The median nerve of the right hand treatment. Median nerve (n

In the human body - a large number of nerves, they are responsible for the movement of the legs, arms and other functions. So, for example, in a person’s hand there are three main ones: radial, median, ulnar nerves. Compression or injury to the median nerve, or any other, can lead to serious problems with hand movements. It is about him that we will talk today, learn about his functions, location, main pathologies.

Anatomy

The median nerve is one of the largest nerves in the brachial plexus. It originates from the bundles of the brachial plexus, or rather, from the lateral and medial. In the shoulder region, it is conveniently located in the groove of the biceps muscle among all the other nerves. Then it descends along the front through the hole in the elbow to the forearm, where it is very conveniently located between the flexors of the fingers - deep and superficial. Further, it passes into the lower section along the median sulcus and already through the carpal tunnel enters the palm. In the region of the palmar aponeurosis, it divides into three terminal branches, which further create seven separate digital nerves.

The median nerve in the forearm innervates not only two of the pronators, but all the flexors. An exception is the half of the deep flexor, which is responsible for the motor function of the fingers. As for the hand, here it is responsible for the muscles of the thumb and both vermiform, the middle of the palm and the palmar side of I-III and half of the IV fingers.

Nerve function

Each of the nerves in the human body is responsible for certain functions. So, the median nerve provides flexion and extension of three fingers on the hand: thumb, index and middle. In addition, he is responsible for the opposition of the thumb and pronation of the forearm.

Nerve tissues regenerate very poorly, and with this kind of damage in the distal part of the nerve, Wallerian degeneration can develop very quickly - this is a process during which the nervous tissue is resorbed, and it is replaced by scar connective tissue. That is why no one can guarantee that the outcome of treatment will be favorable; in the end, the patient receives a disability.

Nerve injury: classes

The median nerve of the hand, depending on how much it was damaged, can provoke several pathologies:

Shake. In this case, morphological and anatomical disorders were not observed. Sensitivity and movement functions return already 15 minutes after injury.
Injury. This condition is due to the fact that the anatomical continuity of the nerve trunk is preserved, but the epineural membranes are torn, and blood enters the nerve. With such damage, motor function is restored only after a month.
Compression. With this pathology, the severity of disorders is observed, and it depends on the severity and duration of compression, minor violations can be observed, but there are also serious cases that require only the intervention of a surgeon.

Partial damage manifests itself in the form of loss of individual functions. In this case, the functions are not restored on their own, only an operation is needed.
Complete break - in this condition, the nerve is stratified into two separate ends - peripheral and central. If serious measures are not taken, then in this case the middle fragment is replaced by a small part of the scar tissue. Functions will not recover on their own, muscle atrophy will increase every day, trophic disorders are observed further. In this case, only surgery can help, but it also does not always give the desired results.

Neuropathy or neuritis of the median nerve can be diagnosed at an early stage, and if appropriate measures are taken, this pathology can be cured without any consequences.

Causes of neuropathy

Many people in the world are faced with such a problem as hand neuropathy. Very often it is associated with fatigue, lack of sleep, and if you have a good rest, sleep, then everything will pass, but in reality everything is not at all like that.

Usually mononeuropathy - damage to one of the nerve fibers, most often develops due to the fact that the nerve is compressed in the place where it passes superficially under the skin itself or in the narrow channels of the bone. There can be several reasons for neuropathy:

the transferred surgical intervention, in the place where the operation was performed, over time, the blood ceases to circulate correctly, which ultimately leads to swelling and atrophy of the muscles, as well as to the fact that the nerves are compressed;
injury to the hand, during which swelling developed, leading to compression of the nerve;
frequent hypothermia;
exposure;
strong load on the muscles of the hands;

endocrine pathologies, this also applies to diabetics;
intoxication of the body;
lack of B vitamins;
tumors;
previous infections: herpes, malaria, diphtheria, tuberculosis and even HIV;
long-term use of drugs, which include phenytoin and chloroquine.

Symptoms of neuropathy

Few of the patients go to the hospital at the first symptoms of pathology, most often they try to use folk remedies. Ointments are used, compresses are made, but it is not always possible to cure the median nerve in this way, the symptoms may reappear and be even more acute. Pathology manifests itself in the form of burning pain that accompanies the patient throughout the day, numbness of the fingers, hands and even the entire hand also appears. In addition, other symptoms may appear:

edema;
spasms and convulsions;
goosebumps on the skin;
decreased temperature sensitivity;
lack of coordination;
difficult hand movement.

When visiting a doctor or on your own, at home, it is possible to determine by movement disorders whether the patient has neuritis, median nerve neuropathy, or not.

Definition of median nerve movement disorder

To determine movement disorders with compression or any other lesion of the median nerve, the doctor may recommend the following tests:

if you make a fist, then at this moment the index, as well as partially the thumb and middle fingers remain unbent, and the other two fingers on the hand are pressed so hard that it can be difficult even to unclench them later;
if the median nerve is affected, then the patient, when crossing his fingers, is not able to quickly rotate the thumb of the affected hand around the thumb of the healthy one, this test is called the "mill";
the patient will not be able to scratch the table with the index finger, he can only rub with the distal phalanx of the finger, or he simply knocks with it, at this moment the brush lies on the table;
if two palms are put together, then the index finger of the injured hand will not be able to scratch the healthy one;
the patient fails to abduct the thumb enough to form a right angle with the index finger.

If, after a visual inspection, there are such malfunctions in the movement of the fingers, then it is recommended to undergo a comprehensive examination.

Diagnosis of the disease

Before you choose the right method of treatment, you need to undergo a complete examination by a neurologist who will evaluate reflexes, muscle strength, conduct special tests and tests.

Of the instrumental diagnostic methods, the best ones are:

electroneuromyography;
X-ray examination;
magnetic tomography.

These studies will reveal where the nerve was damaged, find out what the cause of the pathology is, and identify the degree of conduction failures. If necessary, the patient will be advised to undergo laboratory tests, only after that it is possible to accurately diagnose and select the most effective therapy.

Treatment of the disease

Treatment of the median nerve is selected individually for each patient, because the causes of the disease can be different and the degree of damage is different for everyone. During treatment, the doctor may resort to etiotropic therapy. This treatment includes taking antibiotics, antiviral and vascular agents.

In addition, the doctor prescribes the intake of anti-inflammatory and decongestant drugs, and physiotherapy, massage and exercise therapy also give good results.

In cases where it has been established that the nerve is compressed, the cause must be eliminated. In this case, the most powerful resolving therapy is needed, but in order to carry it out, you need to start with various enzymes, as well as take resolving and softening scar tissue agents. There are cases that manual therapy and massage help to quickly recover from all symptoms.

In order for the treatment to be effective, it is necessary to carry out restorative procedures, which ones are suitable in a particular case, the resuscitator decides.

If the median nerve is injured, then in this case it is necessary to determine exactly which of the methods of treatment will be effective - conservative or operative. To do this, it is recommended to conduct needle myography, it is with its help that you can accurately determine the degree of damage.

Prevention

Damage to the median nerve is a serious condition, if no action is taken, then it will be impossible to restore the motor function of the fingers. As preventive measures, methods are used to help normalize metabolic processes, it is also very important to treat infectious pathologies in time. In addition, you need to regularly do gymnastics for the hands, especially if the patient's activity is associated with constant work with his hands (seamstresses, programmers, and others).

Conclusion

Summing up the above, we can say for sure that any even the most insignificant damage to the median nerve can lead to irreparable consequences. Therefore, if you suddenly notice that your fingers do not bend well, they often cramp or you cannot clench your fist, then it is better to consult a doctor. In case of a hand injury, the advice of a doctor and examination is very important. It is better to cure minor changes than to have an operation later, which, moreover, does not give the desired results in severe cases.

Any pain primarily signals a malfunction in the body. Painful inflammation of the peripheral nervous system is called neuritis. Often the defeat of the upper extremities is referred to as neuropathy of the radial nerve. The disease occurs as a result of compression of the nerve endings, characterized by pain, loss of sensation, dysfunction, and sometimes paralysis of the limb.

The arm is connected to the central nervous system by bundles of the median, radial and ulnar nerves. An inflammatory process that spreads to several bundles of nerve endings at once is called polyneuritis.

The disease leads to dysfunction of the extensor muscles. Further inflammation is accompanied by the extinction of tendon reflexes. Depending on which nerve is inflamed, the function of the corresponding part of the arm suffers. Compression of the peripheral nerve roots can be observed both at the exit from the spinal column and throughout the upper limb.

Causes of pathology

As a rule, the disease develops due to infringement of the nerve in the arm. The cause of inflammation can be injuries of the upper limbs, violations of the injection technique, wounds on the arm, physical overstrain of the hand. There are other factors that can trigger the onset of a disease of the nerve bundles:

hormonal changes;
alcohol intoxication or exposure to poisonous substances;
SARS, herpes, measles and others;
disruption of the vascular bed;
pneumonia or tuberculosis;
endocrine diseases.

The work of the median nerve, together with the bundles of the radial and ulnar, provides both sensitive and motor function of the hand. For example, damage to the nerves under the arm can develop from constant trauma to the area if a person moves with the help of crutches. Neuritis of the median bundle is typical for pianists who have to repeatedly bend and unbend their fingers.

The defeat of the ulnar bundle affects the sensitivity of the fingers (fingers 4 and 5). The phalanges of the affected fingers do not unbend, the hand becomes similar to the paw of an animal. A lesion in the region of the beam bundle leads to disruption of the elbow joint, a "fall" of the hand with a straightened arm.

Classification and diagnosis

Inflammation of the nerve endings is characterized by loss of sensation and dysfunction of movement. The type of neuritis is determined by the causes of occurrence, the type of affected nerve bundles and their number. With local neuritis, one nerve is affected. Polyneuritis of the hand includes inflammation of several nerve bundles at once - median, ulnar and radial.

There are many diseases characterized by pain in the upper extremities, so the diagnosis of neuralgia is somewhat difficult and is based on the exclusion of possible causes. To make a correct diagnosis and start treatment, the doctor must determine the underlying disease that caused the pain syndrome.

Usually, with neuralgia of the upper extremities, the nerve fibers of the median, radial and ulnar bundles are involved in the process. In this case, pain is present throughout the arm. Unpleasant sensations in the shoulder or forearm indicate unilateral neuralgia.

When diagnosing, the anamnesis, complaints and symptoms of the patient are taken into account, and an external examination is performed. In this case, the doctor puts some tests to help determine the localization of the process. To conduct a full-fledged treatment, it is important to determine the degree of muscle damage, in this case, electromyography is performed.

Symptoms

The clinic depends on what functions the nerve endings originally performed, how affected they are, as well as their localization. There are three types of peripheral nerve fibers: autonomic, motor, and sensory. The defeat of each of them has characteristic symptoms:

inflammation of the vegetative fibers is manifested by a change in the skin and swelling, the occurrence of trophic wounds;
movement disorder includes paresis, paralysis, lack of reflexes;
decreased sensitivity is characterized by numbness, tingling ("crawling").

The main symptoms are pain, numbness of the limb, stiffness of movements. In addition, there are specific manifestations depending on the localization of inflammation.

Damage to the radial nerve leads to motor disorders of the arm in the area of the elbow and hand. There is a decrease in sensitivity, paresthesia, a decrease in the extensor reflex. If the symptoms of the disorder are noted in the lower third of the shoulder, stiffness of movement occurs in the hand and fingers, the back of the hand becomes numb.

With the pathology of the median nerve, the inner surface of the forearm and fingers hurts, the sensitivity in half of the palm decreases. Impossible to move the hand, the first three fingers do not bend. The inflammatory process of the median bundle leads to atrophy of the thumb base muscle.

The disease of the ulnar nerve entails loss of sensitivity of the other half of the palm: the 4th and 5th fingers. There is weakness of the adductor and abductor muscles. Compression of the nerve fibers of the ulnar bundle occurs in the musculoskeletal canal, a tunnel syndrome is formed.

Treatment of neuritis

Self-treatment of any form of neuritis is unacceptable. To relieve pain, you can take NSAIDs (non-steroidal anti-inflammatory drugs). The sick arm needs to create conditions of rest, fixing it in a half-bent form. To find out the causes of the disease in order to receive adequate treatment, you should contact a specialist: a neurologist, neuropathologist, traumatologist, orthopedist.

Treatment of neuritis is complex, selected individually for each patient. Includes the following items:

painkillers and anti-inflammatory drugs;
decongestants;
drug blockade;
antibiotics for infectious etiology of the disease;
drugs to improve the patency of the bloodstream;
vitamin therapy.

The treatment is quite long, but NSAIDs are prescribed for a short time due to side effects. After reducing the pain syndrome, they are replaced with ointments with an anesthetic and warming effect. It is possible to apply medical compresses along the median and ulnar nerve.

After the acute period subsides, physiotherapy procedures are widely used. This can be electrophoresis with hydrocortisone and lidocaine, ultrasound, amplipulse, and acupuncture. Assign special exercises to increase the range of motion in the hand and strengthen the muscles.

Prevention

In order to prevent the appearance of neuritis, one should try to avoid injuries and hypothermia, treat infectious and chronic diseases that have arisen in a timely manner. It should be remembered about the possibility of vaccination, especially during the season of epidemics of viral infections. To maintain immunity, it is useful to use hardening, lead a healthy lifestyle, play sports.

Gymnastics and sports are especially important for people of mental labor, for example, office and other workers who spend most of their time in a sitting position.

Not the least role in the prevention of neuritis is played by proper balanced nutrition. The diet should contain vitamins and minerals in full. The main thing is not to start the disease, because the timely treatment started is usually successful.

The information is given for general information only and should not be used for self-treatment.

Do not self-medicate, it can be dangerous. Always consult your doctor.

median nerve neuropathy

Neuropathy of the median nerve - lesion n. medianus in any part of it, leading to pain and swelling of the hand, a disorder in the sensitivity of its palmar surface and the first 3.5 fingers, a violation of the flexion of these fingers and opposition of the thumb. Diagnosis is carried out by a neurologist based on the results of a neurological examination and electroneuromyography; additionally, with the help of radiography, ultrasound and tomography, musculoskeletal structures are examined. The treatment includes painkillers, anti-inflammatory, neurometabolic, vascular pharmaceuticals, exercise therapy, physiotherapy, massage. Surgical interventions are performed according to indications.

median nerve neuropathy

Neuropathy of the median nerve is quite common. The main contingent of patients is young and middle-aged people. The most common sites of damage to the median nerve correspond to the zones of its greatest vulnerability - anatomical tunnels, in which compression (compression) of the nerve trunk is possible with the development of the so-called. tunnel syndrome. The most common tunnel syndrome n. medianus is carpal tunnel syndrome - compression of the nerve when it passes to the hand. The average incidence in the population is 2-3%.

The second most common site of damage to the median nerve is its area in the upper part of the forearm, which runs between the muscle bundles of the round pronator. This neuropathy is called pronator teres syndrome. In the lower third of the shoulder n. medianus may be compressed by an abnormal process of the humerus or Struser's ligament. Its defeat in this place is called Struser's tape syndrome, or the syndrome of the supracondylar process of the shoulder. In the literature, you can also find a synonymous name - the Coulomb-Lord-Bedossier syndrome, which includes the names of the co-authors who first described this syndrome in 1963.

Anatomy of the median nerve

N. medianus is formed by joining the bundles of the brachial plexus, which, in turn, start from the spinal roots C5-Th1. After passing the axillary zone, it goes next to the brachial artery along the medial edge of the humerus. In the lower third of the shoulder, it goes deeper than the artery and passes under the ligament of Struzer, when it enters the forearm, it goes in the thickness of the round pronator. Then it passes between the flexor muscles of the fingers. On the shoulder, the median nerve does not give branches, sensory branches depart from it to the elbow joint. On the forearm n. medianus innervates almost all the muscles of the anterior group.

From forearm to hand n. medianus passes through the carpal tunnel. On the hand, it innervates the muscles that oppose and abduct the thumb, partially the muscle that flexes the thumb, and the worm-like muscles. Sensory branches n. medianus innervate the wrist joint, the skin of the palmar surface of the radial half of the hand and the first 3.5 fingers.

Causes of median nerve neuropathy

Neuropathy of the median nerve can develop as a result of a nerve injury: its contusion, partial rupture of fibers in case of cut, lacerated, stab, gunshot wounds or damage by bone fragments in fractures of the shoulder and forearm, intra-articular fractures in the elbow or wrist joints. The reason for the defeat of n. medianus may be dislocations or inflammatory changes (arthrosis, arthritis, bursitis) of these joints. Compression of the median nerve in any of its segments is possible with the development of tumors (lipomas, osteomas, hygromas, hemangiomas) or the formation of post-traumatic hematomas. Neuropathy can develop as a result of endocrine dysfunction (diabetes mellitus, acromegaly, hypothyroidism), diseases that entail changes in ligaments, tendons and bone tissues (gout, rheumatism).

The development of tunnel syndrome is due to compression of the median nerve trunk in the anatomical tunnel and a violation of its blood supply due to concomitant compression of the vessels supplying the nerve. In this regard, the tunnel syndrome is also called compression-ischemic. Most often, neuropathy of the median nerve of this genesis develops in connection with professional activities. For example, painters, plasterers, carpenters, packers suffer from carpal tunnel syndrome; round pronator syndrome is observed in guitarists, flutists, pianists, in nursing women who hold a sleeping child on their arm for a long time in a position where his head is on the mother's forearm. The cause of the tunnel syndrome can be a change in the anatomical structures that form the tunnel, which is noted with subluxations, tendon damage, deforming osteoarthritis, rheumatic disease of the periarticular tissues. In rare cases (less than 1% in the general population), compression is due to the presence of an abnormal process of the humerus.

Symptoms of median nerve neuropathy

Neuropathy of the median nerve is characterized by severe pain syndrome. The pain captures the medial surface of the forearm, hand and fingers 1-3. Often it has a burning causalgic character. As a rule, pain is accompanied by intense vegetative-trophic disorders, which is manifested by swelling, heat and redness or coldness and pallor of the wrist, the radial half of the palm and 1-3 fingers.

The most noticeable symptoms of movement disorders are the inability to make a fist, oppose the thumb, bend the 1st and 2nd fingers of the hand. Difficulty bending the 3rd finger. When the hand is bent, its deviation to the ulnar side is observed. Tenor muscle atrophy is a pathognomonic symptom. The thumb is not opposed, but placed on a par with the rest, and the hand becomes similar to a monkey's paw.

Sensory disturbances are manifested by numbness and hypesthesia in the zone of innervation of the median nerve, i.e., the skin of the radial half of the palm, the palmar surface and the rear of the terminal phalanges of 3.5 fingers. If the nerve is affected above the carpal tunnel, then the sensitivity of the palm is usually preserved, since its innervation is carried out by a branch extending from the median nerve to its entrance to the canal.

Diagnosis of neuropathy of the median nerve

Classically, median nerve neuropathy can be diagnosed by a neurologist during a thorough neurological examination. To identify motor insufficiency, the patient is asked to perform a series of tests: clench all fingers into a fist (1st and 2nd fingers do not bend); scrape on the surface of the table with the nail of the index finger; stretch a sheet of paper, taking it only with the first two fingers of each hand; rotate with your thumbs; connect the tips of the thumb and little finger.

With tunnel syndromes, Tinel's symptom is determined - soreness along the nerve when tapping at the site of compression. It can be used to diagnose the location of the lesion n. medianus. In pronator teres syndrome, Tinnel's symptom is determined by tapping in the area of the pronator's snuffbox (upper third of the inner surface of the forearm), with carpal tunnel syndrome - by tapping on the radial edge of the inner surface of the wrist. In supracondylar process syndrome, pain occurs when the patient simultaneously extends and pronates the forearm while flexing the fingers.

Clarify the topic of the lesion and differentiate neuropathy n. medianus from shoulder plexitis, vertebrogenic syndromes (sciatica, disc herniation, spondylarthrosis, osteochondrosis, cervical spondylosis), polyneuropathy helps electroneuromyography. In order to assess the condition of bone structures and joints, bone radiography, MRI, ultrasound or CT of the joints are performed. In supracondylar process syndrome, an x-ray of the humerus reveals a “spur”, or bone process. Depending on the etiology of neuropathy, a traumatologist, orthopedist, endocrinologist take part in the diagnosis. According to the indications, a blood test for RF and C-reactive protein, an analysis of blood sugar levels, and hormonal studies are carried out.

Treatment of neuropathy of the median nerve

Depending on the genesis of the neuropathy of the median nerve, its treatment, along with specialists in the field of neurology, is carried out by doctors of related medical fields: traumatology-orthopedics, endocrinology, surgery. The first priority is the elimination of the etiological factor: drainage of the hematoma, removal of the tumor, reduction of dislocation, treatment of arthritis, correction of endocrine disorders, creation of rest in the affected area of the nerve.

In parallel, anti-inflammatory and analgesic therapy with NSAIDs (ortofen, nimesulide, naklofen, diclofenac), and in more severe cases with glucocorticoids (diprospan, prednisolone) is carried out. In case of intense pain syndrome, extra-articular therapeutic blockades are carried out - a combination of lidocaine + hydrocortisone is injected into the area of nerve damage. An effective analgesic is phonophoresis with dimexide, electrophoresis. An obligatory component of complex therapy are pharmaceuticals that improve nerve nutrition: neurometabolites (vitamins B1 and B6, neostigmine, ipidacrine) and vascular agents (xanthinol nicotinate, nicotinic acid). In the recovery period, exercise therapy, massage of the affected hand, electromyostimulation, mud therapy, ozocerite are used.

In the absence of the effect of conservative therapy, especially with traumatic nerve injury, median nerve neuropathy is an indication for surgical intervention. Depending on the situation, a nerve suture, neurolysis with temporary implantation of an electrical stimulator, and nerve plasty are used.

Neuropathy of the median nerve - treatment in Moscow

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Neuropathy of the median nerve and how to recognize it for the average person

The disease of neuropathy of the median nerve is often found in the practice of a neurologist. Proper movement of the arms and hands depends on the health of the radial, median, and ulnar nerves. The slightest damage to them leads to problems and discomfort. Violation of the work of the nerves accompanies the disease, called neuropathy of the upper extremities in neurology.

General information

According to human anatomy, the median nerve (from the Latin nervus medianus) is the largest in the brachial plexus. It innervates almost the entire upper limb.

The median nerve responds:

for flexion of the muscles of the forearm;
for the motor activity of the thumb, middle and index fingers;
wrist sensitivity;
abduction and adduction of the left and right hand.

Reasons for the defeat

Neuropathy of the median nerve is considered damage to its site. The cause of the disease is often soft tissue swelling due to any mechanical damage or disease.

Damage to the median nerve is due to the following factors:

Injuries. Sprains, dislocations, fractures, bruises provoke the expansion of blood vessels, fluid accumulates in soft tissues. Nerve compression occurs. The situation can be aggravated by damage to the bone, its improper fusion.
Arthritis. With this disease, the soft tissues of the body swell, and there is pressure on the nerve. A chronic disease often leads to a disastrous result, deformity of the hand. This is due to the fact that the tissues begin to wear out, and the surfaces of the joints undergo fusion, the bone is exposed.
Fluid in soft tissues also accumulates due to other diseases, such as: nephrosclerosis, kidney problems, thyroid hormones, pregnancy, menopause, ischemia, and some other pathologies.
genetic predisposition. If parents, grandparents suffered from joint problems, sometimes it is inherited.
The risk group includes people with diabetes. Due to impaired glucose metabolism and oxygen starvation of cells, the destruction of the nerve fiber occurs.
carpal tunnel syndrome. This disease refers to diseases of the peripheral nervous system. Blood circulation is disturbed when the hands do not change their position while in a static state. This provokes compression of the nerve. Often the syndrome develops with prolonged use of the mouse and keyboard.
Due to certain activities, compression-ischemic neuropathy of the median nerve occurs. It is associated with prolonged macrotraumatization of the nerve. Contributes to this, for example, hard physical labor with overload of the forearm and hand.

The external causes of neuropathy of the median nerve of the hand also include:

intoxication of the body;
alcohol abuse;
past infections (eg, HIV, diphtheria, herpes).

Classification

Neuropathy (neuropathy) is a disease characterized by damage to nerve fibers. When only one nerve becomes inflamed during an illness, this is called mononeuropathy, two or more is called polyneuropathy.

Neuropathy is divided into 3 forms:

diabetic (when nerve fibers and blood vessels are affected due to high blood sugar);
toxic (infectious diseases, chemicals - all this affects the state of nerve fibers);
post-traumatic (this type of disease develops after damage to the myelin sheath of the nerve. Most often, the sciatic, ulnar and radial nerves are injured);

Neuritis develops under similar conditions as median neuropathy, but inflammation is characteristic of this disease.

According to the type and location of the pathology development zone, neuropathy has the following classification:

N medianus approaches the hand through the carpal canal. Here it innervates the muscles responsible for the opposition and abduction of the thumb, the worm-like muscles, the muscles that flex the finger. Also, its branches supply nerve fibers to the wrist joint.

Median nerve neuropathy is associated with carpal tunnel syndrome, as the disease develops starting with constant compression in the wrist.

From the point of view of surgery, lesions of the median nerve are divided into open and closed. Open, in addition to the nerve, affect the tendons, blood vessels and muscles of the patient. Closed include bruising, squeezing or stretching. Damage to the median nerve can form along with plexopathy - a lesion of the cervical or brachial nerve plexuses.

Complex lesions (eg, trauma) often involve the ulnar nerve. There is a cubital syndrome (with compression of the nerve of the cubital canal).

Symptoms of the disease

Neuropathy of the median nerve of the hand (or neuritis) refers to diseases of the nervous system. At the beginning of the development of the disease, the patient has difficulty squeezing the first, second and third fingers of the hand into a fist. It is also difficult and easy for him to move the second and third fingers of his hand. Other symptoms:

The impossibility of opposing the thumb to the rest.
Poor sensation in the palm and fingers.
The appearance of the "monkey's paw". This is due to the fact that atrophy of the muscles of the hand occurs. As a result, the first finger of the hand is installed with the second in the same plane.
The main symptom is acute pain, which manifests itself in the segment from the forearm to the fingers of the affected hand.
Numbness of the hand, muscle weakness, tingling in the forearm.

Diagnostics

To diagnose neuralgia of the median nerve, the doctor performs a series of procedures. With the development of the disease, the patient cannot perform some actions. For example, an attempt to scratch the surface of the table with the index finger (while the palm is pressed against the table) fails. The patient is unable to clench his hand into a fist, as well as oppose the thumb to the others.

Another way to diagnose is to ask the patient to show the "mill". To do this, with crossed arms, you need to rotate the sore finger of a healthy hand around the thumb of the injured one. If the nerve is affected, the person will not be able to do it.

With neuropathy of the median nerve, the patient's thumb cannot be moved to the side so that a right angle with the index finger is obtained. Also, the index finger of one hand cannot scratch a healthy hand if 2 palms are put together.

The doctor also diagnoses in the following ways:

computed tomography of the hand;
electroneuromyography;
hand x-ray.

The examination will show what treatment is best to carry out. Diagnostic data will give the doctor the opportunity to study information about damage to the joint and bone canals of the nerve. The doctor will evaluate the reflexes, the state of the muscles, and answer the question of whether the disease is caused by the narrowness of the canal or the patient's lifestyle. The doctor will determine whether it is possible to prescribe neurolysis for the treatment of the disease - a surgical intervention during which the sensitivity of the nerves is restored.

Treatment

People with median nerve neuropathy rarely see a doctor in the first stage of the disease. Conversion occurs when the more troubling symptoms of neurological problems appear:

spasms, convulsions;
goosebumps;
problems with coordination;
lack of sensitivity to temperatures.

For the treatment of the median nerve of the hand to be successful, it is important to find the exact location of the lesion. It is equally important to establish the cause, which is done at the diagnostic stage.

For effective therapy, the doctor also needs:

determine the degree of nerve damage;
to identify the factors leading to this symptom;
find a specific hit point.

operational (with the help of surgical intervention);
conservative (drugs). Often, doctors turn to etiotropic therapy. This treatment with antibiotics, antiviral agents, vascular drugs.

The degree of damage is determined using a special examination - needle myography. If the nerve is compressed, treatment may include the following steps:

Resorption therapy has a good effect on eliminating nerve compression. It involves taking various drugs and enzymes, agents that absorb and soften scar tissue. If the compression is not strong, manual therapy and special massage are often enough.
Nerve recovery. Special medicines prescribed by a doctor contribute to the "revitalization" of the nerve.
Muscle rehabilitation. The goal of therapy is to restore their muscle volume. Medical procedures are prescribed by a rehabilitation doctor.
Conservative treatment of the radial and ulnar nerves may include wearing splints.

What other means are used?

Demixidol in the area of the carpal tunnel.
Acupuncture.
Interstitial electrical stimulation.
Therapeutic blockades in the carpal tunnel (diprospan plus lidocaine), intramuscular injections (movalis plus novocaine)
Non-steroidal anti-inflammatory drugs, in addition to blockades (arthrosilene).

During the diagnosis, a disease can also be detected - plexitis of the median nerve. It is caused by injury or infection.

Initially, medical, conservative methods of therapy are always used. With a low efficiency of physiotherapy treatment, an operation is performed in the clinic. The decision in favor of surgical intervention is made in violation of the integrity of the nerve trunk, severe weakness in the fingers.

It is not recommended to treat the disease with folk remedies. During therapy, the patient should not overwork and expose himself to heavy physical exertion. In the acute period of the disease, you need to lie more, rest.

Exercise therapy and special exercises are usually prescribed in the postoperative period. Physiotherapy is carried out with conservative treatment or also after surgery.

Patients with an illness can be shown sanatorium treatment. A contraindication to it is the acute period of the disease.

Forecast and prevention

If there is no threat to health in the form of infections or injuries, sufficient attention should be paid to the prevention of neuropathy of the upper extremities, namely:

Physical exercises for the hands. They include a simple warm-up for the brushes.
When working at a computer, it is important to take breaks. When using a computer mouse, you need to hold it in different hands alternately.
Taking a vitamin is useful, as well as strengthening the overall health of a person. This reduces the risk of neurological diseases of the extremities.

It should be remembered that timely treatment started guarantees a good prognosis for future hand performance. Restoration of motor activity should begin as soon as possible. Ignoring therapy or improper self-medication often causes disastrous consequences.

median nerve neuropathy

The median nerve is one of the major branches of the brachial plexus along with the brachial and radial nerves. It originates from two bundles - lateral and medial. Goes through parts of the biceps (biceps muscle). In front, through the ulnar region, it reaches the forearm and is localized between the flexors of the fingers. Through the canal of the wrist enters the palm. Here it is divided into three parts, which are further divided into seven more branches.

The median nerve innervates almost the entire upper limb, as it has a long path and gives a huge number of branches along the way. Responsible for flexion of the muscles of the forearm, for the movements of the thumb, middle and index fingers, abduction and adduction of the hand, its rotation is possible. It is responsible not only for motor activity, but also for the sensitivity of the wrist.

Reasons for the defeat

The defeat of this nerve is due to the influence of internal and external factors:

Regular prolonged use of a computer mouse and keyboard. Constant identical movements in the process of working at a computer lead to the development of such a pathology as carpal tunnel syndrome - a disease of the peripheral nervous system. The hands are in a static position of flexion or extension, blood circulation and trophism of the nervous tissue are disturbed. The risk factors here are the female gender, since the median nerve canal is anatomically narrower than in males, the third or fourth stage of obesity - the load on the upper limb increases.
All types of arthritis. Most of the problems with the body begins with inflammation. Soft tissues swell, the lumen of the canal narrows, respectively, the nerve is subjected to pressure from the outside. In connection with the chronic pathological process, many tissues are sclerosed and erased. The articular surfaces gradually fuse together, as the bone surface is exposed. The hand deforms over time, due to the incorrect position of the anatomical structures, the patient's condition worsens.
Injuries. A frequent problem of orthopedics in conjunction with neurology. When the arm is sprained, dislocated, fractured, or bruised, the body's adequate response is to dilate blood vessels and accumulate fluid in the soft tissues. As in the previous case, nerve compression occurs. The bones are displaced, there is a risk of improper union, which sharply aggravates the situation.
The accumulation of a large amount of fluid is associated with concomitant human diseases: nephrosclerosis, acute or chronic renal failure, pregnancy, menopause, lack of thyroid hormone, disruption of the genital organs, and so on.
Edema is caused by specific and non-specific pathogens (tenosynovitis). Pathology can proceed as a catarrhal form, and with the formation of pus. Microorganisms reach the site of the lesion in several ways: from neighboring anatomical structures, through the blood, and directly through the wound.
Diabetes. The causative factor is a violation of glucose metabolism and energy starvation of cells that gradually die. The nerve fiber is destroyed.
genetic predisposition. If close relatives (brothers, sisters, parents) suffered from similar diseases, there is a high risk of its development in the person himself.

Classification

Injuries to the median nerve are classified in terms of surgery into open and closed. Open wounds include all types of wounds: stab, lacerated, cut, chopped, and so on. They can affect, in addition to the nerve, tendons, and muscles, and blood vessels.

Closed injuries include contusion, sprain, concussion and compression.

Diseases according to orthopedic classification are divided into three groups:

Neuropraxia - reversible damage to nerve fibers;
Axonotmesis - pathology is characterized by the degeneration of individual sections of the nervous tissue;
Neurotmesis - deep damage to the nerve trunk, including violations of the connective tissue membrane.

neuropathy

Neuropathy of the median nerve - damage due to constant compression of the anatomical formation. Otherwise known as carpal tunnel syndrome. The highest prevalence among middle-aged people is from thirty to sixty years.

In most cases, this disease develops on one side. The main complaint of the patient is pain and numbness of the upper limb, as its innervation is disturbed, and pain receptors, on the contrary, are irritated. Discomfort at first worries only at night, which prevents a person from sleeping. As the disease progresses, the symptoms increase in the daytime, which reduces the ability to work and quality of life. Unpleasant sensations are localized not only in the area of large joints, but also throughout the course of the median nerve up to the fingertips.

There is a loss of strength, muscle tone. Median nerve disease is due to impaired blood supply to tissues, metabolism and oxygen delivery. The patient sometimes cannot hold even the lightest and smallest things. For the same reason, the color of the skin of the hands changes.

Since the nerve is also responsible for tactile sensitivity, accordingly, the reaction to external stimuli is reduced or absent. The patient does not feel touch, temperature fluctuations.

Movement disorders, muscle atrophy are gradually noted.

Median nerve neuropathy is diagnosed by tests of pain and tactile sensitivity, an increase in symptoms with increased pressure on the forearm or raising the limb for a while.

For clarification, directions for laboratory and instrumental diagnostics are issued. Blood and urine tests give an expanded picture of the patient's health status, his concomitant pathologies (hypothyroidism, diabetes mellitus, nephrosclerosis). This is important for the attending physician, since the disease could develop precisely because of them.

A direct study of the carpal tunnel is engaged in electroneuromyography. It determines the location of the lesion, its size, depth. It is based on connecting electrodes installed on the arm to a computer that reads electrical impulses from the nerve fiber at rest and during movement.

Treatment begins with fixing the wrist in the correct position with an orthopedic bandage. Drug therapy includes the use of drugs with B vitamins, non-steroidal anti-inflammatory drugs (Diclofenac), glucocorticosteroids (Prednisolone), vasodilators (Pentilin), diuretics according to indications (Veroshpiron). Anticonvulsants (Pregabalin) and antidepressants (Duloxetine) are used to relieve pain and have a general calming effect. Treatment is complemented by massage, physiotherapy exercises.

Neuropathy sometimes requires surgery to repair or widen the carpal tunnel.

neuropathy

Neuropathy of the median nerve is a pathology associated with traumatization of the upper limb, namely its bruise, injury, fracture.

In connection with the deformation of the bones of the limb, the nervous system almost fails to adequately innervate the hand and fingers. From this follows almost the entire clinical picture. The patient complains of pain in the thumb, index and middle fingers, discomfort on the inside of the forearm. The hand is not able to perform flexion, extension and rotational movements. Outwardly, muscle atrophy is observed in the region of the tubercle near the thumb. Tactile and temperature sensitivity is lost.

Neuralgia is diagnosed by examining the movements of the fingers and the hand as a whole. Nerve damage can be studied in detail using ultrasound diagnostics, ultrasonography and electroneuromyography.

Treatment involves the use of anticholinesterase agents (Galantamine), muscle relaxants (Norcuron), antioxidants (vitamin E). The therapy is complemented by acupuncture, physiotherapy, massage.

It is necessary to treat by surgical intervention only in case of a strong proliferation of connective tissue at the site of injury, as this negatively affects the functioning of the nerve. Neurolysis of the median nerve is performed using microsurgical devices and a microscope.

Neuritis

Neuritis of the median nerve is a disease associated with inflammation of the anatomical formation. This group includes pathologies of both infectious and non-infectious etiology.

The patient notes weakness in the hand, difficulty in bending the upper phalanges of the fingers. There may be a tingling sensation or "goosebumps". Outwardly, there is a change in the shade of the skin, their cyanosis, excessive sweating of the palm, swelling of the limb, a violation of the structure of the skin and nails. When a person's condition worsens, trophic ulcers, epidermal cracks develop, muscles atrophy and are replaced by connective tissue, in this case, the restoration of motor activity is almost impossible.

The neurologist is obliged to study the mobility of the hands, starting with a healthy one. He asks the patient to clench his palm into a fist, to bend the limb as much as possible in the wrist area. The results of laboratory studies show the presence of inflammation (an increase in the number of leukocytes, an erythrocyte sedimentation rate, a decrease in blood protein).

Additionally, it is diagnosed by radiography, computed and magnetic resonance imaging in order to visually study the forearm area and the course of the median nerve.

Treatment with the development of microorganisms begins with the use of broad-spectrum antibiotic therapy of the group of penicillins, cephalosporins. To raise immunity, it is necessary to use vitamin complexes, as well as immunomodulatory drugs. Treatment should include non-steroidal anti-inflammatory and decongestants, analgesics. Of the physiotherapy procedures, electrophoresis with painkillers, pulsed currents and UHF gives the greatest effect.

The information on the site is provided for informational purposes only, does not claim to be reference and medical accuracy, and is not a guide to action. Do not self-medicate. Consult with your physician.

Carpal tunnel syndrome is a lesion of the median nerve that occurs against the background of prolonged compression in the wrist or injury. This pathology most often develops in women from 40 to 60 years. The cause of the syndrome can be a professional activity that puts a lot of stress on the carpal tunnel, nerve damage and other negative factors associated with impaired human health.

What is median nerve neuropathy

The median nerve starts from the inside of the shoulder, runs through the elbow joint towards the wrist, and ends in the palm of the hand. It is responsible for the flexion of the fingers and the movement of the hand.

The nerve is very often injured in the lower part of the forearm, since in this area it is superficial. Medianus is responsible for the motor ability of the muscles and for the sensitivity of the upper limbs.

The composition of the nerve includes fibers of the spinal nerve of the median and lower bundles of the brachial plexus. Due to frequent injuries in this area, neuropathy occurs, which negatively affects the quality of life of the patient.

Pathology develops against the background of a bruise, fracture, cut in the area of the hand, even if the nerve was not damaged. It's all about the scars that form during the healing process, which tend to put pressure on the nerve, which leads to the disease.

Causes

Neuropathy of the median nerve develops not only as a result of injury, but also against the background of certain diseases. Pathology comes in the following forms:

Diabetic. Nerve damage occurs due to prolonged high blood sugar levels. In this case, the disease has its development against the background of incorrect treatment of diabetes mellitus.
Toxic. In this case, the cause of the pathology is the long-term use of certain medications, alcohol abuse, infectious intoxication. The most common form of alcohol poisoning. Toxic substances have a negative effect on the nerve fibers, destroying them.
Post-traumatic. Against the background of injuries and wounds, the myelin sheath loses its usual integrity, which becomes the cause of the disease.
Tunnel. Compression of the neurovascular bundle in a narrow anatomical canal (tunnel). This pathology is a harbinger of compression-ischemic disease and leads to damage to the median nerve.

Also, the cause of the disease can be:

arthrosis;
arthritis;
gunshot, stab, cut wounds;
fracture of the shoulder and forearm;
fractures in the wrist and elbow joint;
dislocations;
tumors;
bursitis;
post-traumatic hematoma;
disruption of the endocrine system;
gout;
rheumatism.

Tunnel syndrome occurs when there is pressure on the median nerve in the tunnel, which disrupts blood flow. The risk area includes:

carpenters;
ironers;
painters;
pianists;
guitarists;
plasterers;
packers.

The syndrome can develop in breastfeeding women who hold the baby in their arms for a long time. Tunnel syndrome also appears due to anatomical changes that occur against the background of subluxations, osteoarthritis, tendon damage, rheumatism, and swelling of the periarticular tissues. Rare cases include an abnormal process of the humerus.

Symptoms

The main symptoms of neuropathy of the median nerve are:

Pain in the brush area.
decline sensitivity.
Atrophy muscles.
Numbness in fingers and hand.
Decreased grasping strength.
puffiness upper limbs.
Absent bending at least three fingers.
Burning in the area of the palm, fingers, hand.

The disease can be identified by the disorder sensitivity radial area of the palm, ring, middle and partially index finger. The trophism and motor functions noticeably change.

The course of neuropathy varies, in some cases the signs of the disease appear very quickly over several days, or, conversely, the disease progresses for a long time, sometimes it can take years.

Diagnostics

Diagnosis of neuropathy of the median nerve begins with a study of the patient's complaints and a visual examination of the changes in the hand. In addition, the area where a decrease in sensitivity was noticed is revealed. A special test is carried out to find disorders of the motor system:

During squeezing hands into a fist 1,2 and 3 (partially) fingers do not bend.
pressing palm to the surface of the table with the second finger, the scratching movement is not obtained if the other fingers are crossed.
opposition 1 and 5 fingers broken.

Computer tomography of the hand, which will show or exclude the presence of congenital narrowness of the carpal tunnel.
Electroneuromyography, which will allow you to monitor how the impulse passes along the nerve. This will help to understand how impressed he is.
Ultrasonography(ultrasound).
Magnetic resonance tomography, which will make it possible to recreate the whole picture of the disease. An MRI can help determine the type, size, and location of the lesion.

After confirming the diagnosis, the specialist prescribes adequate treatment.

Surgical treatment

Carpal tunnel syndrome, which appeared against the background of nerve compression in the area of the hand, requires dissection. Such an operation can be performed both openly and endoscopically.

Endoscopic surgery does not require a large incision, but with conventional surgery it is possible to view the entire canal and make sure that there are no more large formations.

Most often, older people mistake neuropathy for a sign of aging and see a doctor late, which subsequently complicates treatment. In this case, the conduction of the nerve is completely impaired, an operation is prescribed.

A complete violation of nerve conduction means a violation of its integrity and also implies surgical treatment.

Conservative treatment

If you consult a doctor in time with a problem that has arisen, then the treatment is always successful. At the initial stage of the pathology, it is recommended to fix the arm in its usual position with the help of a splint. Also, the patient is prescribed a number of non-steroidal anti-inflammatory drugs, drugs to accelerate nerve regeneration.

It is very important during therapy to eliminate the root cause of the disease. It is desirable to get rid of alcoholism, if it is. With diabetes, it is necessary to monitor the level of sugar in the blood, to exclude medications that cause intoxication.

Also, specialists prescribe painkillers, vitamins of group B. If there are indications, the patient takes antidepressants and anticonvulsants. Wellness baths, exercise therapy, acupuncture, massage, balneotherapy favorably affect the healing process.

Medical treatment

For the treatment of neuropathy, as needed, prescribe:

Alpha lipoic acid.
Benfotiamine.
Actovegin.
Drugs that improve peripheral circulation (trental, sermion)

All drugs are prescribed only by a doctor who decides on their need.

Complementary Therapies

Ozokeritotherapy. Affected nerves are treated with ozocerite, which helps to restore the affected tissues. Treatment is carried out for about an hour for two weeks.
Peloid therapy is a healing mud treatment that helps improve recovery processes, reduces and stops the destruction of nerve fibers. Removes inflammatory processes. The procedure is carried out for three weeks for 20 minutes.

Vasodilating methods are also used:

high frequency magnetotherapy. A magnetic field with a high frequency induces eddy currents in the cells, which contributes to the heating of tissues. The course is carried out for 10 days for 15 minutes.
low frequency magnetotherapy. This method helps to relax the smooth muscles of blood vessels, reduces blood viscosity, and increases blood flow. The procedure is carried out for two weeks for 12 minutes.
Ultratonotherapy. A small discharge helps to heat the tissues of the nerve, which allows you to expand the vessels and restore blood circulation and lymph flow. The course is held for 10 days for 10 minutes.

Spa treatment

motor function and muscle strength.
limb sensitivity.
neuromuscular conduction.

It is impossible to undergo sanatorium treatment during the period when the disease is in an acute form.

Prevention

To prevent the occurrence or recurrence of pathology, the following prevention is recommended:

cherish hands, especially in the area of the hand from injuries, wounds, fractures and dislocations.
Not supercool.
Change hand position more often.
Do not lift gravity.
Follow the level Sahara in blood.
If possible, change professional activity.
Study sports.
visit periodically doctor and check limbs for tumors.
After a long stay in one position of the hands, it is worth them mash and increase blood flow.
follow the reception medicinal funds.
Do not abuse alcohol drinks.
Control arterial pressure.

Prevention will help to avoid relapses and the development of pathology.

Consequences and complications

Neuropathy of the medial nerve can have the following consequences and complications:

Destruction fibers, which leads to incapacitation of the hands.
Deterioration quality life.
Due to loss sensitivity there may be additional injuries.
Gangrene.
Deformation fingers.
Periodic pain.
Necrosis fabrics.
Puffiness.
muscular weakness.

Neuropathy can be prevented by taking care of your health and taking preventive measures. If the problem nevertheless arose, it is not necessary to postpone treatment and bring the disease to an acute and chronic form, this will help to avoid consequences and complications.

With damage to the C7-spinal nerve or the middle trunk of the brachial plexus, the function of the median nerve suffers partially, as a result, there is a weakening of the flexion of the hand, its rotation inward in combination with a lesion of the radial nerve. Almost the same loss of function of the median nerve occurs when the external bundle of the brachial plexus is damaged, into which the fibers of the upper nerve pedicle pass from the middle trunk, but already in combination with damage to the musculocutaneous nerve.

With damage to the spinal nerves С8–Th1, the lower trunk and the internal bundle of the brachial plexus (Dejerine-Klumpke palsy) suffer in combination with damage to the ulnar nerve, those fibers of the median nerve that make up its lower leg (weakening of the flexors of the fingers and tenar muscles).

The motor function of the median nerve mainly consists in the rotation of the hand inward, in palmar flexion of the hand due to contraction of the corresponding muscles, flexion of the fingers, mainly I, II and III, extension of the middle and terminal phalanges of the II and III fingers.

Sensitive fibers of the median nerve innervate the skin of the palmar surface of I, II, III and the radial half of the IV fingers, the corresponding part of the palm, as well as the skin of the rear of the terminal phalanges of these fingers.

With damage to the median nerve (with neuritis of the median nerve), the rotation of the hand inward suffers, the palmar flexion of the hand is weakened, the flexion of the I, II and III fingers and the extension of the middle phalanges of the II and III fingers are disturbed.

Superficial sensitivity in median nerve neuritis is impaired on the hand in a zone free from innervation of the ulnar and radial nerves. Articular-muscular feeling with neuritis of the median nerve is always impaired in the terminal phalanx of the index, and often II fingers.

Muscle atrophy in lesions of the median nerve is most pronounced in the thenar region. The resulting flattening of the palm and bringing the thumb close and in one plane to the index finger create a peculiar position of the hand, which is called the “monkey”. Pain in damage to the median nerve, especially partial, is quite intense and often takes on a causal character. In the latter case, the position of the brush can become bizarre.

Vasomotor-secretory-trophic disorders are also common and characteristic of damage to the median nerve: the skin, especially the I, II and III fingers, becomes bluish or pale in color; nails become “dull”, brittle and striated; there is skin atrophy, thinning of the fingers (especially II and III), sweating disorders, hyperkeratosis, hypertrichosis, ulceration, etc. These disorders, like pain, are more pronounced with partial rather than complete damage to the median nerve.

The median nerve, like the ulnar nerve, gives its first branches only on the forearm, so the clinical picture with a high lesion is the same throughout from the axillary fossa to the upper forearm. With damage to the median nerve in the middle third of the forearm, the functions of inward rotation of the hand, palmar flexion of the hand, and flexion of the middle phalanges do not suffer.

The main tests for determining movement disorders that occur when the median nerve is affected (median nerve neuritis) are the following:

When clenching the hand into a fist, I, II, and partly III, the fingers do not bend
Flexion of the terminal phalanges of the thumb and forefinger is impossible, as well as scratching with the index finger on the table with the brush tightly adjacent to it.
When testing the thumb, the patient cannot hold a strip of paper with a bent thumb and will hold it by bringing the adductor muscles with the straightened thumb from the saved

Among neurological disorders, various kinds of neuropathies associated with ischemic, inflammatory or compression (tunnel) damage to the nerve fiber are often diagnosed. Median nerve neuropathy is a common pathology in modern people. This is due to a certain lifestyle and predominantly manual labor without the concomitant development of the muscle groups of the upper limb. We are talking about professions related to the use of computer technology.

If the median nerve of the hand is damaged, then a segmental disturbance of sensitivity occurs in the area of \u200b\u200bthe palm and non-fast fingers of the hand. Anatomically n. Medianus is responsible for providing motor activity and skin sensitivity in the region of the first three fingers of the hand. With neuropathy of the median nerve of the hand, an inflammatory reaction may occur in the area of the carpal joint, the motor activity of the thumb is disturbed.

The anatomical features of this plexus of axons are that they are formed by two groups of bundles at once, extending in the form of radicular nerves from the spinal cord. The C5-Th1 segment gives rise to two pairs of radicular nerves: ventral and dorsal. The former are responsible for movement, the latter for skin sensitivity. If the inflammation or lesion begins at the level of the C5-Th1 intervertebral disc, then only one function of the median nerve may "fall out". With compression, ischemia, or inflammation of the median nerve in the forearm, shoulder, or wrist, a combination of clinical symptoms of neurological and motor dysfunction occurs.

Damage to the nerve fiber can be observed along the entire length of its path to the hand. First, the median nerve descends into the armpit and passes to the beginning of the humerus. Here, injury can occur by wearing tight and uncomfortable clothing. On the forearm, the nerve passes deep into the thickness of the muscle and layer and is reliably protected from injury. The next dangerous area is the carpal carpal tunnel, which can be deformed. Compression of the median nerve in this anatomical node occurs in almost 80% of programmers and representatives of other professions associated with manual labor based on the performance of monotonous movements of the same type.

Causes of damage and inflammation of the median nerve

Damage to the median nerve can be associated not only with the performance of professional duties. There are pathogenic causes that can provoke inflammation of the median nerve, among them it is worth noting the following factors:

traumatic impact on the areas through which the innervation passes (fractures of the shoulder and forearm, the beam in a typical place, the bones of the wrist);
stretching of the muscle and tendon tissue in the area of the carpal canal - lead to the formation of rough connective tissue in the form of scar bands, which significantly impairs the patency of the canal and has a compressive effect on the structure of the nerve fiber;
deformation of the structural tissues of the carpal joint due to arthritis or arthrosis, rheumatoid manifestations or gout;
tumor processes;
the formation of hematomas after bruises and ruptures of soft tissues without violating the integrity of the epidermis;
endocrine pathologies associated with a deterioration in the blood supply to the soft tissues of the upper extremities (diabetic angiopathy, narrowing of the capillary bed in hypothyroidism or its stretching in acromegaly);
atherosclerosis, capillary and arterial insufficiency of blood supply;
violation of the integrity of large main blood vessels;
syndrome of prolonged limb compression with soft tissue atrophy.

In addition, pathology can be provoked by mechanical factors of influence. For example, a number of people have a habit of holding their hands for a long time in an unnatural twisted position. The habit of not paying attention to inconveniences when organizing your workplace and choosing tools can also play a cruel joke. If the implementation of professional duties associated with the use of the brush causes pain and a feeling of stiff tissues, then you should think about changing the tool or workplace.

Compression ischemic syndrome can be caused by the anatomical features of the development of the carpal tunnel. Signs of this may appear for the first time at the age of 10 - 13 years. A teenager may begin to complain of pulling sensations in the wrist area, pain in the first three fingers of the hand. In most cases, this pathology resolves on its own by the age of 14-15.

However, approximately 20% of patients have persistent anatomical defects in the carpal tunnel. This provokes squeezing of blood vessels and nerve fibers. In this case, there are two types of negative influence on the median nerve of the hand. He suffers from mechanical pressure and from a lack of nutrition due to improper blood supply.

Neuropathy of the median nerve, which is formed by the type of tunnel syndrome, is an officially recognized occupational disease. According to the medical classification, representatives of such processions as musicians, plasterers, painters, massage therapists, builders and carpenters, hairdressers and tilers, tennis players and packers are subject to such injuries.

Syndrome of pinching of the median nerve of the hand in the carpal tunnel

As mentioned above, the median nerve of the hand passes through the carpal tunnel, where it can be subjected to compression and ischemia. Median nerve tunnel syndrome leads to the development of a severe pain syndrome, the appearance of characteristic signs of an inflammatory reaction (redness and swelling, impaired mobility, deterioration of sensitivity).

In order to provide first aid, it is necessary to eliminate the pinching of the median nerve, and this must be done in such a way as not to violate the integrity of the surrounding tissues.

The median nerve of the carpal tunnel can be released using osteopathic techniques and manual therapy. Therefore, if you have pain in the wrist area and there is a loss of sensation in the palm of your hand, some fingers, we recommend that you make an appointment for a free appointment at our manual therapy clinic. Here, an experienced doctor will conduct an examination, make a diagnosis and tell you what can be done to alleviate the condition right now, and what will need to be done for a full recovery.

Damage to the median nerve of the forearm

Another common pathology is damage to the median nerve of the forearm, associated with traumatic effects in the form of fractures, bruises and sprains of the ligamentous apparatus. These lesions are typical for people engaged in heavy physical labor and who are fond of sports associated with lifting weights (weightlifting).

The median nerve of the forearm is quite well protected by muscle tissue and fascia from mechanical stress. Therefore, traumatic compression injuries are likely here. The clinic of this process is that shortly after the injury, swelling of the carpal tunnel develops, the sensitivity of the first three fingers and the palmar part of the hand is disturbed.

Detailed symptoms may also accompany deforming osteoarthritis of the shoulder, elbow and carpal joints. At the same time, the clinic of cartilage and bone tissue deformation comes to the fore. After some time, signs of impaired innervation join.

Compression and ischemic neuropathy of the median nerve: symptoms of neuropathy

In the practice of a neurologist, compression neuropathy of the median nerve is more common than manifestations of an ischemic process against the background of impaired capillary blood supply to the soft tissues of the upper limb. Among the potential patients, one can note people who are in the prime of life and professional opportunities. This age category is from 25 to 45 years. It is her representatives who are most often diagnosed with compression neuropathy of the median nerve associated with professional activities or improperly distributed physical activity during sports.

The disease is more often referred to in the specialized literature as carpal tunnel syndrome. Treatment is possible only with the help of manual therapy. In difficult cases, when precious time is lost and the pathology has passed into the final stage, a surgical operation will be required.

Ischemic neuropathy of the median nerve can also result from narrowing of the carpal tunnel. But more often ischemia is observed in persons with impaired blood circulation. This may be a consequence of cardiovascular or endocrine pathology. In most cases, ischemic neuropathy of the median nerve accompanies diabetes mellitus, hypothyroidism, and gout.

Clinical symptoms of neuropathy of the median nerve of the hand may include the following manifestations:

severe pain in the wrist, passing to the palm, the first three fingers of the hand;
discoloration of the soft outer tissues (redness or, conversely, an unnatural pale and bluish hue);
restriction of motor activity (the patient cannot clench his hand into a fist, take his thumb to the side);
over time, there is a noticeable dystrophy of some muscle groups of the palmar zone with a loss of their turgor, elasticity and volume;
sensitivity suffers (the patient cannot distinguish between hot and cold, hard and soft).

Diagnosis can be made using X-ray, MRI, CT and ultrasound. It is important for the doctor to establish the place where the infringement or violation of the patency of the median nerve occurs. To exclude cervical osteochondrosis as a potential cause of this disease, it is necessary to do an x-ray of this spine.

Treatment of neuropathy (neuropathy) of the median nerve

Treatment of the median nerve of the hand begins with an examination. The doctor must establish the cause of the negative impact on the nerve fiber. After that, the treatment of neuropathy of the median nerve begins by eliminating this cause. If the pathology is provoked by the narrowing of the carpal tunnel, then techniques and techniques of osteopathy can be used to expand it and remove all obstacles along the path of the nerve fiber.

Manual therapy for the treatment of median nerve neuropathy offers various techniques:

massage aimed at improving blood supply to soft tissues and relaxing muscle groups;
osteopathy, which allows you to eliminate muscle spasms, spasms of the bloodstream and other clamps;
therapeutic gymnastics and reflexology;
electromyostimulation and kinesitherapy.

The choice of appropriate methods of therapy is carried out by the doctor after examining the patient and making the correct diagnosis.