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흉터조직의 정중신경 침투에 의한 손목굴증후군

Carpal Tunnel Syndrome Caused by Scar Tissue Invasion of Median Nerve Fascicles

Article information

J Korean Neurol Assoc. 2016;34(3):274-275
Publication date (electronic) : August 1, 2016
doi : http://dx.doi.org/10.17340/jkna.2016.3.27
Jin-Young Seo, MD, Sang-Yong Lee, MDa, Tae-Ho Yang, MD,b
Department of Neurology, Chonju Soo Hospital, Jeonju, Korea
aDepartment of Radiology, Chonju Soo Hospital, Jeonju, Korea
bDepartment of Neurology, Chonbuk National University Medical School, Jeonju, Korea
서진영, 이상용a, 양태호,b
전주 수병원 신경과
a전주 수병원 영상의학과
b전북대학교 의과대학 신경과학교실
Address for correspondence: Tae-Ho Yang, MD  Department of Neurology, Chonbuk National University Medical School & Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea  Tel: +82-63-250-1590 Fax: +82-63-251-9363 E-mail: thyang32@naver.com
received : February 19, 2016 , rev-recd : April 15, 2016 , accepted : April 15, 2016 .

47세 여자가 7년 전 손목을 칼로 베인 직후 시작된 좌측 3, 4번 손가락에 국한된 저림 때문에 병원에 왔다(Fig A). 역방향법으로 측정한 2번 손가락-손목구간의 정중신경 감각신경전도속도는 43.5 m/s였고 짧은엄지벌림근에서 기록한 motor inching technique에서 손목주름에서 먼 쪽 -2 cm ~ -3 cm 사이에 잠복기 차이가 현저하였지만(Fig B), 오히려 4번 손가락의 sensory inching technique은 정상이었다(Fig C) [1]. 신경초음파에서는 열상 부위에서 형성된 흉터 조직이 정중신경의 척측 다발 일부에 침투하고 있었으나(Fig. D) 수평손목인대에 의한 정중신경의 압박은 뚜렷하지 않았다(Fig. E).

Figure.

(A) Scar of old laceration injury is located on the anterior surface of her left wrist just proximal to the proximal wrist crease. (B) Median motor nerve inching technique recorded at left abductor pollicis brevis muscle showed abrupt onset latency change(0.9 ms) between -2 and -3cm distal to the wrist crease(red ellipse). (C) Median sensory nerve inching technique recorded at left 4th finger showed no abrupt(≥0.3 ms) onset latency change during serial incremental stimulation. (D) Ultrasonogram. Transverse view at the palmar carpal ligament level. Scar tissue invaded fascicles of left median nerve especially at the ulnar side (white arrows) but in the radial side, fascicular architecture of median nerve is preserved (arrow heads). (E) Longitudinal view of left median nerve. No obvious median nerve compression is observed below the transverse carpal ligament (white arrows). MN; median nerve, TCR; transverse carpal ligament.

증상발생 시기와 초음파 결과를 고려하면 흉터조직에 의한 신경자극이 3, 4번 손가락 저림의 직접적 원인으로 추정되며 신경전도 검사의 이상은 수평손목인대에 의한 무증상 정중신경 압박을 시사한다.

본 증례처럼, 병변의 구조적인 이상을 확인하기 위하여 신경초음파를 활용하면 신경압박의 드문 원인을 밝힐 수 있다[2].

References

1. Oh SJ. Clinical Electromyography: nerve conduction studies 2nd edth ed. Baltimore: Williams & Wilkins; 2003. p. 205–207.
2. Chiou HJ, Chou YH, Chiou SY, Liu JB, Chang CY. Peripheral nerve lesions: role of high-resolution US. Radiographics 2003;23e15.

Article information Continued

Copyright © 2016 Korean Neurological Association

Figure.

Figure.

(A) Scar of old laceration injury is located on the anterior surface of her left wrist just proximal to the proximal wrist crease. (B) Median motor nerve inching technique recorded at left abductor pollicis brevis muscle showed abrupt onset latency change(0.9 ms) between -2 and -3cm distal to the wrist crease(red ellipse). (C) Median sensory nerve inching technique recorded at left 4th finger showed no abrupt(≥0.3 ms) onset latency change during serial incremental stimulation. (D) Ultrasonogram. Transverse view at the palmar carpal ligament level. Scar tissue invaded fascicles of left median nerve especially at the ulnar side (white arrows) but in the radial side, fascicular architecture of median nerve is preserved (arrow heads). (E) Longitudinal view of left median nerve. No obvious median nerve compression is observed below the transverse carpal ligament (white arrows). MN; median nerve, TCR; transverse carpal ligament.