2
ANATOMI
4
Prevalensi
1 - 5 % pada populasi umum
Kelompok Usia
40 - 50 tahun
PENINGKATAN GANGGUAN
TEKANAN PADA MIKROSIRKULASI
CARPAL TUNNEL NERVUS
MEDIANUS
PATOFISIOLOGI
PERUBAHAN HIPERTROFI
JARINGAN IKAT JARINGAN
NERVUS SINOVIAL
MEDIANUS
6
GEJALA KLINIS
➔ Defisit sensorik
➔ Kelemahan motorik
➔ Atrofi pada eminansia thenar
➔ Tes provokasi
Tinel Sign
...
TINEL SIGN
(+) = nyeri/parestesi pada jari yang
diinervasikan oleh nervus medianus
PHALEN TEST
(+) = nyeri/parestesi pada jari yang
diinervasikan oleh nervus medianus dalam
1 menit
MANUAL CARPAL
COMPRESSION TEST
(+) = parestesi pada jari yang diinervasikan
oleh nervus medianus dalam 30 detik
HAND ELEVATION TEST
(+) = nyeri/parestesi pada jari yang
diinervasikan oleh nervus medianus dalam
2 menit
Pemeriksaan Penunjang
Nerve Conduction Studies
Elektromyografi
Motor Unit Potential
● As a rule of thumb, motor unit potentials are less than 2 mV in amplitude, and
have a duration of 10–5 ms with 3–4 phases
● in chronic partial denervation where intramuscular sprouting and re-innervation
has occurred, amplitudes may be 10–20 mV and durations 20–30 ms
● primary muscle disease, motor unit potentials are small and of short duration;
typical values would be 0.5 mV and 5–10 ms
Spontaneus Activity
Recruitment
Pencitraan
USG
MRI
MRI
● Right arm: images show inconspicuous median nerve (white arrows) at the level
of the distal forearm. However, within the wrist there is enlargement and contrast
enhancement of the median nerve and volar bowing of the flexor retinaculum at
the level of the pisiform, and flattening of the median nerve in the crowded carpal
tunnel at the level of the hamate.
● Left arm: images show a normal median nerve (white arrow) at the level of the
pisiform. There is normal median nerve (white arrow) at the level of the hamate.
Terapi
Algoritma Terapi
Opsi terapi non-bedah
● Pembidaian nokturnal
● Suntikan glukokortikoid methylprednisolone (20 hingga 40 mg)
● Glukokortikoid oral prednison 20 mg setiap hari selama 10 hingga 14 hari
● Fisioterapi
● yoga
Thanks!
39
Daftar Pustaka
40