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Choroby i dolegliwości Polecane Porady

Zespół kanału Guyona. Diagnostyka i leczenie

doctor inspecting patient body, professional health care concept
doctor inspecting patient body, professional health care concept

Zespół kanału Guyona – określany również jako zespół kanału nadgarstka nerwu łokciowego – to schorzenie polegające na silnym ucisku nerwu łokciowego w obrębie struktury anatomicznej, wytworzonej przez kości haczykowatą i grochowatą oraz więzadło poprzeczne nadgarstka. Struktura ta nosi miano kanału nadgarstka/Guyona. Nerw łokciowy to wiodący nerw odpowiedzialny za ruchomość dłoni, w tym palców małego, serdecznego oraz kciuka. Jego trwałe upośledzenie wiąże się z utratą sprawności i niedowładem ręki.

Przyczyny schorzenia

Etiologia ucisku nerwu łokciowego w kanale nadgarstka może być różnoraka. Do częstych przyczyn schorzenia zalicza się m.in. urazy nadgarstka (złamania, zwichnięcia), wady anatomiczne, a także schorzenia o charakterze ogólnym (reumatoidalne, zwyrodnieniowe). W przypadku części chorych, zespół kanału Guyona jest powiązany z występowaniem torbieli galaretowatej. Rozwojowi choroby sprzyjają takie czynności jak jazda na rowerze, podróż samochodem (jako kierowca – chodzi o trzymanie kierownicy), podnoszenie ciężarów, chwytanie, odkręcanie i przykręcanie niewielkich przedmiotów oraz chodzenie o kulach.

Objawy i symptomy

Choroba rozwija się niepostrzeżenie. Pierwszym sygnałem ostrzegawczym są występujące okresowo, lekkie zaburzenia czucia palców do przedramienia. Mrowienie i odrętwienie nasila się nocą, powodując promieniujący ból palców i stawu łokciowego. Na dalszych etapach rozwoju schorzenia występują problemy z ruchomością ręki, utratą zręczności, a nawet zanikiem mięśni. Dolegliwości wymuszają utrzymywanie dłoni w charakterystycznej pozycji – tzw. szponiastej (nadmierne wyprostowanie palca czwartego i piątek w stawach śródręczno-paliczkowych oraz zgięcie w stawach międzypaliczkowych bliższych).

Diagnostyka

Z uwagi na podobieństwo objawów, zespół kanału Guyona bywa mylony z zespołem cieśni nadgarstka. Uważna diagnostyka pełni zatem kluczową rolę. Aby zdiagnozować chorobę, należy wykonać badania określające siłę mięśniową, czucie oraz ruchomość ręki. Lekarz poszukuje niedoborów neurologicznych w obszarze unerwienia nerwu łokciowego.

W doprecyzowaniu rozpoznania pomagają badania EMG oraz RTG, pozwalające na sprawdzenie przewodnictwa nerwowego w obrębie nerwu łokciowego na poziomie kanału nadgarstka oraz identyfikację dodatkowych przyczyn kostnych, wywołujących ucisk – relacjonuje dr Jerzy Chęciński, specjalista z zakresu chirurgii estetycznej i chirurgii ręki.

Leczenie zachowawcze

Schorzenie na wczesnym etapie można próbować leczyć zachowawczo. Pomocna okazuje się przede wszystkim farmakoterapia – NLPZ, sterydy i witamina B6.

Przyjmowanie leków powinno być połączone z rehabilitacją, mającą na celu zwiększenie przestrzeni kanału nadgarstka w którym przebiega nerw łokciowy oraz zmniejszenie stanu zapalnego wynikłego z ucisku. Modelowo prowadzona kuracja może przynieść pożądany efekt już po 4-6 tygodniach – dodaje dr Chęciński.

Leczenie operacyjne

W przypadku gdy leczenie zachowawcze nie zdaje egzaminu, konieczny okazuje się zabieg chirurgiczny. Jest on przeprowadzany w znieczuleniu miejscowym. Lekarz wykonuje małe nacięcie nad kanałem nerwu łokciowego tak, by uwidocznić więzadło poprzeczne. W dalszej kolejności więzadło jest przecinane i pozostawiane do wygojenia. Miejsce przecięcia wypełnia się tkanką bliznowatą.

Postępowanie pooperacyjne

Po operacji – podobnie jak po leczeniu zachowawczym – niezbędna jest rehabilitacja, przede wszystkim zabiegi i ćwiczenia z zakresu fizykoterapii.

Ręki nie wolno forsować. Warto też pamiętać o zachowaniu prawidłowej pozycji spania z wyprostowanymi nadgarstkami. W przypadku wystąpienia stanu zapalnego, wskazane jest wykonywanie zimnych okładów. Powrót do zdrowia trwa zazwyczaj 6-8 tygodni. Nieco dłużej może się utrzymać tkliwość blizny pooperacyjnej – podsumowuje dr Chęciński.

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