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Síndrome del Túnel Carpiano
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Síndrome del Túnel Carpiano

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Síndrome del Túnel Carpiano

¿Qué es Sindrome del Tunel Carpiano?

El síndrome del túnel carpiano es una condición producida por un aumento de presión sobre el nervio mediano a nivel de la muñeca. De hecho, es un atrapamiento de este nervio a nivel de la muñeca. Los síntomas pueden incluir insensibilidad, hormigueo y dolor en el brazo, la mano y los dedos. Hay un espacio en la muñeca llamado “túnel carpiano”, donde el nervio mediano y nueve tendones pasan desde el antebrazo a la mano (vea la Figura 1). El síndrome del túnel carpiano se presenta cuando hay un aumento de presión en este túnel debido a una hinchazón, y esa presión se transmite al nervio. Cuando la presión debida a la hinchazón aumenta lo suficiente como para perturbar la forma en que trabaja el nervio, se experimenta insensibilidad, hormigueo y dolor en la mano y los dedos.

 

¿Cuál es la causa de Sindrome del Tunel Carpiano?

Usualmente la causa se desconoce. La presión sobre el nervio puede producirse en diferentes formas: hinchazón del recubrimiento de los tendones flexores, llamada tenosinovitis; la dislocación de articulaciones, las fracturas y la artritis pueden estrechar el túnel; y el mantener la muñeca doblada durante mucho tiempo. La retención de fluidos durante el embarazo puede producir hinchazón en el túnel y síntomas del síndrome del túnel carpiano, que por lo general desaparecen luego de dar a luz. Las afecciones de la tiroides, la artritis reumatoide y la diabetes pueden también asociarse con el síndrome del túnel carpiano. Puede existir también una combinación de causas.

Señales y síntomas de Sindrome del Tunel Carpiano

Los síntomas del síndrome del túnel carpiano incluyen por lo general dolor, insensibilidad, hormigueo, o una combinación de los tres elementos anteriores. La insensibilidad o el hormigueo se presentan con mayor frecuencia en los dedos pulgar, índice, medio y anular. Estos síntomas se perciben por lo general durante la noche, pero pueden notarse también durante las actividades cotidianas, como manejar o leer un periódico. Los pacientes pueden notar a veces debilitamiento en la mano, torpeza ocasional y una tendencia a dejar caer cosas. En los casos más graves se pierde permanentemente la sensibilidad y los músculos de la base del pulgar se encogen lentamente (atrofia de la eminencia tenar), causando dificultad en el movimiento de pellizco.

Diagnóstico de Sindrome del Tunel Carpiano

Es importante obtener una historia clínica detallada, que incluya las afecciones médicas, la manera en que se han usado las manos y la posible existencia de lesiones previas. Puede obtenerse una radiografía para buscar otras causas de los síntomas, como por ejemplo artritis o una fractura. En algunos casos pueden hacerse exámenes de laboratorio, si se sospecha la existencia de una condición médica asociada con el síndrome del túnel carpiano. Puede efectuarse un estudio de conducción nerviosa (nerve conduction study – NCV) y/o un electromiograma (EMG) para confirmar el diagnóstico del síndrome del túnel carpiano, y también para verificar la existencia de otros posibles trastornos nerviosos.

Tratamiento de Sindrome del Tunel Carpiano

Los síntomas a menudo pueden aliviarse sin recurrir a la cirugía. La identificación y tratamiento de afecciones médicas, el cambio de los patrones de uso de las manos, o mantener la muñeca en cabestrillo en posición recta pueden ayudar a reducir la presión sobre el nervio. El uso de férulas en la muñeca durante la noche puede aliviar los síntomas que interfieren con el sueño. Una inyección de esteroides dentro del túnel carpiano puede aliviar los síntomas al reducir la hinchazón que rodea al nervio. Cuando los síntomas son graves o no se observa mejoría, puede requerirse una cirugía a fin de crear mayor espacio para el nervio. La presión sobre el nervio se disminuye haciendo un corte en el ligamento que forma el techo (parte superior) del túnel en el lado de la palma de la mano (vea la Figura 3). Las incisiones efectuadas en esta cirugía pueden variar, pero la meta es siempre la misma: agrandar el túnel y disminuir la presión sobre el nervio. Luego de la cirugía, la sensibilidad alrededor de la incisión puede durar varias semanas o meses. La insensibilidad y el hormigueo pueden desaparecer en forma rápida o lenta. Pueden pasar varios meses hasta que la fuerza en la mano y la muñeca retorne a su nivel normal. Es posible que los síntomas del túnel carpiano no desaparezcan completamente con la cirugía, especialmente en los casos graves. ASSH

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