Diagnostic value of F wave changes in patients with Charcot-Marie-Tooth1A and chronic inflammatory demyelinating polyneuropathy / 北京大学学报(医学版)

OBJECTIVE@#To analyze and compare the characteristics and causes of F wave changes in patients with Charcot-Marie-Tooth1A (CMT1A) and chronic inflammatory demyelinating polyneuropathy (CIDP).@*METHODS@#Thirty patients with CMT1A and 30 patients with CIDP were enrolled in Peking University Third Hospital from January 2012 to December 2018. Their clinical data, electrophysiological data(nerve conduction velocity, F wave and H reflex) and neurological function scores were recorded. Some patients underwent magnetic resonance imaging of brachial plexus and lumbar plexus, and the results were analyzed and compared.@*RESULTS@#The average motor conduction velocity (MCV) of median nerve was (21.10±10.60) m/s in CMT1A and (31.52±12.46) m/s in CIDP. There was a significant difference between the two groups (t=-6.75, P < 0.001). About 43.3% (13/30) of the patients with CMT1A did not elicit F wave in ulnar nerve, which was significantly higher than that of the patients with CIDP (4/30, 13.3%), χ2=6.65, P=0.010. Among the patients who could elicit F wave, the latency of F wave in CMT1A group was (52.40±17.56) ms and that in CIDP group was (42.20±12.73) ms. There was a significant difference between the two groups (t=2.96, P=0.006). The occurrence rate of F wave in CMT1A group was 34.6%±39%, and that in CIDP group was 70.7%±15.2%. There was a significant difference between the two groups (t=-5.13, P < 0.001). The MCV of median nerve in a patient with anti neurofascin 155 (NF155) was 23.22 m/s, the latency of F wave was 62.9-70.7 ms, and the occurrence rate was 85%-95%. The proportion of brachial plexus and lumbar plexus thickening in CMT1A was 83.3% (5/6) and 85.7% (6/7), respectively. The proportion of brachial plexus and lumbar plexus thickening in the CIDP patients was only 25.0% (1/4, 2/8). The nerve roots of brachial plexus and lumbar plexus were significantly thickened in a patient with anti NF155 antibody.@*CONCLUSION@#The prolonged latency of F wave in patients with CMT1A reflects the homogenous changes in both proximal and distal peripheral nerves, which can be used as a method to differentiate the CIDP patients characterized by focal demyelinating pathology. Moreover, attention should be paid to differentiate it from the peripheral neuropathy caused by anti NF155 CIDP. Although F wave is often used as an indicator of proximal nerve injury, motor neuron excitability, anterior horn cells, and motor nerve myelin sheath lesions can affect its latency and occurrence rate. F wave abnormalities need to be comprehensively analyzed in combination with the etiology, other electrophysiological results, and MRI imaging.

Has the median nerve involvement in rheumatoid arthritis been overemphasized? / O envolvimento do nervo mediano na artrite reumatoide tem sido excessivamente valorizado?

Abstract Rheumatoid arthritis (RA) is a well and widely recognized cause of carpal tunnel syndrome (CTS). In the rheumatoid wrist, synovial expansion, joint erosions and ligamentous laxity result in compression of the median nerve due to increased intracarpal pressure. We evaluated the published studies to determine the prevalence of CTS and the characteristics of the median nerve in RA and its association with clinical parameters such as disease activity, disease duration and seropositivity. A total of 13 studies met the eligibility criteria. Pooled data from 8 studies with random selection of RA patients revealed that 86 out of 1561 (5.5%) subjects had CTS. Subclinical CTS, on the other hand, had a pooled prevalence of 14.0% (30/215). The cross sectional area of the median nerve of the RA patients without CTS were similar to the healthy controls. The vast majority of the studies (8/13) disclosed no significant relationship between the median nerve findings and the clinical or laboratory parameters in RA. The link between RA and the median nerve abnormalities has been overemphasized throughout the literature. The prevalence of CTS in RA is similar to the general population without any correlation between the median nerve characteristics and the clinical parameters of RA.

Resumo A artrite reumatoide (AR) é uma causa bem e amplamente reconhecida de síndrome do túnel do carpo (STC). No punho acometido pela artrite reumatoide, a expansão sinovial, as erosões articulares e a frouxidão ligamentar resultam em compressão do nervo mediano decorrente do aumento da pressão intracarpal. Avaliaram-se os estudos publicados para determinar a prevalência de STC e as características do nervo mediano na AR e sua associação com parâmetros clínicos, como a atividade e duração da doença e a soropositividade. Preencheram os critérios de elegibilidade 13 estudos. Os dados agrupados dos oito estudos com seleção aleatória de pacientes com AR revelaram que 86 de 1.561 (5,5%) indivíduos tinham STC. Por outro lado, a STC subclínica teve uma prevalência combinada de 14% (30/215). A área de seção transversa do nervo mediano dos pacientes com AR sem STC foi semelhante à de controles saudáveis. A grande maioria dos estudos (8/13) não apresentou relação significativa entre os achados no nervo mediano e os parâmetros clínicos ou laboratoriais na AR. A ligação entre a AR e as anormalidades do nervo mediano foi excessivamente valorizada em toda a literatura. A prevalência de STC na AR é semelhante à da população em geral, sem qualquer correlação entre as características do nervo mediano e os parâmetros clínicos da AR.

Retalho tenar adipofascial reverso para cobertura do nervo mediano hipertrofiado em macrodactilia / The reverse adipofascial thenar flap for coverage of the hypertrophied median nerve in macrodactyly

A macrodactilia é uma anomalia congênita infrequente, caracterizada pelo crescimento desproporcional dos tecidos ósseo, gorduroso, nervoso, vascular e dérmico nos dedos das mãos ou dos pés. Existem muitas teorias sobre a sua etiopatogenia, sendo a mais aceita a hiperestimulação por fatores de crescimento enviados através dos nervos. Foram descritos alguns casos associados com a síndrome do túnel do carpo. Apresenta-se um caso clínico de síndrome do túnel do carpo por hipertrofia do nervo mediano, evidenciando um aumento de conteúdo dentro do retináculo flexor, o qual foi tratado cirurgicamente com sucesso pela realização de uma retinaculotomia do ligamento anular do carpo junto a um retalho de transposição tenar adipofascial reverso da região tenariana hipertrofiada visando à cobertura do nervo mediano na região do punho.

Macrodactyly is a rare congenital anomaly characterized by the disproportionate growth of bone, fat, nervous, vascular, and dermal tissue in the digits . There are many different theories about its etiopathogenesis, the most accepted being a hyperstimulation by growth factors conducted through nerves. A few cases have been described in conjunction with carpal tunnel syndrome. Here, a clinical case of carpal tunnel syndrome due to hypertrophy of the median nerve is presented, showing an increase of content within the flexor retinaculum. Successful surgical treatment was accomplished by conducting a retinaculotomy of the anterior annular ligament along with a reverse transposition adipofascial flap of the hypertrophied thenar region for coverage of the median nerve at the wrist.

Estudo da auditoria de contas em um hospital de ensino / Estudio de la auditoría de cuentas en un hospital de enseñanza / Study of billing audits in a teaching hospital

RESUMOObjetivos:verificar os itens componentes das contas hospitalares, conferidos por enfermeiros auditores, que mais recebem ajustes no momento da pré-análise; identificar o impacto dos ajustes no faturamento das contas analisadas por enfermeiros e médicos auditores e identificar as glosas relacionadas aos itens conferidos pela equipe de auditoria.Método:pesquisa quantitativa exploratória, descritiva, do tipo estudo de caso único.Resultados:após a análise de 2.613 contas constatou-se que o item mais incluído por enfermeiros foram gases (90,5%) e o mais excluído medicamentos de internação (41,2%). Materiais de hemodinâmica; gases e equipamentos foram os que mais impactaram nos ajustes positivos. Os ajustes negativos decorreram de lançamentos indevidos nas contas e não geraram prejuízos de faturamento. Do total de glosas 52,24% referiu-se à pré-análise dos enfermeiros e 47,76% a dos médicos.Conclusão:a presente investigação do processo de pré-análise fornece subsídios que contribuem para o avanço no conhecimento sobre a auditoria de contas hospitalares.

RESUMENObjetivos:comprobar los elementos que componen las cuentas del hospital, controladas por enfermeras auditores que reciben más ajustes en el momento de pre-análisis, identifi car el impacto de los ajustes a la facturación de las cuentas examinadas por las enfermeras y los médicos auditores; identifi car las glosas relacionadas con los puntos otorgados por equipo de auditoría.Método:estudio cuantitativo, exploratorio, descriptivo, tipo de investigación de caso único.Resultados:después de análisis de 2613 cuentas se encontró que el elemento más incluido por el enfermeros fue gas (90,5%) y lo más excluido fue hospitalización medicamentos (41,2%). Materiales de gases y equipos hemodinámicamente fueron los más afectados en los ajustes positivos. Los ajustes negativos fueron el resultado de errores en las cuentas y no generan pérdidas de ingresos. El rechazo total fue de 52,24% en relación a la pre-análisis de las enfermeras y de 47,76% de los médicos.Conclusión:esta investigación del proceso de preanálisis proporciona subsidios que contribuyen al avance de los conocimientos sobre la auditoría de las cuentas de los hospitales.

ABSTRACTObjectives:to determine which component items of hospital bills, examined by nurse auditors, were adjusted the most during pre-analysis; to identify the impact upon revenue caused by the adjustments to bills analyzed by physician and nurse auditors; and to identify disallowances related to items checked by the audit team.Method:quantitative, exploratory, descriptive, singlecase study.Results:after analysis of 2,613 bills, it was found that the item most included by nurses was gas (90.5%) and the most excluded was inpatient drugs (41.2%). Hemodynamics materials, gases and equipment had the greatest impact on upward adjustments. Downward adjustments were the result of improper entries on bills and did not generate revenue losses. Of total disallowances, 52.24% were related to the pre-analysis of nurses and 47.76% to that of physicians.Conclusion:this study of the pre-analysis process provides input that enhances knowledge about hospital bill audits.

La ultrasonografía en el estudio de la patología regional de la mano y la muñeca: [revisión] / Ultrasound in the evaluation of hand and wrist disorders: [review]

La mano y la muñeca son frecuentemente implicadas en síndromes de dolor regional, inflamatorios y degenerativos. La ultrasonografía ha demostrado ser más sensible que los exámenes clínicos y de radiología convencional para la detección de sinovitis y erosiones. También ha podido revelar una participación subclínica en pacientes con artritis crónica. Las indicaciones de la ultrasonografía a nivel de la mano y la muñeca son amplias e incluyen el diagnóstico de la afección articular y el tendón, la patología de poleas, los cambios morfoestructurales a nivel del nervio mediano en el túnel carpiano; puede servir como guía para las infiltraciones, así como para la valoración del tratamiento en pacientes con artritis crónica. El objetivo de esta revisión es mostrar el resultado de las alteraciones más frecuentes en las que la ultrasonografía ha demostrado ser útil.

The hand and wrist are frequently involved by regional pain syndromes, inflammatory and degenerative conditions. Ultrasonography had demonstrated to be more sensitive than both clinical examination and conventional radiology for the detection of synovitis and erosions. It has also able to reveal a subclinical involvement in patients with chronic arthritis. The indications of ultrasonography at hand and wrist level is wide and include: diagnosis of joint and tendon involvement, pulleys pathology, morphostructural changes at median nerve level into to carpal tunnel, guidance for infiltrations into and treatment monitoring in patients with chronic arthritis. The aim of this review is to show the most frequent alterations in which ultrasound has proven useful.

Os efeitos da mobilização neural como abordagem fisioterapêutica na síndrome do túnel do carpo / The effects of neural mobilization as physical therapy approach in carpal tunnel syndrome

A síndrome do túnel do carpo é uma neuropatia compressiva periférica que consiste na compressão do nervo mediano no canal do carpo. Apresenta maior incidência no sexo feminino e está associada ao esforço repetitivo. Os sinais e sintomas mais freqüentes são fraqueza, hipotrofia dos músculos tenares e dos dois primeiros lumbricais, retração do adutor do polegar e dos músculos flexores profundos e superficiais dos dedos, perda da mobilidade no deslizamento longitudinal e transversal do nervo mediano. Esses estão associados a edema, inflamação e retração do tecido conjuntivo neural. O objetivo deste estudo foi mostrar a aplicação da técnica de mobilização neural, como tratamento para a síndrome do túnel do carpo. Tal técnica tem como principal objetivo restaurar o movimento e a elasticidade tecidual do nervo periférico.

The carpal tunnel syndrome is a peripheral compressive neuropathy that consists in median nerve compression in the carpal tunnel. It occurs more often in females and is associated with repetitive strain. The more frequent signals and symptoms are weakness, hypertrophy of the tenhar and the first two lumbrical muscles, retraction of adductor of thumb and the deep and superficial flexor finger muscles, loss of mobility in the longitudinal and transverse sliding of the median nerve. These signals and symptoms are associated with swell, inflammation and retraction of the conjunctive neural tissue. The objective of the study aimed to show the use of neural mobilization technique as treatment for the carpal tunnel syndrome. Such technique has as main objective to restore range of motion and elasticity of the peripheral nerve tissue.

Clinical features, electrophysiological findings and naked eye appearance of the median nerve in patients with carpal tunnel syndrome

To study the morphological changes of the median nerve during release of the carpal tunnel and to compare it with electrophysiological and clinical parameters. Patients were subjected to full clinical examination, confirmatory tests [Phalen test and Tinel test], routine laboratory investigations, electrophysiological tests [motor and sensory nerve conduction studies of the median nerve] and median nerve decompression surgery. There were no significant differences between the presence or absence of the different clinical features and the surgical grading and vice versa; there were no significant differences between the presence or absence of different surgical features and the clinical grading. There was no significant relation between the clinical grading and the surgical grading. Some electrodiagnostic findings have a reliable relation with surgical findings rather than with clinical findings in patients with CTS. CMAP, compound muscle action potential; CTS; carpal tunnel syndrome; EMG, electromyography; NCS, nerve conduction study

Tractografía y tensor de difusión en el estudio por resonancia magnética del nervio mediano: reporte de un caso / Tractography and diffusion tensor imaging in the study of the median nerve by magnetic resonance imaging: a case report

Introduction: Magnetic resonance imaging (MRI) is an essential tool for the study of central nervous system disorders. Several studies consider the application of diffusion tensor imaging (DTI) and tractography in the study of peripheral nerves. Methodology: We performed tractography and DTI in two female patients, one with a confirmed carpal tunnel syndrome and the other in good health conditions. Values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were recorded. Results: The average FA valué of the fiber was 0.461 (case) and 0.632 (control). No differences were reported between the average valúes of the ADC of the fiber. Discussion: We were able to represent the tract of the median nerve by using a software fortractography reconstruction. The morphology and valúes of quantitative analysis of DTI depend directly on the reconstruction algorithm used, mainly on the minimum FA value of the fiber to be reconstructed. The value of the FA, obtained by zone, was the most constant variable, being lower for the case.

Introducción: La resonancia magnética es una herramienta indispensable en el estudio de enfermedades del sistema nervioso central. Varios estudios consideran la aplicación del tensor de difusión (DTI) y tractografía en el estudio de nervios periféricos. Metodología: Se realizó tractografía y DTI en dos mujeres, una con síndrome del túnel carpiano confirmado y otra sin patología. Se consignaron valores de fracción de anisotropía (FA) y coeficiente de difusión aparente (ADC). Resultados: El valor promedio de FA de la fibra fue 0,461 (caso) y 0,632 (control). No hubo diferencias entre valores promedios de ADC de fibras. Discusión: Se logró representar el tracto del nervio mediano utilizando software de reconstrucción de tractografía. La morfología y valores del análisis cuantitativo del DTI dependen directamente del algoritmo de reconstrucción utilizado, especialmente del umbral mínimo de FA de la fibra a reconstruir. El valor más constante es FA, obtenido por zona, siendo menor en el caso.

Contribution of the Proximal Nerve Stump in End-to-side Nerve Repair: In a Rat Model

BACKGROUND: The aim of this study was to evaluate the contribution of the proximal nerve stump, in end-to-side nerve repair, to functional recovery, by modifying the classic end-to-side neurorrhaphy and suturing the proximal nerve stump to a donor nerve in a rat model of a severed median nerve. METHODS: Three experimental groups were studied: a modified end-to-side neurorrhaphy with suturing of the proximal nerve stump (double end-to-side neurorrhaphy, Group I), a classic end-to-side neurorrhaphy (Group II) and a control group without neurorrhaphy (Group III). Twenty weeks after surgery, grasping testing, muscle contractility testing, and histological studies were performed. RESULTS: The grasping strength, muscle contraction force and nerve fiber count were significantly higher in group I than in group II, and there was no evidence of nerve recovery in group III. CONCLUSIONS: The contribution from the proximal nerve stump in double end-to-side nerve repair might improve axonal sprouting from the donor nerve and help achieve a better functional recovery in an end-to-side coaptation model.

Reliability of Thai version Boston questionnaire.

OBJECTIVE: To determine the reliability of the Thai version Boston questionnaire. SETTING: Hospital-based electrodiagnosis laboratory, Department of Physical Medicine and Rehabilitation. MATERIAL AND METHOD: The Boston questionnaire is the severity rating instrument for carpal tunnel syndrome (CTS). It consists of 11 items of symptom severity scores (SSS) and eight items of functional severity scores (FSS). CTS patients, confirmed by electrodiagnosis, were evaluated by the Thai version Boston questionnaire. The reliability was assessed by internal consistency using Chronbach's alpha coefficient. RESULTS: Thirty-one subjects (4 male and 27 female) enrolled in the present study. Among these, six were classified as mild, nine as moderate, and 16 as severe CTS. Chronbach's alpha coefficient was 0.86 and 0.84 in SSS and FSS, respectively. CONCLUSION: Thai version Boston questionnaire is reliable to measure hand symptoms and disabilities due to carpal tunnel syndrome.

Anatomy study of MGA in Chinese and its effect on legal expertise / 法医学杂志

OBJECTIVE@#This study aimed to clarify the morphology of the Martin-Gruber anastomosis (MGA) in Chinese.@*METHODS@#One hundred and five Chinese upper limbs (36 males and 20 femalese) were dissected to find the connections between medial nerve and ulnar nerve. The MGA was classified as previously described by Lee.@*RESULTS@#MGA was found in 24 cases (22.9%), in 11 of the 36 male and 5 of the 20 female. There was no obvious difference in the frequency of MGA in both upper limbs. Most MGA ulnar position was located at the medial and distal segment of the forearm.@*CONCLUSION@#MGA anatomy could play important role in forensic diagnosis of ulnar nerve injury in Chinese population.

Hamartoma fibrolipomatoso del nervio mediano / Median nerve hamartoma fibrolipoma

Presentamos tres pacientes con un tumor benigno infrecuente denominado hamartoma fibrolipomatoso del nervio mediano, el cual puede estar o no asociado a macrodistrofia lipomatosa.

comparitive study of distal latency of palmar cutaneous branch of median nerve with its main sensory branch among patients with diabetic neuropathy, carpal tunnel syndrome and normal population

It was established that nerve conduction studies are very sensitive and reliable in diagnosis of the diabetic neuropathy. In addition, it was known that asymptomatic carpal tunnel syndrome diagnosed by neuroelectrophysiologic study, is common in patients with diabetes. So, they should be differentiated to select appropriate treatment. This study was designed to identify distal latency ratio of palmar cutaneous branch of median to main branch of median [PCDL/MDL] in the normal, diabetic neuropathy and carpal tunnel syndrome [CTS]. ln the analytic, descriptive cross-sectional study, 60 patients with diabetic neuropathy, 60 patients with CTS and 60 normal cases who presented to 501 army medical center in Tehran, included in the study during 2004.The latency of main branch of median and its palmar cutaneous branch was measured by using EMG-NCV device in each patients. The mean distal latencies of main branch of median nerve in normal, diabetic neuropathy and CTS groups were 3.23 +/- 0.2, 4.48 +/- 0.29 and4.10 +/- 0.21, respectively [P<0.05].The mean distal latencies of palmar cutaneous branch of median nerve in normal, diabetic neuropathy and CTS groups were 2.19 +/- 0.17, 2.81 +/- 0.12 and 2.25 +/- 0.18 [P<0.05]. The mean ratio of PCDL/MDL in normal, diabetic neuropathy and carpal tunnel syndrome groups were 0.67 +/- 0.07, 0.62 +/- 0.02 and 0.54 +/- 0.04, respectively [P<0.05].The PCDL/MDL ratio was not statistically depended on sex in each group. In normal and CTS group, PCDL/MDL ratio had direct colerration with age respectively [0.4 and 0.2] [P<0.05]. In patients with diabetic neuropathy, PCDL/MDL ratio had reverse colerration with age [P<0.05, -0.6]. In patients with diabetic neuropathy, the mean PCDL/MDL ratio was more than that in patients with CTS [P<0.05].

Hamartoma fibrolipomatoso de nervo mediano: relato de caso / Fibrolipomatous hamartoma of the median nerve: case report

Fibrolipomatous hamartoma is a rare benign neoplasm that in some cases is associated with macrodactylia. We describe a 31-year-old man who had a tissue enlargement in the wrist, second and third fingers of the left hand since infancy. At 23-years-old he began with continuous, progressive and high intensity pain that occurred more frequently at night, localized in the left hand. It was associated with paraesthesias and hypostesias predominantly at the fingers described above. Investigation with X-ray, ultrasonography, electrodiagnosis, magnetic resonance image of the left wrist and hand showed carpal tunnel syndrome with macrodactylia by fibrolipomatous hamartoma of the median nerve. The patient did not a have good response to clinical therapy, so he was submitted to a surgical decompression of the left carpal tunnel, and after three months of follow up is asymptomatic.

O hamartoma fibrolipomatoso é neoplasia benigna rara que em alguns casos esta associada com macrodactilia. Descrevemos o caso de homem de 31 anos que apresentava desde o nascimento aumento de volume em região de punho, segundo e terceiro quirodáctilos da mão esquerda. Aos 23 anos iniciou dor contínua, de forte intensidade, predominante no período noturno e de evolução progressiva em mão esquerda. Associada à dor havia hipoestesia e parestesias de predomínio nos segundo e terceiro quirodáctilos esquerdos. A investigação complementar com radiografia, ultrassonografia, estudo eletrofisiológico e ressonância magnética de mão e punho esquerdos confirmaram a suspeita de síndrome do túnel do carpo secundária a macrodactilia com hamartoma fibrolipomatoso do nervo mediano. O paciente foi submetido à descompressão cirúrgica do túnel do carpo esquerdo devido a ausência de resposta ao tratamento clínico e evoluiu com melhora dos sintomas em avaliação após três meses do procedimento.

Extensäo profilática da ligamentotomia ao membro contralateral nos pacientes hemodialisados afetados por síndrome do túnel do carpo / Prophilactic extension of ligamentotomy of the contralateral member in hemodialysed patients affected by the carpal tunnel syndrome

Dentro do contexto das patologias esqueléticas observadas com frequência no paciente dialisado, a síndrome do túnel do carpo ocupa os primeiros lugares na taxa de incidência. Embora seja relatada com percentagens diversas por vários autores, geralmente a mesma aparece de 5 a 8 anos após a hemodiálise, com um percentual de 50 por cento após 15 anos e de 100 por cento após 20 anos. Os A.A., examinando os dados relevados pela casuística própria e aqueles relatados na literatura, voltaram sua atençäo para a maior incidência das síndromes monolaterais do lado do acesso vascular e para a precocidade do aparecimento das mesmas. Com base nessas premissas, formularam a hipótese da possibilidade de uma intervençäo profilática ou de um rígido follow-up a nível do membro contralateral nos pacientes submetidos a ligamentotomia do membro sede do acesso vascular, visto que a intervençäo eletiva de ligamentotomia, mesmo sendo resolutiva para a sintomatologia álgica, näo permite a recuperaçäo morfo-funcional do nervo mediano

El Síndrome del Túnel Carpiano: casuística, etiopatogenia y relación con la mujer adulta climatérica / Carpal Tunnel Syndrome: case study, etiopathogenic and relationship with climateric adult woman

El Síndrome del Túnel Carpiano es una afección de consulta frecuente en Reumatología, y que en la mayoría de los casos no es bien orientada ni diagnosticada en las consultas de Medicina General. Este sindrome consiste en la comprensión o bien en la captura de los impulsos del nervio mediano a su paso por el Túnel Carpiano, siendo la sintomatología principal parestesias y dolor en las manos, irradiada a veces al antebrazo; en los casos severos se observa atrofia y anestesia en el área tenar de la mano que es zona de inervación del mediano. Dada la observación de este cuadro clínico en mujeres adultas en periodo o etapa climatérica, en una forma notable, que llega a mas del 90% de los casos, nos sentimos motivados a realizar el presente estudio, donde encontramos etiopatogénicamente una relación evidente con los cambios endocrinos que se efectúan en las mujeres en esta etapa, mas que con otras enfermedades reumáticas, como el caso de la Artritis Reumatoide, la cual se había invocado como causa etiológica de este síndrome. En nuestros casos estudiados encontramos uno de ellos asociado con Artritis Reumatoide en donde el Sindrome del Túnel Carpiano (S.T.C.) había tenido su aparición pero siguiendo más bien un patrón común con los otros casos. La causa principal es un mecanismo endógeno, en donde estarían implicados cambios de tipo hormonal y probablemente las prostaglandinas, aunque esto aún no se ha podido demostrar. Por otra parte, esta causa estaría asociada a factores locales inespecíficos (inflamatorios) de tipo mecánico, como sería en el caso del uso exagerado de las manos..