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首页> 外文期刊>Journal of Hand Surgery. American Volume >Carpal tunnel syndrome, syndrome of partial thenar atrophy, and W. Russell Brain: A historical perspective
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Carpal tunnel syndrome, syndrome of partial thenar atrophy, and W. Russell Brain: A historical perspective

机译：腕管综合症，部分性关节萎缩症和W.Russell Brain：历史观点

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This article presents the history of the discovery of compression of the median nerve in the carpal tunnel without an identifiable cause as a distinct clinical entity. By analyzing primary sources, we show that, at the beginning of the twentieth century, physicians described patients with paresthesias and numbness in the hands, most prominent at night, accompanied by bilateral symmetrical atrophy along the radial side of thenar eminence. At the time, the 2 most influential hypotheses regarding etiology were, first, compression of the lower trunk of the brachial plexus by a cervical or first rib, and second, compression of the thenar branch of the median nerve as it passes beneath the anterior annular ligament of the wrist. The condition was named syndrome of partial thenar atrophy and was considered a distinct clinical entity. In 1946, after extensive analysis, neurologist Walter Russell Brain concluded that both sensory and motor symptoms of the syndrome were caused by "compression neuritis" of the median nerve in the carpal tunnel. At his suggestion, surgeon Arthur Dickson Wright performed decompression of the nerve by "an incision of the carpal ligament," with excellent results. Brain presented this work at the Royal Society of Medicine in London in 1946 and published his landmark paper in Lancet the following year. In so doing, he established the basis for the disease we know today as idiopathic carpal tunnel syndrome. Unfortunately, in 1947, Brain did not realize that another "condition" with the same clinical picture but without atrophy of the thenar muscles, known as acroparesthesia at the time, was actually the same disease as syndrome of partial thenar atrophy, but of lesser severity. As a result of Brain's influence, 7 other papers were published by 1950. Between 1946 and 1950, there were at least 10 papers that presented, in total, 31 patients (26 women) who exhibited symptoms of compression of the median nerve without an identifiable cause and underwent section of the transverse carpal ligament.
机译：本文介绍了在腕管中发现正中神经受压的历史，而没有明显的临床原因。通过分析主要来源，我们发现，在20世纪初，医生描述了手部感觉异常和麻木的患者，其中最突出的是夜间，同时伴随着沿鼻廓隆起的径向对称性双侧萎缩。当时，关于病因的两个最有影响力的假设是，首先是颈臂或第一肋骨压迫臂丛神经下躯干，其次是当正中神经经过前环下方时压迫正中神经的鱼腥分支腕韧带。该病被称为部分角质萎缩综合征，被认为是独特的临床个体。在1946年，经过广泛分析，神经科医生Walter Russell Brain得出结论，该综合征的感觉和运动症状都是由腕管正中神经的“压缩神经炎”引起的。在他的建议下，外科医生亚瑟·迪克森·赖特（Arthur Dickson Wright）通过“腕骨韧带切开术”对神经进行了减压，效果极佳。 Brain于1946年在伦敦皇家医学会上介绍了这项工作，并于次年在柳叶刀上发表了他的里程碑式论文。通过这样做，他为我们今天所知的特发性腕管综合症奠定了基础。不幸的是，在1947年，Brain并没有意识到具有相同临床表现但没有关节肌肉萎缩的另一种“病症”，当时被称为肢体感觉异常，实际上与部分关节萎缩综合征是同一疾病，但严重程度较低。由于大脑的影响，到1950年又发表了7篇论文。在1946年至1950年之间，至少有10篇论文提出了总共31名患者（26名女性）表现出正中神经受压症状而无法识别的论文。引起并行腕横韧带切面。

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