Treatment of carpal tunnel syndrome. Carpal carpal syndrome: treatment from a practitioner

One of the types of neuritis is carpal tunnel syndrome, which leads to decreased sensitivity of the fingers and disrupts their normal functioning. Lack of timely treatment can lead to muscle atrophy and motor ability of the hand. Knowing the causes of this disease, characteristic symptoms and possible consequences, it will not be difficult for a person to understand that he needs to seek help from a doctor as quickly as possible. You should study information on how to protect yourself from a disease that can leave the patient incapacitated for a long time.

What is carpal tunnel syndrome

A complex of interrelated signs of compression-ischemic compression of the median nerve in the carpal tunnel is called carpal tunnel syndrome. This disease is neuropathic in nature and blocks normal flexion at the junction of the forearm and hand. There are several synonymous names for this syndrome:

carpal tunnel;
wrist;
carpal tunnel.

The carpal tunnel (tunnel) is located at the base of the hand, formed by the carpal bones and the transverse ligament. In addition to the median nerve, the tendons of the finger flexor muscles pass through it. As a result of the disease, the innervation of the muscles that are responsible for abduction and opposition of the thumb (the ability to touch the pulps of other fingers), flexion, and extension of the phalanges is affected. The patient feels pain with the slightest movements of the hand.

Causes of Carpal Tunnel Syndrome

Statistics show that women are more often affected by the syndrome. It often blocks the normal function of the hands of people whose professional activities are associated with systematic flexion-extension movements of the wrist joint: office workers who often use a computer mouse, keyboard, pianists, drummers, etc. for a long time the hand is extended more than 20° in relation to the radius and ulna.

Carpal tunnel syndrome can be caused by:

Injuries. Any traumatic injury to the hand (bruise, sprain, fracture), as a result of which the median nerve of the wrist is compressed, causes symptoms characteristic of carpal tunnel syndrome.
Rheumatoid arthritis. Inflammation of the wrist caused by this disease leads to the growth of the soft tissue of the tunnel in which the median nerve of the wrist is located, and compression of it.
Tenosynovitis is an inflammation of the connective tissue of the tendons. This disease can have both an infectious origin (pulmonary tuberculosis, felon of the fingers) and a mechanical one: overstrain of the tendons as a result of prolonged stress on the hand. The disease is sometimes provoked by prolonged exposure to cold on the human body.
Fluid accumulated in the human body as a result of painful conditions. Swelling during menopause, pregnancy, renal failure, etc., affecting the soft tissues of the canal, leads to compression of the nerve.
A tumor caused by neoplasms on the membranes of nerve tissue. Rarely seen. Diagnosed as schwannoma, neurofibroma, etc.
Diabetes mellitus. Damage to neuronal processes and processes characteristic of this disease may be caused by the accumulation of fructose and sorbitol in nerve tissue. As a result, the median nerve of the carpal tunnel can also suffer from pressure from the carpal tunnel walls.
Acromegaly is a dysfunction of the pituitary gland. This disease is accompanied by an unnatural growth of the bones of the limbs, the soft tissue of the canals in which the nerves are located, which provokes pinching of the carpal tunnel nerve.
Genetics. “Square wrist” is a congenital anomaly in which there is insufficient production of lubrication by the tendons of the hand. The transverse carpal ligament is thicker than in normal people and puts pressure on the nerve endings.

Symptoms of the syndrome

Carpal tunnel syndrome develops gradually. It can affect one or both hands, depending on the reasons: systemic disorders of the body sometimes provoke compression of the median nerve of two limbs, professional activity more often leads to disease in the hand of the active hand. Tissue paresthesia (numbness, loss of sensation) first appears in the morning, but disappears by midday. Later, the duration of the lack of sensitivity increases - it can be felt both during the day and at night. The disease is accompanied by pain in the form of burning and tingling.

Symptoms appear over time in all fingers except the little finger, which is a characteristic feature of carpal tunnel syndrome. In the absence of necessary therapy, the pain spreads to the inside of the forearm. Systemic diseases can simultaneously affect the nerve of the elbow joint. The patient feels weakness in his hand, it is difficult for him to hold small objects. There is awkwardness in movements. Trophic disorders occur (impaired nutrition of tissue cells), which can lead to atrophy of the muscles of the limb.

Diagnostics

Carpal tunnel syndrome requires a neurological examination to establish an accurate diagnosis and prescribe effective treatment for the disease. A person who experiences the symptoms described above should seek help from a neurologist. First, the doctor carefully collects an anamnesis (a set of information obtained from interviewing the patient). If wrist syndrome is suspected, he uses a number of tests to diagnose:

Tinelya. When tapping on the inside of the palm in the area of the canal, the patient feels a tingling sensation in the fingers due to carpal tunnel syndrome.
Falena. Provides for the patient to bend the arm to the maximum extent possible at the wrist joint and maintain this position for exactly a minute. Increased pain and paresthesia will indicate compression of the median nerve of the wrist.
Cuff. A blood pressure measuring device cuff is placed on the patient's forearm, air is pumped into it, and left in this position for a minute. Pain and numbness in areas innervated by the median nerve confirms the presence of carpal tunnel syndrome.
Raised hands. The patient is asked to raise his arms above his head for 40 seconds. Increased paresthesia indicates compression of the median nerve of the hand.

Diagnosis of carpal tunnel syndrome requires an integrated approach. The main diagnostic measures to identify the disease are the following instrumental examination methods:

Electroneuromyography. Using a special device, nerve endings are artificially stimulated with electric current. The speed of impulse movement along the nerve is calculated and the presence or absence of a muscle response to stimulation is recorded. Based on certain signs, the specialist determines: the function of which nerve is impaired, the level and nature of the lesion.
Radiography is an auxiliary method. An x-ray of the wrist joint will show the presence of a fracture, dislocation, inflammatory processes (with arthritis), etc. By eliminating the influencing factors that provoked the disease, the neurologist determines the true cause of the disease and makes a final diagnosis.
Magnetic resonance imaging (MRI) is a modern technique that allows you to obtain a three-dimensional image of any tissue of the human body. This method shows the presence of diffuse edema and widening of the median nerve segments. It can be used to determine the presence of tumors localized on the nerve sheath, lipomas (overgrowth of connective tissue) of the periosteum. This helps to accurately determine the cause of the patient’s symptoms.
Ultrasound (US) is a widely used method in diagnosing carpal tunnel syndrome. With its help, you can identify the reasons that contribute to the inhibition of nerve function in the canal:
damage to muscles, tendons and ligaments;
bursitis;
pathology of blood vessels;
lipomas;
hematomas;
abscess, swelling of adjacent tissues;
bone pathologies, etc.

If the doctor suspects a systemic origin of the cause of carpal tunnel syndrome, the patient is prescribed a series of tests for laboratory testing of the general condition of the body:

blood:
to determine sugar levels;
for thyroid-stimulating hormones to identify dysfunctions of the thyroid gland and metabolic processes in the body.
for detailed analysis (content of red blood cells, leukocytes, hemoglobin, etc.);
for rheumatic tests (biochemical study of blood to determine the presence of inflammatory processes in the body, their exact location, what caused them);
to determine circulating immune complexes (CIC) in plasma, indicating inflammation of bones and soft tissues;
antistreptokinase - an analysis that determines the presence of infection in the human body.
urine for:
determining the level of glucose in urine;
clinical analysis to identify pathologies of the kidneys, genitourinary system and assess dysfunction.

Treatment of carpal tunnel syndrome

The first step in treatment is compliance with the protective regime. It involves fixing the wrist joint with a special orthopedic product, which can be purchased at a pharmacy. The clamp eliminates stress on the wrist area. You will have to keep the joint connecting the forearm and hand completely still for two weeks. Without this regimen, it is impossible to avoid further tissue injury. The attending physician will recommend applying cold 3 times a day for 2-3 minutes to the inner surface of the wrist.

Drug therapy

The neurologist prescribes medications for treatment that can relieve the compressive factor, inflammatory processes and restore sensitivity in the areas of the hand innervated by the median nerve. The medications prescribed by the doctor, their dosage and duration of treatment will depend on the severity and reasons that caused it. Drug therapy often includes the use of:

Group of drugs	Examples of drugs
B vitamins	Milgamma, Neurobion, Neurobex, Doppelhertz active, Benevron
Anti-inflammatory (non-steroidal)	Ksefokam, Dikloberl, Aertal, Movalis, Xefokam
Vasodilators	Pentilin, Nicotinic acid, Trental, Angioflux
Diuretics	Hypothiazide, Furosemide, Diacarb
Anticonvulsants	Gabapentin, Pregabalin
Muscle relaxants (promoting muscle relaxation)	Sirdalud, Mydocalm
Glucocorticosteroids (hormonal drugs)	Metypred, Hydrocortisone, Prednisolone
Antidepressants	Duloxetine, Venlafaxine

Means for topical treatment

Local treatment is used as part of a set of measures to restore the functions of the median nerve of the carpal tunnel. Compresses applied to the wrist joint, in which the active substance is composed of several drugs, are aimed at eliminating swelling and inflammation. Often Dimexide, Hydrocortisone, Lidocaine are used for this, the proportions of which in the compress are recommended by the doctor.

Effective local treatment includes the injection into the carpal canal of a solution of drugs: anesthetics (novocaine or lidocaine) and synthetic glucocorticosteroids (Hydrocortisone or Diprospan). Steroids, when applied topically, with minimal threat of side effects, can significantly inhibit inflammatory processes in the body.

Physiotherapy

Together with drug treatment, the doctor prescribes physiotherapeutic procedures to treat:

Acupuncture. Impact on acupuncture points leads to the activation of the body's reserve forces to fight the disease. The procedure improves blood circulation and relieves pain.
Manual therapy is aimed at desensitizing the central nervous system, which helps reduce pain in the carpal tunnel area.
Shock wave therapy is capable of restoring the vital functions of tissue cells (muscle, nervous), thanks to the rapid narrowing and expansion of adjacent blood vessels under the shock wave of the device.
Ultraphonophoresis. Under the influence of ultrasound, anti-inflammatory medications are administered, which helps eliminate pathologies of the median nerve of the wrist joint.

Surgical intervention

If complex drug therapy does not produce a positive result within six months, the patient is offered surgical intervention. The purpose of the operation is to expand the lumen of the carpal tunnel and eliminate the factors that compress the median nerve through surgery.

Two methods of surgical correction are used under local anesthesia:

Open. An incision about 5 cm long is made on the inside of the wrist with a scalpel and the carpal ligament is crossed.
Endoscopic. There are single-portal and double-portal surgical methods, which are used depending on the complexity of the task. The first differs from the second in the number of skin incisions. In this case, an endoscope is used to visually control the passes of the knife unit.

Both methods are difficult to implement. After endoscopic surgery, the patient returns to work sooner than in the case of open surgery, but postoperative complications are observed more often. The rehabilitation period for a patient who has undergone open surgery is 1.5 months. After a successful uniportal dissection of the ligament, all hand functions are restored in approximately 25 days without complications.

Treatment of carpal tunnel syndrome with folk remedies

Traditional medicine offers recipes for preparing remedies that can cope with the feeling of numbness and pain. Medicines are prepared from natural ingredients according to the following recipes:

Cucumber tincture. Cut three medium pickled cucumbers and two red hot peppers into small cubes. Pour the ingredients into 0.5 liters of vodka and leave for 7 days in a dark place. Strain. Rub into the wrist several times a day until the condition improves.
Oil rubbing. Pour 50 g of ground black pepper into 0.5 liters of vegetable oil. Stir the mixture well and simmer on low heat for half an hour without bringing it to a boil. The medicine is rubbed into the sore spot as often as possible while warm.
Pumpkin wrap. Peel a quarter of a small pumpkin, cut into small cubes and boil in a small amount of water. Crush until a homogeneous paste is obtained and apply warm to the wrist area. Wrap it in polyethylene and cover it with a scarf on top. Keep for 2 hours. Course – 5-7 days.

Video

Repeated sprains and fractures, unusual wrist anatomy, arthritis, and certain other conditions can reduce the space in the carpal tunnel, thereby increasing the risk of CTS. Associated symptoms can often be treated at home, but sometimes medical attention is required for complete recovery.

Steps

Part 1

Treatment of CTS at home

Try not to pinch the median nerve. The carpal tunnel is a narrow tunnel made up of small bones in the wrist, connected by ligaments. This channel protects nerves, blood vessels and tendons. The main nerve responsible for the movements of the palm and its sensitivity is called the median nerve. Therefore, you should avoid activities that lead to pinching and irritation of the median nerve, such as frequent bending of the hand at the wrist, lifting heavy objects, sleeping with curved wrists, and punching hard surfaces.

Make sure your watches and bracelets fit loosely on your wrist; if they are too tight, they can irritate the median nerve.
In most cases of CTS, it is difficult to identify a single cause. Typically, CTS is caused by a combination of factors, such as frequent wrist strain coupled with arthritis or diabetes.
The anatomy of the wrist can also contribute - in some people the bones of the carpal tunnel at or do not have the correct shape.

Stretch your wrists regularly. Daily wrist stretching can help reduce the symptoms of CTS or get rid of them altogether. In particular, wrist stretches help expand the space available for the median nerve within the carpal tunnel because it stretches the ligaments surrounding the tunnel. The best way to stretch both wrists at the same time is to assume a “praying pose.” Place your palms together about 6 inches from your chest and lift your elbows until you feel a stretch in both wrists. Hold this position for 30 seconds, then lower your elbows again. Repeat the exercise 3-5 times a day.

Shake your palms. If you feel numbness or aching pain in one or both palms (or wrists), shake them thoroughly for 10-15 seconds, as if shaking water from them. By doing this, you will achieve quick, albeit temporary, improvement. This shaking will stimulate circulation and improve blood flow to the median nerve, causing symptoms to temporarily disappear. You can do this type of exercise, which helps combat the symptoms of CTS, many times a day, just taking a few seconds away from your work.
- Symptoms of CTS most often appear (and first appear) in the thumb, index and middle fingers, as well as part of the ring finger. This is why people with CTS seem clumsy and often drop things.
- Only the little finger is not affected by CTS symptoms because it is not connected to the median nerve.
Wear a special wrist support bandage. This semi-rigid brace or splint will help you avoid the symptoms of CTS throughout the day by keeping your wrist in a natural position and preventing it from bending too much. A wrist splint or brace should also be worn during activities that may aggravate CTS symptoms, such as computer work, carrying heavy bags, driving, or bowling. Wearing a support bandage while you sleep can help prevent nighttime symptoms, especially if you have a habit of tucking your hands under your body while you sleep.
- You may need a support bandage for several weeks (day and night) to noticeably reduce the symptoms of CTS. However, in some cases, the support bandage has a negative effect.
- Wearing wrist splints is also helpful if you have CTS and are pregnant, since your palms (and feet) are more likely to swell during pregnancy.
- Wrist supports and splints can be purchased at a pharmacy or medical supply store.
Consider changing the position in which you sleep. Certain postures can significantly worsen the symptoms of CTS, reducing sleep duration and quality. The worst posture is one in which your fists are tightly clenched and/or your palms (with curved wrists) are tucked under your body; The posture in which the arms are above the head is also unfavorable. Instead, try sleeping on your back or side with your arms close to your body, wrists straight, and palms open. This position will ensure normal blood circulation in the wrists and blood supply to the median nerve.
- As noted above, using support bands while sleeping can help prevent hand and wrist misalignment, but it will take some getting used to.
- Avoid sleeping on your stomach with your arms under the pillow, as this will cause your wrists to become pinched. People sleeping in this position often experience numbness and tingling in their palms upon awakening.
- Most wrist supports are made of nylon and are secured with Velcro, which can irritate your skin. In this case, place a sock or piece of thin cloth under the bandage to reduce skin irritation.
Take a closer look at your workplace. In addition to poor sleep posture, symptoms of CTS can be caused or exacerbated by poor workplace design. If your computer keyboard, mouse, desk, or chair is positioned poorly and without consideration for your height and body type, it can cause tension in your wrists, shoulders, and mid-back. Make sure the keyboard is positioned in such a way that you don't have to bend your wrists all the time when typing. Buy an ergonomic keyboard and mouse designed to reduce stress on your hands and wrists. Your employer may cover the costs.

Take over-the-counter medications. Symptoms of CTS are often associated with inflammation and swelling in the wrist, which further irritates the median nerve and adjacent blood vessels. Therefore, non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Aleve) are often helpful in reducing the symptoms of CTS, at least in the short term. You can also take painkillers such as paracetamol (Tylenol, Panadol) to relieve pain caused by CTS, but they do not reduce inflammation and swelling.

Part 2
Medical care for CTS
1. Make an appointment with your doctor. If you experience the symptoms listed above in your wrist/hand for several weeks or more, you should see a doctor. Your doctor will examine you and likely order x-rays and blood tests to rule out possible diseases and injuries that have symptoms similar to CTS, such as rheumatoid arthritis, osteoarthritis, diabetes, a stress fracture in the wrist, or blood vessel problems.
  
  Visit a physical therapist or massage therapist.
  
  Try corticosteroid injections. To relieve pain, inflammation, and other symptoms of CTS, your doctor may recommend injections of a corticosteroid drug (such as cortisone) into your wrist or heel of your hand. Corticosteroids are a powerful, fast-acting medication that can relieve swelling in the wrist and relieve pressure on the median nerve. They can also be taken orally, but this is considered much less effective than injections and also causes more severe side effects.
  - Other steroid medications such as prednisolone, dexamethasone, and triamcinolone are also used in the treatment of CTS.
  - Corticosteroid injections can lead to complications such as local infection, excessive bleeding, weakening of tendons, muscle wasting, and nerve damage. Therefore, they are usually done no more than twice a year.
  - If steroid injections do not significantly improve the condition, surgery should be considered.
2. Carpal tunnel surgery should be considered as a last resort. If other treatments have failed to relieve the symptoms of CTS, your doctor may recommend surgery. Surgery is only used as a last resort because there is a risk of making the situation worse, although for many patients surgery helps to completely relieve the symptoms of CTS. The purpose of this surgery is to relieve pressure on the median nerve by cutting the main ligament that is pressing on it. For CTS, surgery is performed using two different methods: endoscopic and open.
  - Endoscopic surgery uses a thin, telescope-like device with a camera on the end (called an endoscope) that is inserted into the carpal tunnel through an incision in the wrist or palm. Using an endoscope, the surgeon sees the canal and can cut the ligament pressing on the nerve.
  - Generally, endoscopic surgery results in less pain, fewer side effects, and faster healing.
  - Unlike endoscopic surgery, open surgery involves making a larger incision in the palm and wrist to reach the problem ligament and release the median nerve.
  - Risks associated with surgery include nerve damage, infection, and scar tissue formation. All this can lead to a worsening of the situation with the SZK.
3. Please remain patient during the post-operative recovery period. During this period, you will be advised to frequently hold your operated arm above heart level and move your fingers, which will help reduce swelling and prevent stiffness. Mild pain, inflammation and stiffness may be present in the hand and wrist for up to six months after surgery, and full recovery may take up to a year. You will be asked to wear a wrist support for the first 2-4 weeks after surgery, although you will be advised to develop your palm.

If you are concerned about carpal tunnel syndrome, try treating it yourself at home. This may help you avoid a trip to the doctor or even surgery.

1. Reasons

Carpal tunnel syndrome is located on the palmar side of your wrist. This is a narrow passage formed by bones and ligaments. When, for one reason or another, the median nerve, which passes through this passage to the thumb and first three fingers, is under constant pressure, inflammation can occur, which is called carpal tunnel syndrome (carpal tunnel). This inflammation often occurs due to an underlying medical condition (diabetes, thyroid dysfunction, high blood pressure, or an autoimmune disease such as rheumatoid arthritis) that causes swelling in the wrist and sometimes obstructed blood flow. Fluid retention during pregnancy or menopause may be another cause of this syndrome.

When the tendons that attach muscle to bone experience too much repeated stress, they alert us with pain signals in an attempt to protect themselves from further damage.

“In a small area like the wrist, the tendons run through a narrow tunnel over the carpal joint and carpal bones,” explains Amy Baxter, MD, CEO of pain management research organization MMJ Labs Pain Relief. “When cells are overstressed, they release lactic acid, which helps hold fibrous tissue together for increased protection, but this causes inflammation and swelling.”

2. Symptoms

Common symptoms of carpal tunnel syndrome include pain, numbness and tingling. “Patients experience a characteristic numbness and tingling sensation in the thumb, index, middle and ring fingers, most often at night (waking up), while driving a car, using a cell phone or other manual activities,” says David Clark Hay, MD, of the Orthopedic Clinic. Kerlan-Job in Los Angeles. “Patients begin to shake their hand to relieve the burning and tingling sensation.”

Symptoms often develop slowly, starting with a tingling sensation, usually in the morning or when falling asleep at night.

3. Traditional medical therapy

The most common treatments for carpal tunnel syndrome include immobilization (fixation) of the affected area to stop the repetitive motion or surgery to relieve pressure on the nerve. However, a study published in the Journal of Orthopedic & Sports Physical Therapy found that physical therapy for carpal tunnel syndrome can treat as well as surgery.

The study involved 100 women from Madrid with the condition, half of whom received physiotherapy and the other half had surgery. Researchers have found that physical therapy (specifically an approach called manual therapy) improves hand and wrist function and reduces pain as effectively as standard surgery for the condition. Moreover, after a month, patients who underwent physical therapy performed better than those who had surgery.

4. Cold and vibration treatment

You've probably heard of treating a sore area with ice, but Baxter warns that this causes the muscles and tendons to harden and reduce blood flow. “Before applying ice, try massaging the affected area to increase blood flow,” advises Dr. Baxter. “Massage makes the muscle fibers soft and flexible, so damage from repetitive strain is minimized and ice becomes more tolerable,” he says.

The simplest treatment for carpal tunnel syndrome is to give your wrist and fingers adequate rest. Stop activities that you think may be causing the numbness and pain. Once symptoms have subsided, activity can be gradually resumed. Orthopedic surgeon Shari Lieberman, MD, says patients should evaluate the ergonomics of their home and workspace to identify problems that are preventing symptom relief. "Changes in the office that may help relieve symptoms include switching to an ergonomic keyboard or mouse, repositioning the keyboard and mouse to give your wrists a neutral position, or using a gentle wrist rest," she says. “At home, patients can take breaks from repetitive tasks to rest their hands and wrists.”

6. Stretching

Simple wrist exercises can be done at any time during the day, whether you're sitting at your desk at work or standing in line at the store. Clench your palm into a fist, and then smoothly straighten the fingers of your palm, sliding along them and along the palm with the fingers of your other hand. Repeat the clenching-extension motion 5-10 times to help release any pressure in your wrist. If you have problems with fluid retention due to pregnancy or a fracture, get into the habit of raising your arms whenever possible.

7. Applying a splint

Keeping your wrists straight (not bent) helps relieve pressure on the medial nerve. Symptoms are more likely to occur at night, so wearing a splint in the evening can help relieve symptoms before they begin. If you experience these symptoms at work due to certain hand activities, you can also wear wrist splints during the day. “The purpose of the splint is to keep the wrist in a neutral position by opening up the carpal tunnel and thereby preventing pressure on the nerve,” says Dr. Lieberman. “We tend to sleep with our wrists bent, which makes symptoms worse. These splints can also be worn during any vigorous activity that aggravates symptoms.”

8. Anti-inflammatory drugs

For mild carpal tunnel syndrome, anti-inflammatory drugs such as ibuprofen or naproxen may help, Dr. Lieberman says. “In mild cases, some patients find that other anti-inflammatory treatments, such as acupuncture and natural anti-inflammatory compounds like turmeric and oils high in omega-3 fatty acids, help,” says Dr. Clark Hay. However, it warns that persistent or worsening symptoms, such as a burning or tingling sensation that becomes constant, could be the start of permanent numbness or weakness if left untreated.

9. When home treatment doesn't work

If you don't get relief using the above methods, then the next step is a steroid injection, says Dr. Lieberman. “The steroid injection reduces inflammation, which results in extra space in the tunnel and less pressure on the median nerve,” she says. The success rate of this treatment is high, with 90 percent of patients getting relief from their symptoms from steroid injections.

The alternative is surgery, which usually cures the carpal tunnel. “Modern surgical techniques, such as miniature open surgery or endoscopic surgery, allow us to almost completely relieve symptoms in the vast majority of patients if they have not hesitated for too long about whether to have surgery or not,” says Dr. Clark Hay.

If you have carpal tunnel syndrome, it is important to take action quickly. “Don't wait more than 2-3 months to see a local surgeon or podiatrist,” says Skills 4 Living Therapy Project Manager Jeanne Harper, who has 30 years of experience treating occupational diseases and is certified in manual therapy. “Prolonged compression of the nerves can cause nerve damage and lead to longer post-operative recovery times,” she says.

Ecology of health: Carpal tunnel syndrome is especially common in older women. Why is this so? This syndrome is considered an occupational disease of those workers who perform monotonous monotonous flexion-extension movements with their hands.

Carpal tunnel syndrome has other names such as carpal tunnel syndrome and also carpal tunnel syndrome. This is a neurological disease, it manifests itself with prolonged numbness and pain in the fingers. The cause of carpal tunnel syndrome is compression of the median nerve between the bones and muscle tendons located in the wrist.

It belongs to the category of tunnel neuropathies, in a nutshell we can say that they arise due to compression of the nerve in the osteo-fibrous as well as fibromuscular canals.

Carpal tunnel syndrome is especially common in older women. Why is this so? This syndrome is considered an occupational disease of those workers who perform monotonous monotonous flexion-extension movements with their hands or prolonged forced flexion of the hand. So what professions are at risk? These are pianists, cellists, drummers, bowlers, experienced artists, motorcycle racers, sign language interpreters, those who work as a jackhammer, a hairdresser, embroiderer, and typewriter. Recently, when the computer is no longer a rarity and more and more professions are related to it, there are many more people suffering from carpal tunnel syndrome.

It is believed that long-term work at the computer has become a risk factor provoking the development of this disease. According to the results of one study, every 6th person working at a computer was diagnosed with this carpal tunnel syndrome. Users whose hand is bent relative to the forearm by 20° or more are at greater risk.

Other studies contradict this and indicate that there are no significant differences in the occurrence of this disease in people who work at a computer and those who do not work on it.

Causes of Carpal Syndrome

There is a nerve in the carpal tunnel, and when it gets pinched, wrist pain occurs. Natural causes of pinching of this nerve are considered to be swelling of the tendons located next to the nerve and swelling of the carpal tunnel.

The reason for pinching this nerve lies in prolonged static load on the same muscles. The load is caused by a large number of monotonous movements and often uncomfortable position of the hands. For example, when working on the same computer keyboard, a person’s hand is under constant tension.

Symptoms of Carpal Tunnel Syndrome

It is characterized by pain, numbness and tenderness (paresthesia) in the area of the median nerve.

At the initial stage of wrist syndrome, a person feels trembling, itching, and tingling in the fingers. Moreover, at first he does not connect this with activity on the computer, since these symptoms manifest themselves several hours after finishing, for example, typing.

At further, later stages, numbness, pain and heaviness in the hands begin to appear, tingling in the palms, fingers, wrists, sensitivity in the wrist area is impaired, tissue irritation and swelling may form. In the morning, your fingers may feel stiff. People with carpal tunnel syndrome may also experience indirect symptoms such as insomnia due to pain and wrist cramps.

The advanced stage of wrist syndrome often leads to atrophy of the muscles of the thumb. The ability to tightly clench the hand into a fist disappears; the thumb does not bend. Hands and fingers may become unruly.

When a person with carpal tunnel syndrome tries to lift a rather heavy object, this can cause pain or loss of arms - the object will simply fall out of their hands. A person with this syndrome loses the ability to talk on the phone for a long time, read a book holding it in front of him in his hands, or hold the steering wheel of a car for more than 10 minutes.

Diagnosis of carpal tunnel syndrome

A neurologist sometimes examines a patient and determines the degree of damage to the wrist muscles caused by working at a computer or other professional activity.

However, a person is able to independently determine this disease. To diagnose carpal tunnel syndrome, the Tinel test and the Phalen test are used.

The first test involves percussion (tapping) in the wrist area above the place where the median nerve passes. If the test is positive, it is accompanied by paresthesia in the palm and fingers.

The second test is maximum flexion for three minutes, i.e. the connected backs of the hands are lowered down, and the elbows should be directed to the sides. You will get something like the letter “T”. If during this time this test causes paresthesia and tenderness on the palmar surface of the 1st, 2nd, 3rd and partially 4th fingers.

Prevention

Since a person is not always able to refuse or significantly reduce the time he spends working at the computer and other things, it is worth thinking about preventative measures. Prevention of carpal tunnel syndrome is also the correct convenient organization of the workplace. Thanks to this approach, you can avoid almost any problems that arise for a person with his hands working at a computer.

One of the main preventive measures should be ergonomics and proper sitting position at the computer. It is advisable to have a chair for work with a back position and height that can be adjusted (it is very good to have a table with an adjustable height). A properly adjusted table and chair make it possible to assume a position where the lower back is located at an angle of 90 degrees with respect to the hips. The shoulder and forearm should form a right angle, and the hands should lie on the keyboard. Basically, the keyboard is located at a height of 65-75 centimeters.

Important preventive measures are also:

Chairs and computer chairs must be equipped with armrests.
Ergonomic keyboard. It should be positioned so that when bending your arms at the elbow, they form a right angle. A correctly positioned keyboard allows your hands to rest when they rest on it.
When working with the mouse, your elbow should be on the table, and your straight hand should be positioned as far as possible from the edge of the table.
The mode of working on the computer is also fundamentally important. It only takes a few minutes to rest the tendons and restore the required volume of synovial fluid. But a person with diabetes will have to increase the duration of rest. The best option is to rest every hour for 10-15 minutes. Rest should not be spent passively. Since a person rests not because he is tired from moving, but because he is working at the keyboard. In this case, the ideal option would be to do arm exercises.

Treatment for Carpal Tunnel Syndrome

It is necessary to begin early treatment for carpal tunnel syndrome caused by prolonged use of a computer keyboard. First of all, you need to eliminate the root cause, for example, diabetes or arthritis. If the disease is not treated, as a rule, it progresses.

In the early stages of the syndrome, a sufficient measure would be conservative therapy, which is expressed in limiting the load on the affected wrist (minimizing computer work), or immobilizing it with a fixed splint. When symptoms subside, begin physical exercises designed to stretch and strengthen the wrist muscles. It is advisable to carry out physical therapy under the supervision of a physician.

In severe cases of tunnel syndrome, accompanied by acute pain and severe inflammation, treatment with medications is required.

With proper nutrition, which is able to fully saturate the body with important bioactive substances, treatment of carpal tunnel syndrome can become very effective and the recovery process will become much faster, the rehabilitation period will be reduced and the ability to work will return faster. The specialist will return to his work in a short time.

Among alternative methods of treatment, yoga turned out to be one of the most effective methods. It helps reduce pain and also improves grip strength.

Set of exercises

Complex 1

Slowly clench your hands into fists and then slowly unclench them. Repeat 5 times.
Place your palms on the table and press your palms onto its surface. Then bend your fingers one by one.
Raise and lower your arms several times. Describe the same number of circles, first with your hands, then with each finger.
Make rotational movements with your brushes, then move your fingers. With your hands clenched into fists, rotate around the axis.
Shake your hands.
Clasp your hands together and press the fingers of one hand onto the fingers of the other hand.

Complex 2

You need to raise your arms and lower them several times, shake your hands.
Clench your fists tightly for a few seconds, then unclench and relax them. Repeat the exercise 5-7 times.
Make rotational movements with your brushes (10-12 times) in each direction.
Stretch your arms out in front of you and actively move your fingers for one minute.
Place your palms towards each other and turn your fingers towards you, i.e. wrists away from you. Try to slowly press from the palm of your hand with the fingers of one hand onto the fingers of the other.

Complex 3

Rub the inner and outer surfaces of your palms until you feel warmth.
On your right hand, bend each finger using the thumb on your right. Perform four presses on each finger. For the right hand, repeat the same.
Turn your palms towards each other with the inner sides and connect them between the soda, palms slightly turned out. Press your fingers into each other, then shake your hands, relaxing them.
Slowly clench your fist. Shake your hands to loosen them.
Slowly clench your fist, then quickly and sharply unclench it, throwing out your fingers. Lower your arms and shake your hands.

When working at a computer, if you still can’t always complete a full set of exercises, still take breaks, raise your arms up and rotate your hands. If you notice symptoms of carpal tunnel syndrome in your wrist, you need to perform such rotations very carefully and slowly. Periodically relax your muscles by shaking your arms. published

Carpal tunnel syndrome is a neuralgia of the carpal nerve called carpal syndrome, carpal tunnel syndrome, carpal tunnel syndrome, or carpal tunnel syndrome.

The carpal nerve is a kind of neural cable emanating from the carpal nerve ganglion, which is a connection of all the nerves of the lower part of the hand to one point of the wrist nerve ganglion for transmitting generalized signals. The carpal nerve passes at the beginning of the hand through a tunnel of three carpal bones and a transverse tendon ligament with the fourth. Together with the carpal nerve, the flexor tendons of the fingers pass through this place.

The carpal nerve is also one of the central main nerves of the arm (there are only three of them, there is also the radial and ulnar), which runs through the entire arm to the nerve plexus in the shoulder.

The carpal nerve is responsible for the sensitivity of the longitudinal middle of the palm from the thumb to the middle of the ring finger and for controlling the movements of the hand and the secretion of sweat glands. To put it roughly, this nerve is responsible for manipulating the hand. Each hand has its own carpal nerve.

Tunnel syndrome or tunnel is a syndrome of neuralgia of the nerves caused by their compression or injury by the surrounding muscles, tendons or musculoskeletal canals, as well as inflammation of the nerve canal from the surrounding body tissues.

The carpal tunnel is an opening or pathway for a nerve to pass from the forearm to the fingers, through the wrist. In other words, this is the channel through which the neurons that make up the median nerve pass, also known as the carpal nerve.

Carpal tunnel syndrome is a disease of the median nerve - neuralgia or neuritis.

Neuralgia of the nerve is a sharp pain caused by atypical irritation of the nerve, which can be caused by its compression, constriction, inflammation of surrounding tissues, as well as the nerve itself, prolonged exposure to cold, deposition of salts in nearby tissues, toxins and allergic reactions. This disease does not cause changes or damage to the nervous tissue, but only causes severe suffering with disruptions in the functioning of the nerve itself.

Neuritis is a severe complication of neuralgia or a self-occurring disease that entails the death of neurons, and sometimes the entire nerve.

This disease can be unilateral, if it affects one arm, or bilateral, when two nerves of both arms hurt.

Complications of the disease are represented by the possibility of damage to the nervous tissue with the possibility of its complete atrophy.

Symptoms

With carpal tunnel syndrome, the symptoms are typical signs of neuralgia or neuritis, manifested in the initial stages by tingling like small needles or a nettle burning sensation, gradually turning into pain in the first three to four fingers of the hand, starting with the thumb.

Over time, the sensitivity of the zone of responsibility of the median nerve begins to decrease until it is completely lost.

Loss of sensation causes motor impairment of the entire hand or just the fingers.

Sometimes CTS is accompanied by disturbances in the microcirculation of fluids with whitening or bluing of the skin, coldness of the affected hand to the touch, problems with sweating, and disturbances in the appearance of the nails. Another sign is that slight movements of the fingers with the arm lowered can bring temporary relief.

Diagnostics

To distinguish CTS from other diseases that can cause pain reactions, diagnostic tests are performed:

The Tinnel test involves lightly tapping the area above the median nerve along the arm above the wrist with a special neurological hammer. With a positive reaction, tingling of the fingers and painful electric jabs in the hand are felt, and sometimes there is pain in the area of tapping. This diagnosis is carried out in severe cases of CTS with increased pain.

Wrist flexion-extension test, where the hand is flexed at the wrist as much as possible and held for a minute. If during this period a tingling sensation appears in the area of responsibility of the nerve, then the test is positive.

Carrying out electromonography to study muscle contractility and identify causes of neuralgia that are not related to compression of the nerve by surrounding tissues.

Cuff test with application of a tonometer cuff with maximum pressure above and below the wrist with observation of paresthesia in case of a positive diagnosis. Paresthesia is a disturbance of sensitivity with false sensations of tingling, goosebumps, burning, etc.

Examination for a “square wrist”, i.e. anatomical structure of the joint with a natural increase in thickness and an approach to a square shape. This anatomical structure often causes natural compression of the nervous tissue.

Causes of CTS

Carpal tunnel syndrome, which most often occurs in elderly or mature people, almost never in children and less often in young people, can be caused by the following reasons:

Work associated with increased load on the hands or vibration influence on them (this type also includes long-term work on the keyboard).
Compression by surrounding tissues due to swelling or injury to the hands.
Obesity causing pressure of fatty tissues.
Genetically determined individual structural features - “square wrist”, increased thickness of the transverse ligament and other changes in the structure of the joint).
Arthritis, gout, bone tuberculosis and other inflammatory joint diseases that can be transmitted to the nerve.
The influence of diabetes mellitus, vitamin deficiency, hormonal disorders, nervous system abnormalities.

The above external causes of carpal nerve neuralgia cause internal reactions, which are directly CTS:

Most often, the pain reaction of the nerve in carpal tunnel syndrome is caused by compression by a large number of surrounding tissues that are closely adjacent to the nerve. Tissue enlargements can be caused by swelling, inflammation, sprains, and hematomas.
In second place are all kinds of inflammation of the surrounding tissues, which can cause pain both on their own and transmitted directly to the nerve itself.
Hypothermia of the joint, provoking a pain reaction or inflammation of the joint.
Various deposits, tumors, hematomas, aneurysms near the nerve, compressing or irritating it.
Circulatory disorders caused by obstruction of any vessels of the hand and causing swelling or lack of nutrition of the tissues of the hand with corresponding consequences.

Treatment of carpal tunnel syndrome

How to treat carpal tunnel syndrome is decided by a neurologist after the necessary examination with an accurate determination of the causes of the disease.

Traditional treatment for carpal tunnel syndrome consists of healing without surgery and begins with complete rest of the affected limb until plastering with a plaster splint. Next, medications of certain groups are prescribed: first of all, anti-inflammatory drugs, then dehydrating diuretics that help relieve tissue edema, drugs that restore microcirculation of intraorganismal fluids. Perhaps a local injection of glucocorticoids designed to urgently reduce swelling and relieve inflammation. Traditional treatment ends with the appointment of physiotherapeutic procedures using a constant magnetic field with acupuncture therapy to improve metabolic processes and stimulate nerve function.

As a rule, traditional methods are quite sufficient, but sometimes surgery is necessary to cut the transverse carpal ligament, freeing the nerve and relieving its pressure on the nerve and tendons, as well as restoring blood circulation if it is pinching the vessels.

Unconventional measures to relieve carpal tunnel syndrome - treatment with folk remedies is even more popular than medical ones due to the non-serious attitude towards such a disease. Elderly people especially like to resort to them - the main risk group for this disease.

The essence of traditional medicine methods is the same as traditional medicine: relieving swelling, inflammation, stimulating nerve function, returning hand functions.

Treating CTS at home is a dangerous activity due to complications in the form of neuritis with the omission of treatment of serious causes, for example, arthritis or bone tuberculosis, as well as other diseases, however, it has a very effective effect in relieving symptoms.

The first remedy for carpal tunnel syndrome is special hand exercises, which can both relieve pain and prevent the onset of the disease:

First clench your fist with all your strength, and then unclench it, stretching your fingers out as much as possible.
Rotation with clenched fists in all directions.
Show with force a kind of ok sign by alternately applying all fingers to the thumb.
Place your palms facing each other with straight elbows in the form of a Chinese greeting and try to lower them as low as possible without moving your elbows or moving your arms away from your body.
Grasp the top of one hand from the back with the palm of the other in the transverse direction and bend the clasped arm. Now you need to try with all your might to straighten it, while providing maximum resistance with your clasping hand.

Rubbing and compresses are made with various warming compounds and compounds that improve blood circulation, promote the outflow of excess fluids from the limb and have an anti-inflammatory effect. Such compositions may contain components from hot foods, for example, pepper, mustard, vitamin-containing and healing ones such as sea buckthorn and aloe, relieving swelling - cucumber, salty foods.

Despite the availability and effectiveness of traditional methods, self-prescribed diagnosis and treatment must be checked and agreed upon with a neurologist in order to avoid complications, as well as not to miss any factors that caused the disease.

Prevention

If previously carpal tunnel syndrome worried primarily the elderly, whose limbs were distorted by arthritis, gout and suffered from disorders of the circulatory system and nervous system, and secondly, workers engaged in very hard and harmful physical labor, for example, logging, which involves with hypothermia and impact on the joints, today the main contingent of patients with this disease has changed dramatically. Nowadays, most people, regardless of age, are susceptible to carpal tunnel syndrome, including schoolchildren.

This is caused by widespread long-term work on the computer, during which the hands are under severe tension and practically unchanged position for several hours. Having got used to it, a person may not notice the unpleasant sensations from overexertion, but the negative impact can cause improper development of muscles and ligaments with compression of both nerves and other internal parts of the hand. To prevent CTS, you can use very simple techniques:

When working at a computer for a long time, use a touchpad instead of a mouse, as it requires more movements and helps to warm up the hand and wrist joint area.
Use a wrist support, which aligns the position of your hand while working on the keyboard and prevents pinching a nerve.
From time to time, carry out preventive hand exercises, which were described above.
Before working your wrists for a long time, they need to be warmed up by stimulating blood circulation with gymnastics or a warm hand bath.
Children and teenagers should not be allowed to work on a computer for a long time, as this will cause not only disturbances in the development of the wrist joint, but also vision, as well as the musculoskeletal skeleton. While working, you need to do small general exercises every half hour.