home All hormones Why do your hands go numb during pregnancy and what to do about it? General information about carpal tunnel syndrome. Local compresses with a complex composition

Why do your hands go numb during pregnancy and what to do about it? General information about carpal tunnel syndrome. Local compresses with a complex composition

Carpal tunnel syndrome- a disease typical of office workers, teenagers, gamers of all ages and people who enthusiastically use their mobile phones to communicate on the Internet.

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

Carpal 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 incorrect position. Other reasons include incorrect bending of the arm when using modern means of communication (tablets, laptops, etc.), injuries and severe bruises hands

Also, finger strain when typing SMS can lead to carpal 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 hobby, the girl lost the mobility of her wrists and fingers, and daily injections of a strong anesthetic saved her from pain in her hands.

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

Exercises for hand joints

The first symptoms of carpal tunnel syndrome are pain, tingling and numbness in the hands, discomfort when bending the hand, thumb and index finger.

Diagnostics

Determine the disease by early stages You can do this by connecting the backs of your hands and lowering your arms down. Elbows should be directed in different directions, wrists bent at right angles. If pain or discomfort appears within one minute, this is a bad sign and it is worth taking action to prevent carpal tunnel syndrome. An accurate diagnosis is made during an examination by a neurologist - using electromyography, the degree of damage to the muscles of the forearm can be determined.

Treatment for acute pain, severe inflammation and severe tunnel syndrome is prescribed medication, 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, which, especially in the presence of the first symptoms of “carpal tunnel syndrome,” should be done daily and regularly. The more often you take breaks from work to do the exercises, the more benefits they will bring, as they improve blood circulation in the wrist muscles and promote their stretching.

AiF infographics

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

When you sit at a desk and work with a keyboard, the angle of your elbow should be straight (90°).
When working with 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 advisable to have a special wrist support - this could be a mouse pad, a specially shaped keyboard, or a computer desk with special silicone pads.
A chair or armchair must have armrests.

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

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

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

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

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

Causes

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

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

Symptoms

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

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

Paresthesia

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

Pain

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

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

Clumsy hand movements and loss of strength

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

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

Decreased sensitivity

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

Amyotrophy

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

Change in skin color

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

Diagnostics

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

Tests for carpal tunnel syndrome:

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

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

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

electroneuromyography;
radiography;

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

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

Treatment

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

Security mode for carpal tunnel syndrome:

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

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

Local treatment

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

Compresses

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

One of the composition options for compresses:

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

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

Injecting drugs into the carpal tunnel

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

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

Drug therapy

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

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

Physiotherapy

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

Treatments for carpal tunnel syndrome include:

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

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

Surgery

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

Carpal tunnel syndrome is a condition that develops when the median nerve inside the carpal tunnel is pinched or injured. In this case, the movements and sensitivity of the fingers are impaired (the first three and part of the fourth fingers are affected).

Carpal tunnel syndrome is considered an occupational disease, since it most often develops in people of certain professions whose activities involve monotonous flexion and extension of the hand. For example, musicians, tailors, secretaries (work with a computer mouse and keyboard).

Carpal tunnel syndrome has two other names: carpal tunnel syndrome And carpal tunnel syndrome. Although the last name is not entirely correct, since there are other tunnel syndromes (for example, deep branch compression syndrome ulnar nerve).

Statistics

The overall prevalence of carpal tunnel syndrome worldwide is between 1.5 and 3%. Moreover, about 50% of all patients are active users of a personal computer.

According to different sources, carpal tunnel syndrome is 3-10 times more common in women than in men.

The peak onset of the disease occurs between 40 and 60 years of age. However, this does not mean that people younger age are not susceptible to this disease: according to statistics, 10% of all patients are under 30 years of age.

It is believed that people who work long hours on a computer every day are most susceptible to developing carpal tunnel syndrome. According to one study, every sixth person examined has it. Users who are at greatest risk are those whose hand is extended by 20° or more in relation to the forearm while working with the keyboard and computer mouse. Carpal tunnel syndrome is a relatively “young” disease. For the first time, a disease similar to carpal tunnel syndrome was described by the English surgeon Sir James Paget in 1854 in a patient with a fracture. radius at wrist level.

A little later it turned out that the disease can develop in workers performing monotonous movements.

Well, in our time, when the personal computer has firmly entered the life of a modern person, carpal tunnel syndrome has almost become an epidemic. However, science does not stand still. Therefore, there is great news for active personal computer users: a special platform and a flying computer mouse with a magnetic ring have been developed that can withstand the weight of a human hand. This stylish new product can be used both to treat carpal tunnel syndrome and to prevent its development.

The structure and function of nerves

There are about 85 billion nerve cells in our body. They are located in the brain and spinal cord (central nervous system - CNS), as well as in nodes (clusters of nerve cells) lying outside the CNS (for example, spinal ganglia - near the spine).

The processes extending from the nerve cells gather together and form bundles - nerves.

Together, all the nerves form the peripheral nervous system, whose task is to transmit impulses from the brain and spinal cord organs and tissues. Moreover, each nerve is responsible for its own area or organ.

Structure of a nerve cell (neuron)

Nerve cell(neuron) - structural highly specialized unit nervous system, which has body(somu) and shoots(axon and dendrites).

Body The nerve cell contains a nucleus, and is limited on the outside by a wall, which consists of two layers of fat. Due to this, only fat-soluble substances (for example, oxygen) enter the cell.

Neurons have different shapes(spherical, spindle-shaped, stellate and others), as well as the number of processes. Depending on the function they perform, neurons are sensitive (receive impulses from organs and transmit them to the central nervous system), motor (send commands from the central nervous system to organs and tissues), and intercalary (communicate between sensory and motor neurons).

Nerve cell body incapable of reproduction (division) and restoration when damaged. However, when an axon or dendrite is cut, the cell ensures restoration of the dead portion of the process (growth).

Axon and dendrites

Axon- a long process of a nerve cell that transmits excitation and information from the neuron to the executive organ or tissues (for example, muscles).

Most nerve cells have only one axon. However, it can divide into several branches that connect with other cells: muscle, nerve or glandular. This connection between the axon and the target cell is called a synapse. Between the axon and the cell there is a synoptic cleft.

At the end of each axon branch there is a thickening in which there are vesicles with a special substance - a mediator. Until a certain point, it is in a “sleeping” state.

On the outside, most axons are covered with Schwann cells (perform a supporting and nutritional function), which form the myelin (pulp) sheath. Between the Schwann cells there are nodes of Ranvier, an area where the myelin sheath is interrupted. However, some axons lack Schwann cells - unmyelinated fibers.

The peripheral nervous system is characterized by myelin fibers.

Dendrites- short branched processes of a neuron, with the help of which it receives information from body cells and other nerve cells.

Nerve structure

A nerve is a structure in which there are intertwined bundles of nerve fibers (mainly axons) running parallel to each other.

On the outside, the nerve is covered in three layers:

1. The endoneurium contains capillaries (small vessels) that supply nerve fibers.
2. The perineurium, which “dresses” bundles of nerve fibers, since it contains collagen (protein is the basis connective tissue), which performs a supporting function.
3. The epineurium is the outer layer formed of dense connective tissue that surrounds the nerve.

Nerves transmit impulses from the brain and spinal cord to the cells of organs and tissues of the body.

How is a nerve impulse transmitted?

This is a complex process that is carried out using a sodium-potassium pump. What does this mean? The fact is that the wall of the outer layer of the axon is a complex structure (membrane), thanks to which sodium and potassium ions can flow both into and out of the axon. As a result, an impulse is formed, which is transmitted from the axon to other cells.

How does impulse transfer occur?

Normally, the axon is at rest and does not conduct impulses. Therefore, potassium ions move inside the axon body, and sodium ions move out (much like if a fresh cell is placed in a salty solution).

However, when an impulse arrives at the axon from the dendrite, the situation changes: sodium moves inside the axon, and potassium moves out. As a result, the internal environment of the axon acquires a positive charge for a short period, leading to the cessation of sodium influx into the cell. But at the same time, potassium continues to leave the axon.

Meanwhile, sodium ions inside the cell spread to other parts of the axon, changing the permeability of its membrane, thus facilitating further propagation of the impulse. When it passes through a certain point in the axon, the body of the nerve cell receives a “command” to relax, so it returns to a state of rest.

This impulse transmission is quite slow (for example, a signal sent by the brain reaches the hand after a minute). However, thanks to the myelin sheaths, it speeds up as it “jumps” through the intervals of Ranvier.

However, the impulse must reach an adjacent cell. To do this, having reached the thickening at the end of the neuron, it promotes the release of mediators from the vesicles, which enter the synoptic cleft. Next, the mediators connect to special receptors on the cell of the target organ (muscles, glands, etc.). As a result, an action occurs: movement of the hand, fingers, turning the head, and so on.

Anatomy of the hand, wrist and forearm

The hand is a part of the human hand that has three sections:

All the bones of the hand are connected to each other by joints, ligaments and muscles. Thanks to this, movements in the hand become possible, which are controlled by the nervous system.

Forearm - part of the human arm, which consists of two tubular bones (length prevails over width): the radius and ulna. On the upper side it is limited by the elbow joint, and below by the wrist.

Structure and functions of the median nerve

Features of the passage

The median nerve begins in the shoulder area from branches formed by fibers of the spinal nerves (sixth to eighth cervical and first thoracic). Then it goes to the hand, but does not give any branches at the level of the shoulder and ulnar fossa.

Having reached the forearm area (from the elbow to the hand), the median nerve gives off several branches. Then it passes in the carpal tunnel under the transverse carpal ligament and branches into terminal branches.

Along its course, the median nerve innervates the following muscles:

Superficial and deep flexor digitorum, which are responsible for flexing fingers II-V
The muscle that helps flex and rotate the forearm is the pronator teres.
Flexor carpi muscle - flexes and abducts the hand
The muscle that flexes the nail phalanx of the first finger
The palmaris longus muscle, which flexes the hand and tenses the palmar aponeurosis (a wide tendon plate that covers the muscles of the hand from the palmar surface)
The quadratus muscle, which is responsible for rotating the hand and forearm
Abductor pollicis muscle
The muscle that opposes the thumb to all the others
Muscle that flexes the thumb
Muscles that bend II-III fingers.

Functions of the median nerve

Based on the areas of innervation, the median nerve is involved in flexion and abduction of the hand to the inside, flexion of the fingers, bringing the elevation of the first finger to the other fingers of the hand, rotation of the hand and forearm.

The median nerve also innervates the skin on the palmar surface of the hand of the first, index and middle fingers, as well as parts of the ring fingers, and on the dorsum of the hand the skin of the terminal phalanges of the index and middle fingers.

Thus, the median nerve provides both movement and sensation to the hand.

Causes of median nerve damage

The lumen of the carpal tunnel is quite narrow. Therefore, any factor that leads to its narrowing or provokes the growth of tissue inside it can cause the development of carpal tunnel syndrome, since this compresses the median nerve between the bones and tendons of the wrist.

Working at a computer for a long time (using a computer mouse and keyboard)

Most often leads to the development of carpal tunnel syndrome, since this type of activity causes minor chronic injury to the soft tissues of the hand, as well as the tendons running in the carpal tunnel. The reason is repeated, similar, fast and frequent movements of the hand and arm. As a result, aseptic (non-bacterial) inflammation of the tendons passing in the carpal tunnel occurs, which leads to their swelling and pinching by the retinaculum.

However, studies have shown that not all frequent personal computer users develop carpal tunnel syndrome. Certain conditions are necessary for it to occur. For example, people most often at risk are those with III-IV degree of obesity (the lumen of the carpal tunnel narrows due to fat), female gender (anatomically narrower carpal tunnel) and some other factors.

Arthritis: rheumatoid, psoriatic or gouty arthritis, as well as other rheumatic diseases affecting the joints

At the onset of the disease there is inflammatory reaction in the joints of the wrist area. In addition, systemic diseases (affect the body as a whole) lead to the development of inflammation and swelling of soft tissues, including muscles and tendons passing through the carpal tunnel, so its lumen narrows.

Then, over time, as the course of the underlying disease worsens, articular cartilage aging occurs. Therefore, they lose their elasticity and cracks appear on them. As a result, the cartilage gradually begins to wear away, and in some places so much so that the bone is exposed. Such changes lead to the death of cartilage and fusion of articular surfaces. Therefore, deformations occur, as a result of which the normal anatomical structure of the hand and carpal tunnel is disrupted.

Acute wrist injuries

They cause the development of carpal tunnel syndrome in approximately 10% of all cases of the disease. Quickly suppress the production of inflammatory mediators in tissues (histamine, prostaglandins). Therefore, pain and swelling are reduced, and tissue sensitivity is improved.

However, systemic corticosteroids have a large number of side effects (for example, sleep disturbance, ulcers in the stomach and intestines). Therefore, they are used with caution, especially for certain diseases (for example, diabetes). In addition, they suppress the activity of the immune system, so they are not prescribed in the presence of infections.
There is another unpleasant point: after stopping corticosteroids, “rebound” syndrome may develop: all symptoms quickly return.

Local treatment

Considered most effective for relieving acute symptoms.

Introduction of medicinal mixtures

A medicinal mixture of an anesthetic (Lidocaine or Novocaine) with a corticosteroid hormone (Diprospan or hydrocortisone) is injected into the carpal tunnel using a special long needle. As a rule, after administering medications into the carpal tunnel cavity, pain and other symptoms of the disease disappear after some time. However, in some cases, the pain may increase, but after 24-48 hours it gradually decreases.

With this method of treatment, the patient’s condition improves after the first injection. If the symptoms do not disappear completely, then two more procedures are performed with a two-week interval between them.

If the disease relapses (symptoms reappear), the course of treatment is repeated.

Local compresses with a complex composition

One of the composition options:

Dimexide - 50 ml
Lidocaine solution 10% - 2 ml, or Novocaine 2% - 30 ml
Hydrocortisone solution - 1 ampoule
Water - 30 ml

The compress is applied for 40-60 minutes.

The prepared composition can be stored in a cool place and used for several days.

Carpal tunnel syndrome: surgery

Surgery is recommended if symptoms persist for 6 months.

The purpose of the intervention is to reduce pressure on the median nerve by expanding the lumen of the carpal tunnel.

There are two types of surgery, which are performed under local anesthesia:

After the operation, a plaster cast is applied to the wrist area for several days. Physiotherapy and physiotherapy(finger movements should be carried out with a fixed wrist).

3 months after surgery, hand function is restored by 70-80%, and after 6 months - completely.

After recovery, the patient can return to his normal activities. However, if you do not change working conditions (proper arrangement of the workplace, use of cuttings), there is a high risk of relapse (return of symptoms of the disease)

Non-drug treatment

Many doctors use acupuncture to treat carpal tunnel syndrome. manual therapy and other techniques.

For hypothyroidism Hormone replacement therapy is prescribed: L-thyroxine, Eutirox.

During menopause physiological or artificial (removal of the ovaries), hormonal preparations containing estrogen (female sex hormone) are prescribed for replacement therapy. However, such treatment is only possible if the woman had her last menstruation no later than 10 years ago and she is under 60 years of age.

If a menstruating woman has taking hormonal contraception, carpal tunnel syndrome has developed, then they are canceled or changed to another drug.

Treatment of diabetes aimed at preventing jumps in sugar levels during the day. Since it is in this case that the large quantities substances that damage neurons. However, treatment has its own characteristics depending on the type of disease.

For type I diabetes, insulin (short-, long- or medium-acting) is prescribed. The dosage and regimen of use is individual, depending on the severity of the disease and blood sugar levels.

For type II diabetes, glucose-lowering drugs (Glucophage, Metformin) are prescribed, which increase the sensitivity of cell walls to insulin, improving the intake of glucose. In addition, they reduce the formation of glucose in the liver, as well as its absorption in the intestine.

While maintaining partial function of the pancreas, drugs are used that stimulate the production of insulin by its cells. These are sulfonylurea derivatives: Chlorpropamide, Gliquidone and others.

Regardless of the type of diabetes, thioctic acid preparations (Tiogamma, Berlition) are prescribed to improve tissue nutrition. They improve the absorption of glucose by tissues, bind free radicals (unstable molecules that damage other normal cells of the body), especially cells of the nervous system.

For chronic renal failure treatment is aimed at improving function and blood circulation in the kidneys, removing excess fluid from the body and the end products of protein metabolism.

For this purpose, drugs that thin the blood and improve blood circulation are used. small vessels(for example, Warfarin, Angioflux).

Sometimes diuretics are prescribed (depending on the degree of preservation of kidney function).

Sorbents (Polysorb, Enterosgel and others) are used to remove the end products of protein metabolism.

For high blood pressure, drugs are used that regulate it: ACE inhibitors (Diroton, Captopril), calcium antagonists (Verapamil) and others.

In case of severe renal failure (stages III-IV), the patient is connected to an artificial kidney apparatus.

Physiotherapeutic procedures

They have proven themselves well both during treatment with medications and during the rehabilitation period after surgery.

However, despite their effectiveness, they are not suitable for everyone.

General contraindications to physiotherapeutic procedures

Tumor processes
Pregnancy
Severe III degree heart failure
Any infectious viral diseases in the acute period (presence of elevated body temperature)
Severe diabetes mellitus (high sugar levels)
Increased arterial pressure- temporary contraindication. After its normalization, the procedure can be carried out.
Presence of a pacemaker
Epilepsy with frequent seizures, hysteria and psychosis
Reduced blood clotting and bleeding tendency
Severe heart rhythm disturbance: severe atrial fibrillation (contraction of the ventricles and atria is asynchronous) and severe extrasystole (with this disease the heart rhythm is disturbed)
Presence of pustular inflammation on the skin (site of device exposure)

Physiotherapeutic procedures are prescribed both for the treatment of carpal tunnel syndrome and the diseases that led to its development.

Ultraphonophoresis

Performed together with medications.

During the procedure, the body is affected by ultrasonic vibrations, which facilitate the penetration of drugs into the cell.

In addition, the therapeutic effect of ultrasound itself: it dilates blood vessels and accelerates blood flow in the capillaries. Thanks to this, pain decreases or disappears, swelling decreases and hematomas resolve.

Dimexide, painkillers, hormones and other drugs are used as medicines. Exception - some medications that ultrasound destroys: novocaine, B vitamins, ascorbic acid and other substances.

The goals are to reduce pain and inflammation, accelerate tissue restoration.

Indications

Diseases of the musculoskeletal system: osteochondrosis, arthrosis, arthritis, (vascular disease)
Active pulmonary tuberculosis
Individual intolerance to drugs for ultraphonophoresis

Method of application

First, the medical worker wipes disinfectant solution the area of skin that is subject to the procedure. Next, apply to the skin medicine, then applies a device that delivers ultrasonic waves to the site of treatment.

The duration of one procedure is from 10 to 30 minutes. Course - 8-12 sessions. After a few months, if necessary, the course of treatment is repeated.

Shock wave therapy

The method is based on the action of acoustic shock waves (generated by a special sensor), the frequency of which is lower than perceived human ear- infrasound. These waves have a high amplitude of energy and a short duration, due to which they propagate in soft tissues without damaging them. At the same time, they restore metabolism and promote cell renewal.

As a result, blood circulation in the affected area improves, pain decreases, and sensitivity is restored. Moreover, after several procedures they begin to disintegrate. bone spurs, and new vessels grow at the site of the lesion.

The method is so effective that if treatment is started in a timely manner, it is equal to the result obtained after surgery.

Goals

Treatment of acute and chronic pain caused by trauma, diseases of the musculoskeletal system (osteochondrosis, arthritis and others) and the nervous system.

Indications

Arthrosis, arthritis, osteochondrosis, hernias and protrusions intervertebral discs, heel spur
Gallbladder and kidney stones
Slow healing of fractures
Soft tissue injuries: muscles, ligaments, tendons
Scar tightening of muscles, tendons and ligaments, so free movements (flexion, extension) in the limb are limited
Pain from bruises, fractures, sprains
Burns and trophic ulcers
Chronic muscle pain resulting from prolonged and frequent overwork

Contraindications

(in addition to the general ones)

Age up to 18 years, since the waves act on the growth zones of bones. Whereas when they are damaged, irreversible changes develop that have a bad effect on the development of the child’s skeleton.

Methodology

The medical worker helps the patient get more comfortable on the couch, then wipes the area of skin, disinfecting and degreasing it. Then it configures the device depending on the area of application and the disease (there are several programs). Next, a special gel is applied to the skin, after which a sensor is applied to the site of treatment, which sends therapeutic impulses.

The course of treatment is 5-7 procedures, each of which lasts 20-30 minutes. The procedures are carried out at intervals of 3-7 days. After treatment, about 90% of patients have a significant improvement in their condition. If necessary, the course of treatment is repeated after several months.

On a note

Do not apply shock waves to the area of the head, intestines, large blood vessels and lungs.

Prevention of carpal tunnel syndrome

According to statistics, the number of patients with carpal tunnel syndrome in last years has increased as the personal computer has become firmly established in the life of modern man. However, the formation of the disease can be prevented.

So, what to do based on the mechanism of development of the disease?

Arrange your workplace
Select the height of the computer desk so that the armrests of the chair are level with its surface. In this position, while working (typing or moving a computer mouse), the forearms rest quietly on the table or armrests, and are not suspended. Therefore, the hands are relaxed while working, and the hand at the wrist does not bend. In this case, there is no additional load on the canal and the median nerve is not pinched.

In addition, while working, try to ensure that the lower back is positioned at an angle of 90° in relation to the hips, and the angle between the shoulder and forearm is also 90°.

Try not to strain or squeeze. Be careful not to pull your head between your shoulders.

Choose a comfortable keyboard and computer mouse
If the position of the hands is correct during work, then the hands lie calmly above the working surface, so movements in them are free. However, if the keyboard is located high, you have to hold your hands above it in a suspended position. This position increases the load on the carpal tunnel. Therefore, it is better to purchase a special hand mat or an inclined keyboard.

Choose a computer mouse so that it fits in your palm while you work. This way the hand gets tired less and is relaxed. For people who have already developed carpal tunnel syndrome, special computer mice have been developed that are shaped like a joystick. When working with them, the carpal tunnel is practically not loaded.

In addition, there are special computer mouse pads that have a cushion (it is better to choose one with a gel filler) at wrist level. In this position, during work, the carpal tunnel is in a straightened state and is minimally loaded.

Position of the brushes when working

Adjust the angle and height of your monitor

In such a way that the text is at eye level while working. Because if the monitor is located low, then you have to constantly tilt your head down, if it is high, then raise it up. With such movements, blood circulation in the cervical spine and arms worsens.

1
1 Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after. THEM. Sechenov Ministry of Health of Russia (Sechenov University), Moscow
2 Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University named after. THEM. Sechenov" of the Ministry of Health of Russia (Sechenov University), Moscow; Neurological Center named after. B.M. Gekhta DZ JSC Russian Railways, Moscow
3 Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.M. Sechenov Ministry of Health of Russia (Sechenov University)

For quotation: Golubev V.L., Merkulova D.M., Orlova O.R., Danilov A.B. Tunnel syndromes of the hand // BC. 2009. P. 7

Tunnel syndrome (synonyms: compression-ischemic neuropathy, tunnel neuropathy, trap neuropathy, trap syndrome) usually refers to a complex of clinical manifestations (sensitive, motor and trophic) caused by compression, pinched nerves in narrow anatomical spaces (anatomical tunnel). The walls of the anatomical tunnel are natural anatomical structures (bones, tendons, muscles), and normally peripheral nerves and vessels pass freely through the tunnel. But under certain pathological conditions, the channel narrows, and a nerve-channel conflict arises [Al-Zamil M.Kh., 2008].

Tunnel neuropathies account for 1/3 of diseases of the peripheral nervous system. More than 30 forms of tunnel neuropathies have been described in the literature [Levin O.S., 2005]. Various shapes Compression-ischemic neuropathies have their own characteristics. We will first consider their general characteristics, then we will focus on the most common forms of hand tunnel syndromes (Table 1).

Causes

The anatomical narrowness of the canal is only a predisposing factor in the development of tunnel syndrome. In recent years, evidence has accumulated indicating that this anatomical feature is genetically determined. Another reason that can lead to the development of tunnel syndrome is the presence of congenital developmental anomalies in the form of additional fibrous cords, muscles and tendons, and rudimentary bone spurs.
However, only predisposing factors for the development of this disease, as a rule, is not enough. Some metabolic and endocrine diseases (diabetes mellitus, acromegaly, hypothyroidism), diseases accompanied by changes in joints, bone tissue and tendons (rheumatoid arthritis, rheumatism, gout), conditions accompanied by hormonal changes (pregnancy), space-occupying formations can contribute to the development of tunnel syndrome the nerve itself (schwannoma, neuroma) and outside the nerve (hemangioma, lipoma). The development of tunnel syndromes is facilitated by frequently repeated stereotypical movements and injuries. Therefore, the prevalence of carpal tunnel syndrome is significantly higher in people engaged in certain activities and in representatives of certain professions (for example, stenographers have carpal tunnel syndrome 3 times more often).

Clinical manifestations

The full picture of tunnel syndrome includes sensory (pain, paresthesia, numbness), motor (decreased function, weakness, atrophy) and trophic disorders. Possible various options clinical course. Most often it starts with pain or other sensory disorders. Less commonly, it begins with movement disorders. Trophic changes are usually expressed insignificantly and only in advanced cases.
The most characteristic feature of carpal tunnel syndrome is pain. Typically, pain appears during movement (load), then occurs at rest. Sometimes the pain wakes the patient up at night, which exhausts the patient and forces him to see a doctor. Pain in tunnel syndromes can include both a nociceptive component (pain caused by inflammatory changes occurring in the area of the nerve-canal conflict) and a neuropathic component (due to nerve damage). Tunnel syndromes are characterized by manifestations of neuropathic pain such as allodynia and hyperpathy, a sensation of electric current passing (electrical shooting), and burning pain. In later stages, pain may be due to muscle spasms. Therefore, when choosing pain therapy, it is necessary to be guided by the results of a thorough clinical analysis of the characteristics of the pain syndrome.

Motor disorders arise as a result of damage to the motor branches of the nerve and manifest themselves in the form of decreased strength and rapid fatigue. In some cases, the progression of the disease leads to atrophy and the development of contractures (“clawed paw”, “monkey paw”).

With compression of arteries and veins, vascular disorders may develop, which is manifested by pallor, a decrease in local temperature, or the appearance of cyanosis and swelling in the affected area. With isolated nerve damage (in the absence of compression of arteries and veins), trophic changes are most often insignificantly expressed.

Diagnostics

As a rule, the diagnosis is established on the basis of the characteristic clinical manifestations described above. It is convenient for the clinician to use a number of clinical tests that allow differentiation different kinds tunnel syndromes. In some cases, it is necessary to conduct electroneuromyography (the speed of impulses along the nerve) to clarify the level of nerve damage. Nerve damage, space-occupying lesions or other pathological changes causing carpal tunnel syndrome can also be determined using ultrasound, thermal imaging, and MRI.

Principles of treatment

Typically, patients do not consult a doctor about carpal tunnel syndrome immediately after the onset of the disease. The reason for referral is most often pain that patients cannot cope with on their own. In order for treatment to be effective, it is necessary to understand the cause and mechanisms of compression.
It is possible to identify general principles (or tasks that the doctor sets for himself) in the treatment of tunnel syndromes.

Stop exposure to the pathogenic factor. Immobilization

The first thing to do is to stop physical impact on the affected area. Therefore, immobilization in the affected area is necessary. Recently, special devices have appeared in our country - orthoses, bandages, splints, which allow immobilization in the area of injury. At the same time, they are very convenient to use, they can be put on and taken off very easily, which allows the patient to maintain his social activity (Fig. 1).
These funds are widely and successfully used abroad. Studies have appeared on the effectiveness of splinting, which have convincingly shown that it is quite comparable to the effectiveness of hormone injections and surgical operations. In our country, these devices are already used by traumatologists; V neurological practice they are clearly not implemented enough yet.

Change the usual locomotor stereotype and lifestyle

Tunnel syndromes are often the result not only of monotonous activity, but also of ergonomic disorders (improper posture, awkward position of the limb during work). Special exercises and recommendations for optimal organization of the workplace have been developed. To relieve pain and prevent relapse, orthoses and splints using the splinting principle are used. In rare cases, you have to change your profession.
Training in specific exercises and physical therapy are an important component of the treatment of tunnel neuropathies in the final stage therapy.

Pain therapy

Physical effects(cold, warm). In mild cases, ice compresses and sometimes “hot” compresses can help reduce pain. A doctor is usually consulted when these or other “home” methods “do not help.”

Anti-inflammatory therapy. Traditionally, for carpal tunnel syndromes, NSAIDs with a more pronounced analgesic and anti-inflammatory effect (diclofenac, ibuprofen) are used. It should be remembered that when long-term use drugs in this group pose a risk of gastrointestinal and cardiovascular complications. In this regard, for moderate or severe pain, it is advisable to use a combination of low doses of the opioid analgesic tramadol (37.5 mg) and the safest analgesic/antipyretic paracetamol (325 mg). Thanks to this combination, a multiple increase in the general analgesic effect is achieved with a lower risk of side effects.

Impact on the neuropathic component of pain. Often, with tunnel syndromes, the use of analgesics and NSAIDs is ineffective (it is in these cases that patients consult a doctor). This may be due to the fact that the dominant role in the formation of pain is played not by the nociceptive, but by the neuropathic mechanism. When pain is the result of neuropathic changes, it is necessary to prescribe drugs recommended for the treatment of neuropathic pain: anticonvulsants (pregabalin, gabapentin), antidepressants (venlafaxine, duloxetine), plates with 5% lidocaine. The choice of a particular drug should be made taking into account the clinical manifestations and individual characteristics of the patient (the possibility of developing side effects). It is important to inform the patient that drugs used for neuropathic pain, unlike “classical painkillers,” do not begin to act immediately (it is necessary to titrate the dose; the effect occurs several days or even weeks after starting the drug).

Injections of anesthetic + hormones. A very effective and acceptable treatment method for most types of tunnel neuropathies is a blockade with the introduction of an anesthetic (Novocaine) and a hormone (hydrocortisone) into the area of infringement. Special guidelines describe techniques and doses of drugs for various tunnel syndromes [Zhulev N.M., 2005]. This procedure is usually resorted to if other measures are ineffective (cold compresses, use of analgesics, NSAIDs), but in some cases if the patient presents at a more advanced stage of the disease and experiences severe pain, it is advisable to immediately offer this manipulation to such a patient.

Other methods of pain relief. Currently, there are reports of the high effectiveness of injection of meloxicam with hydrocortisone into the tunnel area.
An effective way to reduce pain and inflammation is electrophoresis, phonophoresis with dimexide and other anesthetics. They can be carried out in a clinic setting.
Symptomatic treatment. For tunnel syndromes, decongestants, antioxidants, muscle relaxants, and drugs that improve the trophism and functioning of the nerve (ipidacrine, vitamins, etc.) are also used.

Surgical intervention. Surgical treatment is usually resorted to when other options for helping the patient have been exhausted. At the same time, for certain indications, it is advisable to immediately offer the patient surgical intervention. Surgery usually involves releasing the nerve from compression, “reconstructing the tunnel.”
According to statistics, the effectiveness of surgical and conservative treatment does not differ significantly a year later (after the start of treatment or surgery). Therefore, after a successful surgical operation, it is important to remember about other measures that must be followed to achieve a full recovery (prevention of relapses): changing locomotor patterns, using devices that protect against stress (orthoses, splints, bandages), performing special exercises.

Carpal tunnel syndrome

Carpal tunnel syndrome (carpal tunnel syndrome) is the most common form of compression-ischemic neuropathy encountered in clinical practice. In the population, carpal tunnel syndrome occurs in 3% of women and 2% of men [Berzins Yu.E., 1989]. This syndrome is caused by compression of the median nerve as it passes through the carpal tunnel under the transverse carpal ligament. The exact cause of carpal tunnel syndrome is not known. The following factors most often contribute to compression of the median nerve in the wrist area:
Trauma (accompanied by local swelling, tendon sprain).
Ergonomic factors. Chronic microtraumatization (often found among construction workers), microtraumatization associated with frequent repeated movements (among typists, with constant long-term work with a computer).
Diseases and conditions accompanied by metabolic disorders, edema, tendon and bone deformities (rheumatoid arthritis, diabetes mellitus, hypothyroidism, acromegaly, amyloidosis, pregnancy).
Space-occupying formations of the median nerve itself (neurofibroma, schwannoma) or outside it in the wrist area (hemangioma, lipoma).

Clinical manifestations

Carpal tunnel syndrome is characterized by pain, numbness, paresthesia and weakness in the arm and hand. Pain and numbness extend to the palmar surface of the thumb, index, middle and 1/2 ring finger, as well as to the dorsum of the index and middle finger. Initially, symptoms occur when performing any activities using a brush (working on a computer, drawing, driving), then numbness and pain appear at rest, sometimes occurring at night.

To verify the diagnosis of carpal tunnel syndrome, we offer following tests.
Tinel test: tapping the wrist (above the median nerve) with a neurological hammer causes a tingling sensation in the fingers or pain radiating (electrical shooting) to the fingers (Fig. 2). Pain may also be felt in the tapping area. A positive Tinel sign is found in 26–73% of patients with carpal tunnel syndrome [Al Zamil M.H., 2008].
Durkan's test: compression of the wrist in the area of the median nerve causes numbness and/or pain in the 1st–3rd, half of the 4th fingers (as with Tinel's symptom).
Phalen Test: Wrist flexion (or extension) 90 degrees produces numbness, tingling, or pain in less than 60 seconds (Figure 3). A healthy person may also develop similar sensations, but not earlier than after 1 minute.
Opposition test: with severe thenar weakness (which occurs more than late stage) the patient cannot connect the thumb and little finger (Fig. 4); or the doctor (researcher) can easily separate the patient’s closed thumb and little finger.

Differential diagnosis

Carpal tunnel syndrome should be differentiated from arthritis of the carpo-metacarpal joint of the thumb, cervical radiculopathy, and diabetic polyneuropathy.
Patients with arthritis will show characteristic bone changes on x-rays. In cervical radiculopathy, reflex, sensory and motor changes will be associated with neck pain, while in carpal tunnel syndrome these changes are limited to distal manifestations. Diabetic polyneuropathy is usually a bilateral, symmetrical process involving other nerves (not just the median nerve). At the same time, a combination of polyneuropathy and carpal tunnel syndrome in diabetes mellitus cannot be ruled out.

Treatment

In mild cases of carpal tunnel syndrome, ice compresses and a decrease in load can help. If this does not help, you need to take the following measures:
1. Immobilization of the wrist. There are special devices (splints, orthoses) that immobilize the wrist and are convenient to use (Fig. 1). Immobilization should be carried out at least overnight, and preferably for 24 hours (according to at least, in the acute period).
2. NSAIDs. Drugs from the NSAID group will be effective if the inflammatory process dominates in the pain mechanism.
3. If the use of NSAIDs turns out to be ineffective, it is advisable to inject novocaine with hydrocortisone into the wrist area. As a rule, this procedure is very effective.
4. In outpatient settings, electrophoresis can be performed with anesthetics and corticosteroids.
5. Surgical treatment. For mild or moderate carpal tunnel syndrome, conservative treatment is more effective. In case all means have been exhausted conservative care, resort to surgical treatment. Surgical treatment consists of partial or complete resection of the transverse ligament and releasing the median nerve from compression. Recently, they have been successfully used in the treatment of carpal syndrome. endoscopic methods surgery

Pronator teres syndrome (Seyfarth syndrome)

Entrapment of the median nerve in the proximal part of the forearm between the pronator teres fascicles is called pronator syndrome. This syndrome usually begins to appear after significant muscle activity over many hours involving the pronator and flexor digitorum muscles. Such types of activities are often found among musicians (pianists, violinists, flutists, and especially often among guitarists), dentists, and athletes [Zhulev N.M., 2005].
Great importance in the development of pronator teres syndrome has prolonged compression fabrics. This can happen, for example, during deep sleep when the newlywed's head is positioned on the partner's forearm or shoulder for a long time. In this case, the median nerve in the pronator snuffbox is compressed, or the radial nerve in the spiral canal is compressed when the partner’s head is located on the outer surface of the shoulder (see radial nerve compression syndrome at the level of the middle third of the shoulder). In this regard, to designate this syndrome in foreign literature, the terms “honeymoon paralysis” (honeymoon paralysis, newlywed paralysis) and “lovers paralysis” (lovers paralysis) have been adopted.

Pronator teres syndrome sometimes occurs in nursing mothers. In them, compression of the nerve in the area of the pronator teres occurs when the baby’s head lies on the forearm, he is breastfed, lulled to sleep, and the sleeping person is left in this position for a long time.

Clinical manifestations

With the development of pronator teres syndrome, the patient complains of pain and burning 4–5 cm below elbow joint, along the anterior surface of the forearm and irradiation of pain into the 1st–4th fingers and palm.
Tinel's syndrome. In case of pronator teres syndrome, Tinel's sign will be positive when tapping with a neurological hammer in the area of the pronator snuff box (on the inside of the forearm).

Pronator-flexor test. Pronating the forearm with a tightly clenched fist while creating resistance to this movement (counteraction) leads to increased pain. Increased pain can also be observed when writing (prototype of this test).
When examining sensitivity, a sensitivity disorder is revealed, involving the palmar surface of the first three and a half fingers and the palm. The sensory branch of the median nerve, innervating the palmar surface of the hand, usually passes above the transverse carpal ligament. The occurrence of sensory disturbances on the palmar surface of the first finger, the dorsal and palmar surfaces of the second and fourth fingers, with preservation of sensitivity in the palm, allows one to confidently differentiate carpal tunnel syndrome from pronator teres syndrome. Thenar atrophy in pronator teres syndrome is usually not as severe as in progressive carpal tunnel syndromes.

Supracondylar process syndrome of the shoulder (Strother's band syndrome, Coulomb, Lord and Bedossier syndrome)

In the population, the development variant is observed in 0.5–1% of cases humerus, in which a “spur” or supracondylar process (apophysis) is found on its distal anteromedial surface. Due to the accessory process, the median nerve is displaced and stretched (like a bowstring). This makes him vulnerable to defeat.
This tunnel syndrome, described in 1963 by Coulomb, Lord and Bedossier, has almost complete similarities with the clinical manifestations of pronator teres syndrome: pain, paresthesia, and decreased flexion strength of the hand and fingers are detected in the zone of innervation of the median nerve. In contrast to pronator teres syndrome, when the median nerve is damaged under Strather's ligament, mechanical compression of the brachial artery with corresponding vascular disorders is possible, as well as severe weakness of the pronator teres (teres and minor).
The following test is useful in diagnosing supracondylar process syndrome. When extending the forearm and pronation in combination with formed flexion of the fingers, painful sensations with a localization characteristic of compression of the median nerve. If it is suspected that the compression is caused by a “spur” of the humerus, an x-ray examination is indicated.
Treatment involves resection of the supracondylar process (“spur”) of the humerus and ligament.

Cubital tunnel syndrome

Cubital tunnel syndrome (Sulcus Ulnaris Syndrome) is compression of the ulnar nerve in the cubital canal (Mouchet's canal) in the area of the elbow joint between the internal epicondyle of the humerus and the ulna bone and is the second most common after carpal tunnel syndrome.
Cubital tunnel syndrome develops for a number of reasons. Cubital tunnel syndrome can be caused by repetitive bending of the elbow joint. Therefore, cubital tunnel syndrome is classified as a disorder called accumulated traumatic disorder(syndrome overuse). Those. the disorder may occur with normal, frequently repeated movements (most often associated with a specific professional activity) in the absence of obvious traumatic injury. Direct trauma can also contribute to the development of cubital tunnel syndrome, such as leaning on the elbow while sitting. Patients with diabetes and alcoholism are at greater risk of developing cubital tunnel syndrome.

Clinical manifestations

The main symptoms of cubital tunnel syndrome are pain, numbness and/or tingling. Pain and paresthesia are felt in the lateral part of the shoulder and radiate to the little finger and half of the fourth finger. At first, discomfort and pain occur only when pressure is applied to the elbow or after prolonged bending. In a more severe stage, pain and numbness are felt constantly. Another sign of the disease is weakness in the arm. It manifests itself as a loss of “confidence” in the hand: suddenly objects begin to fall out of it during some habitual actions. For example, it becomes difficult for a person to pour water from a kettle. IN advanced stages the hand on the sore arm begins to lose weight, pits appear between the bones due to muscle atrophy.

Diagnostics

In the early stages of the disease, the only manifestation (besides weakness of the forearm muscles) may be loss of sensation on the ulnar side of the little finger.
When erased clinical picture The following tests can help verify the diagnosis of Cubital Tunnel Syndrome:
Tinel test - the occurrence of pain in the lateral part of the shoulder, radiating to the ring finger and little finger when tapping with a hammer over the area of the nerve passage in the area of the medial epicondyle.
Equivalent to Phalen's sign, sudden flexion of the elbow will cause paresthesia in the ring and little fingers.
Frohman's test. Due to weakness of the abductor policis brevis and flexor policis brevis, one may find excessive flexion at the interphalangeal joint of the thumb on the affected hand in response to a request to hold a paper between the thumb and index finger(Fig. 5).
Wartenberg test. Patients with more severe muscle weakness may complain that when putting their hand into a pocket, the little finger is moved to the side (does not go into the pocket) (Fig. 6).

Treatment

At the initial stages of the disease, conservative treatment is carried out. Changing the load on the elbow and eliminating elbow flexion as much as possible can significantly reduce pressure on the nerve. It is recommended to fix the elbow joint in an extension position at night with the help of orthoses, hold the car steering wheel with your arms straightened at the elbows, straighten the elbow when using a computer mouse, etc.
If application traditional means(NSAIDs, COX-2 inhibitors, splinting) for 1 week did not have a positive effect, an injection of an anesthetic with hydrocortisone is recommended.

If the effectiveness of these measures is insufficient, then an operation is performed. There are several techniques for surgical release of the nerve, but all of them in one way or another involve moving the nerve anteriorly from the internal epicondyle. After surgery, treatment is prescribed aimed at quickly restoring nerve conduction.
Guyon's tunnel syndrome
Guyon's tunnel syndrome develops due to compression of the deep branch of the ulnar nerve in the canal formed by the pisiform bone, hamate hook, palmar metacarpal ligament and palmaris brevis muscle. Marked burning pain and sensitivity disorders in the fourth and fifth fingers, difficulty in pinching movements, adduction and extension of the fingers.

Tunnel ulnar syndrome is very often the result of prolonged pressure from working tools, for example, vibrating tools, screwdrivers, pliers, and therefore occurs more often in representatives of certain professions (gardeners, leather cutters, tailors, violinists, people working with jackhammers). Sometimes the syndrome develops after using a cane or crutch. Pathological factors that can cause compression also include enlarged lymphatic ganglia, fractures, arthrosis, arthritis, ulnar artery aneurysm, tumors and anatomical formations around Guyon's canal.
Differential diagnosis. The difference between Guyon's canal syndrome and ulnar canal syndrome is indicated by the fact that when a nerve is damaged in the hand area, pain occurs in the hypothenar and base of the hand, as well as intensification and irradiation in the distal direction during provoking tests. In this case, sensitivity disorders occupy only the palmar surface of the 4th–5th fingers. On the back of the hand, sensitivity is not impaired, since it is provided by the dorsal branch of the ulnar nerve, which arises from the main trunk at the level of the distal third of the forearm.

At differential diagnosis with radicular syndrome (C8), it should be taken into account that paresthesia and sensitivity disorders can also appear along the ulnar edge of the hand. Paresis and hypotrophy of the hypothenar muscles are possible. But with C8 radicular syndrome, the zone of sensory disorders is much larger than with Guyon’s canal, and there is no hypotrophy and paresis of the interosseous muscles. If the diagnosis is made early, limiting activity may help. Patients can be recommended to use fixators (orthoses, splints) at night or during the day to reduce trauma.
If conservative measures fail, surgical treatment is performed aimed at reconstructing the canal in order to free the nerve from compression.

Radial nerve compression syndrome

There are three options for compression lesions of the radial nerve:
1. Compression in the armpit area. Rarely seen. It occurs as a result of the use of a crutch (“crutch paralysis”), and paralysis of the extensors of the forearm, hand, main phalanges of the fingers, abductor pollicis muscle, and supinator develops. The flexion of the forearm is weakened, the reflex from the triceps muscle fades. Sensitivity is lost on the dorsal surface of the shoulder, forearm, and partly the hand and fingers.
2. Compression at the level of the middle third of the shoulder (spiral canal syndrome, “Saturday night paralysis”, “park bench”, “bench” syndrome). It occurs much more often. The radial nerve, emerging from the axillary region, bends around the humerus, where it is located in the bony spiral groove (groove), which becomes the musculoskeletal tunnel, since the two heads of the triceps muscle are attached to this groove. During the period of contraction of this muscle, the nerve is displaced along the humerus and as a result can be injured during forced repeated movements in the shoulder and elbow joints. But most often, compression occurs due to compression of the nerve on the outer-posterior surface of the shoulder. This usually occurs during deep sleep (often deep sleep occurs after drinking alcohol, which is why it is called “Saturday night syndrome”), in the absence of a soft bed (“park bench syndrome”). Pressure on the nerve may be due to the location of the partner's head on the outer surface of the shoulder.
3. Compressive neuropathy of the deep (posterior) branch of the radial nerve in the subulnar region (supinator syndrome, Froese syndrome, Thomson-Kopell syndrome, “tennis elbow” syndrome).
Tennis elbow, tennis elbow, or epicondylitis of the lateral epicondyle of the humerus is chronic illness, caused by a degenerative process in the area of muscle attachment to the external epicondyle of the humerus. Compression syndrome of the posterior (deep) branch of the radial nerve under the aponeurotic edge of the short extensor carpi radialis or in the tunnel between the superficial and deep bundles of the supinator muscle of the forearm can be caused by muscle overloads with the development of myofasciopathies or pathological changes perineural tissues. It manifests itself as pain in the extensor muscles of the forearm, their weakness and hypotrophy. Dorsal flexion and supination of the hand, active extension of the fingers against resistance provoke pain. Active extension of the third finger while pressing it and simultaneously straightening the arm at the elbow joint causes intense pain in the elbow and upper forearm.

Treatment includes general etiotropic therapy and local effects. Take into account the possible connection of tunnel syndrome with rheumatism, brucellosis, arthrosis of metabolic origin, hormonal disorders and other conditions that contribute to compression of the nerve by surrounding tissues. Anesthetics and glucocorticoids are injected locally into the area of the pinched nerve. Complex treatment includes physical therapy, the prescription of vasoactive, decongestant and nootropic drugs, antihypoxants and antioxidants, muscle relaxants, ganglion blockers, etc. Surgical decompression with dissection of the tissues compressing the nerve is indicated if conservative treatment is unsuccessful.
Thus, hand tunnel syndromes are a type of damage to the peripheral nervous system caused by both endogenous and exogenous influences. The outcome depends on the timeliness and adequacy of treatment, correct preventive recommendations, the patient’s orientation in choosing or changing a profession that predisposes to the development of tunnel neuropathy.

The article uses drawings from the book by S. Waldman. Atlas of commom pain syndromes. – Saunders Elsevier. – 2008.

Tunnel syndrome belongs to the group of compression-ischemic neuropathies - diseases peripheral nerves, not associated with infectious and vertebrogenic factors. A pinched median nerve in the carpal tunnel is caused by thickening of the nerve fibers or hardening of the surrounding tendons. The causes of the pathology can be mechanical injuries, inflammation of the joints, tumors, and endocrinopathies. When nerve tissue is compressed, the blood supply to the nerve is disrupted. Similar changes are observed when the same wrist muscles are regularly overstrained.

Carpal tunnel syndrome is an occupational disease of individuals who perform similar movements with the hand during work. This pathology affects grocery store cashiers, computer users, artists, hairdressers, violinists, miners, wrappers, and guitarists. In women, the disease is much more common than in men, which is due to the relatively small volume of the carpal tunnel. The first clinical signs of the disease appear at 30-45 years of age, and its peak occurs at 50-60 years of age. Carpal tunnel syndrome is a chronic disease with frequent changes exacerbations and remissions, manifested by pain, paresthesia, motor dysfunction. These clinical signs have varying degrees of severity.

The same group of neuropathies includes cubital tunnel syndrome. Injuries to the elbow joint lead to inflammation and damage to the tendon arch. It thickens, the channels narrow. Individuals who experience constant compression of the ulnar nerve are most susceptible to developing ulnar nerve tunnel syndrome.

the second most common is cubital tunnel syndrome

There are two types of compression-ischemic neuropathy of the hand:

Primary is an independent pathology that does not depend on other processes occurring in the body. Primary neuropathy is usually caused by overuse of the wrist muscles, as well as prolonged and excessive stress on the joint.
Secondary – a symptom or complication of any disease in the body. Systemic connective tissue diseases, arthrosis, arthritis are manifested by tunnel syndrome.

Carpal tunnel syndrome was discovered by English surgeon Paget in 1854. He was the first to describe the clinical signs of the disease and the mechanism of its development. Currently, the pathology is diagnosed extremely rarely. Its pathogenesis and etiology have been little studied, so tunnel syndrome is poorly recognized and detected. If this problem is left unattended, negative consequences may develop.

Causes

Carpal tunnel syndrome develops when the size of the carpal tunnel decreases or the volume of tissue inside it increases. The main role in the development of compression-ischemic neuropathy is given to injuries at home, at work or during sports.

Reasons for such processes:

sprains, dislocations and fractures of the wrist,
pregnancy and associated swelling of soft tissues,
long-term use of oral contraceptives,
lactation period,
diabetes,
dysfunction of the thyroid gland or its removal,
obesity,
water balance disturbance,
hormonal imbalance,
acromegaly,
renal failure,
sudden weight loss,
amyloidosis,
rheumatoid arthritis,
gout,
hematological diseases,
tumors deforming the wrist,
hereditary predisposition.

In rare cases, neuropathy develops as a result of acute infectious diseases: rash or typhoid fever, tuberculosis, syphilis, brucellosis, herpes. Carpal tunnel syndrome can be caused by vascular pathology. Spasm or thrombosis blood vessel leads to ischemia of the tissues supplied by it, swelling and compression of the nerve in the canal.

Factors contributing to the progression of pathology:

The canal, consisting of hard tissue, reliably protects the median nerve from exogenous factors. Constant loads on the same area lead to permanent deformation. In this case, the nerve fibers suffer and the trophism of soft tissues is disrupted. The tissues of the tunnel thicken, loosen and swell, there is no free space left in the canal, and the pressure on the nerve becomes maximum. At this time, the first clinical signs of the syndrome appear. The body tries to get rid of the disease on its own. Lymph accumulates in the joints of the hand and washes away inflamed cells. Significant stress on the hands leads to stagnation of lymph and increased inflammation. The joints begin to ache and swell.

Another cause of tunnel syndrome is swelling of the nerve fibers, caused by general intoxication of the body with toxic substances. Some medications used long-term and large doses, can cause the development of pathology. These include antibiotics, diuretics, and vasodilators.

persons who, due to the nature of their work activity, make the same type of hand movements;
aged people;
patients with endocrinopathies - dysfunction of the thyroid gland, pancreas or pituitary gland;
patients with bone and joint diseases;
people with incurable diseases - vasculitis, rheumatism, psoriasis and gout.

Pathology that developed against the background systemic disease, leads to loss of elasticity of articular cartilage, their aging, and cracking. Over time, the affected cartilage dies, and the articular surfaces grow together. Such deformations completely disrupt the anatomical structure of the hand.

Symptoms

The symptoms of tunnel syndrome increase as the nerve trunk is compressed.

Clinical signs of the initial stage are unpleasant sensations and discomfort in the hand that occur after prolonged stress on the hand. this area bodies. Patients complain of trembling, itching and slight tingling in the limbs. At the initial stage, symptoms are temporary. When you shake your hands or change the position of your hands, the discomfort disappears.
The narrowing of the canal appears acute pain in the hand, which gets worse after exercise. Upper limb the patients go numb. Any movement of the hand in the wrist joint causes unbearable pain. Numbness, tingling and heaviness in the hands become unpleasant and irritating. Pain and paresthesia are localized in the area of the first three fingers of the hand. They occur at night or early in the morning. Numbness and decreased sensitivity of the limb deprives it of mobility.
Significant narrowing of the tunnel is manifested by stiffness of the affected joint, hypotension and malnutrition. muscle fibers. At the same time, pain and numbness persist and intensify. Patients experience common symptoms: insomnia, irritability, depression. Cramps and constant pain unsettled. A person can no longer lift a heavy object, dial a number cell phone, work with a mouse at a computer, drive a car. Violated fine motor skills, skin color changes. Patients experience weakness when flexing the hand, weakness in flexing the first and second fingers, especially the terminal phalanges. The sensitivity of the palmar surface of the first and second fingers is significantly reduced.

Pain syndrome is the main clinical sign of pathology. Patients complain of a burning or tingling sensation in the hands that occurs at night and disrupts sleep. Patients wake up to shake their arms. Blood flow to the fingers reduces pain. In advanced cases, pain appears not only at night. She torments patients around the clock, which affects their neuropsychic state and leads to impaired performance. Pain is often accompanied by a violation of autonomics and trophism, which is clinically manifested by swelling, hyperthermia and hyperemia of the wrist, palm and three first fingers.

Carpal tunnel syndrome is not life-threatening, but it does impair the quality of life. The intensity and duration of pain increases, insomnia and irritability occur, and diseases of the nervous system develop.

Diagnostics

The diagnosis and treatment of carpal tunnel syndrome is carried out by neurologists, as well as doctors of related specialties - orthopedic traumatologists, endocrinologists, and surgeons. Diagnosis of carpal tunnel syndrome consists of examining the patient and excluding other diseases with similar symptoms.

Collecting anamnesis of the disease - the appearance and increase of clinical symptoms. The patient is asked in detail about the causes of the disease, past injuries, the nature of the pain, and the movements that provoke it.
Examination - assessment of finger sensitivity and hand muscle strength using a wrist dynamometer.
There are several functional tests that can detect damage in the nerve trunk. These include Tinnel's sign, cuff, and raised arms. These diagnostic procedures are performed differently, but mean the same thing. If the patient feels numbness and tingling after the test, then carpal tunnel syndrome occurs.
Electroneuromyography allows you to accurately determine the location and extent of damage to nerve fibers, the level of damage to the nerve roots that form the wrist joint. Electrodes are inserted into the relaxed muscle of the diseased limb and its contractile activity is measured. The study data appears on the monitor in the form of a curve of different amplitudes. When the median nerve is compressed, conduction velocity slows down.
MRI, radiography and ultrasound are auxiliary techniques that identify congenital anomalies hands, fractures and dislocations in injuries and allowing to evaluate changes in the tissues of the musculoskeletal system.

Treatment

Treatment of carpal tunnel syndrome is aimed at preventing further entrapment of the median nerve. Patients are given anti-inflammatory and decongestant therapy to relieve pain and discomfort. Treatment of the underlying disease, manifested by carpal tunnel syndrome, is a mandatory condition, failure to comply with which can lead to frequent relapses and the development of complications.

When the first signs of pathology appear, it is necessary to fix the wrist. Patients are advised to apply cold to the lesion. If the cause of the pathology is work activity, it needs to be changed.

Drug treatment

To eliminate the symptoms of carpal tunnel syndrome, experts prescribe:

NSAIDs – “Ibuklin”, “Diclofenac”, “Nimesil”,
corticosteroid hormones - “Betamethasone”, “Prednisolone”, “Diprospan”,
diuretics - Furosemide, Lasix, Hypothiazide,
vasodilators - Cavinton, Piracetam, Vinpocetine,
muscle relaxants – “Sirdalud”, “Mydocalm”,
neurometabolites - B vitamins, “Neostigmine”, “Nicotinic acid”,
injection of the anesthetic “Novocaine” into the place of compression,
warming ointments and a fixing bandage on the wrist to relieve symptoms at night,
compress of Dimexide, Lidocaine, Hydrocortisone and water,
Methotrexate and other cytostatics are prescribed to suppress the activity of the immune system,
chondroprotectors for joint restoration - “Rumalon”, “Alflutop”,
thyroid hormones for hypothyroidism,
diabetics are prescribed insulin or glucose-lowering drugs,
for hypertension, ACE inhibitors or calcium antagonists are prescribed.

Physiotherapy

Physiotherapeutic procedures for carpal tunnel syndrome:

Surgery

Surgery involves excision of the ligament compressing the median nerve.

Endoscopic surgery is low-traumatic and leaves no scars. Through a small size, a video camera and a special device are inserted into the median canal to cut the ligaments. After surgery, a plaster splint is placed on the wrist.

Open surgery involves making a large incision in the palm along the line of the median canal. The ligament is cut to relieve pressure on the median nerve. The recovery period after open surgery lasts much longer.

Patients are encouraged to move their fingers the day after surgery. After 1.5 months, physiotherapy and occupational therapy are prescribed. During the rehabilitation period, massage and gymnastics are indicated. Patients should rotate their hands, stretch their palms and fingers. If necessary, you can take a pain reliever.

Video: surgery for carpal tunnel syndrome

Exercises used for exacerbation of carpal tunnel syndrome:

Clenching your fingers into a fist.
Rotate your fists to the sides.
Clenching palms, spreading elbows.
Pressure of one hand on the other.
Squeezing a rubber ball.

Video: exercises to prevent carpal tunnel syndrome

After normalization general condition in patients with carpal tunnel syndrome they are indicated Spa treatment in Crimea, Krasnodar and Stavropol Territories.

ethnoscience

Treatment of carpal tunnel syndrome at home includes not only general and local drug therapy, but also the use of traditional medicine. The most effective and common folk recipes:

Prevention

The following rules will help prevent the development of carpal tunnel syndrome:

careful attention to your health,
conducting healthy image life,
sufficient physical activity - gymnastics, swimming, walking, yoga,
comfortable sleeping and convenient work place,
periodic changes in body position,
systematic thermal procedures - baths, saunas,
balanced diet,
prevention and timely treatment of various ailments,
See a doctor when the first signs of pathology appear.

Treatment of carpal tunnel syndrome is aimed at eliminating pain and discomfort, but most importantly, at eliminating the cause of the pathology. It is necessary to treat tunnel syndrome comprehensively in order to permanently get rid of the pathology and prevent relapses. This disease significantly reduces the quality of life of patients. But the prognosis of the pathology is currently considered favorable. Diseases of the peripheral nervous system are so diverse that it is not always possible to determine their cause and diagnose accurate diagnosis. Only highly professional specialists should do this. In recent years, the number of patients with carpal tunnel syndrome has increased, which is due to the strong introduction of computer technology into the life of a modern person.

Why do your hands go numb during pregnancy and what to do about it? General information about carpal tunnel syndrome. Local compresses with a complex composition

Exercises for hand joints

Causes

Symptoms

Paresthesia

Pain

Clumsy hand movements and loss of strength

Decreased sensitivity

Amyotrophy

Change in skin color

Diagnostics

Treatment

Local treatment

Compresses

Injecting drugs into the carpal tunnel

Drug therapy

Physiotherapy

Surgery

Statistics

The structure and function of nerves

Structure of a nerve cell (neuron)

Nerve structure

How is a nerve impulse transmitted?

Anatomy of the hand, wrist and forearm

Structure and functions of the median nerve

Causes of median nerve damage

Working at a computer for a long time (using a computer mouse and keyboard)

Arthritis: rheumatoid, psoriatic or gouty arthritis, as well as other rheumatic diseases affecting the joints

Acute wrist injuries

Local treatment

Carpal tunnel syndrome: surgery

Non-drug treatment

Physiotherapeutic procedures

Ultraphonophoresis

Shock wave therapy

Prevention of carpal tunnel syndrome

Causes

Clinical manifestations

Diagnostics

Principles of treatment

Stop exposure to the pathogenic factor. Immobilization

Change the usual locomotor stereotype and lifestyle

Pain therapy

Carpal tunnel syndrome

Clinical manifestations

Differential diagnosis

Treatment

Pronator teres syndrome (Seyfarth syndrome)

Clinical manifestations

Supracondylar process syndrome of the shoulder (Strother's band syndrome, Coulomb, Lord and Bedossier syndrome)

Cubital tunnel syndrome

Clinical manifestations

Diagnostics

Treatment

Radial nerve compression syndrome

Causes

Symptoms

Diagnostics

Treatment

Drug treatment

Physiotherapy

Surgery

Video: surgery for carpal tunnel syndrome

Video: exercises to prevent carpal tunnel syndrome

ethnoscience

Prevention

Video: specialists about carpal tunnel syndrome