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ABSTRACT
INSTITUTO POLITECNICO NACIONAL
ESCUELA SUPERIOR DE MEDICINA
The syndrome of the tunnel of the carpus (STC) is the most common peripheral
neuropathy of the upper extremity, the incident of STC is 99 for 100.000 person-year,
and the prevalence is 3 ,4% in women and 0,6% in men 1,2, a little more than the 5%
are people that require the repetitive use of hands and wrists in their labor activity.
This syndrome causes pain, stiffness and sleepiness in the palm of the hand and the
thumbs, index, medium and at times also the annul. If the compression on the nerve is
maintained in the time and enlarges, the inconveniences progressing each time more
to being done intense, permanent and disabling. The practice of certain activities as to
type, to weave, to touch violin. Would determine a deficit of circulation in the zone of
the ligament, the one that would go being hardened and enlarging its thickness, as well
as to continue with constant inflammatory processes and an increase the area of
fibrosis of the tunnel of the carpus that goes getting worse with the passage of time and
with the activity exercised.
Little he is known on their physiopathology, three theories are proposed to explain it:
The compression, this obstruction cause pressure increase of the veined flow,
edema and finally isquemia of the nerve,
The shortage microvascular that involves to the hypoxia and isquemia of the
nerve
The vibratory theory.
Which they are not excluded mutually and done not clarify completely if the hypoxia be
found in director indirect relation with the development of this illness and little is known
if the expression of the VEGF is found regular in this suffering as has been verified in
other systems and organs by the hypoxia.
Some patients resolve this illness of not invasive form with physiotherapy that consists
of sessions of mobilization of the connective weaving, improving the circulation of the
ligament and the zone of wound, nevertheless the picture repeats and often deserves
surgical processing, they have been reported that the results of this procedure varies
according to the symptomatology and the functionality that presents each patient that
goes of the (Ciénega and cols.). From the 74% to the 6%, nevertheless the recidivism
is of a 60% of the parestesias and the pain.
Inside the pharmacological processing the AINEs they are found and the use of
glucocorticoids, nevertheless also they exist the use of other medicines as is it the
collagen and polivinilpirrolidona (Fibroquel) which has shown that modulates the
chronic inflammatory processes are modified at the same time some inflammatory
parameters like IL-1, in the articulations and diminishes the activity colagenolitica total
through a significant drop Of the collagenases independent of calcium and diminishes
the fibrosis and molecules of adhesion as the molecule of adhesion intercellular 1
(ICAM-1) and VCAM-1 they are observed diminished for them you woven dealt with
Fibroquel, with a change in the cell metabolism, nevertheless there is not sustainable
scientific evidence for the use of this medicine in the syndrome of tunnel of the carpus.
Keywords: Syndrome of tunnel of the carpus, collagen and polivinilpirrolidona,
electromyography, Factors inducible of hypoxia, Factor of growth of vascular
endothelium.
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