Síndromes compresivos del nervio mediano. Revisión y actualización de la bibliografía Revisión y Actualización de la Bibliografía
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Publicado:
ago 17, 2023
Palabras clave:
Compresión nerviosa, nervio mediano, síndrome del pronador redondo, síndrome del túnel carpiano, descompresión quirúrgica
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Resumen
El nervio mediano desciende por el brazo y, en el codo, comienza a atravesar estructuras que pueden generar compresión, como el ligamento de Struthers, el lacertus fibrosus, el pronador redondo, el flexor superficial de los dedos. Finalmente, en la muñeca, se encuentra otro sitio de compresión producido por el ligamento transverso del carpo. Todas estas estructuras pueden provocar signos y síntomas de atrapamiento nervioso y favorecer el deterioro funcional del nervio. Nuestro objetivo es dar a conocer una actualización sobre estos sitios de atrapamiento del nervio mediano, y cómo realizar un diagnóstico preciso e indicar un tratamiento adecuado.
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Sánchez Saba, J. E., Civit, J. F., Ramírez Vargas, P., Melibosky Ramos, F., Villavicencio Achurra, A., Román Veas, J., Cobb Craddock, P., Orellana Araya, P., & Jorquera Aguilera, R. (2023). Síndromes compresivos del nervio mediano. Revisión y actualización de la bibliografía. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(4), 451-456. https://doi.org/10.15417/issn.1852-7434.2023.88.4.1734
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Actualización
Derechos de autor 2023 Revista de la Asociación Argentina de Ortopedia y Traumatología
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Citas
1. Adler JA, Wolf JM. Proximal median nerve compression: pronator syndrome. J Hand Surg Am 2020;45(12):1157-
65. https://doi.org/10.1016/j.jhsa.2020.07.006
2. Strohl AB, Zelouf DS. Ulnar tunnel syndrome, radial tunnel syndrome, anterior interosseous nerve syndrome, and pronator syndrome. Instr Course Lect 2017;66:153-62. PMID: 28594495
3. Rodner CM, Tinsley BA, O’Malley MP. Pronator syndrome and anterior interosseous nerve syndrome. J Am Acad Orthop Surg 2013;21(5):268-75. https://doi.org/10.5435/JAAOS-21-05-268
4. Miller TT, Reinus WR. Nerve entrapment syndromes of the elbow, forearm, and wrist. AJR Am J Roentgenol 2010;195(3):585-94. https://doi.org/10.2214/AJR.10.4817
5. Xing SG, Tang JB. Entrapment neuropathy of the wrist, forearm, and elbow. Clin Plast Surg 2014;41(3):561-88.
https://doi.org/10.1016/j.cps.2014.03.007
6. Tang DT, Barbour JR, Davidge KM, Yee A, Mackinnon SE. Nerve entrapment: update. Plast Reconstr Surg
2015;135(1):199e-215e. https://doi.org/10.1097/PRS.0000000000000828
7. Simpson RL, Fern SA. Multiple compression neuropathies and the double-crush syndrome. Orthop Clin North Am 1996;27(2):381-8. PMID: 8614586
8. Mooar PA, Doherty WJ, Murray JN, Pezold R, Sevarino KS. Management of carpal tunnel syndrome. J Am Acad
Orthop Surg 2018;26(6):e128-30. https://doi.org/10.5435/JAAOS-D-17-00451
9. Graham B, Peljovich AE, Afra R, Cho MS, Gray R, Stephenson J, et al. The American Academy of Orthopaedic
Surgeons Evidence-Based Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome. J Bone Joint
Surg Am 201619;98(20):1750-4. https://doi.org/10.2106/JBJS.16.00719
10. Karamanos E, Jillian B-Q, Person D. Endoscopic carpal tunnel release: indications, technique, and outcomes.
Orthop Clin North Am 2020;51(3):361-8. https://doi.org/10.1016/j.ocl.2020.02.001
11. Li Y, Luo W, Wu G, Cui S, Zhang Z, Gu X. Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2020;21(1):272. https://doi.org/10.1186/s12891-020-03306-1
12. Lauder A, Mithani S, Leversedge FJ. Management of recalcitrant carpal tunnel syndrome. J Am Acad Orthop Surg 2019;27(15):551-62. https://doi.org/10.5435/JAAOS-D-18-00004
13. Dellon AL, Mackinnon SE. Chronic nerve compression model for the double crush hypothesis. Ann Plast Surg
1991;26(3):259-64. https://doi.org/10.1097/00000637-199103000-00008
14. Novak CB, Mackinnon SE. Multilevel nerve compression and muscle imbalance in work-related neuromuscular disorders. Am J Ind Med 2002;41(5):343-52. https://doi.org/10.1002/ajim.10063
15. Löppönen P, Hulkkonen S, Ryhänen J. Proximal median nerve compression in the differential diagnosis of carpal tunnel syndrome. J Clin Med 2022;11(14):3988. https://doi.org/10.3390/jcm11143988
16. Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study. Hand (N Y) 2013;8(1):41-6. https://doi.org/10.1007/s11552-012-9483-4
17. Barnett SA, Shah SA, Ahmad RI. Endoscopic proximal median nerve decompression: an alternative treatment for pronator syndrome. J Hand Surg Glob Online 2021;3(4):210-4. https://doi.org/10.1016/j.jhsg.2021.03.006
18. Naik AA, Bawa A, Arya A, Gulihar A. Nerve entrapment around elbow. J Clin Orthop Trauma 2021;19:209-15.
https://doi.org/10.1016/j.jcot.2021.05.031
19. Tang JB. Median nerve compression: lacertus syndrome versus superficialis-pronator syndrome. J Hand Surg Eur Vol 2021;46(9):1017-22. https://doi.org/10.1177/17531934211024092
20. Özdemir A, Acar MA, Güleç A, Durgut F, Cebeci H. Clinical, radiological, and electrodiagnostic diagnosis of
pronator syndrome concurrent with carpal tunnel syndrome. J Hand Surg Am 2020;45(12):1141-7. https://doi.org/10.1016/j.jhsa.2020.06.006
21. Lalonde D. Lacertus syndrome: a commonly missed and misdiagnosed median nerve entrapment syndrome. BMC Proc 2015;9(Suppl 3):A74. https://doi.org/10.1186/1753-6561-9-S3-A74
22. Zancolli ER, Zancolli EP, Perrotto CJ. New mini-invasive decompression for pronator teres syndrome. J Hand Surg Am 2012;37(8):1706-10. https://doi.org/10.1016/j.jhsa.2012.05.033
23. Hsiao CW, Shih JT, Hung ST. Concurrent carpal tunnel syndrome and pronator syndrome: A retrospective study of 21 cases. Orthop Traumatol Surg Res 2017;103(1):101-3. https://doi.org/10.1016/j.otsr.2016.10.009
24. Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and
ulnar nerves: MR imaging features. Radiographics 2006;26(5):1267-87. https://doi.org/10.1148/rg.265055712
25. Kim S, Choi J-Y, Huh Y-M, Song H-T, Lee S-A, Kim SM, et al. Role of magnetic resonance imaging in entrapment
and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. Eur Radiol 2007;17(2):509-22. https://doi.org/10.1007/s00330-006-0180-y
26. Choi S-J, Ahn JH, Ryu DS, Kang CH, Jung SM, Park MS, et al. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography 2015;34(4):275-91. https://doi.org/10.14366/usg.14060
27. Cohen BH, Gaspar MP, Daniels AH, Akelman E, Kane PM. Multifocal neuropathy: expanding the scope of double crush syndrome. J Hand Surg Am 2016;41(12):1171-5. https://doi.org/10.1016/j.jhsa.2016.09.009
28. Lee AK, Khorsandi M, Nurbhai N, Dang J, Fitzmaurice M, Herron KA. Endoscopically assisted decompression for pronator syndrome. J Hand Surg Am 2012;37(6):1173-9. https://doi.org/10.1016/j.jhsa.2012.02.023
65. https://doi.org/10.1016/j.jhsa.2020.07.006
2. Strohl AB, Zelouf DS. Ulnar tunnel syndrome, radial tunnel syndrome, anterior interosseous nerve syndrome, and pronator syndrome. Instr Course Lect 2017;66:153-62. PMID: 28594495
3. Rodner CM, Tinsley BA, O’Malley MP. Pronator syndrome and anterior interosseous nerve syndrome. J Am Acad Orthop Surg 2013;21(5):268-75. https://doi.org/10.5435/JAAOS-21-05-268
4. Miller TT, Reinus WR. Nerve entrapment syndromes of the elbow, forearm, and wrist. AJR Am J Roentgenol 2010;195(3):585-94. https://doi.org/10.2214/AJR.10.4817
5. Xing SG, Tang JB. Entrapment neuropathy of the wrist, forearm, and elbow. Clin Plast Surg 2014;41(3):561-88.
https://doi.org/10.1016/j.cps.2014.03.007
6. Tang DT, Barbour JR, Davidge KM, Yee A, Mackinnon SE. Nerve entrapment: update. Plast Reconstr Surg
2015;135(1):199e-215e. https://doi.org/10.1097/PRS.0000000000000828
7. Simpson RL, Fern SA. Multiple compression neuropathies and the double-crush syndrome. Orthop Clin North Am 1996;27(2):381-8. PMID: 8614586
8. Mooar PA, Doherty WJ, Murray JN, Pezold R, Sevarino KS. Management of carpal tunnel syndrome. J Am Acad
Orthop Surg 2018;26(6):e128-30. https://doi.org/10.5435/JAAOS-D-17-00451
9. Graham B, Peljovich AE, Afra R, Cho MS, Gray R, Stephenson J, et al. The American Academy of Orthopaedic
Surgeons Evidence-Based Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome. J Bone Joint
Surg Am 201619;98(20):1750-4. https://doi.org/10.2106/JBJS.16.00719
10. Karamanos E, Jillian B-Q, Person D. Endoscopic carpal tunnel release: indications, technique, and outcomes.
Orthop Clin North Am 2020;51(3):361-8. https://doi.org/10.1016/j.ocl.2020.02.001
11. Li Y, Luo W, Wu G, Cui S, Zhang Z, Gu X. Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2020;21(1):272. https://doi.org/10.1186/s12891-020-03306-1
12. Lauder A, Mithani S, Leversedge FJ. Management of recalcitrant carpal tunnel syndrome. J Am Acad Orthop Surg 2019;27(15):551-62. https://doi.org/10.5435/JAAOS-D-18-00004
13. Dellon AL, Mackinnon SE. Chronic nerve compression model for the double crush hypothesis. Ann Plast Surg
1991;26(3):259-64. https://doi.org/10.1097/00000637-199103000-00008
14. Novak CB, Mackinnon SE. Multilevel nerve compression and muscle imbalance in work-related neuromuscular disorders. Am J Ind Med 2002;41(5):343-52. https://doi.org/10.1002/ajim.10063
15. Löppönen P, Hulkkonen S, Ryhänen J. Proximal median nerve compression in the differential diagnosis of carpal tunnel syndrome. J Clin Med 2022;11(14):3988. https://doi.org/10.3390/jcm11143988
16. Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study. Hand (N Y) 2013;8(1):41-6. https://doi.org/10.1007/s11552-012-9483-4
17. Barnett SA, Shah SA, Ahmad RI. Endoscopic proximal median nerve decompression: an alternative treatment for pronator syndrome. J Hand Surg Glob Online 2021;3(4):210-4. https://doi.org/10.1016/j.jhsg.2021.03.006
18. Naik AA, Bawa A, Arya A, Gulihar A. Nerve entrapment around elbow. J Clin Orthop Trauma 2021;19:209-15.
https://doi.org/10.1016/j.jcot.2021.05.031
19. Tang JB. Median nerve compression: lacertus syndrome versus superficialis-pronator syndrome. J Hand Surg Eur Vol 2021;46(9):1017-22. https://doi.org/10.1177/17531934211024092
20. Özdemir A, Acar MA, Güleç A, Durgut F, Cebeci H. Clinical, radiological, and electrodiagnostic diagnosis of
pronator syndrome concurrent with carpal tunnel syndrome. J Hand Surg Am 2020;45(12):1141-7. https://doi.org/10.1016/j.jhsa.2020.06.006
21. Lalonde D. Lacertus syndrome: a commonly missed and misdiagnosed median nerve entrapment syndrome. BMC Proc 2015;9(Suppl 3):A74. https://doi.org/10.1186/1753-6561-9-S3-A74
22. Zancolli ER, Zancolli EP, Perrotto CJ. New mini-invasive decompression for pronator teres syndrome. J Hand Surg Am 2012;37(8):1706-10. https://doi.org/10.1016/j.jhsa.2012.05.033
23. Hsiao CW, Shih JT, Hung ST. Concurrent carpal tunnel syndrome and pronator syndrome: A retrospective study of 21 cases. Orthop Traumatol Surg Res 2017;103(1):101-3. https://doi.org/10.1016/j.otsr.2016.10.009
24. Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and
ulnar nerves: MR imaging features. Radiographics 2006;26(5):1267-87. https://doi.org/10.1148/rg.265055712
25. Kim S, Choi J-Y, Huh Y-M, Song H-T, Lee S-A, Kim SM, et al. Role of magnetic resonance imaging in entrapment
and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. Eur Radiol 2007;17(2):509-22. https://doi.org/10.1007/s00330-006-0180-y
26. Choi S-J, Ahn JH, Ryu DS, Kang CH, Jung SM, Park MS, et al. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography 2015;34(4):275-91. https://doi.org/10.14366/usg.14060
27. Cohen BH, Gaspar MP, Daniels AH, Akelman E, Kane PM. Multifocal neuropathy: expanding the scope of double crush syndrome. J Hand Surg Am 2016;41(12):1171-5. https://doi.org/10.1016/j.jhsa.2016.09.009
28. Lee AK, Khorsandi M, Nurbhai N, Dang J, Fitzmaurice M, Herron KA. Endoscopically assisted decompression for pronator syndrome. J Hand Surg Am 2012;37(6):1173-9. https://doi.org/10.1016/j.jhsa.2012.02.023