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【正文】 ma OCUPATIONAL DISEASE ? on a more probably than not basis (greater than 50%) that the workplace activities (exposure) in an individual case contributed to the development or worsening of the condition (oute). Summary Dx。臨床徵狀及神經(jīng)傳導(dǎo)檢查皆符合腕隧道癥候群的診斷認(rèn)定基準(zhǔn) Exposure:過(guò)往至今的工作 (repeated and forceful works),皆明顯地增加罹患腕隧道癥候群的機(jī)會(huì) Time sequence: 1980起工作 30年 ,於 2022年開(kāi)始出現(xiàn)雙手腕酸痛 ,無(wú)力和麻的情形 ,合乎危害暴露在前 ,發(fā)病在後之時(shí)序性。 可合理地排除其他非職業(yè)因素造成之腕隧道癥候群之可能。 Thus, 此疾病由職業(yè)引起之可能性大於 50﹪ 。 診斷基準(zhǔn) 勞工保險(xiǎn)職業(yè)病種類(lèi)表之 造成之神經(jīng)麻痺：包括職業(yè)性腕道癥候群等 。 診斷： work related carpal tunnel syndrome, bilateral (雙側(cè)職業(yè)性腕隧道癥候群 ) 後續(xù)處理 個(gè)案因經(jīng)濟(jì)上之需求 ,目前仍需持續(xù)地工作 . Education 1. Avoid sleeping on wrists. 2. Hot and cold presses 3. Take frequent breaks when typing and always stop if tingling or pain. 4. Avoid or reduce the number of repetitive wrist movements whenever possible. Occupational Therapy 1. Wearing a neutral position wrist splint at night 2. Wearing a splint intermittently during work 3. Ergonomic aids, such as split keyboards, keyboard drawers, cushioned mouse pads, and wrist braces. 4. Job modification 5. Forearm/wrist stretching home exercise 6. Referral to an occupational therapist MEDICATIONS ? Cyclooxygenase (COX) inhibitors : ibuprofen or naproxen. selective: celecoxib ? Local steroid injections into the carpal tunnel for short term relief. Prognosis ? Symptoms often improve with treatment, ? but more than 50% of cases eventually require surgery. ? Surgery is often successful, but full healing can take months SURGERY ? Carpal tunnel release 1. Release of the transverse carpal ligament 2. Open or endoscopic approach 3. Depression of the median nerve at the wrist ? Revision after 6 months if worsening Possible Complications ? If untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling. The END
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