小提琴手双侧上肢“双/多重挤压”夹持综合征一例

Bogdan-Alexandru Barbu, C. Handra, Silviu Badoiu, S. Nica
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摘要

上肢夹持综合征是音乐家常见的神经-肌肉-骨骼病理。从这组病态实体中,世界范围内最常见的是腕管综合征,其次是肘管综合征和de Quervain狭窄性腱鞘炎。由于这些疾病与接触与仪器解释和专业环境相关的特定职业因素具有独特的致病相关性,因此这些疾病提出了医疗挑战,并构成了社会经济和专业负担,对个人和社会具有法律分支和影响。Upton和McComas在“双重挤压”综合征模型下描述了这些综合征的临床模式,这些综合征的发展是孤立的,或者更经常地相互关联。从1973年开始到现在,这种临床模式一直是世界各地专家之间有趣的争论点。该模型强调了已经受损的神经元在不同程度上对进一步神经损伤的易感性和脆弱性。这种“双重或多重挤压”综合征的复杂临床表现不仅是由于神经-肌肉-骨骼病理或病变部位的症状重叠,而且还与其他局部或全身性疾病如创伤、糖尿病、骨关节炎、甲状腺疾病、肥胖等有关。职业因素,如重复性运动,紧张和过载,振动,人体工程学等都有助于病态过程的产生和发展。我们不能夸大理解上述因素之间的复杂关系和相互依赖性的含义,因为它们不仅对这些神经病的诊断至关重要,而且对患者的治疗、康复和职业重新安置也至关重要。这些研究支持这样一个事实,即两个病变部位都需要进行医学处理,以获得最佳结果和解决方案。我们报告一名女小提琴手的病例,她患有双侧上肢多发性神经肌肉骨骼病变,经过不同专家多年的侵入性和保守治疗,但症状没有得到满意的临床解决,也没有采取任何专业和法律措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A case of bilateral “double/multiple crush” entrapment syndrome of the upper limbs in a violinist
Abstract Entrapment syndromes of the upper limb are common neuro-muscular-skeletal pathology in musician instrumentists. From this group of morbid entities, the most prevalent worldwide is carpal tunnel syndrome closely followed by the cubital tunnel syndrome and de Quervain stenosing tenosynovitis. Due to their distinctive etiopathogenic correlation with exposure to specific occupational factors linked to instrument interpretation and professional environment, these diseases raise a medical challenge and constitute a socioeconomic and professional burden with legal branchings and implications for individuals and society. These syndromes develop isolated or more often in various associations with each other in a clinical pattern that has been described under the model of “double crush” syndrome by Upton and McComas. From its inception in 1973 until the present time, this clinical model has been a point of interesting debate between various specialists worldwide. This model underlines an already lesioned neuron’s susceptibility and vulnerability for further neural damage at a different level from the initial lesion. The sophisticated clinical presentation of this “double or multiple crush” syndrome is due not only to overlapping symptomatology from each contributing neuro-muscular-skeletal pathology or lesional site but also to other local or systemic conditions such as trauma, diabetes, osteoarthritis, thyroid disease, obesity, etc. The occupational factors such as repetitive movements, strain and overload, vibrations, ergonomics, and others all contribute to the creation and progression of the morbid process. We cannot overstate the implications of understanding these complex relations and interdependencies between the factors mentioned above as they are essential not only for the diagnosis of these neuropathies but also for the treatment, rehabilitation, and occupational reinsertion of the patients. The studies support the fact that both lesional sites need to be medically addressed for an optimal outcome and resolution. We present the case of a female violinist with bilateral multiple neuro-muscular-skeletal pathologies of the upper limb treated previously invasively and conservatively over several years by various specialists without a satisfactory clinical resolution of the symptomatology or any professional and legal measures taken.
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