Pathology of office workers, or carpal tunnel syndrome. Carpal tunnel syndrome (tunnel syndrome): treatment, symptoms, causes, prevention

Tunnel syndrome (tunnel neuropathy) is the general name for a group of neuropathic conditions in which compression of the nerve trunk occurs. The syndrome gets its name from the shape of the osteo-fibrous structure - a canal (tunnel) of joints, tendons and bones surrounding the nerve.

Causes of the disease

The nerve, which runs in a canal made of hard tissue, is reliably protected from external influences. But at the same time, it can suffer from deformations of the canal, the walls of which surround it. Deformations are caused by overstrain of ligaments and tendons, causing a temporary deterioration in the blood supply to the tissues and a deficiency of nutrients in them. With constant loads on this area, the changes are consolidated and become permanent: the tissues of the tunnel thicken, loosen or swell. As a result, there is no free space left in the tunnel and the pressure on the nerve trunk increases, after which disturbances in its functions begin to develop - the conduction of motor signals.

Much less commonly, tunnel syndrome can be caused by swelling of the nerve itself. This condition can develop due to general intoxication of the body with salts of heavy metals, derivatives of arsenic and mercury and other toxic substances. The prolonged course of someone's disease requiring the use of antibiotics, diuretics and vasodilators can also lead to the development of tunnel neuropathy.

Risk factors

Carpal tunnel syndrome usually develops in areas exposed to constant or regular stress in the form of monotonous, repetitive movements. But besides mechanical irritation of the nerve and surrounding tissues, other factors can lead to the disease.

The risk group for carpal tunnel syndrome includes the following categories of the population:

people whose professional or everyday activities include the same type of flexion-extension movements (hairdressers, typists, tennis players, sign language interpreters, musicians - most often violinists, guitarists, painters, etc.);
people over 50 years of age (age-related changes that occur throughout the body invariably affect bone tissue);
people suffering from endocrine diseases (diabetes mellitus, dysfunction of the thyroid gland, pituitary gland), which significantly impair the ability of tissues to recover;
people who have a family history of musculoskeletal diseases or suffer from these diseases (arthritis, osteochondrosis, etc.);
people who are often exposed to microtrauma of joints and ligaments (loaders, bodybuilders, masons, etc.);
people with autoimmune diseases (systemic lupus erythematosus, HIV, etc.)

Types of tunnel syndrome

Carpal tunnel syndrome is the most common type of tunnel neuropathy and is very often mistaken for the only form of the disease.

But this condition can develop when the following nerve trunks are infringed:

Compression of any of the listed nerves falls into the category of tunnel syndromes and has similar symptoms.

Symptoms

Compression of the nerve trunk develops gradually and the intensity of symptoms increases at the same pace. In the initial stage, the syndrome practically does not manifest itself: a person may only experience a feeling of discomfort with prolonged stress on the area of the body in which the nerve is pinched. As the canal narrows, more and more significant dysfunctions of the nerve occur, which are manifested by the following symptoms:

pain in the affected area, increasing after physical activity;
pain may occur at rest (most often at night);
in the peripheral part of the body (the one that is located further than the point of pinching of the nerve), numbness and tingling are felt;
When you try to “stretch” the affected joint or ligament or when you tap this area, the pain intensifies.
If the tunnel is significantly narrowed, the listed symptoms are joined by more pronounced ones:
stiffness of the affected joint;
deterioration of muscle tone in the area of nerve compression;
with simultaneous tension of symmetrical muscles (for example, when clenching both palms into fists), the muscles on the affected limb are less pronounced, which indicates their atrophy.

One of the distinctive signs of tunnel neuropathy is that when a nerve is pinched in a large joint (scapula, elbow, thigh), pain can manifest itself at a considerable distance from the affected area, which makes diagnosis difficult. For example, if you have shoulder pain accompanied by numbness in the shoulder, forearm, or upper back, the nerve may be compressed in both the elbow joint and the scapula.

Complications

Most often, tunnel neuropathy becomes a chronic state, when exacerbations of the disease alternate with periods of remission (asymptomatic course of the disease).

The good news for people suffering from carpal tunnel syndrome is that the pathology rarely extends beyond the affected area and the worst that can happen is an increase in symptoms and pain.

Therefore, this condition is not life-threatening. But it can greatly disrupt its quality. The pain, which becomes longer and stronger over time, can cause disturbances in sleep, appetite, extreme irritability and ultimately lead to other diseases of the nervous system, such as chronic insomnia, anorexia, bulimia, etc.

Diagnostics

First of all, the doctor examining the patient excludes other diseases that have symptoms similar to the clinical picture of tunnel neuropathy. Among such diseases are arthritis, arthrosis, neuralgia, myalgia, etc.

After this, to clarify the diagnosis, neurological tests are used to identify damage in the nerve trunk. The most commonly used test is called the Tinel sign, in which the doctor taps the skin over the canal that contains the damaged nerve. With carpal tunnel syndrome, the patient feels numbness, tingling, and pinpoint itching (the so-called “crawling sensation”). If the syndrome has developed in an area inaccessible to the Tinel test, electromyography may be prescribed, which examines the ability of the nerve to conduct impulses.

Treatment

Treatment of tunnel neuropathy is aimed at relieving the inflammatory process and eliminating swelling in the affected area, relieving the patient of pain and preventing more severe nerve entrapment.

Drug treatment

Among medications, the following groups have confirmed their effectiveness:

(NSAIDs), such as Ibuprofen, Ketorolac, Indomethacin, Nimesulide, etc., in addition to relieving inflammation, provide an analgesic effect;
hormonal drugs (Hydrocortisone, Prednisolone) are introduced into the affected area by injection and/or applied to this area in the form of an ointment;
calcium chloride is injected intravenously to relieve inflammation and stabilize the immune system response;
vitamin preparations are prescribed to improve the conduction of nerve signals and normalize blood circulation in the area of nerve compression.

Physiotherapy

Physical therapy is prescribed on an individual basis, depending on the results of the examination and the degree of compression of the nerve - in some cases, with tunnel neuropathy, it is recommended to exclude any stress on the affected joint.

Surgery

In cases where conservative treatment of carpal tunnel syndrome is ineffective, the doctor may recommend surgical treatment. During the operation, which is performed under general anesthesia and lasts about an hour, the surgeon excises the thickening in the tissue that is compressing the nerve, which allows its function to be restored.

The disadvantages of this treatment method include the fact that it is impossible to predict in advance how effective the operation will be. In a small percentage of cases (about 2-3%), patients experience an increase in symptoms after surgery.

Lifestyle correction

Many people prefer a “convenient” treatment option, in which the doctor prescribes effective medications or procedures without requiring any action from the patient. Unfortunately, tunnel neuropathy requires the active participation of the patient in the treatment process.

The main condition for recovery or achieving long-term remission is the elimination of stereotypic movements that led to compression of the nerve. Often this becomes the only effective measure that alleviates the symptoms of carpal tunnel syndrome.

Try to perform normal activities with your healthy hand if you have a pinched nerve in the elbow, wrist, or shoulder. If this is not possible, minimize the load on your sore hand: perform only the most necessary actions with it, shifting the bulk of the work to your healthy one.

Get into the habit of sleeping on the side opposite your sore arm, leg, or shoulder blade. This will allow the affected area to “rest” during your night’s sleep and thus compensate for daytime stress.

Carpal (or carpal) tunnel syndrome is a condition that develops when the median nerve located in the carpal tunnel is injured or compressed. Sometimes this syndrome is called tunnel syndrome, but this is not quite the correct term, since there are other tunnel syndromes. With the development of this disease, the sensitivity and movements of the first three and part of the fourth finger occur.

In this article, we will introduce you to the causes, symptoms, and treatment of carpal tunnel syndrome. This information will help you make a timely decision about the need for treatment, and you can prevent the development of irreversible damage to the median nerve.

In the world, carpal tunnel syndrome is detected in 1.5-3% of the population, and in half of the cases, patients are active computer users. This disease is considered occupational, because it is much more often encountered by people who, due to their professional activities, are forced to make frequent and monotonous flexion and extension movements of the hand (for example, office workers who work at the computer for a long time, tailors, musicians, etc. ).

This syndrome is most often observed in people 40-60 years old, but can also develop at a younger age. According to statistics, in 10% of cases the disease is detected in people under 30 years of age.

Experts believe that those people who work at a computer for a long time are most susceptible to developing this syndrome. According to one of the numerous studies, it is detected in every sixth active PC user. According to various sources, the syndrome develops 3-10 times more often in women.

Causes

The main cause of carpal tunnel syndrome is compression of the median nerve as it passes through the tunnel formed by the transverse ligament and bones of the wrist. Constriction is caused by inflammation and swelling of the joint, tendons and muscles within the joint or within the carpal tunnel. In most cases, the cause of such damage to the median nerve is work that requires frequent and repetitive movements.

In addition to occupational factors, the development of carpal tunnel syndrome can be provoked by other diseases and conditions:

. With bruises or sprains, swelling of the ligaments and muscles of the hand occurs, which causes compression of the nerve. Dislocations or fractures, in addition to swelling of the soft tissues, may be accompanied by displacement of the bones. Such injuries put pressure on the nerve. With proper treatment of a dislocation or fracture, the compression is eliminated, but with bone deformation or muscle contractures, disorders in the joint can become irreversible.
and other joint lesions of a rheumatic nature. The inflammation and swelling that occurs with these diseases cause compression of the nerve by the soft tissues of the carpal tunnel. With prolonged progression of the syndrome, the cartilage tissue of the joint ages, loses its elasticity and wears out. Wear and death of cartilage leads to fusion of joint surfaces and their deformation.
Tenosynovitis (tendon inflammation). The tendons are affected by pathogenic bacteria and become inflamed. The tissue in the wrist area swells and puts pressure on the nerve. Sources of infection can be: purulent wounds on the hands, panaritium, etc. In addition, inflammation of the tendon tissue can be non-bacterial and caused by chronic stress injuries: frequent movements of the hand and arm, prolonged exercise, exposure to cold.
Diseases and conditions accompanied by fluid retention in the body. Swelling of soft tissues (including in the carpal tunnel) can be observed when taking oral contraceptives, pregnancy, kidney pathologies or.
Median nerve tumor. Such neoplasms are rarely observed. These may include schwannomas, neurofibromas, perineuromas, and malignant nerve sheath tumors. Their growth causes displacement and compression of the nerve.
Diabetes. The course of this disease is accompanied by the accumulation of fructose and sorbitol in the nerve tissues. When they are activated by the enzyme protein kinase C, damage occurs to neurons and their processes. In addition, metabolic disorders lead to insufficient blood flow to the nerves and a decrease in their nutrition. All these consequences cause non-infectious inflammation of the nerves (including the median nerve). Nerves become swollen and can become compressed in narrow areas such as the carpal tunnel.
. This disease develops over a long period of time and is accompanied by growth of the bones of the face and limbs to disproportionate sizes. In addition to bone changes, soft tissue growth is observed. Enlargement of the carpal bones causes a narrowing of the carpal tunnel, and the median nerve is pinched.
Genetic predisposition. Compression of the median nerve can be observed with such anatomical features of the hand as a “square wrist”, congenital insufficiency in the production of lubricant by the tendon sheaths, or a congenital thick transverse carpal ligament.

Symptoms

The first sign of the disease may be numbness in the fingers.

The development of carpal tunnel syndrome occurs gradually. In most cases, one hand is affected, i.e., the “working” hand (for right-handers - the right, for left-handers - the left). Sometimes nerve compression occurs in both arms (for example, with endocrine disorders or pregnancy).

Paresthesia

Tingling and numbness in the fingers is the first sign of the syndrome. Paresthesia is felt by the patient immediately after waking up, but is completely eliminated by noon. As the syndrome develops, they begin to appear at night, and then during the day. As a result, the patient cannot hold the hand suspended for a long time (when putting the phone to the ear, holding the handrail in public transport, etc.). When trying to perform such holds, paresthesia intensifies and the person changes his hand to perform the action (transfers the phone to the other hand, changes its position, etc.).

Pain

Initially, the patient experiences burning or tingling pain. Occurring at night, they disturb sleep, and a person has to wake up in order to lower his arm down or shake his hand. Such actions help normalize blood circulation in the fingers, and pain is eliminated.

Painful sensations do not occur in specific joints, but are widespread. They capture the entire finger - from base to tip. If left untreated, pain begins to appear during the day. Any movement of the hand causes them to intensify, and the patient cannot work fully. In severe cases of the syndrome, pain can involve the entire palm and spread all the way to the elbow, making diagnosis difficult.

Clumsy hand movements and loss of strength

As the syndrome worsens, the patient develops weakness in the arm and is unable to perform precise movements. It is difficult for him to hold small objects (a needle, a button, a pen, etc.), and such actions are accompanied by the feeling that they are falling out of the hand.

In some cases, there is a decrease in the force of opposition of the thumb to the rest. It is difficult for the patient to move it away from the palm and actively grasp objects.

Decreased sensitivity

This symptom appears when there is significant damage to the median nerve. A third of patients complain of a reaction to a sudden change in temperature or cold: a burning sensation or painful numbness is felt in the hand. Depending on the severity of the disease, the patient may not feel a light touch on the hand or a pin prick.

Amyotrophy

This muscle change appears in the absence of treatment in the later stages of the syndrome. The patient experiences a visual decrease in muscle size. In advanced cases, the hand becomes deformed, and it becomes like a monkey's paw (the thumb is brought to the flat palm).

Change in skin color

Violation of the innervation of skin cells leads to disruption of their nutrition. As a result, the skin of the fingers and the area of the hand innervated by the median nerve acquires a lighter shade.

Diagnostics

To diagnose carpal tunnel syndrome, the patient needs to consult a neurologist. The patient's examination plan includes special tests, instrumental and laboratory methods.

Tests for carpal tunnel syndrome:

Tinel test. Tapping from the palm of the hand in the area of the narrowest part of the carpal tunnel causes tingling in the fingers.
Phalen test. The patient should bend the arm as much as possible at the wrist and hold it there for a minute. With carpal tunnel syndrome, increased paresthesia and pain occur.
Cuff test. A blood pressure cuff is placed between the elbow and wrist. It is inflated with air to significant figures and left in this position for one minute. The syndrome causes tingling and numbness in areas innervated by the median nerve.
Raised hands test. Hands are raised above the head and held for a minute. With the syndrome, after 30-40 seconds the patient feels paresthesia in the fingers.

Such tests can be used for preliminary self-diagnosis at home. If you experience discomfort during even one of them, you should consult a doctor.

To clarify the diagnosis, the patient is prescribed the following instrumental examination methods:

electroneuromyography;
radiography;

To identify the causes of the development of carpal tunnel syndrome (for example, rheumatoid arthritis, diabetes mellitus, autoimmune diseases, hypothyroidism, etc.), the following laboratory diagnostic methods may be recommended to the patient:

blood biochemistry;
blood and urine test for sugar;
analysis for thyroid-stimulating hormones;
clinical analysis of urine and blood;
blood test for rheumatoid tests (rheumatoid factor, C-reactive protein, antistreptolysin-O);
blood test for CIC (circulating immune complexes);
blood test for antistreptokinase.

Treatment

Treatment for carpal tunnel syndrome always begins with a protective regimen that removes stress from the wrist. In the absence of such measures, therapy is ineffective.

Security mode for carpal tunnel syndrome:

When the first signs of the syndrome appear, the hand should be fixed using a special clamp. Such an orthopedic product can be purchased at a pharmacy. It allows you to reduce the range of motion and prevent further tissue trauma.
For two weeks, completely avoid activities that cause or worsen symptoms. To do this, it is necessary to temporarily change jobs and eliminate movements that cause increased pain or paresthesia.
Apply cold for 2-3 minutes 2-3 times a day.

The further treatment plan for carpal tunnel syndrome depends on the severity of its symptoms. If necessary, it is supplemented by therapy for the underlying disease that causes compression of the median nerve (for example, rheumatoid arthritis, trauma, hypothyroidism, renal pathologies, diabetes, etc.).

Local treatment

This type of therapy allows you to quickly eliminate acute symptoms and discomfort that bother the patient.

Compresses

To perform compresses, various multicomponent compositions can be used to eliminate inflammation and swelling of the tissues of the carpal tunnel.

One of the composition options for compresses:

Dimexide – 60 ml;
Water – 6 ml;
Hydrocortisone – 2 ampoules;
Lidocaine 10% - 4 ml (or Novocaine 2% - 60 ml).

Such compresses are performed daily. The duration of the procedure is about an hour. The resulting solution from the preparations can be stored in the refrigerator for several days.

Injecting drugs into the carpal tunnel

Using a special long needle, the doctor injects a mixture of solutions of a local anesthetic (Lidocaine or Novocaine) and a glucocorticosteroid hormone (Hydrocortisone or Diprospan) into the carpal tunnel. After the introduction of this composition, pain and other unpleasant sensations are eliminated. Sometimes they can get worse in the first 24-48 hours, but after that they begin to gradually regress and disappear.

After the first administration of such a composition, the patient's condition improves significantly. If the signs of the syndrome return again after some time, then two more such procedures are performed. The interval between them should be at least 2 weeks.

Drug therapy

The choice of medications, dosage and duration of their use depend on the severity of the disease and concomitant pathologies. The drug treatment plan for carpal tunnel syndrome may include the following:

B vitamins (B1, B2, B5, B6, B7, B9 and B 12): Milgamma, Neurobion, Neurobex, Doppelhertz active, Benevron, etc.;
non-steroidal anti-inflammatory drugs: Xefocam, Dicloberl, Airtal, Movalis, etc.;
vasodilators: Pentilin, Nicotinic acid, Trental, Angioflux;
: Hypothiazide, Furosemide, Diacarb, etc.;
anticonvulsants: Gabapentin, Pregabalin;
muscle relaxants (drugs for muscle relaxation): Sirdalud, Mydocalm;
glucocorticosteroids: Metipred, Hydrocortisone, Prednisolone;
antidepressants: Duloxetine, Venlafaxine.

Physiotherapy

Physiotherapeutic treatment methods can be used against the background of drug therapy or for the rehabilitation of patients after surgery.

Treatments for carpal tunnel syndrome include:

acupuncture;
manual therapy techniques;
ultraphonophoresis;
shock wave therapy.

Prescribing physiotherapeutic procedures is possible only if there are no contraindications to them.

Surgery

Surgery for carpal tunnel syndrome is recommended if other methods of therapy are ineffective and symptoms of the disease persist for six months. The purpose of such surgical interventions is aimed at expanding the lumen of the canal and eliminating pressure on the median nerve.

Tunnel syndrome is a whole group of diseases of peripheral nerve fibers that arise due to compression of these nerves in certain anatomical canals (tunnels) of the body, which can be formed by bone, muscle and tendon anatomical structures.

To date, several dozen tunnel syndromes have been described. Some of them are very common, for example, carpal tunnel syndrome, which affects approximately 1% of the entire population, others can be seen quite rarely and are known only to specialized specialists.

Despite the clinical diversity of this group of pathologies of the peripheral nervous system, the root causes of development are the same - pinching of the nerve fiber in its natural anatomical location. This pathology can also be found in the English-language medical literature under the name trap neuropathy, which very well reflects the mechanism of nerve damage.

In addition to compression of the nerve tissue, with the development of tunnel syndrome, a disruption of the blood supply to the nerve occurs. This leads to another common name for this group of pathologies – compression-ischemic neuropathy.

Tinel's symptom is important in the diagnosis of tunnel syndromes: when tapping in the area of the affected nerve, tingling and painful sensations occur

Tunnel syndromes of the arms are the most common; the nerve trunks of the lower extremities are much less likely to be affected. As a rule, the onset of the disease occurs at the age of 30-45 years, women are affected more often than men. The course of the pathology is chronic in nature with periods of exacerbations and remissions, accompanied by 3 clinical syndromes - pain, signs of impaired sensitivity and motor function of the limb, which can be expressed to varying degrees.

Causes

The main significance in the development of compression-ischemic neuropathies is given to microtraumatization of the nerve of a chronic nature, which is of a professional, household or sports nature. That is why the nerve structures that are in close proximity to the moving joints are most often infringed.

By far the number one cause of carpal tunnel syndrome is using a computer mouse and keyboard.

Metabolic and endocrine disorders in the body increase the risk of developing this group of diseases. For example, the disease more often occurs in women during pregnancy, breastfeeding, during menopause, in patients with hypothyroidism, and with long-term use of hormonal drugs, including oral contraceptives.

In some cases, severe weight loss may be the cause of a pinched nerve. This reduces the amount of fatty tissue that protects the nerve and performs shock-absorbing functions for it.

Cases of familial tunnel syndromes have also been described in medicine. At the same time, the relatives initially recorded distinctly narrow canals in which the nerve fibers are located.

The risk of such disorders is also increased in patients with systemic connective tissue diseases, arthritis, arthrosis, previous injuries and joint surgeries, diabetes mellitus, chronic alcoholism, multiple myeloma and other hematological diseases.

The most common tunnel syndromes are discussed below.

Carpal tunnel syndrome

Carpal tunnel syndrome accounts for approximately 50% of all compression-ischemic neuropathies and its incidence has been increasing sharply in recent years, which can be explained by the increase in the number of workers who regularly use a keyboard and computer mouse.

The carpal tunnel (carpal tunnel) itself is very narrow, its bottom and walls are the bones of the wrist, and the canal is covered on top by the transverse carpal ligament. Inside the sheath are the finger flexor tendons and the median nerve.

When carpal tunnel syndrome occurs, the median nerve is affected

The median nerve is mixed in function, that is, it provides both sensitivity and motor activity. It takes part in the innervation of the palmar surface of the 3-5 fingers, interdigital areas and the back of the nail phalanges of the first 3 fingers. The motor part of the nerve ensures the normal function of the muscles that form the eminence of the first finger of the hand.

Symptoms of Carpal Tunnel Syndrome

If carpal tunnel syndrome develops, the patient develops compression-ischemic neuropathy of the median nerve. The pathology is characterized by a chronic long-term course. Among the first signs of neuropathy are pain in the area of corresponding innervation, paresthesia (tingling, crawling sensation, numbness), which appear mainly at night and often cause a person to wake up. As the disease progresses, these symptoms bother you both day and night.

Innervation zone of the median nerve

At the next stage of disease progression, the sensitivity of the skin gradually decreases and motor disorders appear - a decrease in the muscle strength of the tenor muscles, wasting and atrophy of muscle tissue, weakness in the hand, the inability to perform habitual movements and even hold objects.

Pain from carpal tunnel syndrome is characterized by spreading not only to the hand, but also to the forearm, shoulder and even to the neck. Painful sensations are reduced by rubbing and shaking the hands (the blood supply to the damaged nerve improves).

Simple tests to diagnose carpal tunnel syndrome:

Tinel test - upon percussion in the area of the damaged nerve, the appearance or intensification of pain and paresthesia in the area of its innervation is observed.
Upper limb elevation test– to do this, you need to raise and extend your arms straight above your head, and hold your limbs in this position for 60 seconds. Due to a decrease in blood flow, a patient who has carpal tunnel syndrome experiences pain and paresthesia.
Flexion test– to do this, you need to bend the hand at the wrist joint as much as possible and hold it in this position for a minute. Subsequently, when the arm is extended, pain and paresthesia occur in the zone of innervation of the median nerve.
The bottle test becomes positive only if movement disorders are associated. In this case, the patient cannot lift and hold the bottle by the neck with his thumb and forefinger.

In the case of gross pathological changes at a late stage of the disease, the appearance of the hand changes significantly. The skin becomes very pale, the tenor's muscles atrophy, and the hand begins to resemble a primate's paw.

Arrows indicate tenor muscle atrophy in a patient with carpal tunnel syndrome

Treatment for Carpal Tunnel Syndrome

After the diagnosis is made, conservative therapy is resorted to; surgical treatment can be immediately prescribed only in isolated cases, for example, when nerve compression is caused by injury or callus growth after a wrist fracture.

First of all, you need to get rid of all possible factors that could cause the disease. It is important to ensure complete rest for the hand during the active phase of treatment. To immobilize a limb as much as possible, you can use special bandages, bandages, etc. You also need to take care of the ergonomics of your workplace. If you work with a computer, you need to follow some rules for placing your hands on the keyboard and mouse.

There are also various gadgets that allow you to maintain the desired position of your hands when working and prevent further injury to the median nerve, for example, vertical mice, silicone mats with gel pads, and other devices.

Such a simple gadget will ensure the correct position of the hands when working with a regular computer mouse and will be an excellent prevention of the development of carpal tunnel syndrome

Medications include analgesics and anti-inflammatory drugs. In more complex cases and with severe pain, they resort to blockade using glucocorticosteroids. Complex treatment also includes therapeutic exercises, physiotherapy, massage, and acupuncture.

If conservative measures are unsuccessful, then surgery will help cure the neuropathy. In this case, the carpal ligament of the canal is surgically incised and the nerve is released from the trap. There are several ways to perform surgical intervention; in modern clinics, they even use endoscopic equipment for this purpose, which avoids a large surgical incision. The recovery period takes up to 3 months.

Important! Treatment for carpal tunnel syndrome should be started promptly. If no measures are taken for a long time, irreversible changes can occur in the tissues of the median nerve, which will lead to a complete loss of function of the nerve fiber.

Cubital tunnel syndrome

Among the tunnel syndromes of the upper limb, cubital tunnel syndrome should also be highlighted, which occurs as a result of entrapment of the ulnar nerve in the cubital canal.

The cubital canal contains the ulnar nerve, which can be pinched with the development of compression-ischemic ulnar neuropathy

Due to the superficial passage of the nerve fiber in this place and the high mobility of the elbow, the ulnar nerve is prone to damage in the cubital canal area. This pathology is in second place among carpal tunnel syndromes after damage to the carpal tunnel.

Innervation zone of the ulnar nerve

Most often, the cause of the development of pathology is damage to the nerve fiber due to prolonged static overvoltage and pressure on the nerve, for example, the habit of talking on the phone for a long time, resting the elbow on the table, etc. The disease is also contributed to by metabolic and endocrine diseases, injuries, surgeries on the elbow joint, arthritis and arthrosis of this joint.

Symptoms of neuropathy also include three main points:

Characteristic position of the hand in claw-toe neuropathy of the ulnar nerve

pain in the area of innervation of the ulnar nerve;
sensory disorders - insemination, paresthesia, decreased sensitivity;
movement disorders that occur as the disease progresses - weakness of the 4th and 5th fingers of the hand, atrophy of the hypotenor muscles and interosseous muscle fibers, a characteristic position of the hand like a clawed paw.

In the treatment of this pathology, both conservative and surgical methods are used. It is important to fix your arms in an extended position; for this, there are special splints that can be worn at night while sleeping at home. In the complex of therapy, medications, physiotherapy, folk remedies, and physical therapy are used.

Surgery is prescribed if conservative treatment is ineffective. During the manipulation, the ligament that covers the cubital canal from above is dissected and, thus, the nerve is released, which gradually restores its functions on its own (if the disease has not gone too far).

Radial nerve neuropathy

The radial nerve can be compressed in several places along its course, but most often this occurs at the level of the distal portions of the brachial canal.
In this case, signs of complete damage to the trunk of the radial nerve are observed:

paralysis of the muscles that extend the hand and fingers (“droopy hand”);
sensory disorders on the back of the forearm and on the back of the radial half of the hand (1st and 2nd fingers);
pain on palpation of the affected area.

Radial neuropathy manifests as drop hand syndrome

This disease is also called Saturday night paralysis or honeymoon paralysis.

How to treat radial nerve neuropathy? Treatment can be conservative or surgical. If a complex of various therapeutic measures is ineffective, they resort to surgery.

Peroneal nerve neuropathy

Most often, pinching of this nerve occurs between the head of the fibula and the edge of the long tibial muscle. This situation occurs with sharp plantar flexion of the foot, in case of sprain of the ankle joint.

The result is injury to the fibular nerve, which can become chronic with the development of neuropathy. Also, compression of the nerve can be observed when performing certain types of work while squatting, sitting in a cross-legged position, or when applying a tight plaster cast.

In this case, there is paralysis of the muscles that extend the foot and toes, decreased sensitivity of the outer surface of the lower leg, the back of the foot and 1-4 fingers. If neuropathy persists for a long time, atrophy of the anterior and posterior groups of the lower leg muscles develops. Upon palpation and percussion of the affected area, the patient feels pain and the occurrence of paresthesia.

Roth's disease

This is one of the common lower limb tunnel syndromes. In this case, compression-ischemic damage to the lateral cutaneous femoral nerve occurs. The nerve performs only a sensory function and does not contain motor fibers; it innervates the skin of the anterior outer surface of the middle third of the thigh.

In Roth disease, the lateral cutaneous nerve of the thigh is compressed.

The main symptom of the pathology is numbness and burning pain in the corresponding innervation zone. In the later stages of development of the pathology, there is a complete loss of sensitivity in this area of the skin. When the hip is extended, the pain increases, and when it flexes, it decreases.

As a rule, this disorder does not cause serious inconvenience for the patient, but in some cases the pain becomes very severe. This situation is an indication for surgery in the inguinal ligament area.

Interestingly, Sigmund Freud suffered from neuropathy of the lateral cutaneous nerve of the thigh, believing that this pain was psychogenic in nature.

When tarsal tunnel syndrome develops, the tibial nerve is compressed. Compression occurs predominantly in the area of the osteofibrous tarsal canal (tarsal).

Most often, the pathology develops due to injuries in the ankle joint; in some cases, the cause of the compression cannot be determined

The main symptom of the disease is pain felt in the area of the sole of the foot and toes. Painful sensations arise or intensify when walking, and a symptom of intermittent claudication occurs. The pain also occurs spontaneously at night and helps the patient wake up. Very often the pathology is bilateral.

Piriformis syndrome

In the case of the development of compression-ischemic neuropathy of the sciatic nerve, we speak of. It occurs as a result of a spastic contraction of the latter, due to which the sciatic nerve is pressed against the sacrospinous ligament. A similar situation is often observed in patients with degenerative-dystrophic lesions of the spine.

Signs of the disease include burning pain and the development of paresthesia in the area of innervation of the common tibial nerve. Patients also experience a decrease in the Achilles tendon. Over time, weakness of the lower leg muscles develops.

The development of carpal tunnel syndrome significantly affects the quality of life of patients. But the prognosis with a timely diagnosis and proper treatment is favorable. That is why you do not need to delay your visit to the doctor if you are concerned about the symptoms described in the article. It should be understood that there are a lot of diseases of the peripheral nervous system, and only a specialist can find out the cause and make an accurate diagnosis.

Carpal tunnel syndrome occurs when the median nerve is compressed. The pathological process is accompanied by negative symptoms. Carpal (wrist syndrome) develops more often in women, but men also suffer from this pathology.

Damage to the median nerve is often associated with characteristics of professional activity, and often develops against the background of bad habits. How to protect your hands from nerve compression? How to recognize carpal tunnel syndrome in time? Let's figure it out.

general information

The carpal tunnel in the hand area is formed by the transverse ligament on the upper side, the carpal bones below and on the sides. Damage to the median nerve occurs when the anatomical canal is compressed. In the absence of pathological changes, nerves and tendons pass inside the tunnel; excess pressure provokes a narrowing of the cavity, damage to the sensitive branches responsible for the innervation of the fingers.

Why do women suffer from carpal tunnel syndrome more often than men? The carpal tunnel in the fair sex is already present; throughout life, the female body experiences many phenomena associated with hormonal changes: menopause, pregnancy, taking hormonal contraceptives.

Reasons for the development of the disease

Doctors do not give an exact answer to the question about the origin of pathological processes in the carpal tunnel area. There are many factors that increase the risk of median nerve compression in the hand. With age, the risk of pathological changes increases. Often there are several negative factors, and the disease is more acute.

Compression of the nerve in the wrist area occurs in the following cases:

microtrauma due to constant impact on the hand area (construction, repair work, the need for prolonged use of a computer);
swelling of tissues, stretching due to injury to the hand;
negative processes accompanied by deformation of the tendons and carpal tunnel against the background of hormonal imbalances and certain diseases (hypothyroidism, the appearance of osteophytes, menopause, pregnancy);
high degree of obesity;
poor blood supply to tissues due to smoking;
tumors in the wrist or carpal tunnel (lipoma, hemangioma, neurofibroma).

Many doctors consider carpal tunnel syndrome to be an occupational disease of programmers, system administrators, and webmasters. Previously, the pathology was diagnosed at the age of 40 and later, now problems with the hands, compression of the median nerve are often found in young people under 35 years of age.

First signs and symptoms

Negative signs initially appear only after prolonged exercise. As the pathological process progresses, with significant narrowing of the canal, the symptoms become more acute.

It is worth paying attention to the following signs:

numbness of fingers. Negative symptoms appear only at night, fingers from the first to the fourth are affected;
there is pain in the hand area, tingling;
Often patients feel as if they have “goosebumps” inside;
hands become weak.

With further compression of the nerves and tendons, new signs are added:

muscles atrophy;
It is more difficult to perform habitual hand movements than before;
it is impossible to make small, precise movements with your fingers;
if the case is severe, discomfort spreads to the forearm, elbow area, and shoulder.

Diagnostics

The following tests can help confirm or refute the diagnosis of carpal tunnel syndrome:

Durkana.
Falena.
Tinelya.

Also carried out:

electrodiagnostics;
opposition test;
shaking your fingers to control sensitivity.

It is important to differentiate carpal tunnel syndrome from pathologies that have similar symptoms:

cervical radiculopathy;

Effective treatments

If compression of the anatomical canal in which nerves and tendons pass is confirmed, the doctor recommends complex therapy. The pathology is treated by a traumatologist-orthopedist and a neurologist.

Not only drug therapy is required, but also physiotherapy, therapeutic exercises, and limiting the load on the problem area. During treatment, you cannot engage in professional activities that involve monotonous movements of the arm and hand.

Medications

Effective medications reduce pain and eliminate swelling. The action of the compositions allows the compressed canal to return to its usual size and eliminates the cause for the development of negative symptoms.

drugs that relieve inflammation - . Potent tablets, ointments, and gels prevent the spread of the inflammatory process to new areas, reduce swelling, and relieve pain in the problem area. Effective compositions: Diclofenac, Nise, Voltaren, Indomethacin, Acetylsalicylic acid, Ibuprofen, Ketoprofen, Naprofen. The selection of drugs is carried out by the attending physician: medications have contraindications for use; many formulations in tablet form irritate the mucous membranes of the stomach and intestines and have a negative effect on the liver;
hormonal drugs to eliminate pain, break the chain of the inflammatory process. A short course of active treatment using Hydrocortisone and Prednisolone is recommended. Intra-articular injections are an effective method of eliminating inflammation and reducing pain. Hormonal drugs have more side effects than NSAIDs; long-term use often leads to irreversible damage in various parts of the body.

Other treatment methods supplement the use of medications:

electrophoresis with hydrocortisone and analgesics;
wearing special splints and orthoses to fix the affected hand in a physiological position;
in the early stages of pathology, mild pain syndrome is helped by applying cold, reducing the load on the hands and fingers.

Folk remedies and recipes

Proven recipes:

cabbage leaf compress to relieve swelling and reduce inflammation. The effectiveness of the procedure is increased by applying thin honey to the surface of a cut cabbage leaf. The combination of a beekeeping product and cabbage juice has a positive effect not only for carpal tunnel syndrome, but also for arthritis, rheumatism, gout, and periarthritis of the shoulder joint;
contrast baths with chamomile infusion, sea salt, sage infusion. Each product has a positive effect on the condition of the hands, reducing swelling and inflammation. To prepare a decoction of medicinal herbs, pour a tablespoon of the raw material into a liter of boiling water, let it brew for an hour, and strain. A hand bath with sea salt is 2 liters of warm water plus two tablespoons of a healthy product. The duration of the procedure is no more than a third of an hour, the water temperature is no higher than +36 degrees;
compress with horseradish leaves. Another simple way to reduce pain in a problem hand. Before use, dip the washed leaves in boiling water for a minute, shake off the water, cool, wrap the affected area, and leave for 45 minutes. After the procedure, apply nourishing cream. If the skin of your hands is tender and flaky, it is advisable to lubricate your hands with vegetable oil before the treatment session;
diuretic tea against tissue swelling. Stopping excess pressure on the anatomical tunnel is the main goal of therapy. There are many recipes for teas and herbal infusions that accelerate the removal of excess fluid from the body. Medicinal herbs, fruits and berries do a good job: dill, lingonberries, parsley, cornflower, bearberry. Corn silk, wild strawberries, horsetail, and knotweed have a beneficial effect. Diuretic berries and herbs are used with caution. There are restrictions: in particular, active removal of fluid using traditional medicine and drugs is prohibited during pregnancy.

Important! The use of traditional methods complements drug therapy and physiotherapy, but does not replace them. In difficult cases, only surgical treatment helps. The operation removes compression of the problem area. The surgeon partially or completely cuts the transverse ligament, and the lumen of the anatomical canal is restored.

Possible complications

Not all patients turn to a neurologist and orthopedist-traumatologist on time, especially with mild pain in the hand of a periodic nature. The longer the start of treatment is delayed, the higher the risk of severe damage to the median nerve.

In advanced cases, the nerve fibers atrophy, and the mobility of the fingers is impaired due to the lack of innervation. Untimely therapy often leads to loss of sensory and motor function of the fingers.

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Prevention measures

Carpal tunnel syndrome interferes with normal activities and manifests itself as discomfort in the hand. Every person should know preventive measures to reduce the risk of pathological changes in the hand area.

How to proceed:

stop smoking: lack of nutrition worsens the condition of blood vessels and nerve fibers;
take breaks from working at the computer, remember to take a five-minute rest every hour, and do not forget about exercises for your hands and fingers;
relax your arms and hands more often when painting and plastering. Builders and repairmen should massage their hands and, after a shift, apply ointments and gels with a cooling, decongestant effect;
properly equip the workplace to minimize stress on the hands. When working at a computer for a long time, armrests to support your elbows are required;
be sure to use a mouse pad, place the brush further from the edge, maintain the bend angle in the elbow area at 90 degrees;
exercise every day, do exercises. Good condition of the musculoskeletal system, elasticity of the ligaments reduces the risk of developing carpal tunnel syndrome in the wrist area;
control body weight. The fewer extra pounds, the lower the load on joints and cartilage tissue;

Video. Elena Malysheva about carpal tunnel syndrome:

Tunnel syndromes form a separate group, representing a whole complex of trophic, sensory and motor disorders that appear as a result of compression in the canals of peripheral nerves.

Tunnel syndromes and causes of their occurrence:

Congenital anomalies expressed in the narrowness of the canal;
. injuries;
. frequent repetitions of stereotypical movements;
. concomitant diseases (rheumatoid arthritis, chronic renal failure, amyloidosis, diabetes mellitus, hypothyroidism and others).

Despite the fact that carpal tunnel syndromes can occur in different places and for different reasons, there is a general list of symptoms characteristic of this group of diseases:

. “shooting” and “pecking” pains;

Numbness;

Tingling sensation when moving;

Limited movement;

Weakness of certain muscle groups;

Hypotrophy.

The doctor studies the clinical picture of the disease, performs ultrasound and electroneuromyography.

Tunnel syndromes and their types

There are two main types of tunnel syndromes:

Each of these pathologies has its own specific characteristics and can bring a lot of trouble to a person.

Carpal tunnel syndrome (carpal tunnel syndrome)

In recent years, more and more people are faced with manifestations. This is due to the fact that people, for one reason or another, spend too much time working with electronic devices: computers, tablets, mobile phones.

The cause of this type of syndrome is compression of the carpal ligament. Most often, this disease affects musicians (pianists, violinists, cellists) and people whose work involves stress on the hands and frequent repetition of flexion and extension movements (programmers, builders).
This type of tunnel syndrome manifests itself as a decrease in the sensitivity of the middle, index and thumb fingers, pain, including at night, and the transition of the pain syndrome further along the arm (up to the elbow joint). The sensitivity of the first three fingers to touch and temperature decreases, muscle weakness.

Tunnel syndrome: treatment

In the treatment of carpal tunnel syndrome, both surgical (nerve excision) and conservative treatment methods (physiotherapy, steroids, exercise therapy, acupuncture, limb fixation, vitamin therapy) are equally successfully used. The doctor's recommendations will largely depend on the stage of the disease. However, before you begin to treat the disease, you need to find the reason why it manifested itself. When it is a local or general disease, it would be more appropriate to conduct additional examinations and therapy for the underlying disease. It is possible that then the syndrome will go away along with the disease that provoked it.