Carpal tunnel syndrome treatment. Ulnar nerve tunnel syndrome. Muscle bed syndrome

Carpal tunnel syndrome or carpal tunnel syndrome is a disease of a neuralgic nature. Included in the group of tunnel neuropathies. It manifests itself as prolonged pain and numbness of the fingers. The most common cause is prolonged compression of the median nerve between the bones and tendons of the wrist.

It occurs much more often in women than in men. The consequence of the manifestation of pain is a pinched nerve, which, in turn, can be caused by a thickening of the tendons that run very close to the nerve, as well as thickening or swelling of the nerve itself. This occurs as a result of constant stress on the same wrist muscles. Often the first unpleasant sensations arise when using a computer mouse for a long time, when the hand is in a suspended state.

In cases where a person is engaged in office work for a long time or in activities that place a lot of pressure on the wrists, the disease can cause a complication in the form of cubital tunnel syndrome.

Etiology

In fact, any condition or process that reduces the size of the carpal tunnel or increases the volume of tissue within the tunnel itself can cause the symptoms of carpal tunnel syndrome. The most common causes are wrist sprains, dislocations and fractures. In addition, the causes may be:

• pregnancy. During this period, too much fluid accumulates in the body, which leads to swelling;
• . A person develops problems with nerve fibers if this disease progresses;
• changes in the functioning of the thyroid gland, in the case of extraction of half or all of the gland. The person begins to gain weight, which increases pressure on the wrist. Changes in hormonal levels also adversely affect nerve fibers.

If a person has any of the above problems, then he will experience unpleasant and tingling sensations when:

• prolonged use of force;
• uncomfortable body position;
• incorrect positioning or support of the wrists;
• repeating the same actions with your hands;
• elevated body temperature;
• prolonged vibration (for example, when traveling by car or bus);
• keeping the wrist suspended for a long time (working at a computer).

All of the above factors can trigger progression serious problems. In addition, drinking alcohol, smoking or obesity can worsen the situation.

Also, the causes of occurrence can be processes in the body, such as:

• hormonal disbalance;
• hereditary predisposition;
• age category;
• infections and fractures.

Symptoms

On early stage As tunnel syndrome progresses, it is manifested by trembling, itching and slight tingling. Some symptoms may appear much later, after the end of any active action wrist. The late stage of the disease is characterized by significant numbness, pain and heaviness in the hands, sensitivity in the hands decreases, and a tingling sensation in the fingers increases, which becomes unpleasant and irritating.

Often, people with carpal tunnel syndrome experience insomnia, which is associated with pain and cramps in the hand. With the most advanced syndrome, muscle atrophy is observed, the person can no longer clench his hand into a fist. His hands and arms stop “obeying” him. People exposed to the symptoms of the syndrome lose the ability to lift heavy things or use mobile phone, read a book while hanging, spend a long time working on a PC, sit behind the wheel of a car for more than 15 minutes. They also have problems with fine motor skills.

Doctors note that the symptoms of the syndrome often appear during sleep. In any case, on initial stage the symptoms are temporary; changing the position of the hands and shaking them helps to get rid of the discomfort. On late stages progression pathological process Such measures are not effective and do not eliminate discomfort.

Diagnostics

The patient himself will not be able to diagnose carpal tunnel syndrome, since the average person will not be able to distinguish the usual short-term numbness from the painful syndrome. Therefore, you should visit a highly qualified specialist.

At the appointment, the doctor will conduct full examination and prescribe appropriate tests (may vary depending on the reason for the unpleasant sensations). During the examination, the doctor has the opportunity to identify:

• numbness of the entire palm or some fingers - thumb, index, middle and partially ring fingers. The little finger remains unaffected, which can be a problem for specialists important factor in making a diagnosis;
• swaying over the affected area. There is also a sharp manifestation of tingling in the fingertips;
• the maximum degree of wrist flexion for one minute leads to complete numbness, colic or weakening of the hand muscles;

For additional diagnostic purposes, doctors may use a small current to determine the speed of nerve conduction. They also resort to radiographic examination, which makes it possible to exclude other diseases or inflammatory processes.

Treatment

Treatment for carpal tunnel syndrome is possible in several ways. The choice of one of them directly depends on the stage and symptoms of inflammation of the nerve fiber. Treatment may be:

• independent, but based on the doctor’s recommendations. Usually used in the simplest cases (on early stage). To do this, use warming ointments and a fixing bandage for the wrist. It helps relieve symptoms while a person sleeps and also helps them disappear completely. Independent treatment methods also include changing working conditions;
• medicinal. The simplest anti-inflammatory drugs will help reduce pain and discomfort. Steroid injections have their place, but are only temporary. Some simple wrist exercises will give additional benefits;
• contacting a physiotherapist. The treatment that he can offer on his part consists of optimizing the patient’s workplace, advising on the correct position of the body at work in general and the wrist in particular. Will give advice on what physical exercises should be performed to relieve symptoms and suggest methods of prevention;
• surgical intervention. Such a radical method of treatment is resorted to only in case of manifestation of the most advanced symptoms when a person cannot perform practically any movements with his hand. Operation open type consists of a small incision in the transverse carpal ligament, after which the skin is sutured, leaving the ligaments separated. This is a simple type of operation, after which the patient can go home on the same day. Symptoms of carpal tunnel syndrome are minimized immediately after surgery. But full recovery may take from a month to a year, depending on the stage of development of the syndrome.

Prevention

In modern society, a huge number of people spend most of the day at the computer. Therefore, the main preventive method is the correct arrangement of things in the workplace where the computer and keyboard are located. It follows from this that the main measure to prevent the occurrence of the syndrome is to adjust the height of the chair in relation to the table, which, in turn, depends on the person’s height. A work chair must have armrests. Positive effect gives a special (or maybe homemade) wrist rest. It is also important to give your joints a break for at least 1-2 minutes per hour of working on equipment.

The most effective method of preventing carpal tunnel syndrome is considered to be light hand exercises. Exercises are performed 10 times on each hand:

• clench your hand tightly into a fist and with the same force open your palm as wide as possible;
• rotational movements of each finger clockwise and counterclockwise;
• clench your hands into a fist and perform circular movements with your wrist in all directions;
• bring your palms together, then move all your fingers as far as possible, and then cross them forcefully;
• put your palms together, pressing tightly, and move each pair of fingers in turn;
• Cross your fingers in a lock, both palms are horizontal. Bend your fingers down, thereby raising your wrists up;
• connect the pad one by one thumb with all the fingers on the hand;
• join your palms in front of your chest and, without unclenching them, slowly lower your hands below waist level, and then return to the starting position;
• Position your palms as in the point above and squeeze them with force.

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Apathy is what it is mental disorder, in which a person does not show interest in work, any activities, does not want to do anything and, in general, is indifferent to life. This condition very often comes into a person’s life unnoticed, since it does not manifest itself as painful symptoms - a person may simply not notice deviations in mood, since the causes of apathy can be absolutely any life process, and most often a combination of them.

Wilson-Konovalov disease is a hereditary pathology that is characterized by a disorder of copper metabolism in the human body. Moreover, this element tends to accumulate in various organs, leading to disruption of their functioning. This pathology affects both men and women. But representatives of the stronger sex suffer from it 4 times more often. The progression of the disease does not depend on lifestyle and place of residence. IN medical literature This condition is also called hepatocerebral dystrophy or hepatolenticular degeneration.

Carpal tunnel syndrome seriously reduces quality of life and affects ability to work. Patients experience pain in the fingers, hands and wrist, and also complain of numbness and tingling in this area. The syndrome can have both mild and severe course. At proper treatment It is possible to restore the functionality of the hand and wrist and significantly relieve symptoms.

Carpal tunnel syndrome is quite common and affects 4 to 10 million people in the United States alone. Is treatment possible at home? Doctors are optimistic. In most cases, home remedies help with mild to mild stage diseases. However, in severe cases of the syndrome, surgical intervention may be required.

What is carpal tunnel syndrome (CTS)?

Prolonged pain in the wrist and numbness (decreased sensitivity) of the fingers indicates possible development carpal tunnel syndrome. Given neurological disease characterized by compression/malfunction of the median nerve located between the bones and tendons of the wrist on the palmar side. Nerve compression occurs due to disturbances occurring in the “tunnel,” a narrow passage that runs through the wrist and is made up of bones, tendons and ligaments. It is in this tunnel that the median nerve is located.

The median nerve is a branch of a network of nerves that begins near the neck and shoulder and continues down the arm. This nerve provides sensitivity to the thumb, index, middle and partially ring finger. When the nerve is compressed and CTS develops, sensations of numbness, tingling, weakness in the thumb area, as well as Blunt pain in the wrist and hand. It is not always clear why nerve compression occurs, however, some factors that increase the likelihood of developing CTS. These include:

Female gender (the risk of developing CTS during menopause is especially high);

Features of the anatomy of the hand and wrist (people with wide and short hands, as well as with a square-shaped wrist are susceptible to CTS);

Hormonal diseases (diabetes, pathologies thyroid gland);

Diseases of the musculoskeletal system (fibromyalgia, rheumatoid arthritis);

Previously suffered fractures or tendon injuries;

Hereditary predisposition (cases of CTS in the family);

Psychosocial factors;

Overweight and obesity;

Work or activity associated with heavy loads on the wrist or monotonous, frequently repeated movements in the wrist area (occupational factor).

How to relieve the symptoms of carpal tunnel syndrome at home?

CTS usually does not go away on its own. If left untreated, symptoms often worsen. Therefore, it is important to see a doctor if you have persistent numbness or weakness in your hand.

However, lifestyle changes and the use of certain home remedies may be helpful in mild to moderate cases of CTS. If following these tips does not improve your condition, you should make an appointment with your doctor.

10 Tips for Carpal Tunnel Syndrome

If possible, avoid repetitive movements of your hands, do not strain your wrist (for example, use less of a computer mouse, smartphone and other electronic gadgets for gaming and typing);

Pay attention when your actions lead to discomfort, pain or numbness in the hand and wrist area, it is recommended to stop performing such actions as soon as unpleasant sensations are recorded;

Do frequent breaks if you need to perform repetitive movements with your hands;

Try to keep your wrist in a neutral position, without bending it too much up or down;

Carry weights in a backpack rather than in your hands to avoid additional stress on your fingers, hand and wrist;

Avoid using highly vibrating power tools if your job involves constant or frequent use such a technique, take frequent breaks;

Adjust your work station so that your wrist is in a neutral position while working.

Do not squeeze the pen/pencil too tightly while writing or drawing.

Avoid sleeping positions where your arm or wrist are bent.

Regularly perform a simple arm warm-up and massage several times a day and every 30-40 minutes if the work involves tension in the wrist and hand.

10 ways home treatment carpal tunnel syndrome

Rest your sore arm for at least two weeks;

Use anti-vibration attachments or attachments if you need to work with vibrating tools;

Wear a special brace or orthopedic device on your wrist that will rest the median nerve;

Do stretching exercises for the hand, fingers and wrist (exercises should be performed calmly, effortlessly, in a gentle manner);

Massage the back of the hand, palm and wrist;

Wear gloves to protect your hands and wrists;

Use warm bandages to reduce pain;

Apply ice if there is swelling;

Buy dishes, household utensils and tools with comfortable handles;

Take pain relievers and anti-inflammatory medications, such as naproxen or ibuprofen, as directed by your doctor. However, it should be remembered that medications cannot fully alleviate the symptoms of CTS and eliminate its cause, in addition, these drugs can cause intestinal problems and stomach bleeding.

Non-surgical and non-drug treatment for carpal tunnel syndrome (CTS)

Some methods alternative treatment may reduce symptoms of CTS. In particular, research shows that the following techniques provide short-term relief:

- yoga- Stretching and strengthening exercises for the muscles and tendons in the wrist area help reduce pain and improve functionality;

- manual therapy;

- ultrasound therapy- warms up the affected tissues, thereby reducing pain and promoting recovery;
- use of local anti-inflammatory drugs medicines;

- laser therapy;

- acupuncture.

Before using any alternative treatment methods, you should consult your doctor. Replacement traditional methods Alternative therapy sessions that have no proven effectiveness are not recommended.

Traditional Treatment for Carpal Tunnel Syndrome

Treatment of TTS should be carried out under the supervision of a physician. If the syndrome is associated with one of the chronic diseases (arthritis, diabetes, hypothyroidism), then it is important to carry out complex treatment (together with therapy for the underlying disease). CTS may be associated with pregnancy. As a rule, the syndrome goes away on its own 6-12 weeks after birth.

A non-drug treatment can include splinting your wrist while you sleep. If there is nerve damage or muscle damage, more serious treatment is recommended.

Patients are usually prescribed to wear a special brace/orthopedic device that keeps the wrist in a stationary position. Also, in the presence of pain, inflammation, swelling, injections and drugs are prescribed for oral administration, which have anti-inflammatory and analgesic effects. In particular, corticosteroids in the form of tablets or capsules can reduce inflammation and swelling, thereby reducing compression of the median nerve. Corticosteroids can also be injected locally into the wrist. The injections are believed to medical specialists, are more effective for CTS than oral forms of corticosteroids. There is currently no evidence to support the effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of carpal tunnel syndrome. However, the doctor may prescribe NSAIDs if he considers their use appropriate for a particular patient.

Carpal tunnel syndrome can occur in various parts of the body, but traditionally we're talking about about carpal tunnel syndrome. The median nerve is compressed under the influence of prolonged static load, which provokes inflammation of the surrounding tissues. Traditionally, the disease is diagnosed in people who spend a lot of time at the computer, as well as drivers and cashiers. Patients complain of weakness in their hands, a feeling of numbness and the inability to hold an object for a long time. Without proper treatment, the situation worsens and various types of complications appear.

Treatment

Treatment of carpal tunnel syndrome should be carried out by a specialist, since many pathologies of the joints and other systems have similar symptoms. Accurate diagnosis and qualified medical care are the key to maintaining maximum limb mobility.

How is carpal tunnel syndrome treated? There are several approaches:

1. Wrist fixation and reduction physical activity affected limb.
2. Taking medications of various types.
3. Physiotherapy.
4. Surgical intervention.
5. Traditional medicine.
6. Diet.
7. Alternative therapy.

If the pathology is detected at the very beginning of development, it can be eliminated with the help of physiotherapy, wrist bracing and minor restrictions. When the syndrome greatly bothers the patient, painkillers and anti-inflammatory drugs are used. In case of rapid progression of the disease and absence positive reaction For drug therapy, surgery is performed. It is also possible to use folk remedies to relieve symptoms, but they will not replace full treatment.

Security mode and wrist lock

If carpal tunnel syndrome is detected early, wearing an orthosis to fix the hand has an excellent effect. The special design ensures immobility of the wrist in the damaged area. The median nerve is not subject to stress, so the pain subsides. Wearing an orthosis is recommended at night to give the hand a physiological position. You should also use the design when performing monotonous work, which can aggravate the disease.

An important role is played by lifestyle correction and restriction certain types activities. If the syndrome has developed due to excessive computer work, the provoking load should be reduced to a minimum. A prerequisite for recovery is exercise and short breaks from work. It is useful to shake your hands, clench them into fists, and rotate your hands around their axis. The best option is to develop a special complex together with a physical therapy doctor. The first days of the exercise are performed under the strict supervision of a specialist. Treatment then continues at home.

Attention! At increased risk complications, the specialist recommends a change in activity.

If the patient is found accompanying pathologies, and there is also a high risk of complications, it is necessary to change jobs. It should eliminate or minimize the load on the inflamed areas.

Treatment at home (conservative methods)

When fixation does not help, and the pain symptom intensifies, they come to the rescue conservative methods effects that can be applied at home. Depending on the characteristics of the course of carpal tunnel syndrome and provoking factors, the specialist prescribes medications, selects vitamins, or suggests injecting medicine into the joint. A specific treatment regimen is drawn up only after a complete examination.

Medicines

Drug treatment for carpal tunnel syndrome is aimed at relieving pain and reducing inflammation. Traditionally used non-steroidal anti-inflammatory drugs:

• "Diclofenac";
• "Movalis";
• "Nurofen";
• "Nimesil";
• "Ibuprofen."

It is also possible to take a diuretic, which helps get rid of local swelling. Corticosteroids are selected by the attending physician, since self-administration poses a health hazard. Muscle relaxants and vasodilators are used as a supplement.

Drug treatment of carpal tunnel syndrome at home is more effective if combined with reasonable physical activity and lifestyle correction. If the disease is detected at the initial stage, two weeks are enough for recovery.

Vitamin and mineral complexes

To increase the body's defenses and improve the general condition of the joints, vitamin therapy is actively used. It speeds up the healing process, helps alleviate the patient’s condition and improves metabolic processes in tissues.

Vitamins indicated for use in carpal tunnel syndrome:

1. Vitamin B6.
2. Vitamin B12.
3. Vitamin WITH.

Vitamin B6 restores the endings of nerve fibers, reducing pain and swelling in the affected area.

Vitamin B12 contains essential mineral elements that are useful in enhancing the body's defenses. Guarantees fast recovery damaged nerve fibers.

Vitamin C is involved in the process of hematopoiesis. It has an anti-inflammatory and strengthening effect, enhances the effectiveness of B vitamins.

Local treatment - injection of drugs into the joint

When the patient's condition prevents him from performing even the most necessary actions, the situation is corrected by introducing medications into the affected area. For these purposes, a mixture of corticosteroids and anesthetics is used. Lidocaine and novocaine are used as anesthetics, and the hormonal agents most often chosen are diprospan or hydrocortisone.

After the first injection, the patient feels significant relief. After two weeks, the procedure is repeated. After another two weeks, the final, third injection is performed. If corticosteroids are administered more frequently, it may cause side effects. When relief does not occur even after three injections, it is necessary to double-check the correctness of the diagnosis or select other treatment regimens.

Non-drug treatment

Treatment of carpal tunnel syndrome without harmful drugs includes reducing the load on the affected area for two weeks and simultaneously performing physiotherapeutic procedures. Physical exercise are developed together with a physical therapy doctor or neurologist.

Attention! The implementation of a special treatment complex begins only after the acute inflammation has resolved.

Attempts to exercise forcefully during attacks of pain can aggravate the course of the disease. For short-term relief, ice packs and other distractions are used.

Treatment of the disease that led to the syndrome

If carpal tunnel syndrome occurs against the background of another disease, the underlying pathology must first be treated.

The following diseases can provoke the syndrome:

1. Diabetes.
2. Arthritis.
3. Thyroid dysfunction.
4. Osteochondrosis.
5. Bursitis.

Can also cause carpal tunnel syndrome hormonal changes and lack of B vitamins. If the cause of the changes is hypovitaminosis, then it is eliminated special diet and reception vitamin supplements. When hormonal levels change, replacement medications are required.

Diabetes requires control of blood glucose levels. Patients are prescribed insulin-containing drugs. For arthritis, bursitis, and osteochondrosis, anti-inflammatory drugs and chondoprotectors are used. For pathologies of the thyroid gland, hormonal drugs and restoratives are selected.

Physiotherapy

The use of physiotherapy can reduce local inflammation, enhance metabolic processes in tissues and reduce pain. For these purposes they are used the following types physiotherapeutic treatment of carpal tunnel syndrome:

1. Medicinal electrophoresis with painkillers.
2. High frequency magnetic therapy.
3. Local darsonvalization.
4. Massotherapy.
5. Laser therapy.
6. Mud therapy.
7. Ultraphonophoresis.
8. Shock wave therapy.

It is also possible to use neuroelectric stimulation to restore the conductivity of nerve fibers.

Ultraphonophoresis

A special procedure during which anti-inflammatory drugs are administered under the influence of ultrasound. This technique allows you to improve local metabolic processes, increase oxygen saturation of tissues and restore the conductivity of nerve fibers.

For achievement therapeutic effect for carpal tunnel syndrome, 13-15 sessions are required. The duration of each procedure is from 10 to 30 minutes, depending on the severity of the pathology and the expected results. Ultraphonophoresis is contraindicated in oncological diseases, infectious lesions skin, as well as in the presence of injuries at the site of exposure.

Shock wave therapy

Shockwave therapy involves applying low-frequency sound waves to problem areas. It is used to reduce pain, reduce inflammation, restore tissue nutrition and increase joint resistance to external influences.

The procedure is contraindicated for pregnant women, young people under 23 years of age, and patients with pathologies circulatory system. This treatment of carpal tunnel syndrome is dangerous for patients with a pacemaker, so its presence should be reported to your doctor in advance.

Surgery

If conservative medicine fails, the person is offered surgery. This can be done in two ways:

1. Endoscopic.
2. Open.

During endoscopic surgery, a special device with a video camera is used, which is inserted through a minimal incision. Low level of intervention ensures rapid recovery and absence of severe pain in the postoperative period.

Open surgery allows you to completely cut the ligaments throughout the affected area. Using this method in the treatment of carpal tunnel syndrome, healing takes longer and the risk of complications increases.

Before performing any type of operation, the surgeon warns about possible complications. These include wound infection, injury to a nerve or vessel, and a large scar. In most cases, all symptoms go away after surgery, but after two years, the disease returns in about 60% of patients.

Recovery after surgery takes half a year. In the first month you cannot lift heavy objects so as not to disrupt the process of ligament fusion. In the sixth week, physical therapy is prescribed, which allows you to quickly restore mobility to the problem area. If the patient adheres to all the recommendations and does not return to his previous lifestyle, carpal tunnel syndrome will no longer be a problem after surgery.

Latest Research

Modern treatment methods are aimed at restoring blood supply to the affected area and reducing inflammation.

Modern methods of treating carpal tunnel syndrome:

1. Laser therapy.
2. Local darsonvalization.
3. "Alloplant".
4. Bioresonance therapy.

Laser therapy involves exposure to a low power laser. Provides restoration of affected tissues, improvement of local blood supply and removal of swelling. Due to this, it is possible to achieve greater mobility of the hand and reduce pain symptoms.

Local darsonvalization– this is the effect on tissues of high-frequency currents. This technique helps with the restoration of nerve fibers and the reduction of inflammatory processes. Painful sensations decrease, swelling in the affected area disappears.

« Alloplant"is a new generation drug that is injected into the joint for carpal tunnel syndrome. It decomposes over a long period of time, providing long-lasting healing effect. Activates tissue regeneration, enhances local immunity and triggers cell renewal. It is not rejected by the body and does not cause an allergic reaction.

Bioresonance therapy- This is an analogue of ancient Chinese acupuncture. Special device affects biologically active points, increasing the body's defenses. This method can relieve inflammation, reduce swelling and reduce pain from carpal tunnel syndrome.

Diet for illness

People suffering from carpal tunnel syndrome often have problems with overweight. Because of this, experts recommend monitoring body weight and joint condition, for which refined foods, sweets and fatty varieties meat. Seafood, chicken and turkey meat are beneficial. You should include avocados, nuts, pumpkin seeds and flax seeds. They are rich in omega-3 fatty acids, which reduce inflammatory processes. A specific diet is selected taking into account concomitant diseases. Ideally, a diet with possible restrictions compiled by the attending physician.

Alternative Methods

When pain increases, a person willingly uses alternative methods treatment of carpal tunnel syndrome. These include:

1. Acupuncture.
2. Acupuncture.
3. Palmistry.
4. Acupressure.
5. Yoga.

Alternative treatments are not credible official medicine. Experts believe that such influence schemes are useless, and they work only through self-hypnosis. The only exception is yoga, which allows you to restore joint mobility and strengthen the grasp reflex. Yoga also has a general strengthening effect on the body, which has a beneficial effect on the patient’s condition.

Folk remedies

Traditional recipes are an excellent addition to the drug treatment of carpal tunnel syndrome. They help relieve inflammation and reduce pain in the fingers.

Attention! Any folk remedies for the treatment of carpal tunnel syndrome are used after consultation with a specialist.

Sea ​​buckthorn

The berries are crushed and mixed with water. Heat the mixture to a comfortable temperature, and then steam the brushes for half an hour. Then the hands are wiped dry and wrapped. The procedures are repeated every day for a month, after which they take a two-week break.

Pumpkin compress

The pumpkin is crushed into a paste, applied to the inflamed area and wrapped well. The compress is applied every day for a week.

Pepper rub

Add 1 liter to 100 g pepper vegetable oil and heat the mixture. Rub a warm solution over the painful area twice a day. After applying the composition, you should warm your hands.

Cowberry

Pour 2-3 tbsp. l. lingonberry leaves in a glass boiled water, and then boil the mixture for 15 minutes. The resulting decoction is filtered and drunk in small sips throughout the day. This folk remedy has a mild diuretic effect, which is quite enough to get rid of swelling of the hands.

Treatment of carpal tunnel syndrome requires qualified medical care. When trying to self-medicate folk remedies one should remember about the likelihood of the disease progressing to chronic nature. Therefore, you should not rely only on traditional methods treatment.

The carpal tunnel is located on the palmar side of the hand at the junction of the forearm and the hand and is formed by the carpal bones on one side and the transverse carpal ligament on the other.

The tendons of the finger flexor muscles and the median nerve pass through the carpal tunnel.

When the contents of the carpal tunnel are compressed, the median nerve, which is least resistant to damage compared to tendons, is the first to suffer. Therefore, neurological symptoms come to the fore.

Carpal tunnel syndrome- one of the types of tunnel neuropathies (nerve diseases), in which damage occurs peripheral nerves as a result of prolonged compression and constant trauma in the musculoskeletal canals by chronically inflamed surrounding tissues.

Carpal tunnel syndrome is also known as carpal tunnel syndrome or carpal tunnel syndrome.

Causes of the disease

There are various reasons that can cause the development of carpal tunnel syndrome:

• Tissue swelling as a result of injury to the forearm and hand (fractures, dislocations, bruises);
• Tissue swelling in pregnant women, especially during pregnancy later pregnancy, and in women taking oral contraceptives;
• Chronic inflammation and swelling of the carpal tunnel structures due to constant occupational trauma (the same type of repetitive flexion-extension movements with constant voltage brushes, work associated with constant vibration);
• Tissue swelling as a consequence of a number of diseases internal organs(renal failure), endocrine diseases(decreased thyroid function, early period menopause, condition after removal of ovaries, diabetes);
• Narrowing of the synovial sheaths (sheaths) of tendons and thickening of their walls as a result of acute or chronic inflammation for systemic connective tissue diseases (rheumatism), metabolic disorders (), tuberculosis;
• Discrepancy between the size of the canal and the size of its contents as a result of genetically inherited characteristics (square wrist, thick transverse ligament, narrower canal in women, etc.), or pathological growth of the bones of the hand and wrist (acromegaly);
• Tumor of the median nerve;
• There is an observation that the diagnosis of carpal tunnel syndrome is more often made in the cold season, which proves the role of cold and hypothermia in the development of this disease.

Symptoms

At the beginning of the disease, tingling, burning sensations and pain appear in the thumb, index, middle, and less often ring fingers. The pain is most often dull, aching, can spread to the hand and forearm, and is felt in the deep tissues of the arm. There is often numbness in the skin of the hand and fingers in the morning immediately after waking up, which is accompanied by a decrease or loss of pain sensitivity.

First, sensitivity is lost on the palmar surface of the index and middle fingers; over time, numbness also affects the palmar surfaces of the thumb and ring fingers. The feeling of numbness usually goes away within a few hours of waking up.

Pain, numbness and tingling usually go away if you lower your hand down and move your fingers lightly. But after some time the symptoms appear again.

As the disease progresses, motor disturbances appear: it becomes difficult for the patient to hold small objects in his fingers, inaccuracy of movements appears, objects may periodically fall out of the hands against the will of the person, the strength of gripping objects with the hand with the participation of the thumb decreases.

Often there are symptoms of impaired microcirculation of the diseased hand in the form of pale skin or the appearance of a bluish tint due to vasospasm, coldness of the skin of the fingers to the touch, impaired sweating (increased or, conversely, decreased sweating). As a result of constant vascular spasm, the nutrition of the skin and nails is disrupted with a significant deterioration in their appearance.

Diagnostics

Diagnostic tests and electromyography are used to confirm the diagnosis of carpal tunnel syndrome.

Diagnostic tests

1. Flexion and extension test. The arm is held in the position of maximum flexion or extension for 1 minute. With carpal tunnel syndrome, tingling sensations appear in the skin of the thumb, index and middle fingers during this time.
2. Tinnel test. Lightly tapping the carpal tunnel area causes tingling and pain in the fingers. The Tinnel test is positive, as a rule, in severe cases of the disease.

Electromyography studies the ability of muscles to contract under the influence of electrical impulses. Allows you to confirm the diagnosis of carpal tunnel syndrome or suspect another cause of median nerve disease other than compression in the carpal tunnel.

Treatment of carpal tunnel syndrome

The stage of the disease and the prevailing symptoms determine how to treat carpal tunnel syndrome, which techniques are preferable for a particular patient, and whether surgery can be avoided.

Conservative (without surgery) treatment:

1. Restriction of movements in the sore hand for a long period of time, up to the application of a splint on the wrist or a plaster splint;
2. Medications:
   • non-steroidal anti-inflammatory drugs to reduce pain;
   • dehydrating action (removing water from the body), namely diuretics to relieve swelling;
   • injection of glucocorticoids into the carpal tunnel area to locally reduce tissue swelling and relieve inflammation;
   • drugs that improve blood circulation through the vessels to restore blood supply to the tissues of the diseased hand and restore the function of the median nerve.
3. Physiotherapeutic treatment: constant magnetic field, acupuncture for improvement metabolic processes in damaged tissues.

Surgical treatment is used if conservative treatment is ineffective and consists of cutting the transverse carpal ligament. The operation is performed under local anesthesia. Crossing the transverse carpal ligament allows you to relieve pressure on the finger flexor tendons and median nerve and restore normal blood supply to the tissues of the hand.

After the operation, the affected arm is immobilized with a plaster splint for 10-12 days. IN postoperative period the patient is prescribed physiotherapy, massage, thermal procedures, B vitamins. The function of the hand and the patient’s ability to work are completely restored 4-5 weeks after the operation.

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. He often blocks normal function hands of people whose professional activity associated with systematic flexion-extension movements of the wrist joint: office workers who often use a computer mouse, keyboard, pianists, drummers, etc. in their work activities. Workers whose hand is extended more than 20° relative to the radius for a long time are at risk, ulna bones.

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: tendon overstrain as a result of prolonged stress on the hand. The disease is sometimes provoked by prolonged exposure to cold on the human body.
• Fluid that accumulates in the human body as a result of painful conditions. Swelling during menopause, pregnancy, renal failure etc., affecting the soft tissues of the canal, leading to compression of the nerve.
• A tumor caused by neoplasms on the membranes of nerve tissue. Rarely seen. Diagnosed as schwannoma, neurofibroma, etc.
• Diabetes. Damage to neuronal processes and their processes characteristic of this disease may be caused by accumulation in nerve tissues fructose and sorbitol. 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" - congenital anomaly, in which there is insufficient production of lubrication in the tendons of the hand. The transverse carpal ligament is thicker than in normal people and puts pressure on 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 characteristic feature 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 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 determine accurate diagnosis and prescribing 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 with inside palms in the canal area, the patient feels tingling in the fingers with carpal tunnel syndrome.
• Falena. Provides maximum bending of the arm by the patient at the wrist joint and maintaining this position for exactly a minute. Increased pain and paresthesia will indicate compression of the median nerve of the wrist.
• Cuff. A measuring device cuff is placed on the patient's forearm. blood pressure, pump it with air, leave it 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 involves A complex approach. The main diagnostic measures to identify the disease are the following instrumental methods examinations:

• 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) – modern technique, allowing you to obtain a three-dimensional image of any tissue 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.
• Ultrasonography(Ultrasound) 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 to determine laboratory research general condition body:

• blood:
• to determine sugar levels;
• on 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 kidney pathology, genitourinary system and dysfunction assessments.

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 per area inner surface wrists.

Drug therapy

Neurologist prescribes for treatment medications, capable of relieving the compressive factor, inflammatory processes and restoring sensitivity in 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, A nicotinic acid, Trental, Angioflux
Diuretics	Hypothiazide, Furosemide, Diacarb
Anticonvulsants	Gabapentin, Pregabalin
Muscle relaxants (promoting muscle relaxation)	Sirdalud, Mydocalm
Glucocorticosteroids ( hormonal agents)	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 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.

Towards effective local treatment involves the introduction into the carpal canal of a solution of drugs: anesthetics (novocaine or lidocaine) and synthetic glucocorticosteroids (Hydrocortisone or Diprospan). Steroids are capable of local application with a minimal threat of side effects, significantly slow down 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, relieves pain syndrome.
• Manual therapy aimed at desensitization of the central nervous system, which helps reduce pain in the carpal tunnel area.
• Shock wave therapy can restore vital important functions tissue cells (muscle, nervous), due to the rapid contraction-expansion of adjacent blood vessels under the shock wave of the apparatus.
• 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 give 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 of compression of the median nerve through surgery.

Two methods are used surgical correction 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 cut.
• 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 earlier than in the case of open surgery, but postoperative complications are observed more often. The rehabilitation period of a patient who has undergone open method surgery – 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 recipes:

• Cucumber tincture. Three medium pickles and two red pods hot pepper cut 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 sore spot warm as often as possible.
• 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.

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