לחצות את התעלה – מאמר שביעי בסדרת "ניתוחים על שולחן הניתוחים"
האם באמת כל הבעיה נמצאת שם?

לחצות את התעלה – מאמר שביעי בסדרת "ניתוחים על שולחן הניתוחים"


תסמונת התעלה הקארפלית הינה תופעה נפוצה יחסית,  בעיקר בקרב נשים בגיל העמידה.

מדובר במצב שעלול להיות מאוד לא נעים, וכולל כאבים, נימול, חולשה וחוסר שליטה מלאה על כף היד. ייתכנו סימפטומים חזקים בלילה, ולכן הפרעה משמעותית לשינה.

ההבנה הקלאסית מדברת על העצב שעובר בתעלה ומכונה ה"עצב המדיאני". לפי הבנה זו הלחץ בתעלה גובר מסיבות שאינן ברורות, ונוצר לחץ על העצב ומכאן הסבל הרב.

בעידן המודרני נהוג להאשים את העבודה על המחשב כסיבה העיקרית לעלייה בתחלואה אך דבר זה נבדק ונמצא שאינו קשור.

האבחנה תיעשה על פי בדיקת הולכה עצבית של העצב (EMG).

בדרך כלל בהתחלה המטופל יקבל המלצה לשימוש בסד המקבע את שורש כף היד הכואבת. בנוסף יהיה טיפול של נוגדי דלקת ולעתים זריקת סטרואידים (לרוב קורטיזון). אם לא תחול הטבה משמעותית המטופל יופנה לניתוח שבו יחתכו את הרצועה שבתוך התעלה, וכך נפח התעלה יעלה, והלחץ מהעצב המדיאני ירד. ובא לציון גואל. האמנם?

כמה תובנות חשובות העולות מהמחקר העדכני:

  • בניגוד למה שמקובל לחשוב אותו עצב מדיאני כנראה שאינו האחראי הבלעדי לאותם סימפטומים ברוב המקרים. בפרט הדבר נכון כאשר ישנם סימפטומים בזרת (האצבע הקטנה). העצב המדיאני אינו יכול להשפיע עליה
  • ברוב המקרים לפחות חלק מהבעיה נובע מעמוד השדרה הצווארי. לכן גם במקרים שהניתוח מצליח (ראו להלן), לרוב ייוצרו סימפטומים חדשים באזורים אחרים כעבור זמן מה מהניתוח
  • בדיקת EMG אינה מספיק טובה לניבוי הצלחת הניתוח או חומרת הסימפטומים. מחקרים מראים שישנם הסובלים מתסמונת התעלה ותוצאות ה EMG תקינות לחלוטין, ואחרים עם ירידה משמעותית בהולכה, וללא כל סימפטומים
  • הניתוח עצמו בדרך כלל משפר מאוד את תוצאות ה EMG ולכן נחשב מוצלח. התמונה משתנה כאשר מודדים את הצלחת הניתוח מבחינת הרגשת המטופל, בפרט לאורך זמן, ובפרט אם לוקחים בחשבון כאבים באזורים אחרים לאורך המסלול העצבי כגון צוואר, שכמה, זרוע, אמה

אז מה ניתן לעשות ללא ניתוח ?

בדיקה יסודית של הצוואר והמתח העצבי לאורך היד

ביצוע תרגילים מותאמים אישית

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הפחתת מתח נפשי

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תהליך ההחלמה עשוי להיות ארוך ומתיש, אך בסופו של דבר בע"ה אפשר להתרפא !

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