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How to get rid of carpal tunnel syndrome. Conservative treatments for carpal tunnel syndrome

26.11.2019 -
Burns and frostbite

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

Anatomy
ZK - inelastic fibro-osseous tunnel formed by the bones of the wrist and the flexor retinaculum. In front of the ZK, the retainer of the tendons of the flexor muscles (retinaculum flexorum [syn.: transverse ligament of the wrist]) is stretched between the tubercle scaphoid and the tubercle of the large trapezoid bone from the lateral side, the hook of the hamate bone and the pisiform bone with the medial. Behind and from the sides, the canal is limited by the bones of the wrist and their ligaments. Eight carpal bones articulate, forming together an arc, facing a slight bulge back to back side, and concavity - to the palm. The concavity of the arch is more significant due to the bony protrusions towards the hand on the scaphoid on one side and the hook on the hamate 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 proper fascia of the palm, which covers the muscles of the eminence of the thumb and little finger with a thin plate, and in the center of the palm it is represented by a dense palmar aponeurosis, which runs in the distal direction between the thenar and hypothenar muscles. The length of the carpal tunnel is on average 2.5 cm. Through the carpal tunnel pass CH and nine tendons of the flexors of the fingers (4 - tendons of the deep flexors of the fingers, 4 - tendons of the superficial flexors of the fingers, 1 - tendon of the long flexor of the thumb), which pass to the palm, surrounded by synovial sheaths. The palmar sections of the synovial sheaths form two synovial bags: the radial (vagina tendinis m. flexorum pollicis longi), for the tendon of the long flexor of the thumb and the ulna (vagina synovialis communis mm. flexorum), common to the proximal sections of the eight tendons of the superficial and deep flexors of the fingers. Both of these synovial sheaths are located in the carpal tunnel, wrapped in a common fascial sheath. Between the walls of the SC 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 a subsynovial connective tissue through which the vessels pass. CH is the softest and ventrally located structure in the carpal tunnel. It is located directly under the transverse ligament of the wrist (retinaculum flexorum) and between the synovial sheaths of the flexor tendons of the fingers. SN at the wrist level consists on average of 94% of sensory and 6% of motor nerve fibers. The motor fibers of the SN in the SC area are predominantly combined 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 in the dorsal position. However, the motor branch of HF has many anatomical variations that create a great deal of 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 carpal tunnel syndromes. peripheral nerves and the most common neurological disorder in the hands. The incidence of STS is 150:100,000 of the population, more often STS occurs in women (5-6 times more often than men) of middle and old age.

Allocate professional and medical risk factors for the development of CTS. In particular, professional (exogenous) factors include the static setting of the hand in a state of excessive extension in the wrist joint, which is typical for people long time working at a computer (the so-called “office syndrome” [those users who, when working with the keyboard, are at greater risk when the hand is extended by ≥ 20 ° or more in relation to the forearm]). Prolonged repetitive flexion and extension of the hand (eg, in pianists, painters, jewelers) can lead to CTS. In addition, the risk of SZK is increased in people working in low temperature conditions (butchers, fishermen, workers in fresh-frozen food departments), with constant vibrational movements (carpenters, road foremen, etc.). It is also necessary to take into account the genetically determined narrowing of the SC and / or the inferiority of the nerve fibers of the heart failure.

There are four groups of medical risk factors: [ 1 ] factors that increase intratunnel tissue pressure and lead to a violation 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: the consequences of fractures of the bones of the wrist, isolated or in combination with post-traumatic arthritis, deforming osteoarthritis, disimmune diseases, incl. rheumatoid arthritis (note: in rheumatoid arthritis, HF compression occurs early, so every patient with CTS should exclude the development of rheumatoid arthritis); [ 3 ] volumetric formations of the median nerve: neurofibroma, ganglioma; [ 4 ] degenerative-dystrophic changes in the median nerve resulting from diabetes mellitus, alcoholism, hyper- or beriberi, 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. Decreased motor activity in the elderly often contributes to the development of obesity, one of the risk factors for the development of HF compression neuropathy (Evidence 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 CTS provocation is chronic trauma to the wrist joint and its structures. All this contributes to the development of aseptic inflammation of the vascular-nerve bundle in a narrow channel, leading to local edema of fatty tissue. Edema, in turn, provokes even greater compression of the anatomical structures. Thus, a vicious circle is closed, which leads to the progression and chronicity of the process (Chronic or repeated compression of the heart failure causes local demyelination, and sometimes degeneration of the axons of the heart failure).

note! Possible double crush syndrome, first described by A.R. Upton and A.J. McComas (1973), which consists in SN compression in several sections 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 the axon in one place makes it more sensitive to compression in another, located more distally. This phenomenon is explained by a violation of the axoplasmic current 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 than the first three fingers of the hand], daytime and nighttime paresthesias in these areas (relieved by shaking the hand]). Attention should be paid to the fact that in CZK, sensory phenomena are predominantly localized in the first three (partly in the fourth) fingers of the hand, since the sign of the hand to the fingers (palm) receives sensitive innervation from the SN branch that runs outside the ZK. Against the background of sensitivity disorders, there are motor disorders of the type of sensitive apraxia, especially pronounced in the morning hours after waking up, in the form of disorders of fine purposeful movements, for example, it is difficult to unbutton and fasten buttons, lace up shoes, etc. Later, patients develop pain in the hand and I, II, III fingers, which at the beginning of the disease can be blunt, aching character, and as the disease progresses, they intensify and acquire a burning character. Pain may occur in different time days, but more often accompany attacks of nocturnal paresthesias and intensify with physical (including positional) load on the hands. Due to the fact that HF ​​is a mixed nerve and combines sensory, motor and autonomic fibers, neurological examination in patients with compression-ischemic neuropathy may reveal HF at the wrist level. clinical manifestations corresponding to damage to certain fibers. Sensitivity disorders are manifested by hypalgesia, hyperpathia. A combination of hypo- and hyperalgesia is possible, when zones of increased perception of pain stimuli are found on some parts of the fingers, and zones of reduced perception of pain stimuli on others ( note: as with the other most common compression syndromes, the clinical picture may rapidly or slowly worsen or improve over time). Motor disorders in carpal tunnel syndrome are manifested as a decrease in strength in the muscles innervated by the median nerve (abductor abductor muscle of the first finger, superficial head of the short flexor of the first finger), and atrophy of the muscles of the elevation of the first finger. Vegetative disorders are manifested in the form of acrocyanosis, changes in skin trophism, sweating disorders, sensations of coldness of 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 variants of the main symptoms.
note! It is necessary to remember about the possibility of a patient having a Martin-Gruber anastomosis (AMH) - anastomosis from SN to the ulnar nerve [LN] (Martin-Gruber anastomosis, median-to-ulnar anastomosis in the forearm). In the case of the direction of the anastomosis from the FN to the SN, it is called the Marinacci anastomosis (ulnar-to-median anastomosis in the forearm).


AMG renders [ !!! ] significant impact on clinical picture lesions of the peripheral nerves of the upper limb, making it difficult to make a correct diagnosis. In the case of a connection between SN and FN, the classic picture of a certain nerve lesion may become incomplete or, conversely, redundant. So, if heart failure is affected in the forearm distal to the place of AMH discharge, 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 composition of the connection, sensitivity disorders can not occur or be expressed insignificantly. In the case of damage to the FN distal to the site of AMH attachment, the clinic may become redundant, since, in addition to the FN's own fibers, the fibers that come through this connection from the heart failure suffer (which may contribute to a false diagnosis of CTS). In this case, in addition to the clinical manifestations of the FN lesion, 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 the HF lesion. Sometimes the anastomosis itself can be an additional potential lesion site due to compression from the adjacent muscles.

read also the post: Anastomosis Martin-Gruber(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. Krishzh, 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 day) paresthesias and pains, 4th - persistent sensory disturbance; 5th - motor disorders. Later, Yu.E. Berzinysh et al. (1982) somewhat simplified this classification and proposed to distinguish 4 stages: 1st - episodic subjective sensations; 2nd - regular subjective symptoms; 3rd - violations of sensitivity; 4th - persistent movement disorders. In addition to the above classifications, 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: I degree (mild) - intraneural edema, in which transient paresthesias are observed, an increase in vibration sensitivity threshold; movement disorders are absent or slight muscle weakness is observed, the symptoms are inconsistent, transient (during sleep, after work, during provocative tests); II degree (moderate) - demyelination, intraneural fibrosis, increased vibration and tactile sensitivity, muscle weakness without atrophy, symptoms are transient, there are no permanent paresthesias; III degree (pronounced) - axonopathy, Wallerian degeneration of thick fibers, decreased skin innervation up to anesthesia, atrophy of the muscles of the eminence of the thumb, paresthesias are 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, with a remitting course - exacerbation or remission).

Diagnostics

Diagnosis of CTS includes: [ 1 ] medical history, including any medical problems, illnesses, injuries that the patient has had, current symptoms, and an analysis of daily activities that may cause these symptoms; [ 2 ] hand diagrams (the patient fills in the diagram of his hand: in what places he feels numbness, tingling or pain); [ 3 ] neurological examination and provocation tests: [ 3.1 ] Tinel test: tapping with a neurological hammer on the wrist (above the site of passage of CH) causes a tingling sensation in the fingers or irradiation of pain (electric lumbago) in the fingers (pain can also be felt in the area of ​​tapping); [ 3.2 ] Durkan's test: compression of the wrist in the area of ​​CH passage causes numbness and / or pain in fingers I - III, half of IV fingers (as with Tinel's symptom); [ 3.3 ] Phalen test: 90° flexion (or extension) of the hand results in numbness, tingling, or pain in less than 60 seconds (a healthy person may also develop similar sensations, but not earlier than 1 minute); [ 3.4 ] Gillett 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 ] Goloborodko test: the patient is opposite the doctor, the patient’s hand is held palm up, the doctor’s thumb is placed on the eminence of the thenar muscles, the doctor’s 2nd finger rests on the patient’s 2nd metacarpal bone, the thumb of the doctor’s other hand rests on the elevation of the hypothenar muscles, 2 the th finger of the doctor's hand rests on the 4th metacarpal bone of the patient; a “disintegrating” movement is made at the same time, stretching the transverse ligament of the wrist and briefly increasing the cross-sectional area of ​​the SC, while a decrease in the intensity of manifestations of HF neuropathy is observed for several minutes.

If CTS is suspected, [ !!! ] carefully study the sensitivity (pain, temperature, vibration, discrimination) in fingers I - III, then evaluate the motor activity of the hand. Basically, they examine the long flexor of the thumb, the short muscle that abducts the thumb of the hand, and the muscle that opposes it. An oppositional test is carried out: with pronounced tenar weakness (which occurs more than late stage) the patient cannot connect the thumb and little finger; or the doctor (researcher) can easily separate the closed thumb and little finger of the patient. It is important to pay attention to possible vegetative disorders.

see also: article "Validation of the Boston questionnaire for the assessment of carpal tunnel syndrome(Boston Carpal Tunnel Questionnaire) in Russia” D.G. Yusupova et al. (journal "Neuromuscular diseases" No. 1, 2018) [read]

"gold standard" instrumental diagnostics serves as electroneuromyography (ENMG), which allows not only to objectively examine the 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 carpal tunnel surgery and as a method differential diagnosis in cases with doubtful symptoms, as well as for the diagnosis of volumetric formations of the hand. MRI allows visualization of the ligamentous, muscular apparatus, fascia, subcutaneous tissue.

One of the methods to visualize the structure of the nerve in CTS is ultrasound (ultrasound), which allows visualization of HF and surrounding structures, which helps to identify the causes of compression. For the diagnosis of HF lesions at the level of the SC, the following indicators are significant (Senel S. et al., 2010): [ 1 ] increase in the cross-sectional area of ​​the CH in the proximal part of the SC (≥0.12 cm²); [ 2 ] decrease in the cross-sectional area of ​​CH in the middle third of the SC; [ 3 ] change in the echostructure of the SN (disappearance of internal division into bundles), visualization of the SN before entering the SC during longitudinal scanning in the form of a strand with uneven contour, reduced echogenicity, homogeneous echostructure; [ 4 ] detection using color-coded techniques of the vasculature within the nerve trunk and additional arteries along the course of heart failure; [ 5 ] thickening of the ligament - tendon retainer (≥1.2 mm) and an increase in its echogenicity. Thus, when scanning HF, the main ultrasound signs of the presence of compression-ischemic CL are: thickening of the HF proximal to the carpal tunnel, flattening or decrease in the thickness of the HF in the distal CL, decreased echogenicity of the HF before entering the CL, thickening and increased echogenicity of the flexor retinaculum ligament.


X-ray examination of the hands in CTS carries [ !!! ] limited information content. It plays a major role in trauma systemic diseases connective tissue, osteoarthritis.

Treatment

Conservative and surgical treatment of CTS is possible. Conservative treatment is recommended for patients with mild degree disease, mainly in the first six months from the onset of symptoms. This includes splinting and wearing a brace (with the hand in a neutral position; it is usually recommended to brace the hand during nighttime sleep for 6 weeks, but some studies have demonstrated high effectiveness of wearing a splint/brace during the daytime), as well as injections of glucocorticoids (GC) into ZK, which reduce inflammation and swelling of the tendons (however, HA has 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 made between 2 and 7 weeks from the onset of the disease. Due to the risk of developing adhesive process in the canal, many specialists do no more than 3 injections with an interval of 3-5 days. If there is no improvement in clinical and instrumental data, surgical treatment is recommended. The effectiveness of the use of NSAIDs, diuretics and B vitamins, physiotherapy, manual therapy and reflexology has not been proven (level of evidence B).

The operation for CTS is to decompress (reduce pressure in the area of ​​the SC) and reduce the compression of the SN by dissecting the transverse carpal ligament. There are three main methods of heart failure decompression: classical open approach, minimally invasive open approach (with minimal tissue dissection - about 1.5 - 3.0 cm) and endoscopic surgery. All of them are aimed at effective decompression of CH in the canal by complete dissection of the carpal ligament. Endoscopic decompression is as effective as open technique surgical intervention on the SC. The advantages of endoscopic HF decompression over open decompression methods are the smaller size postoperative scar and less pronounced pain syndrome, however, due to access restrictions, the risk of trauma to the nerve or artery increases. Factors affecting the outcome of the operation are: older age of patients, permanent numbness, the presence of subjective weakness of the hand, thenar muscle atrophy, the presence of diabetes mellitus, stage III CTS.

read also the article “Immediate and long-term results of median nerve decompression in carpal tunnel syndrome” Gilveg A.S., Parfenov V.A., Evzikov G.Yu.; FGAOU VO "First Moscow State medical University them. THEM. Sechenov" Ministry of Health of the Russian Federation, Moscow (journal "Neurology, neuropsychiatry, psychosomatics" No. 3, 2018) [read]

More about SZK in the following sources:

article "Carpal Tunnel Syndrome: Anatomical and Physiological Basis for Manual Therapy" by A.V. Stephanidi, I.M. Dukhovnikova, Zh.N. Balabanova, N.V. Balabanova; Irkutsk State medical Academy postgraduate education, Irkutsk (magazine " Manual therapy"No. 1, 2015) [read];

article "Diagnosis and treatment of carpal tunnel syndrome" Pilgun A.S., Shernevich Yu.I., Bespalchuk P.I.; Belarusian State Medical University, Department of Traumatology and Orthopedics, Minsk (magazine "Innovations in Medicine and Pharmacy" 2015) [read];

article "Carpal (carpal) tunnel syndrome" A.A. Bogov (Jr.), R.F. Masgutov, I.G. Khannanova, A.R. Gallyamov, R.I. Mullin, V.G. Topyrkin, I.F. Akhtyamov, A.A. gods; Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan; Kazan (Privolzhsky) Federal University, Kazan; Kazan State Medical University, Kazan (Practical Medicine magazine No. 4, 2014) [read];

article “Carpal Tunnel Syndrome (Literature Review)” Khalimova A.A., “Rakhat” Medical Center, Almaty, Kazakhstan (magazine “Vestnik AGIUV” special issue, 2013) [read];

article "Carpal Tunnel Syndrome in the Elderly" by A.S. Gilveg, V.A. Parfenov; First Moscow State Medical University. THEM. Sechenov (magazine "Doctor Ru" No. 1, 2017) [read];

article "Carpal tunnel syndrome in the postpartum period" I.A. Strokov, V.A. Golovacheva, N.B. Vuytsik, E.A. Mershina, A.V. Farafontov, I.B. Filippova, V.E. Sinitsyn, G.I. Kuntsevich, G.Yu. Evzikov, Z.A. Suslin, N.N. Yakhno; Department of Nervous Diseases of the First Moscow State Medical University. THEM. Sechenov; Center for Radiation Diagnostics of the Federal State Budgetary Institution "Treatment and Rehabilitation Center" of the Ministry of Health of the Russian Federation; Federal State Budgetary Institution "Scientific Center of Neurology" RAMS, Moscow (Neurological Journal, No. 3, 2013) [read];

article "Carpal tunnel syndrome in rheumatic diseases" E.S. Filatov; Federal State Budgetary Institution "Research Institute of Rheumatology named after N.N. V.A. Nasonova" RAMS, Moscow (journal "Neuromuscular Diseases" No. 2, 2014) [read];

article "Opportunities ultrasound in the diagnosis of carpal tunnel syndrome” E.R. Kirillov, Kazan State Medical University of the Ministry of Health of the Russian Federation, Kazan (Practical Medicine magazine No. 8, 2017) [read] ( additional literature);

article "Change in the cross-sectional area of ​​the median nerve at various stages of carpal tunnel syndrome" Maletsky E.Yu., Aleksandrov N.Yu., Itskovich I.E., Lobzin S.V., Villar Flores F.R.; GBOU VPO North-Western State Medical University. I.I. Mechnikov, St. Petersburg (Medical Visualization magazine No. 1, 2014) [read];

article "The study of tactile sensitivity using Semmes-Weinstein monofilaments in patients with carpal tunnel syndrome and healthy individuals" I.G. Mikhailyuk, N.N. Spirin, E.V. Salnikov; State health institution of the Yaroslavl region " Clinical Hospital No. 8, Yaroslavl; SBEI HPE "Yaroslavl State Medical Academy" of the Ministry of Health of the Russian Federation (journal "Neuromocular Diseases" No. 2, 2014) [read];

article " Modern methods diagnosis of carpal tunnel syndrome” N.V. Zabolotskikh, E.S. Brileva, A.N. Kurzanov, Yu.V. Kostina, E.N. Ninenko, V.K. Bazoyan; FPC and teaching staff of GBOU VPO KubGMU Ministry of Health of the Russian Federation, Krasnodar; Research Institute-KKB No. 1 im. prof. S.V. Ochapovsky MZ KK, Krasnodar (magazine "Kuban Scientific Medical Bulletin" No. 5, 2015) [read];

article "Electroneuromyography in the diagnosis of carpal tunnel syndrome" N.G. Savitskaya, E.V. Pavlov, N.I. Shcherbakova, D.S. Yankevich; Scientific Center of Neurology of the Russian Academy of Medical Sciences, Moscow (magazine "Annals of Clinical and Experimental Neurology" No. 2, 2011) [read];

article "Dynamic carpal tunnel syndrome: manual muscle testing to determine the level and cause of damage to the median nerve" A.V. Stephanidi, I.M. Dukhovnikov; Irkutsk State Medical Academy of Postgraduate Education, Irkutsk (Journal "Manual Therapy No. 2, 2016) [read];

article "The use of local administration of corticosteroids in the treatment of carpal tunnel syndrome" V.N. Kiselev, N.Yu. Aleksandrov, M.M. Korotkevich; FSBI All-Russian Center for Emergency and Radiation Medicine named after V.I. A.M. Nikiforov" Ministry of Emergency Situations of Russia, St. Petersburg; FGBOU DPO "North-Western State Medical University named after N.N. I.I. Mechnikov, Ministry of Health of the Russian Federation, St. Petersburg; Russian Research Neurosurgical Institute. prof. A.L. Polenova (branch of the Federal State Budgetary Institution "National Medical Research Center named after V.A. Almazov" of the Ministry of Health of the Russian Federation), St. Petersburg (journal "Neuromuscular Diseases" No. 1, 2018) [read];

article "Treatment of carpal tunnel syndrome (tunnel compression mononeuropathy of the median nerve)" M.G. Bondarenko, teacher of massage and physiotherapy, Kislovodsk Medical College Ministry of Health of the Russian Federation (magazine "Massage. Body Aesthetics" No. 1, 2016, con-med.ru) [read];

article "Carpal Tunnel Syndrome: state of the art question” A.V. Baitinger, D.V. Cherdantsev; Federal State Budgetary Educational Institution of Higher Education "Krasnoyarsk State Medical University. professor V.F. Voyno-Yasenetsky" Ministry of Health of the Russian Federation, Krasnoyarsk; ANO "Research Institute of Microsurgery", Tomsk (magazine "Issues of Reconstructive and Plastic Surgery" No. 2, 2018) [read];

article "Issues of diagnosis and treatment of carpal tunnel syndrome" Gilveg A.S., Parfenov V.A., Evzikov G.Yu.; Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University named after I.I. THEM. Sechenov" Ministry of Health of the Russian Federation, Moscow (journal "Neurology, neuropsychiatry, psychosomatics" 2019, App. 2) [read]

Carpal tunnel syndrome (otherwise called carpal tunnel syndrome) is a fairly common problem of modern mankind. The thing is that this pathology has a direct impact on the work of the hand and the wrist itself. In this article, we will take a closer look at this ailment, its primary symptoms and the main methods of treatment.

Description of pathology

The wrist is known to be surrounded by numerous tufts fibrous tissue. It plays the role of a support function for the joint itself. The space formed between the fibrous tissue regions and the bony parts themselves is called the carpal tunnel.

The median nerve, namely, it passes through the entire wrist, provides sensitivity to the large, middle and index finger On the hand. Swelling or changes in the position of tissues in this area can lead to compression and irritation of this nerve. That is why neurological symptoms often come to the fore.

Thus, carpal tunnel syndrome is one of the types of so-called tunnel neuropathies, characterized by damage to peripheral nerves as a result of their constant compression and trauma.

Main reasons

  • Tumor of the median nerve itself.
  • Swelling of tissues due to mechanical damage and injuries of the hand (dislocations, bruises, fractures).
  • Chronic inflammatory processes in this area.
  • The channel size does not match the volume of its content.
  • Swelling of tissues in women in position, especially on later dates.
  • There is evidence that carpal tunnel syndrome is diagnosed mainly in the cold season. This, in turn, proves the role of hypothermia in the development of this pathology.

Who is at risk?

  1. People with a genetic predisposition.
  2. Patients with disorders in the work of the endocrine system.
  3. People of short stature, overweight.
  4. Menopausal women using oral contraceptives.
  5. People suffering kidney failure, tuberculosis.

Symptoms

Initially, carpal tunnel syndrome manifests itself in the form of a constant tingling and burning sensation in the area of ​​​​the thumb, middle and even ring fingers. Some patients complain of pain. Most often it is aching in nature, it can spread to the forearm. Immediately after waking up, some feel numbness of the hand, which is accompanied by a loss of pain sensitivity.

If you lower your hand down and move your fingers slightly, then the discomfort passes very quickly. However, he should be alert. Experts recommend in such a situation to immediately seek advice in order to exclude carpal tunnel syndrome.

Symptoms in the absence of qualified treatment soon again make themselves felt. As the pathology progresses, various motor disorders appear. It becomes difficult for the patient to hold any small objects in his hand, the grip strength decreases, inaccuracies appear in the movements involving the brush.

Very often there are clinical manifestations of impaired microcirculation of the affected area in the form of blanching of the skin, increased / decreased sweating in this area. As a result, there is a deterioration in the nutrition of the skin and nails, which is accompanied by a change in their appearance.

Thus, it becomes clear that carpal tunnel syndrome should not be ignored. The symptoms described above act in this case as alarm bells. If the patient does not seek help from a doctor, the likelihood of complications increases.

Diagnostics

The reason that provoked this condition, as a rule, is established during the examination of the patient and the study of the characteristics of his lifestyle (history taking). Very often, the diagnosis of the syndrome is limited to this.

In some cases, specialists additionally prescribe a flexion and extension test, Tinel test, X-ray, MRI, ultrasound and electromyography. The last test allows you to evaluate the ability of muscles to permanently contract under the influence of electrical impulses. Thanks to him, the doctor can confirm carpal tunnel syndrome or identify another cause of the lesion.

Treatment

With such a pathology, only two treatment options are possible: drug treatment or surgical surgical intervention.

How to treat carpal tunnel syndrome? Conservative therapy implies a complete cessation of the activity that provoked the appearance of the problem. In addition, experts recommend avoiding strong grasping movements, performing work with arching or tilting of the wrist.

An excellent solution is to wear a special bandage. In the early stages, it reduces the manifestation of symptoms, keeps the wrist at rest. The bandage allows you to neutralize pain and numbness.

As for drug therapy, in this case, anti-inflammatory drugs (Aspirin, Ibuprofen) are prescribed. Their main purpose is to reduce swelling. Vitamin B6 helps to neutralize pain.

If such simple means do not help to overcome the syndrome of the carpal tunnel, the treatment is supplemented by injections of the drug "Cortisone". They are used to reduce swelling directly in the canal itself.

Physiotherapy (acupuncture, constant magnetic field) is considered an excellent solution. She is appointed to improve metabolic processes in previously damaged tissues.

Alternative Treatment Options

This pathology requires surgical intervention in the event that conservative therapy is ineffective. The operation is performed using local anesthesia. During the procedure itself, the surgeon cuts the transverse ligament of the wrist, which allows you to reduce pressure on median nerve and tendons, restore normal blood supply.

After the operation, the patient is placed in a plaster splint for approximately 12 days. Rehabilitation measures imply a special massage, physiotherapy exercises, thermal procedures. The patient's ability to work returns in full approximately five weeks after the operation was performed.

Carpal tunnel syndrome and complications

It should be noted that this pathology does not apply to those violations that may pose a danger to life. However, a person who has been ill for a long time over time may lose the ability to carry out the usual actions with his hand normally. Exceptionally competent therapy can prevent such an unpleasant complication and help to fully restore the work of the hand.

5413 1

Carpal tunnel syndrome (ICD 10 - G56.0) is a common problem that affects the functioning of the hand and wrist.

The violation occurs when nerve compression inside the wrist.

Any condition that affects the size of the canal or causes tissue to grow inside it can trigger the syndrome.

What happens in case of violation

The wrist is surrounded by bundles of fibrous tissue, which performs a supporting function for the joint. The space between these fibrous tissue strips and the bony parts of the wrist is the carpal tunnel.

The median nerve passes through the wrist and provides sensation to the thumb, index and middle fingers.

Any condition that causes swelling or changes in the position of tissue in the wrist can compress and irritate this nerve.

Irritation of the median nerve leads to tingling and numbness of the thumb, index and middle fingers, a condition referred to as "carpal tunnel syndrome".

Causes and risk groups

Causes of carpal tunnel syndrome:

  1. Swelling due to damage to the forearm and hand.
  2. Swelling of tissues in pregnant women, especially in the later stages, and in women using oral contraceptives.
  3. Chronic inflammation and swelling of the structures of the carpal tunnel with constant occupational trauma.
  4. Swelling of tissues as a result of certain diseases of internal organs, endocrine disorders.
  5. Narrowing of the synovial membranes of the tendons and thickening of their walls due to acute or chronic inflammation in systemic connective tissue disorders, metabolic disorders, and tuberculosis.
  6. The discrepancy between the size of the canal and the size of its contents due to genetically inherited indicators or abnormal growth of the bones of the hand and wrist.
  7. Tumor of the median nerve.

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The risks of occurrence include:

  • use of force;
  • pose;
  • wrist position;
  • monotony of action;
  • hypothermia;
  • vibration.

At-risk groups:

  • people with a genetic predisposition;
  • people of short stature, overweight;
  • people suffering from tuberculosis, renal failure;
  • people with rheumatoid arthritis, problems in the thyroid gland;
  • women in menopause and when using hormonal contraceptives.

Anatomy of the wrist

Symptoms and signs

The syndrome has the following symptoms - gradual numbness in parts whose sensitivity is controlled by the median nerve.

After that, pain appears in the places of innervation. Also among the symptoms of carpal tunnel syndrome, it can be noted that numbness occurs in the hand, especially in the morning after a night's sleep. The patient shakes and rubs the brushes all night long, which gives a little improvement.

The pain may radiate up to the shoulder and even the neck. As the disease worsens, the thumb muscles may stop working, causing awkwardness in actions when it is necessary to take, for example, a cup.

It is difficult for the patient to touch the tips of other fingers with the tip of the thumb, to hold different objects.

Diagnostic methods and tests

The doctor will ask about the signs and medical history, perform an examination of the wrist and hands. The examination will consist of checking for strength, tenderness, and signs of nerve irritation or damage.

Other tests:

  • electrodiagnostic tests;
  • x-ray;

The syndrome must be distinguished from Arnold-Chiari anomaly and hernia. cervical.

How to treat pathology

Treatment may be conservative or surgical.

Conservative treatment

The activity that causes the symptoms should be stopped.

Avoid repetitive hand movements, strong grasping movements, holding vibrating objects, or bending or arching the wrist.

If you smoke, give up this habit. Lose weight if you have excess weight. Reduce the amount of caffeine.

Wrist brace facilitates manifestations of early stages violations. It keeps the wrist at rest. When the wrist is in the correct position, the channel has a normal volume, so there is enough space for the nerve.

The bandage helps to neutralize numbness and pain, it does not allow the brush to bend during sleep. The bandage can also be worn during the day to reduce manifestations and provide rest to the tissues of the wrist.

In addition, the following exercises help:

  1. Shake your hands.
  2. Clench your hands into a fist, hold for 3 seconds, then fully unclench for 6 seconds. Repeat 10 times.
  3. Stretch your arms in front of you, raise and lower them 5 times.
  4. Describe 10 circles with your fingertips.
  5. Press with one hand on the fingers of the other hand 10 times in a row.

Through these exercises, blood circulation in the muscles improves.

It is important that the movements are different.

It should be borne in mind that CTS - SZK appears in people not only because they carry out monotonous movements, but also because they do it for a long time.

Medical treatment

Anti-inflammatory drugs can also help eliminate swelling and symptoms of the lesion (, aspirin). Large doses of vitamin B-6 help to neutralize symptoms.

If simple measures fail to curb symptoms, consideration should be given to cortisone shots into the carpal tunnel. This tool is used to relieve swelling in the canal, it can temporarily eliminate symptoms.

Cortisone can help the doctor make a diagnosis. If the patient does not feel better after the injection, this may indicate another disorder that causes these manifestations.

If the symptoms disappear after the injection, then they appeared in the wrist.

Physiotherapy

The doctor may refer you to a physiotherapist or an occupational health specialist. The primary goal of treatment is to reduce the impact or eliminate the cause of pressure in the wrist.

A physical therapist can check the workplace and the way work tasks are performed. He can suggest how best to position the body and in what position to hold the wrist, prescribe exercises and suggest how to prevent problems in the future.

Surgical treatment

If attempts to control the manifestations fail, the patient may be offered surgery to reduce compression of the median nerve.

There are several different surgeries to relieve pressure on the nerve.

After the pressure on the nerve is removed, the blood supply to the nerve is restored, and most patients feel relief. But if the nerve is compressed for a long time, it can thicken, and a scar can form on it, which will prolong recovery after the procedure.

The most common operation is an open intervention using local anesthetic, which blocks nerves that are only in a specific part of the body.

This operation is performed on an outpatient basis, meaning you can leave the hospital right away.

Complications

Carpal tunnel syndrome is not a life-threatening disorder.

A long-term ill person may eventually lose the ability to normally carry out individual movements with his hand or fingers.

And just started on time competent treatment can prevent such a complication and help restore the work of the hand.

Preventive measures

Warning measures:

findings

Complications of the syndrome are rare and include atrophy and weakness of the muscles at the base of the thumb.

This can become a permanent disorder if not treated on time. Such a violation affects the motor skills of the hand and the performance of certain movements.

As a rule, the prognosis for the disorder is positive, and it turns out to cure it conservatively or surgically.

Carpal tunnel syndrome occurs due to compression of the median nerve between the bones and tendons of the muscles of the wrist.

Its main symptoms are pain, numbness and tingling in the thumb, index, middle and ring fingers.

After a long period of pressure on the nerve, weakening of the strength of the fingers may develop, and the muscles at the base of the thumb may atrophy. In more than half of the cases, both hands are affected.

About 5% of people in the world suffer from this disease. It usually occurs in adulthood. Women are more susceptible to the disease than men. In 30% of people, the symptoms of the syndrome decrease within a year without special treatment.

Risk factors for developing the syndrome include:

  • obesity;
  • hypothyroidism;
  • pregnancy;
  • repetitive, monotonous work.

The causes of the disease are often types of work, which include:

  • work on a computer;
  • work that requires a strong grip of the hands;
  • vibrating tools.

Anatomical features of the canal structure

The carpal canal (tunnel) is an anatomical compartment located at the base of the palm. Nine flexor tendons and the median nerve pass through this tunnel, which is surrounded on three sides by the bones of the wrist, forming an arch or arch.

The median nerve provides sensory and motor function to the thumb, index, middle, and half of the ring fingers. At the level of the wrist, the nerve innervates the muscles at the base of the thumb, which allow it to retract from the other four fingers, as well as exit the plane of the palm.

Carpal and Curbital Tunnel Syndrome

Simply bending the wrist to 90 degrees reduces the size of the canal. The median nerve can be compressed by a decrease in the size of the canal, an increase in the size of its internal tissues (eg, swelling of the lubricating tissue around the flexor tendons), or both.

Compression of the median nerve causes atrophy, weakness, and loss of sensation in the fingers innervated by it.

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Symptoms of the disease

Symptoms of carpal tunnel syndrome usually begin gradually. People with carpal tunnel syndrome experience numbness, tingling, or burning in their fingers, particularly the thumb, index, middle, and radial half of the ring finger. The discomfort usually increases at night and in the morning.

sick hands

Pain and discomfort may radiate up the arm and be felt in the forearm or even the shoulder. Less specific symptoms may include pain in the wrists or hands, loss of grip strength and manual dexterity.

If the syndrome remains untreated, weakness and atrophy of the muscles of the thumb may occur. these muscles do not receive sufficient neural stimulation.

Diagnosis of carpal tunnel syndrome

Diagnosis is based on a thorough examination of the patient's medical history, signs, symptoms, clinical examinations, and can be confirmed by electrodiagnostic tests such as electromyography and nerve conduction velocity.

If there is nerve dysfunction and muscle atrophy at the base of the thumb, the diagnosis is usually confirmed.

Physical tests

The Phalen test is performed by gently flexing the wrist, then holding it in that position for 60 seconds and waiting for symptoms.

A positive result results in pain and/or numbness in the distribution of the median nerve.

The faster the numbness begins, the stronger the syndrome that has arisen.

The Tinel test is a way to detect irritated nerves. It is performed by lightly tapping the skin on the flexor dorsi muscle to induce a tingling sensation in the distribution of the nerves. The Tinel test is less sensitive but more specific than the Phalen test.

The Durkan test, performed by squeezing the wrist or applying firm pressure to the palm over a nerve for 30 seconds, may also be done to check for symptoms.

The arm raising test is performed by raising both arms above the head. If the symptoms reproduce in the distribution of the nerve within 2 minutes, the diagnosis is positive. The hand raising test has high sensitivity and specificity.

The purpose of electrodiagnostic testing is to compare median nerve conduction velocity with conduction in other nerves supplying the arm.

The most sensitive, specific and reliable test is the combined sensory index (Robinson index). Electrodiagnosis is based on the demonstration of weakened nerve conduction through the carpal tunnel in the context of its normal conduction elsewhere.

The role of MRI or ultrasound imaging in the diagnosis of carpal tunnel syndrome has not been established and their use is not recommended.

Syndrome according to ICD-10

Carpal Tunnel Disorders Cover a Range of Problems physical health recognized in the international system of classification of diseases ICD-10.

The disease refers to mononeuropathies of the upper limb, with the exception of the current traumatic nerve disorder.

In ICD-10, this syndrome is coded G56.0 and is defined as carpal tunnel syndrome.

Treatment at home

Home treatment can relieve pain and prevent further or permanent damage to the median nerve if treatment is started when only the first symptoms of the disease appear.

If there are mild symptoms such as occasional tingling, numbness, weakness, or pain in the fingers or hands, the following steps should be taken to reduce inflammation:

  • It is necessary to give rest to the fingers, hands and wrists. It is important to stop doing activities that may be causing numbness and pain. When the symptoms subside, you can resume these activities gradually.
  • You can apply ice on your wrist for 10 to 15 minutes, once or twice an hour.
  • You can wear a wrist splint at night to keep your wrist in a neutral position and relieve pressure on the median nerve.
  • When the pain is gone, you can begin exercises to increase the flexibility and strength of the hand and wrist. You can learn the best hand and wrist positions during movements.
  • Consider taking non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections to relieve pain and reduce swelling. Studies do not show high effectiveness of these remedies, but they can relieve the symptoms of the disease.

Conservative treatment

Treatment of carpal syndrome should begin as soon as possible after the onset of symptoms.

Conservative treatments are helpful if you have mild or moderate symptoms that started less than 10 months ago.

Physical activity can reduce the risk of developing the syndrome.

At the same time, it is necessary to arrange more frequent breaks to rest the hands and avoid activities that exacerbate the symptoms of the syndrome.

Additional treatment options include wrist splinting. You may need to experiment to find a treatment that works for your particular case.

Before using additional or alternative treatment, you should consult your doctor.

  • Yoga. Yoga poses designed to strengthen, stretch, and balance the upper body and joints can help reduce pain and increase hand strength.
  • Hand therapy. Research has shown that certain physical and occupational hand therapies can reduce the symptoms of carpal tunnel syndrome.
  • ultrasound therapy. High-intensity ultrasound can be used to raise the temperature in the affected area of ​​body tissues to reduce pain and promote healing.

Current research shows conflicting results with ultrasound therapy, but it can help reduce symptoms within a few weeks.

Surgery

Surgical treatments associated with transverse carpal ligament incision have better outcomes than non-surgical therapies. Tire after surgical operation not required.

Surgery may be appropriate if symptoms are severe or do not respond to other treatments.

Carpal tunnel surgery aims to relieve pressure by contracting the ligaments compressing the median nerve.

The operation can be performed by two different methods:

  1. Endoscopic surgery. The surgeon, using an endoscope, makes incisions in the ligaments by making one or two small incisions in the arm or wrist. Endoscopic surgery is less painful than open surgery in the first few days or weeks after surgery.
  2. Open surgery. The surgeon makes an incision in the palm of the hand above the carpal tunnel and cuts the ligaments to release the nerve.

As the tissue heals, the ligaments gradually fuse, making more room for the nerve. This internal healing process usually takes several months, but the skin heals within a few weeks.

Operational risks may include incomplete release of the ligament, infection of the wound, scarring, and nerve or vascular injury.

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Conclusion

In most cases, the relief of symptoms of the disease with the help of conservative or surgical treatment reveals minimal residual symptoms nerve damage.

Long-term chronic course of the syndrome (usually in the elderly) can lead to permanent nerve damage, i.e., irreversible numbness, muscle atrophy and weakness. Recurrence of carpal tunnel syndrome after successful surgery is very rare.

Related video

Recently various pathologies of the musculoskeletal system are increasingly found in young people. One such problem that disrupts the functioning of the hand is carpal tunnel syndrome. Pathology is also known as tunnel or carpal syndrome. It is characterized by compression of the median nerve of the hand at the wrist. This can occur with various disorders associated with narrowing of the carpal tunnel. But most often this happens with constant increased loads on the brush. Therefore, pathology occurs mainly in manual workers, and women are more likely to be affected by it.

general characteristics

Innervation of all peripheral parts of the musculoskeletal system occurs through nerve fibers extending from spinal cord. They pass through special channels designed to protect them from being squeezed. But in some places, such channels are small and are called tunnels.

A particularly narrow tunnel is located in the wrist. Here, in a small gap between the three bones of the hand and the transverse ligament of the wrist, there are several tendons, many blood vessels and the median nerve, which provides innervation to the palm and three fingers of the hand. Therefore, its normal operation depends on the condition of the carpal tunnel. The peculiarities of its anatomical structure lead to the fact that the nerve is often compressed between the tendons and the transverse ligament of the wrist.

With the narrowing of this channel, a tunnel, or carpal, syndrome occurs. This is the name of a condition in which inflammation or compression of the median nerve occurs. There is its ischemia, that is, a violation of the blood supply. This slows down the speed nerve impulses and the normal innervation of the hand is disturbed. There are various motor disorders and neurological symptoms. If you do not immediately remove the pressure on the nerve, scar tissue gradually forms inside it, it thickens. Over time, the chances of recovery decrease, as it may develop atrophy.

Causes

Compression of the median nerve can occur for a variety of reasons. Although most often this occurs under the influence of external factors. The median nerve can be compressed both due to narrowing of the carpal tunnel, and due to an increase in the size of the tissues inside it. Often this happens due to injury. A severe bruise, fracture, sprain or dislocation always causes swelling. The condition is especially aggravated if the bones are displaced during injury.

A common cause of carpal syndrome is also constant stress on the wrist. They can be:

  • monotonous movements, as when typing on a computer keyboard;
  • incorrect position of the hand when working, for example, with a computer mouse;
  • application of force, frequent lifting of weights;
  • work at low temperatures;
  • vibration related activities.


Quite often, carpal tunnel syndrome occurs in those who work at the computer for a long time.

Therefore, most often office workers, musicians, tailors, assemblers of equipment, and builders are subject to narrowing of the carpal canal. And in about half of the cases, this pathology occurs in active computer users.

In addition, narrowing of the canal can occur due to inflammation and compaction of the synovial membrane. The cause of this is often tendonitis of the tendons, arthritis, especially rheumatoid or gouty, rheumatism. Bad habits, frequent use of caffeine, obesity, impaired peripheral circulation can also provoke a narrowing of the channel. Some medications, such as hormonal contraceptives, also sometimes cause swelling.

Some internal diseases can also lead to the development of carpal tunnel syndrome. Basically, these are those that cause the accumulation of fluid in the tissues. Edema often occurs during pregnancy, disorders of the kidneys or heart. Carpal tunnel syndrome can also be caused by diabetes, hypothyroidism, peripheral neuropathy and other pathologies. This sometimes happens in women menopause due to hormonal changes in the body.

Symptoms

One of the first signs of carpal tunnel syndrome is paresthesia in the hand, especially in the morning. The patient feels numbness, tingling in the fingertips, burning, coldness. This symptom gradually increases, the patient can no longer hold the hand on weight, the sensitivity of the skin is disturbed. Then comes the burning pain. It can occur only at the site of nerve innervation in the hand, or it can spread throughout the arm to the shoulder. Usually one working arm is affected, but with pathologies associated with fluid retention, narrowing of the canal can occur on both sides.

The muscles of the hand gradually weaken, especially the thumb suffers. Therefore, grasping movements of the hand are disturbed. It is difficult for the patient to hold various objects in his hand, even light ones. Therefore, there are difficulties in performing the most common actions. The patient begins to fall out of the hands of objects, he can not fasten buttons, hold a spoon. Gradually, muscle atrophy intensifies, deformity of the hand occurs. Vegetative disturbances may also occur. In this case, there is a cooling of the brush, blanching of the skin, in the palm of your hand it coarsens and thickens. Possible violation of sweating, discoloration of the nails.

A feature of the carpal tunnel syndrome, unlike other similar pathologies, is that the little finger is not affected.

When making a diagnosis, the doctor must pay attention to these characteristic symptoms. After all, it is important to differentiate pathology with a hernia of the cervical spine or Arnold-Chiari anomaly, in which pain and numbness in the hand can also occur.


The main method of treatment is to ensure the correct position of the hand, preventing nerve compression.

Treatment

To cure carpal tunnel syndrome, it is necessary to start therapy as early as possible. Otherwise, the degeneration of the nerve and its atrophy will make it impossible to restore the innervation of the hand. When the first symptoms of pathology appear, first of all, it is necessary to exclude the factors that cause the narrowing of the canal. In case of injury, you need to remove the swelling as soon as possible or put the bones in place. It is also necessary to immediately begin treatment of diseases that led to swelling or inflammation.

If the cause of the pathology is increased loads then the main treatment would be to avoid them. You need to stop using vibrating tools, avoid repetitive movements, work with an inclined or bent wrist. Lifestyle changes are required for 1-2 weeks. A special bandage effectively limits unnecessary movements. It prevents flexion of the hand and keeps the carpal tunnel straight. Due to this, the compression of the nerve is removed, and the pain disappears. Sometimes it may be necessary to make a bandage individually. At the initial stage of the pathology, if it is not associated with other serious disorders, only with the help of a well-chosen orthosis can you get rid of this syndrome.

If these symptoms occur, an occupational hygienist should be consulted. He will advise in what position to keep your hand while working, how best to use tools in order to avoid similar problems in the future. Usually, if all the recommendations of the doctor are followed, recovery occurs in 4-6 weeks. But then for some time you need to put on a bandage at night to avoid bending the hand and squeezing the nerve.

In more severe cases, pain medications are used to treat the pain. Most often, these are NSAIDs - Movalis, Nimesulide, Ketanov. good effect gives a combination of such funds with Paracetamol. The use of high doses of vitamin B6 helps to improve blood circulation and relieve numbness. These can be Neurobion or Milgamma preparations. Vasodilators are also used, for example, Trental or A nicotinic acid, diuretics - Furosemide, muscle relaxants - Mydocalm.


Sometimes severe pain can be relieved with this pathology only with the help of an injection of Hydrocortisone.

At severe pain that are not relieved by conventional medicines, an injection of Cortisone is prescribed. This remedy, injected directly into the canal, quickly relieves pain and swelling. And for a doctor, such an injection can become in an additional way diagnostics. If the pain after the injection does not go away, then their cause was not carpal syndrome, but another pathology. For injection, a combination of Diprospan with Lidocaine can also be used. But this cannot be considered an effective treatment, since it only relieves external symptoms. And for the complete removal of nerve compression, it is necessary to eliminate its causes.

Except internal use medicines For the treatment of carpal tunnel syndrome, the following methods are used:

  • at the initial stages, it is recommended to apply ice for 2-3 minutes several times a day;
  • local treatment with compresses with Dimexide, Lidocaine or Hydrocortisone;
  • physiotherapy treatment with shock wave therapy, ultraphonophoresis, acupuncture;
  • massage;
  • physiotherapy;
  • in the most difficult cases the release of the restrained nerve with the help of surgical intervention is shown.


In the most severe cases, nerve compression can only be relieved with surgery.

Operation

If conservative therapy fails to relieve pressure in the carpal tunnel, surgical treatment may be recommended. During the operation, the transverse carpal ligament is most often cut, which increases the size of the channel and frees the nerve. This treatment is performed on an outpatient basis through a small incision in the palm of the hand, using local anesthesia.

After the operation, rehabilitation takes several months. Typically, carpal tunnel symptoms disappear as soon as the pressure on the nerve is relieved, but the ligament needs to be repaired and the incision healed. At first, the hand is held on a kerchief, it is better to keep it higher in the early days. Ice and NSAID tablets can be used to prevent pain and swelling. After removing the stitches for rehabilitation, physiotherapy procedures are applied.

Ice packs, magnetotherapy, and ultrasound are used to accelerate healing. Useful massage, performing special exercises. Finger movements should be carried out from the first day after the operation. And it is better to start more serious classes with modeling from special soft plasticine. Then you can perform movements with your fingers and brush, gradually increasing their intensity.

Carpal tunnel syndrome is not life threatening. But it seriously disrupts performance, causes discomfort. Therefore, it is advisable to immediately begin to eliminate the compression of the nerve so that complications do not develop.



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