkan tekanan terhadap nervus medianus. Tekanan yang berulang-ulang dan lama akan mengakibatkan peninggian tekanan intrafasikuler. Akibatnya aliran darah vena intrafasikuler melambat. Kongesti yang terjadi ini akan mengganggu nutrisi intrafasikuler lalu diikuti oleh anoxia yang akan merusak endotel. Kerusakan endotel ini akan mengakibatkan kebocoran protein sehingga terjadi edema epineural. Apabila kondisi ini terus berlanjut akan tejadi fibrosis epineural yang merusak serabut saraf. Lama-kelamaan saraf menjadi atrofi dan akan digantikan oleh jaringan ikat yang mengakibatkan fungsi dari nervus medianus terganggu.
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