Síndrome do túnel do carpo

Exame

O eletrocardiograma (EMG) é o teste diagnóstico de escolha.[29]Concannon MJ, Gainor B, Petroski GF, et al. The predictive value of electrodiagnostic studies in carpal tunnel syndrome. Plast Reconstr Surg. 1997 Nov;100(6):1452-8. http://www.ncbi.nlm.nih.gov/pubmed/9385956?tool=bestpractice.com [30]Practice parameter for electrodiagnostic studies in carpal tunnel syndrome (summary statement). American Academy of Neurology, American Association of Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology. 1993 Nov;43(11):2404-5. http://www.ncbi.nlm.nih.gov/pubmed/8110238?tool=bestpractice.com [31]Jablecki CK, Andary MT, So YT, et al. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee. Muscle Nerve. 1993 Dec;16(12):1392-414. http://www.ncbi.nlm.nih.gov/pubmed/8232399?tool=bestpractice.com

A EMG é útil para o diagnóstico da síndrome do túnel do carpo (STC), excluindo ou identificando outros diagnósticos neurológicos, avaliando a gravidade do dano no nervo mediano, ajudando com a escolha do manejo, julgando o sucesso das intervenções, determinando o prognóstico, e como uma linha basal que pode ser acompanhada ao longo do tempo.

Exame

Complementar à EMG; útil se houver suspeita de lesão com efeito de massa, como um cisto ganglionar. Tem algum valor diagnóstico (porém inferior à EMG), determinando se o nervo mediano está edemaciado.[33]American College of Radiology. ACR appropriateness criteria®: chronic hand and wrist pain. 2023 [internet publication]. https://acsearch.acr.org/docs/69427/Narrative http://www.ncbi.nlm.nih.gov/pubmed/29724426?tool=bestpractice.com [34]Descatha A, Huard L, Aubert F, et al. Meta-analysis on the performance of sonography for the diagnosis of carpal tunnel syndrome. Semin Arthritis Rheum. 2012 Jun;41(6):914-22. http://www.ncbi.nlm.nih.gov/pubmed/22244369?tool=bestpractice.com [35]Cartwright MS, Hobson-Webb LD, Boon AJ, et al; American Association of Neuromuscular and Electrodiagnostic Medicine. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug;46(2):287-93. http://www.ncbi.nlm.nih.gov/pubmed/22806381?tool=bestpractice.com [36]Fowler JR, Gaughan JP, Ilyas AM, et al. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011 Apr;469(4):1089-94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048245 http://www.ncbi.nlm.nih.gov/pubmed/20963527?tool=bestpractice.com

Exame

Útil se houver suspeita de lesão com efeito de massa, especialmente no momento pré-operatório.[33]American College of Radiology. ACR appropriateness criteria®: chronic hand and wrist pain. 2023 [internet publication]. https://acsearch.acr.org/docs/69427/Narrative http://www.ncbi.nlm.nih.gov/pubmed/29724426?tool=bestpractice.com ​ A RNM é mais precisa que a ultrassonografia para delinear o túnel do carpo, mas não é superior à EMG, e requer muitos recursos.