home Audience 1 Neuropathy of the median nerve and how to recognize it for the average person. Sensory neuropathy of the median nerve

Neuropathy of the median nerve and how to recognize it for the average person. Sensory neuropathy of the median nerve

neuropathy median nerve(nervus medianus), otherwise neuritis, neuropathy, is pathology manifested as a result of damage to its sheath or nerve fiber itself, which leads to dysfunction and manifests itself in motor and sensory disorders.

Being a mixed nerve fiber, it innervates the muscles of the forearm involved in flexion of the hand, the muscles of the fingers, and is also responsible for the sensitivity of the palmar surface of the hand, 1-3 and partially 4 fingers (except the little finger).

Classification

Due to the occurrence should be distinguished:

Traumatic neuropathies
Occur with direct damage to the nerve due to injury, fractures.
Neuropathy due to inflammatory and degenerative diseases of the joints;
Neuropathy in endocrine diseases
For example, diabetic polyneuropathy, narrowing of capillaries in hypothyroidism. In such cases, pathological process affects various nerve fibers and usually does not appear as an isolated lesion of the median nerve.
Compression-ischemic neuropathies (tunnel syndromes)
Are the most common cause development of isolated neuropathies of the median nerve. It is formed during compression, which occurs in the anatomically narrowest places where n lies. medianus:

Carpal syndrome - compression in the carpal tunnel;
Pronator teres syndrome - compression by the same muscle in the forearm;
Spur compression (supracondylar process) humerus.

Reasons for the defeat

Injuries to the upper extremities lead either to direct damage to the fiber, or to its compression and malnutrition.

Fractures of the bones of the shoulder, forearm, wrist;
Bruises, dislocations, sprains and ruptures of ligaments and tendons, accompanied by the formation of hematomas and severe swelling of tissues;
Wounds (stab, chopped, cut, gunshot, etc.).

Prolonged static load on the arm, overstrain of the muscles of the hand and forearm, which occurs in people of certain professions (ironers, carpenters, dentists, musicians) or with high monotonous physical activity. All this can lead to disruption of trophism and compression of the nerves, possible development tunnel syndrome. Recently, often the reason is prolonged work at the computer with wrong position brushes. Compression by the process of the humerus is sometimes the result of an uncomfortable position of the arm (prolonged pressure on the arm bent at the elbow). In the risk group, in addition to people of relevant specialties, there are also women, overweight people;
Arthritis, arthrosis, rheumatism and other diseases can lead to swelling of adjacent tissues, joint changes, bone deformities, which also often has a pathological effect on the neurovascular bundle;
Endocrine diseases (diabetes mellitus, acromegaly, hypothyroidism) cause circulatory and metabolic disorders in the body and, as a rule, lead to systemic lesions - polyneuropathy. In diabetes mellitus, a disorder of glucose metabolism occurs, which leads to hypoxia and degenerative changes nervous tissue. This can also be manifested by such a pathology as, for example, visual impairment;
Tumor processes in the upper limb can also affect nerve formations. The most common are hygromas, lipomas, hemangiomas, neurofibromas, and schwannoma. Less common malignant formations soft tissues and bones;
Atherosclerotic changes, arterial vascular insufficiency;
Syndrome prolonged compression upper limb;
Pathological processes on bone formations (spur of the humerus);
Infectious diseases;
The consequences of injections in the vicinity of the passage of nerve fibers with the formation of infiltrates.

Ask your question to a neurologist for free

Irina Martynova. Graduated from the Voronezh State medical University them. N.N. Burdenko. Clinical intern and neurologist of BUZ VO \"Moscow Polyclinic\".

Symptoms

Pain

Burning pain, depending on the level of the lesion, is localized in the forearm, hand, goes to the first 3 fingers (thumb, middle, index). It intensifies with external influence(touch, bright light, noise, stress) and can subside when immersed in water or wrapped in a wet cloth.

Expert opinion

Mitrukhanov Eduard Petrovich

Doctor -

This nature of pain in medicine is called causalgic.

Movement disorders

Manifested in muscle weakness, inability to squeeze the hand, take your thumb away, paresis. Sometimes there are changes in the form of muscle atrophy in the area of \u200b\u200bthe ball of the thumb.

Sensitivity disorders

Manifested in numbness, reduced perception of pain, cold and hot. Such violations are determined in the zone of innervation - the palmar surface of the hand and 1-3 fingers. Along with hypesthesia (decrease in sensitivity), paresthesias (sensations of heat, cold) may occur.

Vegetative changes

May cause changes in skin tone in the affected area (redness, pallor), swelling, coldness.

Diagnostics

Neuritis can be detected during a neurological examination. For this, the following diagnostic tests are carried out:

When asked to make a fist, 1-3 fingers do not bend;
When pressing the palm to the table, the patient cannot perform scratching movements with the index finger;
Impossible to cross index and middle fingers;
Unable to oppose the thumb with the little finger.

Expert opinion

Mitrukhanov Eduard Petrovich

Doctor - neurologist, city polyclinic, Moscow. Education: Russian State Medical University, GBOU DPO Russian medical Academy postgraduate education Ministry of Health of the Russian Federation, Volgograd State Medical University, Volgograd.

When tapping with a neurological hammer in the direction of travel n. medianus, it is possible to detect the place of its lesion or compression by the occurrence of acute pain (Tinnel's symptom).

With carpal syndrome defined at the inner edge of the wrist. When compressed by a round pronator - in the snuffbox of the aforementioned muscle (this is a hole in the upper third of the forearm). A pathognomonic symptom of fiber compression by the supracondylar process of the humerus is pain that occurs when the forearm is extended and rotated inward with a bent hand.

Instrumental research methods

ENMG - electroneuromyography, consists in recording neuromuscular conduction and muscle excitability using electrodes, allows you to evaluate functional state peripheral nerves. Is used for differential diagnosis with others neurological diseases and allows you to assess the degree of damage to the fiber.

X-ray examination, MRI, CT

They are used in cases where it is necessary to assess the condition of bones, ligaments, joints, injuries and diseases of which could lead to neuritis. In such cases, fractures, arthrosis, pathological bone formations, the presence of osteochondrosis can be determined. cervical spine, which can also cause similar symptoms.

ultrasound

Sometimes it is carried out to determine the width of the nerve fiber in order to further use these data when performing injections into the affected area.

Other laboratory and instrumental methods (blood tests, rheumatic tests, hormone testing) may be needed to diagnose endocrine, systemic inflammatory and infectious diseases that cause damage to the peripheral nervous system.

Treatment

First of all, treatment aimed at eliminating the cause occurrence of neuropathy and can be carried out medical specialists different profile.

Drainage of a hematoma that caused nerve damage is a surgical procedure and is performed when conservative methods do not allow it to resolve, with a large volume or in cases of suppuration. It is an opening of the hematoma cavity, washing antiseptics, drainage and subsequent wound closure.
Removal of the tumor is carried out in cases where it disrupts the function of neighboring tissues, including nerves. A consultation with a surgeon, sometimes an oncologist, is required to exclude a malignant process. These specialists determine further surgical tactics.
In case of injuries of the musculoskeletal system, treatment is carried out in trauma departments and is aimed at restoring the functions of bones, ligaments, tendons, joints, and reducing swelling in the area of injury.
Correction endocrine disorders carried out by an endocrinologist.
In diabetes mellitus, it is necessary to stabilize and constantly monitor blood sugar levels in order to avoid complications of diabetic angiopathy and polyneuropathy. If there is insufficient function thyroid gland shows the use of thyroid hormonal drugs.

In parallel with etiotropic treatment, drug therapy is carried out aimed at eliminating inflammation in the affected area and stopping pain syndrome.

For this, appoint:

NSAIDs

diclofenac

It has a pronounced anti-inflammatory, analgesic and moderate antipyretic effect. Available in the form of tablets, gels, ointments, injection solutions. For the treatment of neuritis, the most justified external or intramuscular application. Contraindications are ulcerative processes in the gastrointestinal tract, hematopoietic disorders. To avoid negative impact on the gastric mucosa, most NSAIDs should be taken after meals. The price, depending on the form of the medication, varies from 10 to 150 rubles.

Ibuprofen

Pharmacological effects are manifested in a decrease in the inflammatory response, a moderate analgesic effect. Topical application in the form of ointments and gels and oral administration is provided. Do not use in case of ulcers and bleeding in the gastrointestinal tract, bleeding, renal and liver failure, pregnancy, lactation, age up to 12 years. The cost ranges from 30 rubles to 300 rubles for patented drugs based on ibuprofen.

Nimesulide (nise, nimesil)

It has a similar mechanism of action with diclofenac, but is a more selective drug. It has a pronounced anti-inflammatory and analgesic effect. Produced in the form of ointment, gel, tablets, powder for suspensions (nimesil). Contraindications are similar to those for ibuprofen. The cost of the drug is 50-250 rubles.

artrosilene

The drug based on ketoprofen is available in various forms, suggesting its local, oral and parenteral use. Along with reducing inflammation, it has a strong analgesic effect, which is realized both locally and through the central nervous system. Contraindications also include ulcerative necrotic lesions digestive system, third trimester of pregnancy, severe violations of the liver and kidneys. Price: 180 - 450 rubles.

Movalis

The active ingredient is Meloxicam. More modern drug capable of selectively inhibiting inflammatory mediators. The advantages include a powerful anti-inflammatory effect, with a lower risk of adverse reactions compared to other classic NSAIDs. In addition to ointments and tablets, it has an injectable form. Limited use in the same cases as for Artrosilene. The price ranges from 500 to 850 rubles.

Glucocorticosteroid drugs

Are used with severe pain syndrome and inflammation in combination with NSAIDs.

Especially their use is justified by the presence of joint pathology, inflammation of the ligaments.

Prednisolone

Suppresses the activity of leukocytes and macrophages, blocks the synthesis of prostaglandins, constricts blood vessels, affects carbohydrate, protein and fat metabolism. Significantly reduces inflammation and immune cell migration. Issued in different forms. But for the treatment of neuritis, it is used topically, and is also injected parenterally into the cavity of the inflamed joint or tissue. A contraindication for injection into the affected areas is the presence of an infectious process in the focus, bleeding. Topical application may be limited to fungal and infectious skin diseases. The cost in pharmacies is from 25 to 150 rubles.

Diprospan (Betamethasone sodium phosphate)

It is a suspension for injection, has an immunosuppressive, good analgesic effect, especially when administered intraarticularly and interstitially. Contraindications are the same as for the injectable form of prednisolone. Price: 200-220 rubles.

Dexamethasone

A glucocorticosteroid agent, in the case of neuropathy, is usually applied by injection into the affected area. It has similar indications and contraindications with other members of the group. Cost: 30-180 rubles.

Blockade

Used in cases where there is the need to quickly stop severe pain syndrome. Of course, the action is not very long. However, blockades can be carried out repeatedly, and a stable therapeutic effect can be achieved. The bottom line is the introduction of a local anesthetic substance into the affected area, which prevents the occurrence of excitation in the nerve fiber. Sometimes adrenaline is added to the solution to cause vasospasm and reduce the resorption of the anesthetic into the blood. This method gives a good result, but should be performed with caution by an experienced doctor. For blockade in the carpal tunnel or round pronator, a mixture of anesthetics with NSAIDs and HA is used. (diprospan with lidocaine, movalis with novocaine).

Usually 2-3 such blockades are enough to eliminate the tunnel syndrome.

Novocaine (Procaine)

It has a large therapeutic breadth, low toxicity, but also a relatively short period of action. Of the contraindications, only individual intolerance to the components. Price - 15-75 rubles.

Lidocaine (xylocaine)

Low toxicity and a more pronounced analgesic effect compared to novocaine make this drug the most used in neurological practice. The cost is from 21 rubles.

Marcaine (Bupivacaine)

It has the most prolonged action (4 times more than lidocaine), but is quite toxic when it enters the bloodstream. The use is limited in persons with hypotension and children under 2 years of age. Price from 800 rubles.

Drugs that promote nerve recovery

Milgamma

It is a medication based on B vitamins and lidocaine, has pronounced antioxidant properties, relieves pain and inflammation, helps restore nerve fibers and endings. Treatment begins with an injection in the amount of 5-10, then they switch to taking tablets. Limited use in severe heart failure, pregnancy, lactation, childhood.

Neuromidin

Belongs to the group of cholinesterase inhibitors. Improves conduction along the nerve fiber and neuromuscular transmission. Contraindicated in epilepsy, angina pectoris, bradycardia, bronchial asthma, intestinal obstruction, gastrointestinal ulcers, pregnancy, feeding, under 18 years of age. The cost in pharmacies is from 980 rubles.

Thioctacid

metabolic medicine, which has antioxidant properties, is able to normalize carbohydrate and lipid metabolism. It is used in the form of tablets and injections. It is also effective in diabetic polyneuropathy. Not applicable during pregnancy breastfeeding, childhood and adolescence.

Vascular drugs

Actovegin

It is a preparation from calf blood, used in the form of injections. Increases the ability of tissues to tolerate hypoxia, improves metabolic processes. Also available as an ointment. It is not prescribed for pulmonary edema, fluid retention in the body, kidney pathology. Cost from 110 rubles.

Trental (Pentoxifylline)

It has a pronounced antiplatelet, antispasmodic and angioprotective effect, improves tissue nutrition. It is used orally, intravenously or intramuscularly. The use is limited to hemorrhages, pregnancy, feeding. Price - from 130 rubles.

Other drugs

Dimexide

It is applied only locally. It is able to penetrate deep into the tissue, where it has anti-inflammatory, analgesic and antimicrobial effects. Used in the form of ointment or compresses based on its 99% solution. For a compress, the solution is mixed with water and novocaine in equal proportions. Contraindications: impaired renal and liver function, angina pectoris, pregnancy, lactation. Price from 35 rubles. for a solution up to 140 r. for ointment.

Finalgon

Ointment based on capsaicin with an irritating and analgesic effect, which is formed as the substance penetrates deep into the tissue. Limited use in children and persons with intolerance to the components. (~250 rubles)

Mydocalm

Refers to the number of muscle relaxants of central action. Relaxes the muscles, has a moderate analgesic effect, improves peripheral circulation. Contraindicated in myasthenia gravis, under the age of 3 years. average cost— 300 r.

exercise therapy

Therapeutic Physical Culture aimed at improving the blood supply to the affected area restoration of muscle tone.

With the defeat of n.medianus, it is necessary to give a hand correct position: fix the wrist with a splint, take the thumb away, and bend the rest.

Exercises:

Abduction and flexion of the hand;
Stretching a rubber bandage with a healthy and sick hand;
Abduction of 1 finger;
Bending 2-4 fingers;
Internal rotation of the forearm and hand;
Circular movements thumb.

Massage

Begin massage with cervical and thoracic spine. Then they move on to the upper limb. Massage in the forearm and hand is carried out by stroking, rubbing, kneading and vibration. Duration 10-15 minutes.

The course of therapy is 15-20 procedures.

Electromyostimulation

It is carried out for the prevention of muscle atrophy by stimulation with electric current, leading to their contraction. All this is combined with their own strong-willed efforts. The technique is carried out several times a day for a short duration in order to avoid severe overwork muscles. Contraindications: extrasystole, cardiac arrhythmias, severe arterial hypertension, thrombophlebitis.

Mud treatment

Therapeutic mud stimulates anabolic processes in the nervous tissue, reduces inflammation. Applications are applied to the zone of innervation, the temperature of the mud is 42-440C. Sulfide mud is kept for 15-20 minutes. For sapropel and peat - the exposure time is 25-30 minutes.

Mud treatment is carried out 1 time in 2-3 days, the course of therapy is 12-18 procedures.

Ozokeritotherapy

It is an application to the diseased area of ozocerite - a natural hydrocarbon, otherwise called mountain wax. Previously, the substance is heated to 45-50 degrees and kept over the site of injury for 30-60 minutes. The course of treatment is 10-12 procedures.

Surgery

Held with the ineffectiveness of conservative treatment, the inability to restore the function of the nerve fiber, especially when it is mechanically damaged.

Nerve suture. Represents the stitching of the ends of the nerve. It is possible in the absence of foci of necrosis and only in cases that exclude its strong tension.
Neurolysis. It is performed with incomplete violation of the integrity of the fiber or overstretching, when it is squeezed by scar and connective tissue. The essence of the operation is to free the nerve from connective tissue growths.
Nerve plasty. It is carried out in cases where it is impossible to combine the edges of n.medianus. It is carried out after the relief of an acute inflammatory process by autotransplantation of the superficial sensitive area of the nerve fiber to the site of injury.

Prevention

Prevention of the development of neuritis of the median nerve consists in the following rules:

Avoid working at the computer long use mice, do not keep your hand on weight for a long time;
Limit the same type of movement, leading to compression of the neurovascular bundle;
Periodically perform gymnastics for the hands, give them a rest after a long monotonous work;
Timely diagnose and treat endocrine disorders.

Forecast

With timely complex treatment, the prognosis is generally favorable, especially in young people.

Elderly patients with inadequate treatment may develop complications in the form of muscle contracture and paralysis, which will lead to dysfunction of the upper limb.

Clinics

Clinics that specialize in the treatment of neuropathies ( comparison of prices for some services is indicated)

Cost of services in Moscow

Clinic for Rehabilitation Neurology – 1990
Scientific Center of Neurology – 3000
Multidisciplinary medical Center on Polyanka - 2500

Cost of services in St. Petersburg

Name of the clinic - Primary appointment with a neurologist

Center of Clinical Neurology – 2800
Doctrine - 2800
CMRT - 1100

Median nerve neuropathy is a syndrome that occurs for various reasons.

But most often this condition is associated with inadequate and non-physiological loads on the upper limb. Therefore, preventive measures play an important role. If you had to face such a problem, then you still need to consult a doctor who will determine the cause of the pain and prescribe an adequate complex treatment. In this case, the risk of complications will be minimal.

Carpal tunnel syndrome is a lesion of the median nerve that occurs against the background of prolonged compression in the area of the hand or its injury. This pathology most often develops in women from 40 to 60 years. The cause of the syndrome can be a professional activity that gives heavy load carpal tunnel, nerve damage and other negative factors associated with human health problems.

What is median nerve neuropathy

The median nerve starts from inner region shoulder, stretches through the elbow joint towards the wrist and ends in the palm of your hand. It is responsible for the flexion of the fingers and the movement of the hand.

The nerve is very often injured in the lower part of the forearm, since in this area it is superficial. Medianus is responsible for the motor power of the muscles and for the sensitivity of the upper extremities.

The composition of the nerve includes fibers of the spinal nerve of the median and lower trunk of the brachial plexus. Due to frequent injuries in this area, neuropathy occurs, which negatively affects the quality of life of the patient.

Pathology develops against the background of a bruise, fracture, cut in the area of the hand, even if the nerve was not damaged. It's all about the scars that form during the healing process, which tend to put pressure on the nerve, which leads to the disease.

Causes

Neuropathy of the median nerve develops not only as a result of injury, but also against the background of certain diseases. Pathology happens:

Diabetic. Nerve damage occurs due to prolonged high level blood sugar. In this case, the disease has its development against the background of incorrect treatment of diabetes mellitus.
Toxic. In this case, the cause of the pathology is long-term use certain medications, alcohol abuse, infectious intoxication. Most often found alcoholic form poisoning. Toxic neuropathy has a negative effect on the nerve fibers, due to aggressive substances, destroying them.
Post-traumatic. Against the background of injuries and wounds, the myelin sheath loses its usual integrity, which becomes the cause of the disease.
Tunnel. It is provoked by a tunnel that puts pressure on the neurovascular bundle. This pathology is a harbinger of compression-ischemic disease and leads to damage to the median nerve.

Also, the cause of the disease can be:

Tunnel syndrome occurs when pressure is applied to the median nerve in the tunnel, which disrupts blood flow. The risk area includes:

The syndrome can develop in breastfeeding women who long time hold the child in their arms. Tunnel syndrome also appears due to anatomical changes that occur against the background of subluxations, osteoarthritis, tendon injuries, rheumatism of periarticular tissues. TO rare cases refer to an anomalous process of the humerus.

Symptoms

The main symptoms of neuropathy of the median nerve are:

Pain in the brush area.
decline sensitivity.
Atrophy muscles.
Numbness in fingers and hand.
Decreased grasping strength.
puffiness upper limbs.
Absent bending at least three fingers.
Burning in the area of the palm, fingers, hand.

The disease can be identified by the disorder sensitivity radial area of the palm, ring, middle and partially index finger. The trophism and other functions noticeably change.

The course of neuropathy varies, in some cases the signs of the disease appear very quickly over several days, or, conversely, the disease progresses for a long time, sometimes it can take years.

Diagnostics

Diagnosis of neuropathy of the median nerve begins with a study of the patient's complaints and a visual examination of changes in the hand. In addition, the area where a decrease in sensitivity was noticed is revealed. A special test is carried out to find disorders of the motor system:

During squeezing hands into a fist 1,2 and 3 (partially) fingers do not bend.
pressing palm to the surface of the table with the second finger, the scratching movement is not obtained if the other fingers are crossed.
opposition 1 and 5 fingers broken.

Computer tomography of the hand, which will show or exclude the presence of congenital narrowness of the carpal tunnel.
Electroneuromyography, which will allow you to monitor how the impulse passes along the nerve. This will help to understand how impressed he is.
Ultrasonography(ultrasound).
Magnetic resonance tomography, which will make it possible to recreate the whole picture of the disease. An MRI can help determine the type, size, and location of the lesion.

After confirming the diagnosis, the specialist prescribes adequate treatment.

Treatment of tunnel syndrome with a surgical method

Carpal tunnel syndrome, which appeared against the background of nerve compression in the area of the hand, requires dissection. This operation can be carried out as open way and endoscopic.

Endoscopic surgery does not require a large incision, but with conventional surgery it is possible to view the entire canal and make sure that there are no more large formations.

Most often, older people take neuropathy as a sign of aging and go to the doctor quite late, which subsequently complicates treatment. In this case, the conduction of the nerve is completely impaired, an operation is prescribed.

A complete violation of nerve conduction means a violation of its integrity and also implies surgical treatment.

Conservative treatment

If you consult a doctor in time with a problem that has arisen, then the treatment is always successful. At the initial stage of the pathology, it is recommended to fix the arm in its usual position with the help of a splint. Also, the patient is prescribed a number of non-steroidal anti-inflammatory drugs, drugs for the normalization of nerve cells, accelerating its recovery and regeneration.

It is very important during therapy to eliminate the root cause of the disease. It is desirable to get rid of alcoholism, if it is. With diabetes, it is necessary to monitor the level of sugar in the blood, to exclude medications that cause intoxication.

Also, specialists prescribe painkillers, vitamins of group B. If there are indications, then the patient takes antidepressants and anticonvulsants. Wellness baths, exercise therapy, acupuncture, massage, balneotherapy favorably affect the healing process.

Medical treatment

For the treatment of neuropathy, as needed, prescribe:

All drugs are prescribed only by a doctor who decides on their need.

Complementary Therapies

Ozokeritotherapy. Affected nerves are treated with thermal and chemical ozocerite, which helps to restore the affected tissues. Treatment is carried out for about an hour for two weeks.
Peloid therapy, This is a healing mud treatment that helps improve recovery processes, reduces and stops the destruction of nerve fibers. Removes inflammatory processes. The procedure is carried out for three weeks for 20 minutes.

Vasodilating methods are also used:

high frequency magnetotherapy. A magnetic field with a high frequency induces eddy currents in the cells, which contributes to the heating of tissues. The course is carried out for 10 days for 15 minutes.
low frequency magnetotherapy. This method helps to relax the smooth muscles of blood vessels, reduces blood viscosity, and increases blood flow. The procedure is carried out for two weeks for 12 minutes.
Ulypraton therapy. A small discharge helps to heat the tissues of the nerve, which allows you to expand the vessels and restore blood circulation and lymph flow. The course is held for 10 days for 10 minutes.

Spa treatment

motor function and muscle strength.
limb sensitivity.
reaction.
Nerve and muscle conduction.

It will also relieve pain. pass Spa treatment it is impossible during the period when the disease is in an acute form.

Prevention

To prevent the occurrence or recurrence of pathology, the following prevention is recommended:

cherish hands, especially in the area of the hand from injuries, wounds, fractures and dislocations.
Not supercool.
Change hand position more often.
Do not lift gravity.
Follow the level Sahara in blood.
If it is possible to change professional activity.
Study sports.
visit periodically doctor and check limbs for tumors.
After a long stay in one position of the hands, it is worth them mash and increase blood flow.
follow the reception medicinal funds.
Do not abuse alcohol drinks.
Control arterial pressure.

Prevention will help to avoid relapses and the development of pathology.

Consequences and complications

Neuropathy of the medial nerve may have the following consequences and complications:

Destruction fibers, which leads to incapacitation of the hands.
Deterioration quality life.
Due to loss sensitivity further injury may result.
diabetic neuropathy can lead to gangrene.
Deformation fingers.
Periodic pain.
Necrosis fabrics.
Puffiness.
muscular weakness.

Neuropathy can be prevented by taking care of your health and taking preventive measures. If the problem nevertheless arose, it is not necessary to delay treatment and bring the disease to acute and chronic form, this will help to avoid consequences and complications.

In the human body - a large number of nerves, they are responsible for the movement of the legs, arms and other functions. So, for example, in a person’s hand there are three main ones: radial, median, ulnar nerves. Compression or injury to the median nerve, or any other, can lead to serious problems with hand movements. It is about him that we will talk today, learn about his functions, location, main pathologies.

Anatomy

The median nerve is one of the largest nerves in the brachial plexus. It originates from the bundles of the brachial plexus, or rather, from the lateral and medial. In the shoulder region, it is conveniently located in the groove of the biceps muscle among all the other nerves. Then it descends along the front through the hole in the elbow to the forearm, where it is very conveniently located between the flexors of the fingers - deep and superficial. It then proceeds to lower section along the median sulcus and through the carpal tunnel into the palm. In the region of the palmar aponeurosis, it divides into three terminal branches, which further create seven separate digital nerves.

The median nerve in the forearm innervates not only two of the pronators, but all the flexors. An exception is the half of the deep flexor, which is responsible for the motor function of the fingers. As for the hand, here it is responsible for the muscles of the thumb and both vermiform, the middle of the palm and the palmar side of I-III and half of the IV fingers.

Nerve function

Each of the nerves in the human body is responsible for certain functions. So, the median nerve provides flexion and extension of three fingers on the hand: thumb, index and middle. In addition, he is responsible for the opposition of the thumb and pronation of the forearm.

Nerve tissues regenerate very poorly, and with this kind of damage in the distal part of the nerve, Wallerian degeneration can develop very quickly - this is a process during which resorption of the nervous tissue occurs, and it is replaced by scar connective tissue. That is why no one can guarantee that the outcome of treatment will be favorable; in the end, the patient receives a disability.

Nerve injury: classes

The median nerve of the hand, depending on how much it was damaged, can provoke several pathologies:

Shake. In this case, morphological and anatomical disorders were not observed. Sensitivity and movement functions return already 15 minutes after injury.
Injury. This condition is due to the fact that the anatomical continuity of the nerve trunk is preserved, but the epineural membranes are torn, and blood enters the nerve. With such damage, motor function is restored only after a month.
Compression. With this pathology, the severity of disorders is observed, and it depends on the severity and duration of compression, minor violations can be observed, but there are also serious cases that require only the intervention of a surgeon.

Partial damage manifests itself in the form of loss individual functions. In this case, the functions are not restored on their own, only an operation is needed.
Complete break - in this condition, the nerve is stratified into two separate ends - peripheral and central. If serious measures are not taken, then in this case the middle fragment is replaced by a small part of the scar tissue. Functions will not recover on their own, muscle atrophy will increase every day, trophic disorders are observed further. In this case, only surgery can help, but it also does not always give the desired results.

Neuropathy or neuritis of the median nerve can be diagnosed on initial stage, and if appropriate measures are taken, then cure this pathology possible without any consequences.

Causes of neuropathy

Many people in the world are faced with such a problem as hand neuropathy. Very often it is associated with fatigue, lack of sleep, and if you have a good rest, sleep, then everything will pass, but in reality everything is not at all like that.

Usually mononeuropathy - damage to one of the nerve fibers, most often develops due to the fact that the nerve is compressed in the place where it passes superficially under the skin itself or in the narrow channels of the bone. There can be several reasons for neuropathy:

the transferred surgical intervention, in the place where the operation was performed, over time, the blood ceases to circulate correctly, which ultimately leads to swelling and atrophy of the muscles, as well as to the fact that the nerves are compressed;
injury to the hand, during which swelling developed, leading to compression of the nerve;
frequent hypothermia;
exposure;
strong load on the muscles of the hands;

endocrine pathologies, this also applies to diabetics;
intoxication of the body;
lack of B vitamins;
tumors;
previous infections: herpes, malaria, diphtheria, tuberculosis and even HIV;
long-term use of drugs, which include phenytoin and chloroquine.

Symptoms of neuropathy

Few of the patients go to the hospital at the first symptoms of pathology, most often they try to use folk remedies. Ointments are used, compresses are made, but it is not always possible to cure the median nerve in this way, the symptoms may reappear and be even more acute. Pathology manifests itself in the form of burning pain that accompany the patient throughout the day, numbness of the fingers, hands and even the entire hand also appears. In addition, other symptoms may appear:

When visiting a doctor or on your own, at home, it is possible to determine by movement disorders whether the patient has neuritis, median nerve neuropathy, or not.

Definition of median nerve movement disorder

To determine movement disorders with compression or any other lesion of the median nerve, the doctor may recommend the following tests:

if you make a fist, then at this moment the index, as well as partially the thumb and middle fingers remain unbent, and the other two fingers on the hand are pressed so hard that it can be difficult even to unclench them later;
if the median nerve is affected, then the patient, when crossing his fingers, is not able to quickly rotate the thumb of the affected hand around the thumb of the healthy one, this test is called the "mill";
the patient will not be able to scratch the table with the index finger, he can only rub with the distal phalanx of the finger, or he simply knocks with it, at this moment the brush lies on the table;
if two palms are put together, then forefinger an injured hand will not be able to scratch a healthy one;
the patient fails to abduct the thumb enough to form a right angle with the index finger.

If, after a visual inspection, there are such malfunctions in the movement of the fingers, then it is recommended to undergo a comprehensive examination.

Diagnosis of the disease

Before you choose the right method of treatment, you need to go through full examination a neurologist who will evaluate reflexes, muscle strength, conduct special tests and tests.

From instrumental methods diagnostics are best suited:

electroneuromyography;
X-ray examination;
magnetic tomography.

These studies will reveal where the nerve was damaged, find out what the cause of the pathology is, and identify the degree of conduction failures. If necessary, the patient will be advised to undergo laboratory tests, only after that it is possible to accurately diagnose and select the most effective therapy.

Treatment of the disease

Treatment of the median nerve is selected individually for each patient, because the causes of the disease can be different and the degree of damage is different for everyone. During treatment, the doctor may resort to etiotropic therapy. This treatment includes taking antibiotics, antiviral and vascular agents.

In addition, the doctor prescribes the intake of anti-inflammatory and decongestant drugs, also good results gives physiotherapy, massage and exercise therapy.

In cases where it has been established that the nerve is compressed, the cause must be eliminated. In this case, the most powerful resolving therapy is needed, but in order to carry it out, you need to start with various enzymes, as well as take resolving and softening scar tissue agents. There are cases that manual therapy and massage help to quickly recover from all symptoms.

In order for the treatment to be effective, it is necessary to carry out restorative procedures, which ones are suitable in a particular case, the resuscitator decides.

If the median nerve is injured, then in this case it is necessary to determine exactly which of the methods of treatment will be effective - conservative or operative. To do this, it is recommended to conduct needle myography, it is with its help that you can accurately determine the degree of damage.

Prevention

Damage to the median nerve is a serious condition, if no action is taken, then it will be impossible to restore the motor function of the fingers. As preventive measures techniques are used to help normalize metabolic processes, it is also very important to treat in time infectious pathologies. In addition, you need to regularly do gymnastics for the hands, especially if the patient's activity is associated with constant work with his hands (seamstresses, programmers, and others).

Conclusion

Summing up the above, we can say for sure that any even the most insignificant damage to the median nerve can lead to irreparable consequences. Therefore, if you suddenly notice that your fingers do not bend well, they often cramp or you cannot clench your fist, then it is better to consult a doctor. In case of a hand injury, the advice of a doctor and examination is very important. It is better to cure minor changes than to have an operation later, which, moreover, does not desired results in severe cases.

The most common cause of damage to the median nerve is carpal tunnel syndrome, in which compression of the median nerve occurs under the palmar ligament at the level of the wrist. Patients usually complain of numbness or pain, which often occurs at night and wakes them up, but sometimes occurs at rest or during exercise. Shaking the arm relieves pain and numbness. Numbness and paresthesia are localized in the region of innervation of the median nerve (I-IV fingers), but often patients claim that the entire hand is numb.

Women are more often ill, especially those engaged in intensive manual labor (typists, seamstresses, cutters, musicians). The syndrome may also be caused by rheumatoid arthritis, hypothyroidism, acromegaly. During pregnancy, carpal tunnel syndrome occurs in 20% of women; it usually disappears after childbirth without requiring treatment. In most patients, Phalen's symptom (appearance of paresthesia with forced flexion of the hand) and Tinnel's symptom (appearance of paresthesia in the zone of innervation of the median nerve during percussion in the canal area) are detected. Almost all patients can find at least a slight weakness in the abduction and opposition of the thumb; atrophy of the muscles of the eminence of the thumb occurs relatively late.

Diagnosis can be confirmed by electroneuromyography.

Treatment primarily includes immobilization of the hand in the wrist joint with splints, non-steroidal anti-inflammatory drugs, diuretics, applications with dimexide, novocaine and corticosteroid on the canal area. It is important to reduce the load on the hand or take breaks during work. In a relatively recent onset of the disease, the effect can be achieved by introducing corticosteroids into the carpal tunnel.

With the ineffectiveness of conservative treatment and an increase in muscle atrophy surgery is indicated.

Symptoms of median nerve neuropathy

Muscles innervated by the median nerve: round muscle penetrating the forearm (m. pronator teres); square muscle penetrating the forearm and hand (m. pronator quadratus); radial flexor of the hand (m. flexor carpi radialis), long palmar muscle (m. palmaris longus); superficial flexor of fingers (m. flexor digitorum sublimus); long flexor of the thumb (m. flexor pollicis longus), deep flexor of the fingers, radial part (m. Flexor digitorum profundus), short muscle that abducts the first finger (m. abductor pollicis brevis), muscle that opposes the thumb (m. opponens pollicis ); short thumb flexor (m. flexor pollicis brevis); worm-like muscles I-II (mm. lumbricales).

The motor function of the median nerve includes: pronation of the forearm and hand; palmar flexion of the hand and its abduction to the radial side; flexion of the proximal phalanges of the I, II, III fingers and extension of the middle and distal phalanges of the II, III fingers; flexion of the distal phalanx of the first finger; opposition of the first finger.

Sensitive fibers of the median nerve innervate the skin of the radial part of the palmar surface of the hand, the palmar surface of I, II, III and the radial part of the IV fingers, the skin of the rear of the distal phalanges of I, II, III fingers.

In addition, the median nerve contains a significant number of sympathetic fibers that provide autonomic-vascular-trophic innervation.

Symptoms of damage to the median nerve at different levels. The median nerve does not give off branches on the shoulder. Therefore, with a high nerve lesion, all functions are disturbed: the flexion of the hand is weakened, the hand is retracted to the ulnar side, it is impossible to bend the II–III fingers, bend the distal phalanx of the first finger and oppose the first finger; difficult pronation of the forearm and hand. The muscles of the first finger atrophy, the tenar disappears, the palm flattens, the first finger is located in the same plane with the rest, the hand takes the form of a “monkey's paw”. Superficial sensitivity is disturbed on the palmar surface of the hand and 31/2 fingers, joint-muscular feeling is usually impaired in the second finger.

To facilitate memorization of the innervation zones of the skin of the hand and fingers, the “UMRU” rule is used (the first letters Latin names ulnar, median and radial nerves): the ulnar part of the palmar surface is innervated by the ulnar nerve, the radial part of the palmar surface is innervated by the median, the radial part of the dorsal surface by the radial and the ulnar part of the dorsal surface by the ulnar.

Damage to the median nerve is naturally associated with severe pain and severe vegetative-vascular and trophic disorders. The skin acquires a cyanotic (pale) color, its thinning or hyperkeratosis, changes in the nails, anhidrosis (hyperhidrosis) are detected, and ulcerations easily occur. With partial damage to the nerve, the development of complex regional pain syndrome (CRPS) - causalgia is possible.

To a large extent, a similar syndrome develops with compression or chronic trauma in the upper third of the forearm between the heads of the round pronator (pronator syndrome). The development of this syndrome is possible with frequently repeated intense pronator movements (working with a screwdriver, squeezing clothes); prolonged pressure on the ventral surface of the proximal segments of the forearm (“wedding night paralysis” or “honeymoon paralysis”; breastfeeding a child whose head lies on the mother’s forearm; pressing the musician’s forearm to the edge of the guitar); unsuccessful intravenous injections(calcium chloride, etc.).

With damage to the median nerve in the middle and lower part of the forearm, the function of pronation, flexion of the hand and fingers is usually preserved. The basis of the syndrome is sensory disorders, and the only motor defect may be a violation of the opposition of the first finger.

A common variant of damage to the median nerve is carpal tunnel syndrome. Traumatization of the nerve in the carpal tunnel is due to many reasons: overstrain of the muscles and tendons passing through the canal, associated with household and professional activity(washerwomen, milkmaids, typists, gymnasts, etc.); thickening of the nerve (amyloidosis, leprosy); congenital narrowness of the canal; proliferation of connective tissue in the canal, metabolic disorders and other pathological changes (myxedema, gout, diabetes mellitus, acromegaly, menopause, pregnancy and lactation, obesity, oral contraceptives, systemic scleroderma, rheumatoid arthritis). It is allowed that different variants nocturnal dysesthesias are the result of compression of the median nerve in the carpal tunnel.

The clinical equivalent of carpal tunnel syndrome: night (morning) pain and paresthesia in fingers I, II, III (less often in other fingers and on the forearm); hypoesthesia in I, II, III fingers; weakness of opposition ("bottle" test - it is difficult to grasp the bottle, fasten the buttons, start the watch); often - vegetative-trophic disorders (Raynaud's syndrome).

Study of the functions of the median nerve

1. The patient is offered to clench his fingers into a fist - I, II (III) fingers remain unbent.

2. The patient is offered to “scratch” the second finger on the table - the specified action cannot be performed.

3. The patient is offered to hold a sheet of paper with fingers I and II, and the doctor tries to pull out the sheet (Froman's test); the patient holds the paper with a straightened 1st finger (function of the ulnar nerve) and does not flex the distal phalanx.

4. The patient is offered I and II (I and V) to make a “ring” with his fingers and counteract the efforts of the doctor who is trying to break this ring. The opposition has been weakened.

5. The patient is offered to bend the hand, and the doctor counteracts the bending - the strength of the hand flexors is reduced.

6. Similarly, the strength of the flexors of the II, III fingers, the distal phalanx of the I finger is checked.

7. With fixed proximal phalanges, the patient is offered to bend the middle and distal phalanges, the researcher prevents this movement and fixes the weakness of the flexors.

8. The patient is offered to pronate the pre-supinated and unbent forearm and hand, the doctor resists this movement - weakness of the pronators is detected.

9. Find out the presence of subjective disorders of sensitivity (pain, paresthesia, nocturnal dysesthesia).

10. Examine the sensitivity on the hand and fingers and specify the zone of disorders.

11. Pay attention to the presence of vasomotor and trophic disorders on the hand and fingers.

12. Appreciate appearance brushes ("monkey paw").

Consultation on treatment with traditional oriental medicine ( acupressure, manual therapy, acupuncture, herbal medicine, Taoist psychotherapy and others non-drug methods treatment) is carried out at the address: St. Petersburg, st. Lomonosov 14, K.1 (7-10 minutes walk from the metro station "Vladimirskaya / Dostoevskaya"), with 9.00 to 21.00, without lunch and days off.

It has long been known that the best effect in the treatment of diseases is achieved with the combined use of "Western" and "Eastern" approaches. Significantly reduce the duration of treatment, reduces the likelihood of recurrence of the disease. Since the "eastern" approach, in addition to techniques aimed at treating the underlying disease, pays great attention to the "cleansing" of blood, lymph, blood vessels, digestive tract, thoughts, etc. - often this is even a necessary condition.

The consultation is free of charge and does not obligate you to anything. On her highly desirable all the data of your laboratory and instrumental research methods over the last 3-5 years. After spending only 30-40 minutes of your time, you will learn about alternative methods treatment, find out how to improve the effectiveness of already prescribed therapy and, most importantly, about how you can fight the disease yourself. You may be surprised - how everything will be logically built, and understanding the essence and causes - the first step to successful problem solving!

The disease of neuropathy of the median nerve is often found in the practice of a neurologist. Proper movement arms and hands depends on the health of the radial, median and ulnar nerve. The slightest damage to them leads to problems and discomfort. Violation of the work of the nerves accompanies the disease, called neuropathy of the upper extremities in neurology.

According to human anatomy, the median nerve (from the Latin nervus medianus) is the largest in the brachial plexus. It innervates almost the entire upper limb.

The median nerve responds:

for flexion of the muscles of the forearm;
for the motor activity of the thumb, middle and index fingers;
wrist sensitivity;
abduction and adduction of the left and right hand.

Reasons for the defeat

Neuropathy of the median nerve is considered damage to its site. The cause of the disease is often soft tissue swelling due to any mechanical damage or illness.

Damage to the median nerve is due to the following factors:

Injuries. Sprains, dislocations, fractures, bruises provoke the expansion of blood vessels, fluid accumulates in soft tissues. Nerve compression occurs. The situation can be aggravated by damage to the bone, its improper fusion.
Arthritis. With this disease, the soft tissues of the body swell, and there is pressure on the nerve. A chronic disease often leads to a disastrous result, deformity of the hand. This is due to the fact that the tissues begin to wear out, and the surfaces of the joints undergo fusion, the bone is exposed.
Fluid in soft tissues also accumulates due to other diseases, such as: nephrosclerosis, kidney problems, thyroid hormones, pregnancy, menopause, ischemia, and some other pathologies.
genetic predisposition. If parents, grandparents suffered from joint problems, sometimes it is inherited.
The risk group includes people suffering from diabetes. Due to impaired glucose metabolism and oxygen starvation of cells, the destruction of the nerve fiber occurs.
. This disease refers to diseases of the peripheral nervous system. Blood circulation is disturbed when the hands do not change their position while in a static state. This provokes compression of the nerve. The syndrome often develops with long work with mouse and keyboard.
Due to certain activities, compression-ischemic neuropathy of the median nerve occurs. It is associated with prolonged macrotraumatization of the nerve. Contributes to this, for example, hard physical labor with overload of the forearm and hand.

The external causes of neuropathy of the median nerve of the hand also include:

intoxication of the body;
alcohol abuse;
past infections (eg, HIV, diphtheria, herpes).

Classification

Neuropathy (neuropathy) is a disease characterized by damage to nerve fibers. When only one nerve becomes inflamed during an illness, this is called mononeuropathy, two or more is called polyneuropathy.

Neuropathy is divided into 3 forms:

(when nerve fibers and blood vessels are affected due to high sugar in blood);
toxic ( infectious diseases, chemical substances- all this affects the state of nerve fibers);
post-traumatic (this type of disease develops after damage to the myelin sheath of the nerve. Most often, the sciatic, ulnar and radial nerves are injured);

Neuritis develops under similar conditions as median neuropathy, but inflammation is characteristic of this disease.

According to the type and location of the pathology development zone, neuropathy has the following classification:

N medianus approaches the hand through the carpal canal. Here it innervates the muscles responsible for the opposition and abduction of the thumb, the worm-like muscles, the muscles that flex the finger. Also, its branches supply nerve fibers to the wrist joint.

Median nerve neuropathy is associated with carpal tunnel syndrome, as the disease develops starting with constant compression in the wrist.

From the point of view of surgery, lesions of the median nerve are divided into open and closed. Open, in addition to the nerve, affect the tendons, blood vessels and muscles of the patient. Closed include bruising, squeezing or stretching. Damage to the median nerve can form along with plexopathy - a lesion of the cervical or brachial nerve plexuses.

Complex lesions (eg, trauma) often involve the ulnar nerve. There is a cubital syndrome (with compression of the nerve of the cubital canal).

Symptoms of the disease

Neuropathy of the median nerve of the hand (or neuritis) refers to diseases of the nervous system. At the beginning of the development of the disease, the patient has difficulty squeezing the first, second and third fingers of the hand into a fist. It is also difficult and easy for him to move the second and third fingers of his hand. Other symptoms:

The impossibility of opposing the thumb to the rest.
Poor sensation in the palm and fingers.
The appearance of the "monkey's paw". This is due to the fact that atrophy of the muscles of the hand occurs. As a result, the first finger of the hand is installed with the second in the same plane.
The main symptom is sharp pain, manifested in the segment from the forearm to the fingers of the diseased hand.
Numbness of the hand, muscle weakness, tingling in the forearm.

Diagnostics

To diagnose neuralgia of the median nerve, the doctor performs a series of procedures. With the development of the disease, the patient cannot perform some actions. For example, an attempt to scratch the surface of the table with the index finger (while the palm is pressed against the table) fails. The patient is unable to clench his hand into a fist, as well as oppose the thumb to the others.

Another way to diagnose is to ask the patient to show the "mill". To do this, with crossed arms, you need to rotate the sore finger of a healthy hand around the thumb of the injured one. If the nerve is affected, the person will not be able to do it.

With neuropathy of the median nerve, the patient's thumb cannot be moved to the side so that a right angle with the index finger is obtained. Also, the index finger of one hand cannot scratch a healthy hand if 2 palms are put together.

The doctor also diagnoses in the following ways:

computed tomography of the hand;
electroneuromyography;
hand x-ray.

The examination will show what treatment is best to carry out. Diagnostic data will give the doctor the opportunity to study information about damage to the joint and bone canals of the nerve. The doctor will evaluate the reflexes, the state of the muscles, and answer the question of whether the disease is caused by the narrowness of the canal or the patient's lifestyle. The doctor will determine whether it is possible to prescribe neurolysis for the treatment of the disease - a surgical intervention during which the sensitivity of the nerves is restored.

Treatment

People with median nerve neuropathy rarely see a doctor in the first stage of the disease. Conversion occurs when there are more anxiety symptoms neurological problems:

spasms, convulsions;
goosebumps;
problems with coordination;
lack of sensitivity to temperatures.

For the treatment of the median nerve of the hand to be successful, it is important to find the exact location of the lesion. It is equally important to establish the cause, which is done at the diagnostic stage.

For effective therapy, the doctor also needs:

determine the degree of nerve damage;
to identify the factors leading to this symptom;
find a specific hit point.

Treatment happens:

operational (using surgical intervention);
conservative (drugs). Often, doctors turn to etiotropic therapy. This treatment with antibiotics, antiviral agents, vascular drugs.

The degree of damage is determined using special survey- needle myography. If the nerve is compressed, treatment may include the following steps:

Absorption therapy has good effect to relieve nerve compression. It involves taking various drugs and enzymes, agents that absorb and soften scar tissue. If the compression is not strong, manual therapy and special massage are often enough.
Nerve recovery. Special medicines prescribed by a doctor contribute to the "revitalization" of the nerve.
Muscle rehabilitation. The goal of therapy is to restore their muscle volume. Healing procedures prescribed by a rehabilitation physician.
Conservative treatment of the radial and ulnar nerves may include wearing splints.

What other means are used?

Demixidol in the area of the carpal tunnel.
Acupuncture.
Interstitial electrical stimulation.
Therapeutic blockade in the carpal tunnel (diprospan plus lidocaine), intramuscular injections(movalis plus novocaine)
Non-steroidal anti-inflammatory drugs, in addition to blockades (arthrosilene).

During the diagnosis, a disease can also be detected - plexitis of the median nerve. It is caused by injury or infection.

Initially, medical, conservative methods of therapy are always used. With a low efficiency of physiotherapy treatment, an operation is performed in the clinic. The decision in favor of surgical intervention is made in violation of the integrity of the nerve trunk, great weakness in the fingers.

It is not recommended to treat the disease folk remedies. During therapy, the patient should not overwork and expose himself to severe physical activity. In the acute period of the disease, you need to lie more, rest.

exercise therapy and special exercises usually assigned to postoperative period. Physiotherapy is carried out with conservative treatment or also after surgery.

Patients with an illness can be shown sanatorium treatment. A contraindication to it is the acute period of the disease.

Forecast and prevention

If there is no threat to health in the form of infections or injuries, sufficient attention should be paid to the prevention of neuropathy of the upper extremities, namely:

Physical exercises for the hands. They include a simple warm-up for the brushes.
When working at a computer, it is important to take breaks. When using a computer mouse, you need to keep it in different hands alternately.
Vitamin intake is useful, as well as strengthening general condition human health. This reduces the risk of neurological diseases of the extremities.

It should be remembered that timely treatment started guarantees a good prognosis for future hand performance. Recovery motor activity you need to start as early as possible. Ignoring therapy or improper self-medication often causes disastrous consequences.