home Endocrinology Carpal tunnel syndrome on both sides. Carpal tunnel syndrome: what is this disease, how to recognize it and treat it. Healing tincture will help eliminate pathology

Carpal tunnel syndrome on both sides. Carpal tunnel syndrome: what is this disease, how to recognize it and treat it. Healing tincture will help eliminate pathology

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, because 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 hold the hand suspended for a long time (when putting the phone to the ear, holding the handrail in public transport, 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 (the thumb is brought to the 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 discomfort 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 the causes of the development of carpal tunnel syndrome (for example, rheumatoid arthritis, diabetes mellitus, 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. Such an 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 that causes compression of the median nerve (for example, rheumatoid arthritis, trauma, hypothyroidism, renal pathologies, diabetes, etc.).

Local treatment

This type of therapy allows you to quickly eliminate acute symptoms and discomfort 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, 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.

Synonyms of the disease: carpal syndrome, carpal tunnel syndrome, carpal tunnel syndrome.

Introduction

Carpal tunnel syndrome is a common problem that affects hand and wrist function. The syndrome occurs when the median nerve inside the carpal tunnel is compressed. Any condition that reduces the size of the carpal tunnel or causes tissue to grow inside the tunnel can cause symptoms of carpal tunnel syndrome.

In recent years, this syndrome has received a lot of attention due to the assumption that it may be associated with the professional activities of workers performing monotonous flexion-extension movements of the hand, for example, when typing on a computer or performing assembly work. Manual workers, musicians, tailors, secretaries, and bakery workers often get sick. In reality, many people develop this condition, regardless of the type of work they do. Mostly women get sick.

Anatomy

The carpal tunnel is an opening that runs from the forearm through the wrist to the hand, formed by the carpal bones at the bottom and the transverse carpal ligament at the top. This hole forms the carpal tunnel. The median nerve and flexor tendons pass through the carpal tunnel. The median nerve lies on top of the tendons, just under the transverse carpal ligament. It provides sensation to the thumb, index finger, middle finger and half of the ring finger.

The median nerve also gives rise to a branch of the nerve that controls the muscles of the thumb. The thenar muscles help the thumb move and allow the ball of the thumb to touch the tip of each finger on one hand, a movement called "opposition."

The flexor tendons play an important role because they allow the fingers and hand to make grasping movements.

Causes

Any condition that reduces the volume of the carpal tunnel or increases the size of the tissues within the tunnel can lead to the symptoms of carpal tunnel syndrome (CTS). For example, a wrist injury can cause swelling and excess pressure in the carpal tunnel. The internal volume of the canal may be reduced after a wrist fracture or dislocation if bone is caught in the canal.

Other body conditions can also cause symptoms of SBS. During pregnancy, the body can retain fluid, which leads to excess pressure in the carpal tunnel. Symptoms of SBS can develop in people with diabetes and may occur due to nerve damage (neuropathy) or compression of the median nerve. Patients with reduced thyroid function and hypothyroidism are often susceptible to symptoms of SBS.

The way people perform their tasks may place them at increased risk for CCM.

These risks include:

One of these risks cannot create a problem. But a way of working that involves multiple factors can cause greater risk. And the longer a person is exposed to one or more risks, the more obvious the possibility of developing the condition of IBS. However, scientists believe that other factors, such as smoking, obesity and caffeine intake, may be more important in determining a person's susceptibility to developing SBS.

In addition, SBS can occur when the synovium becomes hardened due to irritation or inflammation. This compaction causes pressure to build up inside the carpal tunnel. But the canal cannot lengthen or widen, so the transverse carpal ligament begins to compress the median nerve. If the pressure continues to increase, the nerve stops functioning normally.

Any condition that causes abnormal pressure in the canal can contribute to the symptoms of SBS. Various types of arthritis can cause swelling and pressure in the carpal tunnel. A wrist bone fracture may subsequently cause SCS if the bone fragments cause the flexor tendons to become abnormally positioned.

When the median nerve is compressed, the blood supply to the outer sheath of the nerve slows down and blood may stop flowing there. This condition is called ischemia. At first, only the outer sheath of the nerve is affected. But if the pressure continues to build, the inside of the nerve begins to thicken. New cells called fibroblasts form inside the nerve, and scar tissue appears. This causes a feeling of pain and numbness in the hand. If the pressure is relieved immediately, the symptoms will quickly subside. Pressure that is not addressed immediately can result in a decreased or even lost chance of recovery.

Symptoms

One of the first symptoms of SBS is a gradual numbness in the areas sensitive to the median nerve. After this, pain occurs in the areas where the nerve is innervated. There is a feeling of numbness in the hand, especially in the early morning after a night's rest. Patients shake their hands and rub them all night, which causes some relief.

The pain may spread up the arm towards the shoulder and even reach the neck. As this condition progresses, the thumb muscles may weaken and atrophy, causing awkwardness when using the hand, such as when holding a glass or cup.

It is difficult for the patient to touch the tips of the other fingers with the pad of his thumb, or to hold various objects, for example, a steering wheel, a newspaper or a telephone. Patients cannot fasten buttons or peel potatoes.

Diagnosis

The doctor begins the examination with a detailed history, followed by a physical examination. The patient's description of symptoms and physical examination are important components in making the diagnosis of SBS. Usually, patients first of all complain of waking up in the middle of the night from a feeling of pain and a feeling of numbness in the entire hand.

A thorough examination usually reveals that the little finger is not affected. This may be important information for making a diagnosis. When you wake up and feel numbness in your hand, pinch your little finger to check if it is also numb, be sure to tell the doctor whether your little finger is numb or not. Other complaints include numbness when performing hand grasping movements, such as sweeping, hammering, or driving.

If symptoms begin after a hand injury, an x-ray may be needed to see if the bone is broken.

If more information is needed to make a diagnosis, your doctor may order an electrical stimulation test to analyze the functioning of the nerves in your hand. Several tests determine how well the median nerve is functioning, including a nerve conduction velocity test. This test measures how quickly impulses travel through a nerve.

Carpal tunnel syndrome should be differentiated from Arnold-Chiari malformation and cervical herniation.

Treatment options

Conservative treatment

Activities that cause symptoms should be changed or, if possible, stopped. Avoid repetitive hand movements, strong grasping movements, holding vibrating tools, or performing work that requires bending or arching of the wrist. If you smoke, talk to your doctor about possible help in quitting the habit. Lose weight if you are overweight. Reduce your caffeine intake.

Wrist bandage

A wrist brace sometimes relieves symptoms in the early stages of SBS. It keeps the wrist in a resting position (without bending back or tilting). When the wrist is in this position, the carpal tunnel maintains as much volume as possible so there is ample space for the nerve within the carpal tunnel. The bandage helps relieve feelings of numbness and pain; it does not allow the hand to bend during sleep. A wrist brace can also be worn during the day to relieve symptoms and provide rest to the tissues in the carpal tunnel.

Drug treatment

Anti-inflammatory medications may also help relieve swelling and reduce symptoms of SBS. These medications include common over-the-counter medications such as ibuprofen and aspirin. Some studies have shown that high doses of vitamin B-6 help reduce symptoms. Certain types of exercise can also help prevent or at least control the symptom of SBS.

If these simple measures do not help control symptoms, a cortisone injection into the carpal tunnel should be considered. This medication is used to relieve swelling in the canal and may temporarily relieve symptoms.

Cortisone can help relieve symptoms and also help your doctor make a diagnosis. If the patient does not experience even temporary relief after the injection, this may indicate the presence of another disease that is causing these symptoms. If symptoms go away after the injection, they likely originated in the carpal tunnel. Some doctors believe that in this case, surgery to open the transverse carpal ligament is indicated.

Physiotherapy

Your doctor may advise you to see a physical therapist or occupational therapist. The main goal of treatment is to reduce the impact or get rid of the cause of carpal tunnel pressure. A physical therapist can examine your work position and the way you perform work tasks. He can suggest how best to position your body and in what position to hold your wrist, recommend a set of physical exercises and suggest how to avoid similar problems in the future.

Surgery

If attempts to control symptoms fail, the patient may be offered surgery to relieve pressure on the median nerve. Several different surgeries have been developed to relieve pressure on the median nerve. Once pressure on the nerve is relieved, blood supply to the nerve improves and most patients feel relief. However, if a nerve is compressed for a long time, it can harden and become scarred, which will slow down recovery from surgery.

The most common procedure is open surgery, which uses a local anesthetic to block nerves located only in a specific part of the body. A small incision is made in the palm of the hand, usually less than 5 cm in length. In some cases, a slightly longer incision is made towards the forearm. The incision allows you to see the palmar fascia. This is a layer of connective tissue in the palm located just under the skin. The doctor cuts this membrane and opens the transverse carpal ligament. Having seen the transverse carpal ligament, the surgeon cuts it with a scalpel or scissors.

After cutting the transverse carpal ligament, the surgeon sutures only the skin, leaving the ends of the transverse carpal ligament free. The free ends remain separated, which reduces the pressure placed on the median nerve. Over time, the space between the two ends of the ligament will fill with scar tissue.

After the skin is sutured, the hand is bandaged with a cotton-gauze bandage. This surgery is usually performed on an outpatient basis, meaning you can leave the hospital the same day.

The International Center for Neurosurgery was the first clinic in Ukraine to popularize this operation. The technique for performing this operation was borrowed from London.

Rehabilitation

If conservative treatment is successful, you will feel improvement within 4-6 weeks. You may need to continue wearing a wrist splint at night to control symptoms and prevent your wrist from bending while you sleep. Try to perform the movements with the correct position of the body and wrist. Limit activities that require repetitive movements, strong gripping, or vibration of the hand.

If surgery has been performed, recovery will take longer. After surgery, pain will be reduced and relief will occur, but you may feel soreness at the incision site for several months.

First, take time throughout the day to support your recovering arm so that your hand is elevated above the level of your heart. Move your fingers and thumb periodically throughout the day. The bandage should remain on the hand until your next visit to the doctor. Try not to get the seams wet. They will be removed within 10-14 days after surgery.

You may need to see a physiotherapist or occupational therapist for 6-8 weeks, but full recovery may take several months. You will begin to perform active movements of the hands and a variety of motor exercises. Physical therapists use ice packs, soft tissue massage, and stretching exercises to help you perform certain movements. Once the stitches are removed, you can begin to carefully strengthen your hands by squeezing and stretching special plasticine. A physical therapist can help you find a way to complete your tasks that doesn't put too much strain on your hand and wrist. Before completing the course, your physical therapist will teach you how to avoid such problems in the future.

Programmer, pianist, seamstress and sign language interpreter - what unites people of such different professions? They have the same working tool - their own hands, and therefore the risk of developing the same occupational disease, called carpal tunnel syndrome (synonyms: carpal tunnel neuropathy or carpal tunnel syndrome). Let's talk further about the causes, symptoms and treatment of this disease.

In the wrist of each person there is a common canal or anatomical tunnel, the purpose of which is to conduct peripheral nerves, tendons and blood vessels to the palm and fingers. The walls of this tunnel are the bones of the wrist - on three sides, and on the side of the palm - the transverse (carpal) ligament.

Normally, this tunnel is quite narrow, especially the section under the ligament. It is this anatomical narrowness that is fertile ground for the formation of carpal tunnel pathology.

Since the median nerve passes through the carpal canal, which innervates the fingers from the thumb to the ring finger, any narrowing of the already narrow carpal space leads to disruption of the normal blood supply and compression of the median nerve.

The result is compression-ischemic neuropathy of the median nerve - the primary source of all clinical manifestations of carpal tunnel syndrome.

Causes of carpal tunnel syndrome

The cause of carpal tunnel syndrome is compression of the median nerve in the anatomical tunnel near the wrist joint.
The syndrome development algorithm is most often as follows:

A person makes monotonous movements with a brush for a long time (typing on a keyboard, manipulating a computer mouse, doing handicrafts - sewing or knitting something). In this case, the wrist is usually bent and the hand is constantly tense - this creates the conditions for the occurrence of the so-called repetitive stress injury. In the English-language medical literature it is also called “chronic repetitive strain injury.”
As a result of constant tension, stagnation and inflammation occur in the tissues of the wrist. The situation is aggravated by the resulting microtraumas of ligaments, muscles, and tendons.
Injured tissues become inflamed and swell, which leads to narrowing of the anatomical tunnel in the wrist, compression of the median nerve - clinical signs of carpal syndrome appear.

Compression-ischemic neuropathy of the median nerve can also occur for other reasons:

as a result of injuries to the hand and forearm, in which swelling of the wrist tissue develops;
due to congenital abnormalities of the bones and connective tissue of the wrist, which lead to narrowing of the carpal tunnel;
due to acute or chronic inflammatory disease of the connective tissue, in which the carpal tunnel narrows;
due to cysts or tumors in the carpal tunnel.

The likelihood of developing carpal tunnel syndrome increases if:

Symptoms and signs of carpal tunnel syndrome

Carpal tunnel syndrome is characterized by:

Much more often only one hand is affected. This will be the dominant (working) hand if the trigger for the development of the syndrome was “chronic repetitive strain injury.”

If the syndrome occurs as a result of a systemic connective tissue disease or endocrine disorder, both arms may be affected at the same time.

The syndrome develops gradually - first there are sensory disturbances, then motor and trophic dysfunctions.
In the early stages, all characteristic symptoms bother the patient at night or early in the morning. They go away after shaking or kneading the affected limb.
Sensory and motor disorders extend only to the part of the hand innervated by the median nerve - the inner surface of the fingers from thumb to ring, the dorsum of the middle and index fingers.

The spectrum of symptoms of carpal tunnel syndrome includes:

Everyday awkwardness due to impaired fine motor skills. The patient has difficulty performing precise movements with his fingers - fastening buttons, peeling vegetables.
Sensory disturbances – pain, numbness, goosebumps, tingling sensation in the fingertips. The pain symptom can be either minor, not causing severe discomfort, or acute, spreading throughout the entire arm. Periodically occurring numbness of the fingers changes over time to chronic.
Motor disorders, when episodes of muscle weakness and incoordination of finger movements are replaced by hand paresis and muscle atrophy.
Obvious symptoms of trophic disorders in the limb are changes in the temperature of the affected areas of the hand, hair loss, yellowness and brittleness of the nails, and bluish skin.

Diagnostic tests

The diagnosis is made by a neurologist based on the following diagnostic signs and symptoms:

Numbness of the fingers, decreased tactile sensitivity.
Positive Tinel test.
Tapping the wrist with a hammer in the projection of the carpal tunnel leads to shooting or tingling pain in the fingers.
Positive Durkan test.
Squeezing the wrist in the anatomical tunnel area causes numbness in the first four fingers.
Positive Phalen test.
A hand bent at a right angle loses sensitivity in less than 1 minute.
Positive opposition test.
With severe carpal tunnel syndrome, the patient cannot connect the pads of the thumb and little finger.

Instrumental research methods used:

, with the help of which you can accurately determine the degree of conduction of the median nerve;
X-ray, ultrasound, tomography are necessary to exclude others.

Treatment for Carpal Tunnel Syndrome

The goal of treatment for carpal tunnel disease is to eliminate or reduce compression of the median nerve. The treatment method depends on the symptoms and severity of the syndrome.

In the early stages, conservative treatment methods are indicated, including:

fixation of the wrist joint in a physiological position using a tight bandage or orthosis;

drug therapy: non-steroidal anti-inflammatory drugs orally, into the carpal tunnel, the use of vitamin B6, decongestants, ;

: thermal procedures to relieve swelling and improve trophism of wrist tissue, electrophoresis with analgesics or glucocorticoids;

massage and exercise therapy to stimulate blood circulation in the hands;

giving up unhealthy habits and a decongestant, salt-free diet;

occupational hygiene - practical use of ergonomic devices when working with a computer (special keyboard, mat with a wrist pad), changing the type of activity.

In severe cases and if conservative therapy is ineffective, the help of a surgeon may be required. The following types of surgeries are practiced to eliminate carpal tunnel syndrome:

Endoscopic dissection of the carpal ligament.
Under local anesthesia, the transverse palmar ligament is divided through two small incisions in the palm. As a result, the canal space expands and the nerve stops being compressed.
Open surgery to cut the carpal ligament and reconstruct the carpal tunnel.

Surgical treatment, usually carried out on an outpatient basis, is very effective: in the vast majority of cases, motor functions of the wrist joint and sensitivity of the hand are completely restored.

The rehabilitation period after surgery can last from several months to a year - it all depends on the degree of pathological changes in the carpal tunnel and median nerve before surgery.

Even though carpal tunnel syndrome is not a life-threatening disease, its symptoms cannot be ignored. Indeed, over time, without treatment, this seemingly harmless pathology can lead to a complete loss of limb performance and even disability.

Timely and targeted therapy almost always guarantees complete recovery and restoration of hand functionality.

Carpal tunnel syndrome(CTS [syn.: carpal tunnel syndrome, English. carpal tunnel syndrome]) - a complex of sensory, motor, vegetative symptoms that occurs when there is a malnutrition of the trunk (SN) in the area of the carpal tunnel (CT) due to its compression and (or) overstretching, as well as violations of longitudinal and transverse sliding of the CH. According to Russian and foreign data, in 18 - 25% of cases of tunnel [in the occlusion] neuropathy, HF develops [ !!! ], which is characterized by positive (spontaneous pain, allodynia, hyperalgesia, dysesthesia, paresthesia) and negative (hypoesthesia, hypalgesia) symptoms in the zone of sensitive innervation of the median nerve. Untimely detection and treatment of CTS leads to irreversible loss of hand function and decreased quality of life, which determines the need for early diagnosis and treatment of CTS.

Anatomy

The ZK is an inelastic fibro-osseous tunnel formed by the carpal bones and the flexor retinaculum. In front, the ZC is limited by the retinaculum of the flexor tendons (retinaculum flexorum [syn.: transverse carpal ligament]), stretched between the tubercle of the scaphoid bone and the tubercle of the large trapezoid bone on the lateral side, the hook of the hamate bone and the pisiform bone on the medial side. The canal is limited at the back and sides by the carpal bones and their ligaments. The eight carpal bones articulate, forming together an arch, with a slight convexity facing back towards the back, and a concavity towards the palm. The concavity of the arch is more significant due to the bony projections towards the hand on the scaphoid bone on one side and the hook on the hamate bone on the other. The proximal part of the retinaculum flexorum is a direct continuation of the deep fascia of the forearm. Distally, the retinaculum flexorum passes into the fascia of the palm, which with a thin plate covers the muscles of the eminence of the thumb and little finger, and in the center of the palm is represented by a dense palmar aponeurosis, which passes distally between the thenar and hypothenar muscles. The average length of the carpal tunnel is 2.5 cm. The SN and nine digital flexor tendons pass through the carpal tunnel (4 - deep digital flexor tendons, 4 - superficial digital flexor tendons, 1 - flexor pollicis longus tendon), which pass to the palm, surrounded by synovial vaginas. The palmar sections of the synovial sheaths form two synovial bursae: the radial bursa (vagina tendinis m. flexorum pollicis longi), for the long flexor pollicis tendon, and the ulnar bursa (vagina synovialis communis mm. flexorum), common for the proximal sections of the eight tendons of the superficial and deep flexor digitorum. Both of these synovial sheaths are located in the carpal tunnel, enveloped in a common fascial sheath. Between the walls of the SG and the common fascial sheath of the tendons, as well as between the common fascial sheath of the tendons, the synovial sheaths of the flexor tendons of the fingers and the SN, there is subsynovial connective tissue through which the vessels pass. The SN is the softest and most ventrally located structure in the carpal tunnel. It is located directly under the transverse carpal ligament (retinaculum flexorum) and between the synovial sheaths of the flexor tendons of the fingers. The SN at the wrist level consists on average of 94% sensory and 6% motor nerve fibers. The motor fibers of the SN in the ZC region are predominantly united into one nerve bundle, which is located in most cases on the radial side, and in 15–20% of people, on the palmar side of the median nerve. Mackinnon S.E. and Dellon A.L. (1988) believe that if the motor bundle is located on the palmar side, it will be more prone to compression than if it is dorsal. However, the motor branch of HF has many anatomical variations that create great variability in the symptoms of carpal tunnel syndrome.

Before reading the rest of the post, I recommend reading the post: Innervation of the hand by the median nerve(to the website)

Etiology and pathogenesis

note! CTS is one of the most common peripheral nerve tunnel syndromes and the most common neurological disorder in the hands. The incidence of CTS is 150: 100,000 population; CTS most often occurs in women (5 to 6 times more often than in men) of middle and old age.

There are occupational and medical risk factors for the development of CTS. In particular, professional (exogenous) factors include a static position of the hand in a state of excessive extension in the wrist joint, characteristic of people who work at a computer for a long time (the so-called “office syndrome” [those users who, while working, are at greater risk with the keyboard, the hand is extended ≥ 20° or more relative to the forearm]). CTS can be caused by prolonged repetitive flexion and extension of the hand (for example, pianists, artists, jewelers). In addition, the risk of CTS is increased in people who work in low temperatures (butchers, fishermen, workers in fresh frozen food departments), with constant vibration movements (carpenters, road workers, etc.). It is also necessary to take into account the genetically determined narrowing of the cerebral cortex and/or the inferiority of the nerve fibers of the SN.

There are four groups of medical risk factors: [ 1 ] factors that increase intratunnel tissue pressure and lead to disruption of the water balance in the body: pregnancy (about 50% of pregnant women have subjective manifestations of CTS), menopause, obesity, renal failure, hypothyroidism, congestive heart failure and taking oral contraceptives; [ 2 ] factors that change the anatomy of the carpal tunnel: consequences of fractures of the wrist bones, isolated or in combination with post-traumatic arthritis, deforming osteoarthritis, dysimmune diseases, incl. rheumatoid arthritis (note: with rheumatoid arthritis, compression of the HF is observed early, so the development of rheumatoid arthritis should be excluded in every patient with CTS); [ 3 ] space-occupying formations of the median nerve: neurofibroma, ganglioma; [ 4 ] degenerative-dystrophic changes in the median nerve that occur as a result of diabetes mellitus, alcoholism, hyper- or vitamin deficiency, contact with toxic substances. [ !!! ] Elderly patients are often characterized by a combination of the above factors: heart and kidney failure, diabetes mellitus, deforming osteoarthritis of the hands. A decrease in physical activity in old age often contributes to the development of obesity, one of the risk factors for the development of compressive neuropathy HF (Evidence Level A).

note! Despite the fact that there are several dozen local and general factors contributing to the development of the syndrome, the majority of researchers come to the conclusion that the primary cause of provocation of CTS is chronic trauma to the wrist joint and its structures. All this contributes to the development of aseptic inflammation of the neurovascular bundle in a narrow canal, leading to local swelling of the fatty tissue. Edema, in turn, provokes even greater compression of anatomical structures. Thus, a vicious circle is completed, which leads to progression and chronicity of the process (Chronic or repeated compression of the HF causes local demyelination, and sometimes degeneration of HF axons).

note! Possible double crush syndrome, first described by A.R. Upton and A.J. McComas (1973), which consists in compression of the SN in several areas of its length. According to the authors, in most patients with CTS, the nerve is affected not only at the level of the wrist, but also at the level of the cervical nerve roots (spinal nerves). Presumably, compression of an axon at one location makes it more sensitive to compression at another, more distal location. This phenomenon is explained by a violation of the axoplasmic flow in both the afferent and efferent directions.

Clinic

In the initial stages of CTS, patients complain of morning numbness of the hand(s) [more pronounced in the first three fingers of the hand], daytime and nighttime paresthesia in these areas (decreased by shaking the hand)). It should be noted that in STS, sensory phenomena are predominantly localized in the first three (partially in the fourth) fingers of the hand, since the sign of the hand up to the fingers (palm) receives sensitive innervation from the branch of the SN, which passes outside the STS. Against the background of sensory disturbances, there are motor disturbances such as sensitive apraxia, especially pronounced in the morning after waking up, in the form of disorders of fine purposeful movements, for example, it is difficult to unbutton and fasten buttons, lacing shoes, etc. Subsequently, patients develop pain in the hand and fingers I, II, III, which at the beginning of the disease can be dull, aching in nature, and as the disease progresses they intensify and acquire a burning character. Pain can occur at different times of the day, but more often accompanies attacks of nocturnal paresthesia and intensifies with physical (including positional) stress on the hands. Due to the fact that the HF is a mixed nerve and combines sensory, motor and autonomic fibers, a neurological examination in patients with compression-ischemic neuropathy of the HF at the wrist level may reveal clinical manifestations corresponding to damage to certain fibers. Sensitivity disorders are manifested by hypalgesia and hyperpathy. A combination of hypo- and hyperalgesia is possible, when in some areas of the fingers zones of increased, and in others - zones of decreased perception of pain stimuli are found ( note: As with the other most common compression syndromes, the clinical picture may rapidly or slowly worsen or improve over time). Movement disorders in carpal tunnel syndrome manifest themselves as decreased strength in the muscles innervated by the median nerve (abductor brevis of the first finger, superficial head of the flexor brevis of the first finger), and atrophy of the muscles of the eminence of the first finger. Autonomic disorders manifest themselves in the form of acrocyanosis, changes in skin trophism, impaired sweating, a feeling of coldness in the hand during attacks of paresthesia, etc. Of course, the clinical picture in each patient may have some differences, which, as a rule, are only variations of the main symptoms.

note! It is necessary to remember about the possibility of the patient having a Martin-Gruber anastomosis (AMG) - an anastomosis from the SN to the ulnar nerve [LN] (Martin-Gruber anastomosis, median-to-ulnar anastomosis in the forearm). If the anastomosis is directed from the FN to the SN, it is called Marinacci anastomosis, ulnar-to-median anastomosis in the forearm.

AMG provides [ !!! ] significant impact on the clinical picture of lesions of the peripheral nerves of the upper limb, making it difficult to make a correct diagnosis. In the case of a connection between the SN and LN, the classic picture of damage to a particular nerve may become incomplete or, conversely, redundant. Thus, when the SN is affected in the forearm distal to the origin of the AMH, for example with CTS, the symptoms may be incomplete - the strength of the muscles that are innervated by the fibers passing as part of the anastomosis does not suffer, in addition, in the case of the presence of sensory fibers in the connection, sensitivity disorders may do not occur or be expressed insignificantly. In the case of damage to the FN distal to the site of attachment of the AMH, the clinic may become redundant, since in addition to the own fibers of the FN, the fibers that come through this connection from the SN are affected (which can contribute to a false diagnosis of CTS). In this case, in addition to the clinical manifestations of FN damage, weakness of the muscles innervated through the HF anastomosis may additionally occur, as well as in the case of the presence of sensory fibers in the anastomosis - sensitivity disorders characteristic of HF damage. Sometimes the anastomosis itself can be an additional potential site of injury due to compression from adjacent muscles.

read also the post: Martin-Gruber anastomosis(to the website)

Characterizing the course of the disease, many authors distinguish two phases: irritative (initial) and the phase of loss of sensory and motor disorders. R. Kriszh, J. Pehan (1960) distinguish 5 stages of the disease: 1st - morning numbness of the hands; 2nd - night attacks of paresthesia and pain; 3rd - mixed (night and daytime) paresthesia and pain, 4th - persistent sensory impairment; 5th - motor disorders. Subsequently, Yu.E. Berziniš et al. (1982) somewhat simplified this classification and proposed to distinguish 4 stages: 1st - episodic subjective sensations; 2nd - regular subjective symptoms; 3rd - sensitivity disorders; 4th - persistent motor disorders. In addition to the classifications presented above, which are based only on clinical manifestations and objective examination data, a classification has been developed that reflects the degree of damage to the nerve trunks and the nature of the manifestation of neuropathies.

Based on the International Classification of the degree of damage to the nerve trunk (according to Mackinnon, Dellon, 1988, with additions by A.I. Krupatkina, 2003), neuropathies are divided according to the severity of compression: degree I (mild) - intraneural edema, in which transient paresthesia is observed, an increase in vibration sensitivity threshold; there are no movement disorders or mild muscle weakness is observed, symptoms are inconsistent, transient (during sleep, after work, during provocative tests); II degree (moderate) - demyelination, intraneural fibrosis, increased threshold of vibration and tactile sensitivity, muscle weakness without atrophy, transient symptoms, no permanent paresthesias; III degree (severe) - axonopathy, Wallerian degeneration of thick fibers, decreased innervation of the skin up to anesthesia, atrophy of the muscles of the eminence of the thumb, paresthesia is permanent. When formulating a clinical diagnosis, V.N. Stock and O.S. Levin (2006) recommend indicating the degree of motor and sensory defects, the severity of the pain syndrome, the phase (progression, stabilization, recovery, residual, in case of remitting course - exacerbation or remission).

Diagnostics

Diagnosis of STS includes: [ 1 ] medical history, including any medical problems, illnesses, injuries the patient has had, current symptoms, and an analysis of daily activities that may cause these symptoms; [ 2 ] hand diagrams (the patient fills out a diagram of his hand: in which places does he feel numbness, tingling or pain); [ 3 ] neurological examination and provocation tests: [ 3.1 ] Tinel test: tapping the wrist with a neurological hammer (above the site of passage of the heart failure) causes a tingling sensation in the fingers or pain radiating (electrical shooting) to the fingers (pain can also be felt in the area of tapping); [ 3.2 ] Durkan test: compression of the wrist in the area where the HF passes causes numbness and/or pain in the 1st - 3rd, half of the 4th fingers (as with Tinel’s symptom); [ 3.3 ] Phalen test: flexion (or extension) of the hand 90° leads to numbness, tingling or pain in less than 60 seconds (a healthy person can also develop similar sensations, but not earlier than after 1 minute); [ 3.4 ] Gillett's test: when the shoulder is compressed with a pneumatic cuff, pain and numbness occur in the fingers (note: in 30 - 50% of cases, the described tests give a false positive result); [ 3.5 ] Holoborodko test: the patient is opposite the doctor, the patient’s hand is held palm up, the thumb of the doctor’s hand is placed on the eminence of the thenar muscles, the 2nd finger of the doctor rests on the 2nd metacarpal bone of the patient, the thumb of the doctor’s other hand rests on the eminence of the hypothenar muscles, 2 The doctor’s 4th finger rests on the patient’s 4th metacarpal bone; At the same time, a “collapsing” movement is performed, stretching the transverse carpal ligament and briefly increasing the cross-sectional area of the wrist, while a decrease in the intensity of the manifestations of SN neuropathy is observed for several minutes.

If CTS is suspected, it is necessary [ !!! ] carefully study the sensitivity (pain, temperature, vibration, discrimination) in fingers I - III, then evaluate the motor activity of the hand. They mainly examine the flexor pollicis longus, the abductor pollicis brevis muscle, and the opponensus muscle. An opposition test is performed: with severe thenar weakness (which occurs at a later stage), the patient cannot connect the thumb and little finger; or the doctor (researcher) can easily separate the patient’s closed thumb and little finger. It is important to pay attention to possible autonomic disorders.

read also: article “Validation of the Boston Carpal Tunnel Questionnaire in Russia” by D.G. Yusupova et al. (magazine “Neuromuscular Diseases” No. 1, 2018) [read]

The “gold standard” for instrumental diagnostics is electroneuromyography (ENMG), which allows not only to objectively examine nerves, but also to assess the prognosis of the disease and the severity of CTS. MRI is usually used to determine the location of nerve compression after unsuccessful surgical interventions on the carpal tunnel and as a method of differential diagnosis in cases with questionable symptoms, as well as to diagnose space-occupying formations of the hand. MRI allows visualization of the ligamentous, muscular apparatus, fascia, and subcutaneous tissue.

One of the methods that allows you to visualize the structure of the nerve in CTS is ultrasound, which allows you to visualize the SN and surrounding structures, which helps to identify the causes of compression. For diagnosing HF lesions at the GC level, the following indicators are reliably significant (Senel S. et al., 2010): [ 1 ] increase in the cross-sectional area of the SN in the proximal part of the CC (≥0.12 cm²); [ 2 ] reduction in the cross-sectional area of the SN in the middle third of the GC; [ 3 ] change in the echostructure of the SN (disappearance of internal division into bundles), visualization of the SN before entering the SG during longitudinal scanning in the form of a cord with an uneven contour, reduced echogenicity, homogeneous echostructure; [ 4 ] identification, using color-coded techniques, of the vascular network inside the nerve trunk and additional arteries along the SN; [ 5 ] thickening of the tendon retinaculum ligament (≥1.2 mm) and increasing its echogenicity. Thus, when scanning the SN, the main ultrasound signs of the presence of compression-ischemic STS are: thickening of the SN proximal to the carpal tunnel, flattening or decreasing the thickness of the SN in the distal part of the CS, a decrease in the echogenicity of the SN before entering the CS, thickening and increased echogenicity of the flexor retinaculum ligament.

X-ray examination of the hands with CTS carries [ !!! ] limited information content. It acquires primary importance in cases of injuries, systemic connective tissue diseases, and osteoarthritis.

Treatment

Conservative and surgical treatment of CTS is possible. Conservative treatment is recommended for patients with mild disease, mainly in the first six months from the onset of symptoms. It includes splinting and wearing an orthosis (in a neutral position of the hand; it is usually recommended to immobilize the hand during night sleep for 6 weeks, but some studies have demonstrated the high effectiveness of wearing a splint/orthosis during the day), as well as injections of glucocorticoids (GC) into the GCs, which reduce inflammation and swelling of the tendons (however, GCs have a detrimental effect on tenocytes: they reduce the intensity of collagen and proteogligan synthesis, which leads to tendon degeneration). According to the recommendation of the American Association of Orthopedic Surgeons (2011), HA injections are performed between 2 and 7 weeks from the onset of the disease. Due to the risk of developing an adhesive process in the canal, many specialists do no more than 3 injections with an interval of 3 to 5 days. If there is no improvement according to clinical and instrumental data, surgical treatment is recommended. The effectiveness of the use of NSAIDs, diuretics and B vitamins, physiotherapeutic treatment, manual therapy and reflexology has not been proven (level of evidence B).

Surgery for CTS involves decompression (reducing pressure in the CTS area) and reducing compression of the CTS by cutting the transverse carpal ligament. There are three main methods of HF decompression: classic open access, minimally invasive open access technique (with minimal tissue dissection - about 1.5 - 3.0 cm) and endoscopic surgery. All of them are aimed at effective decompression of the HF in the canal by completely cutting the carpal ligament. Endoscopic decompression is as effective as the open technique of cervical surgery. The advantages of endoscopic HF decompression over open decompression methods are a smaller postoperative scar and less severe pain, however, due to limited access, the risk of injury to a nerve or artery increases. Factors influencing the outcome of the operation are: older age of patients, constant numbness, the presence of subjective weakness of the hand, thenar muscle atrophy, the presence of diabetes mellitus, stage III CTS.

Carpal tunnel syndrome is a set of symptoms resulting from compression of the median nerve in the carpal tunnel.

The course of the disease, which is called carpal syndrome, is accompanied by weakness of the hand and numbness of the fingers. This is the general name for neuropathic conditions in which the nerve trunk is compressed.

The nerve is located in a canal of hard tissues that protect it from external influences. However, it suffers from deformation of the canal walls, which is caused by overstrain of tendons and ligaments, causing deterioration of trophism in the tissues. If the overstrain is constant, then the tissues of the carpal tunnel become thicker, looser and more swollen.

As a result, there is no free space left in the canal and the pressure on the nerve increases. This leads to dysfunction of the nerve; it stops conducting motor signals. Sometimes carpal tunnel syndrome can be caused by swelling of the nerve. This occurs due to poisoning of the body with salts of heavy metals, arsenic, and mercury vapor.

Causes of the disease

Carpal syndrome often occurs due to monotonous, regular load on the arm.

But besides mechanical factors, there are several more:

professional activity with the same type of extension-flexion movements;
age-related changes. After age 50, changes occur in the bones and bone structures;
genetic factor. If there is a family history of arthritis, arthrosis, or osteochondrosis, the risk of the disease increases;
diseases of the endocrine system. In the presence of diabetes mellitus and thyroid dysfunction, the regenerative ability of tissues decreases;
microtrauma of the wrists.

Before the start of active computerization of the population, carpal tunnel syndrome was diagnosed in 3% of women and 2% of men. But after computers firmly entered our lives, the disease was called occupational.

Carpal tunnel syndrome is the most common type of tunnel neuropathy. But this condition develops when various nerve trunks are infringed (suprascapular, digital plantar, median, palmar, ulnar, radial, median carpal).

Compression of any of the above nerves leads to carpal syndrome and has similar symptoms. Symptoms will increase gradually, since the disease also does not develop immediately.

At the initial stage, a feeling of slight discomfort appears when the joint is overloaded. As the disease progresses, the canal narrows and greater impairment of nerve function occurs.

Types of disease

There are several types of carpal syndrome.

Carpal tunnel syndrome or compression-ischemic neuropathy of the median nerve of the wrist

This syndrome most often occurs and develops on the dominant hand. It appears more often in women. Its occurrence is caused by heavy physical labor with constant overload of the hands and forearms, and congenital narrowness of the carpal tunnel.

Other concomitant diseases (myxelema, rheumatoid arthritis, venous congestion) also lead to this disease.

Previous injuries to the wrist play an important role, after which a callus forms in the wrist area. Carpal tunnel syndrome often appears during pregnancy and menopause.

A person begins to be bothered by a feeling of tingling, numbness, “goosebumps”, which are felt in the thumb, index, middle fingers, and may be in the ring finger, but never affect the little finger. The pain may radiate to the shoulder or forearm.

Due to such unpleasant symptoms, a person is very uncomfortable sleeping; he has to constantly get up and shake or rub his hand to get rid of the feeling of numbness.

When lowering the hand, the pain subsides, and when raising it intensifies. Pain occurs when performing work associated with tension in the wrist joint.

Pronator syndrome

It is provoked by carrying heavy objects with constant pressure on the forearm. Characteristic symptoms include: pain in the forearm, worsening when writing or raising the arm up.

Characterized by numbness, a crawling sensation in the fingers and palms. There is weakness of the short muscles that abduct the thumb, and the sensitivity of the hand is impaired.

Supracondylar shoulder syndrome

It is also called love paralysis, since the disease often occurs as a result of pressure from the head of a sleeping partner on the arm bent at the elbow.

Cubital syndrome

The cubital canal of the elbow joint of the hand is pinched. Therefore, the disease is called cubital tunnel syndrome.

The damage occurs due to regular flexion and extension of the elbow joint. Often diagnosed in thin women. Also if there was an elbow injury.

Moreover, cubital syndrome can develop after a fairly long period of time. Painful sensations are observed in the ring finger, little finger, and in the elbow area when trying to bend or straighten it. The pain worsens in cold weather.

Guyon's bed syndrome

This syndrome is caused by the constant use of a cane, crutches, and tightening screws. This type of syndrome is characterized by atrophy of the hand muscles and disorders of its sensitivity.

Diagnostics

First of all, it is necessary to exclude other diseases that have a similar picture to tunnel neuropathy. These are neuralgia, myalgia, arthrosis, arthritis.

Initially, anamnesis is collected. The doctor asks about existing diseases to differentiate carpal syndrome. Finds out whether there have been injuries to the wrist, shoulder and neck.

Ask about the profession to understand whether carpal tunnel syndrome is caused by professional activity. Testing is then carried out on the wrist, hands, forearms and shoulders.

Phalen test

The patient is asked to raise the elbow to the level of the shoulder, rotate the back of the wrist inward, making sure that the wrists of both hands are touching, and the hands should be held in this position for a minute.

If symptoms such as pain, numbness or tingling occur during the test, this indicates carpal tunnel syndrome.

This position creates maximum pressure on the median nerve area and on the carpal tunnel. When flexing and extending the hand, the patient feels numbness, pain, and “goosebumps” in the palms and fingers.

Tinel test

The doctor taps the skin of the arm over the area where the nerve passes. If tingling is observed in the fingers, this indicates the beginning of nerve regeneration.

Cuff test

A tonometer cuff is placed on the arm and the pressure is increased slightly above normal. Hold for 60 seconds. If numbness and tingling are felt in the fingers during this time, carpal tunnel syndrome is confirmed.

Sometimes other diagnostic methods are required.

Electrodiagnostic. Record the speed of electrical conduction of the nerve.
MRI. Allows you to obtain a detailed clinical picture of the condition of internal organs. In this case, an MRI of the cervical spine is performed.
X-ray of the wrist joint. Allows you to exclude arthrosis and the consequences of injuries.
Ultrasound. Necessary for measuring the width of the median nerve in order to perform injections correctly.

Treatment of tunnel syndromes

If symptoms are mild, carpal tunnel syndrome can be treated at home.

The main goal of home treatment is to provide complete rest to the sore arm and relieve existing symptoms.

Treatment in the early stages can stop the progression of carpal syndrome and prevent irreversible nerve damage.

Home treatment

At home, you should follow a number of rules:

stop activities that cause unpleasant symptoms;
Rest your wrist more often;
apply ice to your wrist 2 times a day;
take anti-inflammatory non-steroidal drugs as prescribed by your doctor to relieve pain;
peace is created for the sore hand and the preconditions for nerve injury in the tunnel are eliminated. For this purpose, a splint is applied. It will help relieve pressure on the median nerve. By wearing it at night, you can fix the affected joint in a neutral position. This prevents compression of the median nerve at night during sleep. Splints may also be worn during work that aggravates symptoms. The neutral position of the wrist is considered to be straight or slightly curved. If, after a couple of weeks of treatment at home, the symptoms do not improve, or even intensify, you should consult a doctor.

Conservative treatment

Treatment of the underlying disease

If carpal tunnel syndrome is caused by other diseases, then it is worth treating them. Hypothyroidism is treated with hormonal therapy. If the syndrome is associated with professional activity, then you should change jobs. Usually after this the functions of the hand are restored.

Medicines

Treatment with vascular, analgesic, and dehydration agents is prescribed. Novocaine blockades are used, as well as blockades with hydrocortisone, lidase in the tissue surrounding the nerve or in the canal.

At the same time, anesthetics and corticosteroids are injected into the carpal tunnel. After the first injections, a person already feels great relief, and three injections are enough for recovery.

Treatment is carried out with non-steroidal anti-inflammatory drugs: Ibuprofen, Indomethacin, to relieve pain and inflammation.

Hormonal drugs that are injected into the affected area with a syringe or smeared with ointment. Calcium chloride in the form of injections to eliminate inflammation and stabilize immune system reactions.

Physiotherapy

A good effect is achieved by manual manipulation of the hand, which is necessary to restore the correct position of the wrist bones. Phonophoresis and electrophoresis help well. Applications with lidase, Dimexide + Hydrocortisone.

If conservative treatment methods do not help, then neurosurgical treatment is prescribed.

Operation

Surgical treatment is needed when the severity of carpal syndrome does not allow doing housework or engaging in professional activities.

During the operation, the ligament located on top of the carpal tunnel is cut. This leads to an enlargement of the canal and the pressure on the nerve is relieved.

Surgery eliminates unpleasant symptoms and completely eliminates side effects. This is an open operation. The minimally invasive technique consists of endoscopic dissection of the carpal ligament, performed through a small incision using a camera and special surgical instruments.

Therapy with folk remedies

Treatment of carpal syndrome with folk remedies at home is aimed at eliminating all unpleasant symptoms of the disease.

Sea buckthorn infusion

Sea buckthorn berries are mixed with water. Then the resulting mixture is heated to 37 degrees. You should steam your hands in the resulting mixture for 30 minutes.

After the procedure, dry your hands thoroughly and put on warm mittens. Brushes should be treated in this way for a month, then take a break for a couple of weeks.

Ammonia and alcohol

A tablespoon of salt is poured with 50 grams of 10% ammonia and 10 grams of camphor alcohol are added. Everything is dissolved in a liter of water. The resulting product is rubbed on sore limbs or used in the form of baths. The product will help get rid of numbness in your fingers and the feeling of goosebumps.

Pepper rub

Pour 100 grams of ground black pepper into a liter of vegetable oil and heat for half an hour over low heat. The warm product is rubbed into the sore hand several times a day.

Prevention

Preventive measures include a number of rules:

When working at a computer, you should use the mouse less often. If it is impossible to work without a mouse, then you need to purchase a special mouse pad with a special wrist rest.
The arm from the elbow to the hand should lie on the table. A computer chair must have armrests.
If you feel tired in the wrist area, you need to do a little exercise for your hands and give them rest. You can clasp the fingers of both hands and rotate your hands in different directions. You can squeeze a rubber ball.
Before sitting down for long periods of work that involve straining your wrists, you need to warm up your hands with gymnastics.
Avoid similar movements that lead to compression of the nerve. It is better to perform all movements with a healthy hand.
It is better to sleep on the side opposite the sore arm. This will allow the affected limb to rest.

Carpal (carpal) syndrome, although not life-threatening, does make life significantly more difficult.

Basically, the life of a modern person itself creates all the conditions for the development of this disease.

It is no longer possible to imagine your life without a computer. Namely, its use in most cases leads to the occurrence of carpal syndrome.

But if you follow the rules of prevention and use folk remedies, you can protect yourself from this pathology or relieve symptoms if they have already begun to appear.