home Consultations Tunnel syndrome of pregnant women - treatment is necessary. Treatment of neuropathy of the femoral nerve. Treatment with physical factors

Tunnel syndrome of pregnant women - treatment is necessary. Treatment of neuropathy of the femoral nerve. Treatment with physical factors

Tunnel syndrome (tunnel neuropathy) is a complex of symptoms that occur as a result of compression peripheral nerves in narrow anatomical spaces- tunnels. IN medical literature more than thirty variants of tunnel neuropathy have been described. There are tunnel syndromes with lesions of the upper, lower extremities, neck, torso. Carpal tunnel syndrome is the most common, which is why it is often referred to as carpal tunnel syndrome. In the structure of tunnel neuropathies, carpal tunnel syndrome accounts for 50% of all cases.

Table of contents:

The carpal tunnel is located at the base of the hand. It is formed by the carpal bones and the transverse ligament. Inside the canal are the median nerve, tendons of the flexors of the fingers and hand, as well as their synovial membranes.

Part median nerve includes sensory and nerve fibers. Sensitive fibers are responsible for the sensitive innervation of the skin of the palmar surface of the first three and half of the fourth fingers, as well as the back surface of the nail phalanges of the same fingers. Motor fibers provide movement of the fingers.

Normally, the median nerve passes freely in the canal. But with microtraumatization of the ligaments that occur in people of certain professions, thickening and swelling of the transverse ligament develop, which leads to compression of the nerve. As a result chronic inflammation connective tissue, which is caused by a constant load of the same type, the ligament thickens, swells, which leads to an increase in pressure inside the canal. High blood pressure leads to venous stasis and, as a consequence, disruption of the blood supply to the nerve.

First of all, the sensory fibers of the nerve suffer, and only then the motor ones. In addition, autonomic fibers may be damaged. nervous system.

Causes leading to the development of carpal syndrome:

The peak incidence falls on 40-60 years. It is noteworthy that women get sick more often than men. This is probably due to the fact that the carpal canal is narrower in women.

In about half of all cases, both hands are affected. But it is worth noting that the signs of the disease primarily occur on the "working" hand (for right-handers on the right, left-handers on the left).

Carpal tunnel syndrome develops gradually. The first sign of the disease is the appearance of a feeling of pain and numbness in the first three fingers of the hand that occur at night. These unpleasant symptoms prevent a person from sleeping normally. When a person wakes up, he is forced to put his hand down, shake off his brush. Then the pain goes away, but returns in the morning. Pain is felt throughout the finger from its base to the final phalanx.

When the disease begins to progress, pain begins to bother a person even during the day, which greatly affects his activity. It is noteworthy that any movement in the wrist increases pain.

Another characteristic symptom- Numbness of the first three fingers in the morning. But then a person begins to feel numbness at night and daytime. Unpleasant symptoms in the fingers are aggravated by holding the hand on weight for a long time, for example, while talking on the phone or driving a car.

As the disease progresses, muscle weakness in the brush area. So, it is difficult for a person to hold small objects in his hand, they slip out of his hands. On late stages develop atrophy of the muscles of the hand, contractures in the form of the so-called "monkey's paw".

With strong or prolonged compression the median nerve develops a decrease in sensitivity. The patient may not feel touch or even painful irritation in the area of the first three fingers.

With compression of the vessels inside the canal, blanching of the skin of the hand, a decrease in local temperature and swelling are possible.

Sometimes tunnel syndrome may be accompanied by pain not only in the hand, but also in the forearm, elbow. This confuses the doctor and may lead to the thought of another pathology, such as osteochondrosis. Therefore, in order to carry out differential diagnosis apply special methods.

For example, there is a simple raised hands test. The patient raises the straightened arms above the head and holds for a minute. In the case of carpal tunnel syndrome, numbness and tingling, sometimes even pain, occur in the first three fingers.

To perform the Phalen test, the patient is asked to bend the hand and hold it there for a minute. In the presence of carpal tunnel syndrome, tingling and pain increase in the first three fingers.

A cuff test is also sometimes performed. The doctor puts a cuff on the patient's arm to measure blood pressure. Then pressurizes the cuff over 120 mm Hg, which is held for a minute. With carpal tunnel syndrome, tingling occurs in the fingers innervated by the median nerve.

But the most reliable diagnostic method still is the Tinel test. The doctor taps with a finger or hammer over the median nerve. In the presence of carpal tunnel syndrome, tingling occurs in the fingers.

Useful diagnostic breakdown is the introduction of corticosteroids with lidocaine into the carpal tunnel. If after that the pain and tingling in the fingers decrease, then pathological process located in the carpal tunnel.

Leading instrumental method definition of carpal tunnel syndrome is electroneuromyography. With the help of this study, it is possible to measure the electrical activity of skeletal muscles, as well as the speed of the nerve impulse. At rest electrical activity muscle is minimal, and increases with muscle contraction. But in the presence of carpal tunnel syndrome, during muscle contraction, electrical activity is low, because the transmission of a nerve impulse along the damaged median nerve slows down.

Treatment of carpal tunnel syndrome

Treatment of carpal tunnel syndrome is primarily aimed at eliminating the cause of the disease, as well as eliminating pain, improving local blood circulation, nutrition and tissue innervation, and restoring hand function.

Conservative treatment will be most effective in patients with symptoms observed for no more than a year. It includes wearing a support splint, as well as the appointment of such medicines:

An effective method of treatment is the introduction of corticosteroids into the carpal tunnel. After the first such procedure, the patient feels significant relief.

Criteria to predict low efficiency conservative treatment:

The patient's age is more than fifty years;
Symptoms of the disease are observed for ten or more months;
Constant tingling in fingers;
The presence of stenosing tendon tenosynovitis;
Positive Pheleng test in less than thirty seconds.

Thus, in 66% of patients without a single criterion, with conservative treatment, it is possible to achieve good result, 40% - in the presence of one criterion, 16.7% - with two and 6.8% - in the presence of three or more criteria.

With the progression of the disease and in the absence of a result from conservative therapy resort to surgical treatment. The operation should be carried out before the onset of irreversible damage to the median nerve. Under the condition of a timely operation, it is possible to achieve a good result in 90% of patients. Target surgical intervention- this is a decrease in pressure on the median nerve by expanding the intracanal lumen. Surgery can be performed endoscopically or open way.

After the operation, the brush is applied plaster cast for a few days. IN recovery period the patient is shown to conduct therapeutic exercises with a fixed wrist and physiotherapy procedures. If the disease is caused by the characteristics of the profession, you should change the type of activity for the recovery period. After three months, the functions of the hand are restored by approximately 70-80%, and after six months completely.

After a full recovery, a person can return to their kind of activity. But if at the same time unfavorable working conditions are not eliminated, a relapse cannot be avoided.

The incidence of carpal tunnel syndrome in last years has increased significantly. Doctors attribute this fact to the fact that computers have appeared in human life. People at the computer work and spend their leisure time. With improper organization of the workplace, uncomfortable position of the hand during the use of equipment, prerequisites for the development of carpal tunnel syndrome are created.

To prevent the occurrence of the disease, the following recommendations should be followed:

Set up yours properly workplace. The table should not be too high. While working at the computer, the arm should not sag, but lie comfortably on the table or armrest of the chair. The brush should be straight.
Pick the right keyboard and mouse. The mouse should fit comfortably in your palm. So the brush will be more relaxed. A special joystick mouse has even been created for people with carpal tunnel syndrome. No less useful may be special mouse pads, equipped with a roller at the wrist level. This will provide correct position brushes. In addition, pay attention to the keyboard, located at an angle.
Take breaks every thirty to forty minutes.
Do hand exercises: shaking the hands, rotating movements in the wrists, clenching the fingers into a fist and unclenching.

Grigorova Valeria, medical commentator

Hands go numb during pregnancy in many women, but this manifests itself in each in different ways. Some only get numb right hand while others have both. Some people get numb hands at night during pregnancy, while others get numb at any time of the day.

Bearing a child is not only happiness, but also a great responsibility. The body, creating conditions for the successful development of the fetus, experiences stress and increased stress due to hormonal changes that affect the functioning of all systems and organs. This period is accompanied by many unpleasant manifestations, including numbness of the hands or feet.

During pregnancy, numbness of the hands can occur for many reasons, and each woman is different. All organs and systems during the gestation period work with a load. Because of this, available chronic diseases, including neurological, can become aggravated.

Why do hands go numb during pregnancy? Is it dangerous for a baby developing in the womb? What can I do to get rid of the numbness? These and other questions arise in any pregnant woman who is faced with such an unpleasant symptom.

In most cases, numbness of the limbs during pregnancy does not pose a threat to the health of the mother and the growing embryo, but there are exceptions. Therefore, it is important to determine the cause of numbness and, if necessary, take timely measures to eliminate it.

For this, a pregnant woman must first contact her gynecologist. He, if a disease is suspected, will refer to a specialist with a narrow profile in order to make an accurate diagnosis and prescribe treatment. If the situation does not require intervention, the doctor will recommend how to behave in order to reduce the likelihood of recurrence of unpleasant sensations.

The main cause of numbness in the legs and arms is pinching or compression of the nerve. But there are many factors that cause a violation of the passage of impulses along the nerve fibers.

Common causes of hand numbness during pregnancy:

Predisposing factors:

Osteoporosis.
Sharp weight gain.
Reducing motor activity.
Exacerbation of chronic, often cardiovascular and neurological diseases.
Overstrain of the muscles of the shoulder girdle.
hereditary predisposition.
Physical or nervous exhaustion.
Strong stress.
Metabolic disease.

Most often, in right-handed people, the right hand goes numb during pregnancy, because it performs most of the actions. For lefties, the situation is reversed. Unpleasant sensations in the left hand are often associated with the work of the heart. An attack of angina pectoris, a violation of the heart due to ischemia, heart disease or other problems are manifested by the fact that the fingers or hand of the left hand go numb.

Why do hands go numb at night

If the hands become numb during sleep during pregnancy, this is most often not dangerous to health. The reason for this is the wrong posture. During pregnancy, hands become numb at night due to long stay in one position. Pinching of blood vessels and nerves leads to circulatory disorders in the extremities and temporary loss of sensation. After waking up and starting vigorous activity numbness spontaneously disappears.

More serious reasons, according to which pregnant women's hands go numb in a dream:

Rheumatoid arthritis. Not only large joints are affected, but also small ones. Inflammation of the articular structures is manifested by soreness, stiffness of the fingers from the second half of the night until the morning. In order for the fingers to begin to bend normally in the morning, it takes 30 minutes or more to knead them.
tenosynovitis- inflammatory lesion of the synovial sheath of the tendon of the hand. Often, pathology is accompanied by carpal tunnel syndrome, that is, carpal tunnel syndrome. Paresthesia develops - a disorder of the sensitivity of the hand with the corresponding symptoms.

Hand numbness treatment during pregnancy

Every woman wants to know what treatment awaits her if her hands and feet go numb during pregnancy.

First you need to determine the exact cause of the decrease in the sensitivity of the limbs. This can only be done by a doctor. If persistent numbness occurs within a few days, you should first of all contact your obstetrician-gynecologist.

After the examination, the doctor will be able to suggest the cause of the disease and advise what to do if the hands or fingers go numb during pregnancy.

The lack of trace elements and vitamins will help replenish multivitamin complexes:

Magnerot;
Supradin;
Elevit Pronatal.

Improve nerve conduction and restore normal level missing substances can take homeopathic remedies:

Ecoberin;
Reprise;
Calcochel;
Avenalam (aerosol for local application with numbness of the hands).

When the condition worsens due to exacerbation chronic illness the gynecologist will refer the patient to narrow specialist. Treatment of systemic autoimmune disease will deal with rheumatologist, osteochondrosis and other neurological problems- neurologist.

Ways to prevent numbness of the limbs

First of all, at the stage of pregnancy planning, go through complex diagnostics to identify diseases that may affect the course of gestation.

To prevent discomfort in the limbs, follow these recommendations:

Limit your consumption of spicy foods and salt. This will help reduce swelling.
Drink better to quench your thirst clean water(up to 2 liters per day).
Normalize your diet by including foods rich in vitamins and minerals. Balanced diet will help fill the deficiency of substances. Try to eat less starchy foods bakery products, rice, potatoes.
If professional activity is associated with stress on the hands or wrists, then take 5-10-minute breaks from work every hour to unload the hands.
Wearing loose clothing will help prevent hand numbness due to pressure on nerves and blood vessels.
Normalize the mode of work and rest. Try to go to bed at the same time, walk more in the fresh air, do special ones.
For a while, refuse to carry a bag over your shoulder.
Wear, which will reduce the load on the back muscles with a growing belly.
Pick up the right pillow. It doesn't have to be big and soft. An orthopedic flat pillow will do. Lie down on it so that your shoulders are on the bed. Then the load on cervical vertebrae decrease.
Try to change your position more often while you sleep. If the hand is still numb, then massage it to restore blood circulation.
Avoid hypothermia.

The favorable course of pregnancy and its outcome largely depend on how physically prepared a woman is for this, how she behaves during this period. It is impossible not to say about the care of loved ones: a sensitive attitude, the creation of a favorable emotional background help to safely endure and give birth to a healthy baby. If you experience numbness or other warning signs, see your doctor. Only he can determine the cause and degree of danger of this condition.

Useful video about tunnel syndrome during pregnancy

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People who work a lot at the computer, or those who, by the nature of their activities, often have to bend and unbend the brush (playing the piano, cello, construction works, sports, etc.) often face such a problem as carpal tunnel syndrome, which occurs from excessive squeezing or pinching of the median nerve. The most susceptible to carpal tunnel syndrome are people who have somatic diseases. In addition, this problem is more common in women than in men, since their carpal tunnel is narrower.

Although carpal tunnel syndrome does not pose a health risk, the condition negatively affects the quality of life and work. In some cases, you may even need to change the type of activity. Therefore, at the first sign of illness, you should consult a doctor.

Causes of the disease

The following factors can be attributed to the causes of this disease:
- professional activity of a person associated with constant monotonous hand movements;
- various injuries, fractures, dislocations of the hand, resulting in compression of the median nerve;
- stagnation of fluid in the body due to pregnancy or taking hormonal contraceptives;
- genetic predisposition;
- thyroid disease;
- diabetes;
- inflammatory and rheumatic diseases of the hand;
- abnormal bone growth (acromegaly).

Symptoms of the disease

The first symptoms of the onset of the disease are pain, tingling, burning and numbness of the fingers. At first they appear from time to time and quickly disappear, but after a while the patient begins to feel them constantly. With the further development of carpal tunnel syndrome, pain occurs in the fingers at night, which can radiate to the forearm and elbow joints. After rubbing or shaking the brush, the discomfort disappears. In addition, the sensitivity of the fingers may decrease in the patient, muscles become weaker, it becomes difficult for a person to hold small objects.

Diagnosis of carpal tunnel syndrome

It is difficult for a non-specialist to diagnose neurological diseases whose symptoms are similar. But only experienced doctor already on the basis of the survey and examination will be able to make the correct diagnosis.

Diagnosis of carpal tunnel syndrome mainly consists of three tests:

1. Tinel test. With light tapping on the wrist with inside the patient feels tingling in the fingers.

2. Phalene test. If, during flexion and extension of the hand, for less than one minute, the patient begins to feel pain and numbness in the palm and fingers, then the diagnosis of carpal tunnel syndrome is confirmed.

3. Cuff test. A blood pressure cuff is placed on the patient's arm. When pressure in it is slightly higher than normal and held for about a minute, a person with this disease feels numbness and tingling in the fingers.

Other research methods may be required, such as:

1. Electrodiagnostic, during which the speed of electrical conduction of the median nerve is measured and recorded.
2. MRI is a method that allows you to get detailed picture the state of human organs without internal interference with the help of magnetic waves. In this case, pictures of the cervical spine are taken.
3. X-ray - research using radiation. This method is used to take pictures of bones.
4. Ultrasound is a method that uses sound waves to measure the width of the median nerve. This may be needed, for example, to guide injections for pathologies such as carpal tunnel syndrome.

Treatment

Treatment is needed first neurological diseases that underlie the formation of carpal tunnel syndrome. For example, in hypothyroidism, replacement therapy, while the restoration of detuned functions occurs quite quickly. For women who use birth control pills, another method of contraception is offered. If, as a result of professional stress, carpal tunnel syndrome has arisen, treatment involves a change in the type of activity.

Physiotherapeutic methods give a good effect: electrophoresis with nicotinic acid, phonophoresis with hydrocortisone, laser therapy, mud therapy.

Good results are obtained by manual manipulations of the hand, which are carried out in order to restore the correct position of the bones of the wrist, as well as the introduction of a mixture of anesthetic (lidocaine, novocaine, etc.) with corticosteroid hormone (diprospan, hydrocortisone) into the carpal tunnel. Usually, after the first injection, the patient feels significant relief. For recovery, as a rule, three injections of the drug are enough.

In situations where carpal tunnel syndrome is chronic, persistent, surgeons recommend surgical treatment.

Surgery

The operation is carried out under local anesthesia in conditions day hospital.
There are two types of surgical treatment: endoscopic procedure or open surgery. Depending on the condition of the patient, the doctor decides what kind of intervention is necessary. During open surgery, the skin is cut from the wrist to the palm and the broad ligament of the wrist is excised, which limits the space in which the median nerve is located. After all the necessary manipulations, the wound is sutured.

Endoscopic surgery is no less effective, in addition, with such an intervention, the scar is not particularly noticeable. With the help of an endoscope, which is inserted into the skin incision, the surgeon performs excision of the ligament.

Postoperative period

The operated arm must be kept elevated to avoid swelling. Help improve finger mobility special exercises. After the effect of anesthesia wears off, the sensitivity of the hand will gradually recover.

Self-absorbable sutures applied to the wound disappear within 10 days. If the sutures were performed with non-absorbable sutures, they will be removed in the clinic after 10-14 days.

The rehabilitation process takes approximately two months. Most patients return to habitual way life. A person with carpal tunnel syndrome, surgical treatment completely eliminates the symptoms of the disease, relapses are very rare.

Folk remedies for the treatment of carpal tunnel syndrome

Home remedies have been used by people for many years to treat conditions such as carpal tunnel syndrome. Symptoms will not bother you if you change your position while working and take a break for 15 minutes. If your muscles rest more, then your health will improve. You can perform simple exercises, such as squeezing a rubber ball. A good effect is refusing to apply ice to the wrist area. In some cases, various plants are used for treatment, the use of which helps to reduce pain in the fingers. Of course, before doing this, you need to consult a doctor.

Infusion of cucumber and wild rosemary

An excellent folk remedy that helps to normalize blood circulation and relieve numbness in the fingers. Pickled cucumbers (3 pieces) should be cut into small pieces and mixed with three pods of red pepper. All this is filled with vodka (0.5 l). The infusion must be put in a dark place for 7 days, then strain and rub the sore wrist.

Sea buckthorn treatment

Sea buckthorn is a good remedy for hand pain for people with a condition such as carpal tunnel syndrome. The treatment is as follows. The berries are crushed and mixed with water. The resulting mixture should be opaque. Then it must be heated to 37 degrees and soar hands for half an hour. It is good to do a light massage before this.

After the procedure, the hands must be thoroughly wiped and insulated. You can use woolen mittens or gloves. Treatment is carried out for a month, then you need to take a break for two weeks.

pumpkin compress

A wonderful remedy that can alleviate the condition of the patient is pumpkin. Apply a compress to the affected arm pumpkin porridge, wrapped with cellophane on top and wrapped in a warm woolen scarf. Such warming wraps are done once a day. The duration of treatment is five to six days.

Treatment with ammonia and salt

From numbness of fingers and burning sensation in carpal tunnel syndrome, this relieves healing remedy: a tablespoon of salt, 50 grams of ten percent ammonia and 10 grams camphor alcohol dissolve in 1 liter of water.

Pepper oil rub

Black pepper is able to defeat carpal tunnel syndrome. How to treat using this remedy? The recipe is simple: pour 100 grams of pepper with a liter of vegetable oil and heat over low heat for at least half an hour. The resulting product in a warm form is rubbed into the affected joint several times a day.

Cowberry decoction

Relieves pain in the hands and swelling of such a folk remedy as a decoction of lingonberries. The leaves of the plant (several teaspoons) should be poured with water (one glass) and boiled for 15 minutes. The product removed from the stove must be filtered. Take one sip several times a day.

How to Reduce Puffiness

Swelling is another unpleasant symptom of a condition such as carpal tunnel syndrome. Treatment consists in the use of diuretic infusions. The use of an infusion of parsley roots gives an excellent result. One tablespoon of raw materials should be poured with boiling water (0.5 l) and left to infuse until morning. Healing infusion drink during the day in a sip.

A similar effect has a remedy from the leaves of white birch. A few tablespoons of leaves should be poured with boiling water (one glass) and brewed for about three hours. The infusion should be consumed in four doses of 1/3 cup before meals.

Bearberry has excellent diuretic and anti-inflammatory properties. The medicine is prepared in this way: the leaves of the plant (1 tbsp) are brewed with one glass of boiling water for several hours. Means drink a tablespoon several times a day.

Prevention of carpal tunnel syndrome

To reduce your chances of developing a condition such as carpal tunnel syndrome, consider the following guidelines.

When working at a computer, give preference to the touchpad, trying to use the mouse less often. If it is impossible to refuse to use the mouse, try to keep the brush straight while working. Pay attention to the position of the arm - from the elbow to the hand, it should lie on the table.

Use comfortable mouse and keyboard models, a wrist support is a good purchase, which will reduce the strain in the hand when working. If you have to spend a lot of time at the computer, change your chair to one that has armrests.

If you often type text on a laptop or netbook keyboard, connect a keyboard from a desktop computer to them from time to time.

If you start to feel tired, take a break for a little gymnastics so that your hands rest. Squeeze and unclench your fingers several times, make rotational movements with your hands in different directions, clap your hands, clasp your fingers in the lock. You can keep a toy on your desktop that will remind you of the need to warm up and which can be used for gymnastics. The rosary is great for this purpose, sorting through the beads one at a time, you will relieve tension in your hands. You can roll two balls in the palm of your hand.

If you know that you have to for a long time load your wrist, pre-warm up your hands by doing gymnastics. You can take a bath with hot water.

Carpal tunnel syndrome makes life much more difficult. In most cases, we earn it by doing our normal business. Using our advice, you can protect yourself from this pathology or alleviate your condition if the symptoms of the disease have already manifested themselves.

Tunnel syndrome is a whole group of diseases of peripheral nerve fibers that occur due to compression of these nerves in certain anatomical channels (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 about 1% of the general population, others can be seen quite rarely and are known only to narrow 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 receptacle. This pathology in the English-language medical literature can also be found under the name of trapped neuropathy, which very well reflects the mechanism of nerve damage.

Beyond squeezing nervous tissue, with the development of carpal tunnel syndrome, there is a violation of the blood supply to the nerve. From here comes 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 pain occur.

Most often, tunnel syndromes of the hands occur, and the nerve trunks of the lower extremities suffer much less often. As a rule, the debut of the disease occurs at the age of 30-45 years, women suffer more often than men. The course of the pathology is chronic 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 importance in the development of compression-ischemic neuropathies is given to chronic microtraumatization of the nerve, which is of a professional, household or sports nature. That is why most often infringed nervous structures, which are in close proximity to the movable joints.

To date, the number one cause of carpal tunnel syndrome is working with a computer mouse and keyboard.

Increase the risk of developing this group of ailments, metabolic and endocrine disorders in organism. For example, the disease occurs more often in women during pregnancy, breastfeeding, during menopausal adjustment, in patients with hypothyroidism, with long-term use hormonal drugs, including oral contraceptives.

In some cases, severe weight loss can be the cause of the pinched nerve. At the same time, the amount of fatty tissue decreases, which protects the nerve and performs shock-absorbing functions for it.

Also in medicine, cases of family tunnel syndromes are described. At the same time, clearly narrow canals in which nerve fibers are located were initially recorded in relatives.

The risk of such disorders is increased in patients with systemic diseases connective tissue, arthritis, arthrosis, past injuries and operations on the joints, diabetes, chronic alcoholism, multiple myeloma and other hematological diseases.

Below are those tunnel syndromes that occur most often.

carpal tunnel syndrome

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

The carpal canal (carpal) itself is very narrow, its bottom and walls are the bones of the wrist, and the canal is covered from above by the transverse carpal ligament. Inside the case are the tendons of the flexor muscles of the fingers and the median nerve.

When carpal tunnel syndrome occurs, the median nerve is affected

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

Symptoms of Carpal Tunnel Syndrome

In the case of the development of carpal tunnel syndrome, the patient develops compression-ischemic neuropathy of the median nerve. Pathology is characterized by a chronic long-term course. Among the first signs of neuropathy, one can note pain in the area of \u200b\u200bthe corresponding innervation, paresthesia (tingling, crawling sensation, numbness), which appear mainly at night and often cause a person to wake up. As the disease progresses indicated symptoms disturb both day and night.

Area of innervation of the median nerve

At the next stage of the progression of the disease, the sensitivity of the skin gradually decreases and movement disorders– Decreased muscle strength of the tenor muscles, malnutrition and atrophy muscle tissue, weakness in the hand, the inability to perform the usual movements and even hold objects.

Pain in 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 (blood supply to the damaged nerve improves).

Simple tests to diagnose carpal tunnel syndrome:

Tinel test - with percussion in the area of \u200b\u200bthe damaged nerve, the appearance or increase of pain and paresthesia in the zone of its innervation is observed.
Upper limb raising test- to do this, you need to raise and stretch straight arms above your head, hold the limbs in this position for 60 seconds. Due to a decrease in the intensity of blood flow in a patient who has carpal tunnel syndrome, there is pain and paresthesia.
Flexion test- for this you need to bend the brush as much as possible in wrist joint 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.
Bottle test - becomes positive only in case of attachment of movement disorders. In this case, the patient cannot lift and hold the bottle by the neck with the thumb and forefinger.

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

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

Treatment of carpal tunnel syndrome

After the diagnosis is made, conservative therapy is used, surgery can be immediately prescribed only in isolated cases, for example, when nerve compression is caused by trauma or proliferation of bone callus after a fracture of the wrist.

First of all, you need to get rid of all possible factors that could cause disease. It is important to ensure complete rest for the arm during the active phase of treatment. To immobilize the limb as much as possible, you can use special dressings, bandages and. 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 the position of hands on the keyboard and mouse.

There are also various gadgets that allow you to maintain the desired position of the hands during work 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 conventional computer mouse and will be an excellent prevention of the development of tunnel syndrome

From medications used analgesics and anti-inflammatory drugs. In more difficult cases and when expressed painful sensations resort to blockade using glucocorticosteroids. IN complex treatment also apply therapeutic exercises, physiotherapy, massage, acupuncture.

If conservative measures were ineffective, then surgery will help to cure neuropathy. In this case, a surgical dissection of the carpal ligament of the canal is performed and the nerve is released from the trap. There are several ways to perform surgery, modern clinics for this purpose, even endoscopic equipment is used, which avoids a large surgical incision. The recovery period takes up to 3 months.

Important! Treatment for carpal tunnel syndrome should be started in a timely manner. If long time do not take any measures, irreversible changes may 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, one should also highlight the syndrome of the cubital canal, which occurs due to infringement ulnar nerve in the cubital channel.

The cubital canal contains the ulnar nerve, which can be infringed 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 area of the cubital canal. This pathology is in second place among carpal tunnel syndromes after carpal tunnel injury.

Zone of innervation 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 your elbow on the table, etc. Also, metabolic and endocrine diseases, injuries, surgeries elbow joint, arthritis and arthrosis of this joint.

Symptoms of neuropathy also include three main points:

The characteristic position of the hand in neuropathy of the ulnar nerve according to the type of "clawed paw"

pain in the zone 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, atrophy of the muscles of the hypotenor and interosseous muscle fibers, the characteristic position of the hand as a clawed paw.

In the treatment of such a pathology, they are used as conservative methods as well as surgical. 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 combination therapy, medical preparations, physiotherapy, folk remedies, physical therapy.

The operation is prescribed in case of ineffectiveness of conservative treatment. During the manipulation, the ligament is dissected, which covers the cubital canal from above 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 parts of the shoulder canal.
In this case, there are signs of a complete lesion of the trunk of the radial nerve:

paralysis of the muscles that extend the hand and fingers ("drooping hand");
sensory disorders on the back of the forearm and on the back of the radial half of the hand (1 and 2 fingers);
pain on palpation of the affected area.

Neuropathy of the radial nerve is manifested by the syndrome of "hanging brush"

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

How to treat radial neuropathy? Treatment can be conservative and surgical. In case of ineffectiveness of the complex of various therapeutic measures, surgery is resorted to.

Neuropathy of the peroneal nerve

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

As a result, an injury to the fibular nerve occurs, which can become chronic with the development of neuropathy. Also, nerve compression can be observed when performing certain types of work on your haunches, sitting in a cross-legged position, when applying a tight plaster cast.

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

Roth disease

This is one of the common tunnel syndromes of the lower limb. This results in a compression-ischemic lesion of the lateral skin femoral nerve. The nerve performs only a sensitive function and does not contain motor fibers; it innervates the skin of the anterolateral surface of the middle third of the thigh.

In Roth's disease, the lateral femoral cutaneous nerve is compressed

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

As a rule, this violation does not cause serious inconvenience to the patient, but in some cases the pain becomes very pronounced. This situation is an indication for surgical operation in the region of the inguinal ligament.

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

In the case of the development of tarsal tunnel syndrome, it is compressed tibial nerve. Compression occurs predominantly in the area of the bone-fibrous tarsal canal (tarsal).

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

The main symptom of the disease is pain that is felt in the sole of the foot and toes. Painful sensations arise or intensify when walking, there is a symptom of intermittent claudication. Also, the pain occurs on its own at night and contributes to the awakening of the patient. Very often, the pathology is bilateral.

piriformis syndrome

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

Among the signs of the disease, one can note burning pain, the development of paresthesias in the zone of innervation of the common tibial nerve. Patients also have a decrease in the Achilles tendon. Over time, weakness of the calf muscles develops.

The development of carpal tunnel syndrome significantly affects the quality of life of patients. But forecast when timely established diagnosis And proper treatment favorable. That is why you do not need to delay the 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, while only a specialist can find out the cause and make an accurate diagnosis.

Tunnel syndrome is a disease that is common among office workers, teenagers, gamers of all ages, and people who enthusiastically use their mobile phones to communicate on the Web.

The history of sms messages is over 20 years old. The first SMS was sent on December 3, 1992. Today, more than 200,000 SMS messages are sent every second around the world - that's about 7 trillion messages a year.

Tunnel syndrome, also known as carpal tunnel syndrome, is common name for a situation where a nerve in an arm or leg is pinched from several sides, which causes pain.

The most common cause of the disease is long work at the computer in wrong position. Other causes include improper hand bending when using modern means communications (tablets, laptops, etc.), injuries and severe bruises of the hands.

Also, tension in the fingers when typing SMS can lead to tunnel syndrome. So, in 2010, it became known about a 16-year-old American schoolgirl Annie Levitz, who sent about 100 SMS during the day. Because of her fanatical passion, the girl lost the mobility of her wrists and fingers, and everyday injections of a strong anesthetic saved her from pain in her hands.

This case led experts to say that problems with the hand are possible not only for office workers or professional athletes, but also for everyone who uses their hands too often and actively. mobile phone or tablet.

Exercises for the joints of the hands

The first symptoms of carpal tunnel syndrome are pain, tingling and numbness in the hands, an unpleasant sensation when the hand, thumb and forefinger are bent.

Diagnostics

Determine the disease early stages it is possible by connecting the backs of the hands and lowering the arms down. The elbows should be directed in different directions, the wrists bent at a right angle. If pain or discomfort appears within one minute, this is bad sign and it is worth doing the prevention of "carpal syndrome". An accurate diagnosis is made during examination by a neurologist - using electromyography, you can determine the degree of damage to the muscles of the forearm.

Treatment for acute pain, severe inflammation and severe cases of carpal tunnel syndrome, medication is prescribed, but if it does not help, this is an indication for surgical treatment(open or endoscopic).

The basis for the prevention of carpal tunnel syndrome are exercises that, especially in the presence of the first symptoms of "carpal syndrome", should be done daily and regularly. The more often you take breaks from work to perform exercises, the more benefits they will bring, as they improve blood circulation in the muscles of the wrist and contribute to their stretching.

AiF infographics

It is also important to properly equip your workplace at the computer, following certain rules.:

When you are sitting at a desk and working on a keyboard, the angle of your elbow at the elbow should be straight (90°).
When using a mouse:

The brush should lie on the table as far from the edge as possible;

- the brush should be straight;

- the elbow should be on the table.

It is desirable to have a special support for the wrist - this can be a mouse pad, a specially shaped keyboard or a computer desk with special silicone pads.
The chair or armchair must have armrests.