Carpal tunnel syndrome treatment. Carpal tunnel syndrome - carpal tunnel syndrome

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

The disorder occurs when compression of the nerve 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 when there is a violation

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

The median nerve, which passes through the wrist, 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 cause pressure and irritation on this nerve.

Irritation of the median nerve causes tingling and numbness in the thumb, index and middle fingers, a condition called “carpal tunnel syndrome.”

Causes and risk groups

Causes, causing the syndrome carpal tunnel:

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

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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, kidney failure;
• people with rheumatoid arthritis, problems at work thyroid gland;
• women during 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 median nerve.

After this, pain appears in the areas of innervation. Also among the symptoms of carpal tunnel syndrome is that there is numbness in the hand, especially in the morning after a night's sleep. Patients shake their hands and rub them all night, which gives a slight improvement.

The pain can travel up to the shoulder and even the neck. As this disease worsens, the muscles thumb may stop working, causing awkwardness in actions when you need to take, for example, a cup.

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

Diagnostic techniques and tests

The doctor will ask about your signs and medical history and examine your wrist and hands. The examination will consist of checking for strength, sensitivity and signs of irritation or damage to the nerve.

Other tests:

• electrodiagnostic tests;
• X-ray;

The syndrome should be distinguished from Arnold-Chiari malformation and cervical hernia.

How to treat pathology

Treatment may be conservative or surgical intervention.

Conservative treatment

You should stop doing the activity that causes the symptoms.

Avoid repetitive hand movements, strong grasping movements, holding vibrating objects, or performing work with a tilted or arched wrist.

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

Wrist bandage eases symptoms early stages violations. It keeps the wrist still. When the wrist is in the correct position, the canal has normal volume, so there is enough space for the nerve.

The bandage helps neutralize numbness and pain; it prevents the hand from bending during sleep. The bandage can be worn during the day to ease symptoms 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 release completely for 6 seconds. Repeat 10 times.
3. Stretch your arms in front of you, raise and lower them 5 times.
4. Make 10 circles with your fingertips.
5. Press the fingers of the other hand with one hand 10 times in a row.

These exercises improve blood circulation in the muscles.

It is important that the movements are different.

It should be taken into account that CTS - STS appears in people not only because they carry out monotonous movements, but also because they do it for a long time.

Drug treatment

Anti-inflammatory medications can also help relieve swelling and symptoms (aspirin). Large doses of vitamin B-6 help neutralize symptoms.

If simple measures will not help control symptoms, the possibility should be considered cortisone injections into the carpal tunnel. This remedy is used to relieve swelling in the canal and may temporarily relieve symptoms.

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

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

Physiotherapy

Your doctor may refer you to a physical therapist or occupational therapist. The primary goal of treatment is to reduce the impact or eliminate the cause of wrist pressure.

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

Surgical treatment

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

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

Once 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 long time, it may thicken and form a scar, which will prolong recovery after the procedure.

The most common operation is open surgery using local anesthetic, which blocks nerves located only in a specific part of the body.

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

Complications

Carpal tunnel syndrome is not a life-threatening disorder.

A person who has been ill for a long time may, over time, 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 hand function.

Preventive measures

Precautions:

conclusions

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 promptly. This disorder affects hand motor skills and the performance of certain movements.

As a rule, the prognosis for the disorder is positive, and it can be treated conservatively or surgically.

Carpal tunnel syndrome is a symptom complex that appears due to compression of the fibers of the median nerve inside the carpal tunnel. Carpal syndrome manifests itself with characteristic symptoms and is accompanied by impaired functioning of the hand. This syndrome most often affects people who perform work with constant stress on the hand. Pathology can be treated conservative methods, but in some cases it is required surgery.

Anatomical features of the canal structure

The carpal tunnel is bounded by the bones of the hand below and laterally on both sides; the transverse carpal (carpal) ligament runs above. The tunnel contains the muscle tendons and the median nerve. This nerve contains sensory and motor pathways. Sensitive nerve fibers They innervate the first 3 fingers and 1/2 of the ring finger, and the motor ones are directed to the muscles of the thumb. Compression of the median nerve occurs when the size of the tunnel decreases or the intratunnel tissue increases due to pathological processes. Characteristic symptoms of the disease appear.

Causes of the syndrome

Carpal tunnel syndrome occurs as a result of the following reasons:

1. Professional factors. Pathology occurs in persons who perform permanent job hands: pianists, artists, computer scientists.
2. Age-related changes. The disease occurs more often in women aged 50–55 years.
3. Swelling in the carpal tunnel as a result of a forearm injury.
4. Hormonal changes during pregnancy. In this case, fluid retention occurs in the membranes of the muscle tendons of the hand.
5. Hereditary predisposition.
6. Endocrine diseases. These include diabetes, thyroid disease, obesity, hypothyroidism.
7. Rheumatoid arthritis, arthrosis and other arthritis.
8. Infectious diseases leading to damage to the tissues of the wrist.
9. Tumors and cystic formations.
10. Wrist and hand injuries: bruises, dislocations, fractures.
11. Systemic connective tissue diseases.
12. Tuberculosis.

Symptoms of the disease

Carpal tunnel syndrome appears some time after exposure to a damaging factor. Symptoms of the disease can appear at any time, bringing the patient a feeling of discomfort and severe pain. The following symptoms are characteristic of carpal tunnel damage:

Symptoms of carpal tunnel damage often bother the patient at night and in the morning after waking up. They decrease during the day, and their appearance is typical when performing the simplest actions: holding a book in your hand, talking on the phone. Shaking the hand or changing the position of the hand helps reduce the manifestations. As the disease progresses, symptoms become permanent. This leads to a deterioration in the patient's quality of life. Difficulties arise in performing small actions: tying shoelaces, fastening buttons, holding a mug. It becomes impossible to touch the other fingers of the affected hand with the thumb.

Diagnosis of carpal tunnel syndrome

Carpal tunnel syndrome does not cause difficulties in diagnosis. The diagnosis is made based on the following data:

1. Questioning the patient. The patient's complaints and medical history are clarified. Based on them, we can assume the cause of the development of the disease.
2. Examination of the affected limb, carrying out functional tests and determination of sensitivity. This can reveal the following:
   • Tinel's symptom - when tapping in the area of ​​the carpal canal, the patient feels a tingling sensation in the fingertips.
   • Phalen test - 60 seconds of wrist flexion causes numbness and weakness of the hand.
   • palpation of the palmar surface causes pain.
   • Upon examination, swelling of the affected area is determined.
3. X-ray of the hand and wrist joint.
4. Electromyography. With its help, the conduction is determined nerve impulses along the fibers of the median nerve.
5. Ultrasound of the wrist joint.
6. Magnetic resonance imaging.

Conservative treatment of carpal syndrome

Conservative treatment of carpal tunnel syndrome is carried out on early stages diseases and includes the following methods:

Fixation of the affected wrist

It is carried out using a special bandage. The wrist joint is fixed in a physiological position, which prevents nerve entrapment. The bandage must be worn during the day, especially during routine hand work, and also at night.

Drug treatment

1. Non-steroidal anti-inflammatory drugs are used in tablets for oral administration or in the form of ointments for local application. Nurofen and ibuprofen can be used in age-appropriate dosages.
2. With severe inflammation and pain syndrome Injection of hormones into the carpal tunnel is prescribed.
3. B vitamins help reduce pathological processes in the carpal tunnel.

Physiotherapeutic treatment

Electrophoresis is prescribed to the affected area, phonophoresis, and laser treatment. These methods reduce inflammation, eliminate swelling, relieve pain, and promote the regeneration of damaged tissue inside the carpal tunnel.

Special exercises

Performed when it subsides acute manifestations diseases. Exercises should be varied and performed an average of 10 times. Here are some simple exercises:

• shaking hands, without sudden movements;
• clenching and unclenching fists;
• raising and lowering hands;
• Perform circular movements with your fingertips;
• pressing the fingers of one hand onto the fingers of the other hand.

With the help of this gymnastics, blood circulation in the tissues of the carpal canal is improved, muscle brushes

Surgical treatment of carpal syndrome

This method of treatment is prescribed if conservative methods are ineffective for 6 months. If carpal tunnel syndrome is severe, it is accompanied by severe pain and limitation of hand functions, then surgery can be performed immediately. Especially in cases where the cause of the disease is tumors or cystic formations. The following operations are performed:

Surgery can be performed on an outpatient basis under local anesthesia. After the operation, swelling of the tissues and limited movements in the hand persist for some time. The patient is shown rehabilitation period. Physiotherapeutic treatment is carried out, physiotherapy. Full recovery hand functions occurs within 6–12 months, depending on the degree of impairment.

Carpal syndrome is a condition that requires immediate assistance.

When characteristic symptoms You should not self-medicate; you should immediately consult a doctor. Early diagnosis and treatment of the disease will avoid progression of the process and surgical intervention. If the occurrence of the syndrome is associated with professional activity, it may be worth changing jobs. This will help reduce the symptoms of the disease and stop further progression.

• painful sensations and tingling sensations in the area of ​​the hand, which are especially severe at night;
• feeling that the hand and wrist are swollen;
• numbness of the second and third fingers.

Carpal tunnel syndrome: diagnosis and treatment at the highest European level

Carpal tunnel syndrome: surgery

Carpal tunnel syndrome: treatment at home

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CARPAL TUNAL SYNDROME: CAUSES OF DISEASE DEVELOPMENT

• Diabetes.
• Various inflammations ( rheumatoid arthritis, rheumatism) in the area of ​​the wrist and hand.
• Peripheral neuropathy.
• Inflammatory processes in tendons.
• Problems with ligaments, degenerative-dystrophic in nature.
• Benign tumors.

Carpal Tunnel Syndrome: Symptoms

Center for Hand Surgery at Kharkov City Clinical Hospital No. 31

Carpal tunnel syndrome (CTS) is caused by nerve compression and irritation in the wrist, resulting in pain, numbness, tingling and/or weakness in the wrist and hand. Repeated sprains and fractures, unusual wrist anatomy, arthritis and some other conditions can reduce the space in the wrist. carpal tunnel, thereby increasing the risk of CTS. From accompanying symptoms you can often get rid of it at home, but sometimes for complete cure medical attention is required.

Steps

Part 1

Try not to pinch the median nerve. The carpal tunnel is a narrow tunnel made up of small bones in the wrist, connected by ligaments. This channel protects nerves, blood vessels and tendons. The main nerve responsible for the movements of the palm and its sensitivity is called the median nerve. Therefore, you should avoid activities that lead to pinching and irritation of the median nerve, such as frequent bending of the hand at the wrist, lifting heavy objects, sleeping with curved wrists, and punching hard surfaces.

• Make sure that wrist watch and the bracelets sat quite loosely on the wrist - if they are too tight on the wrist, this can lead to irritation of the median nerve.
• In most cases of CTS, it is difficult to identify a single cause. Typically, CTS is caused by a combination of factors, such as frequent wrist strain coupled with arthritis or diabetes.
• The anatomy of the wrist can also contribute - in some people the bones of the carpal tunnel at or do not have the correct shape.

1. Stretch your wrists regularly. Daily wrist stretching can help reduce the symptoms of CTS or get rid of them altogether. In particular, wrist stretches help expand the space available for the median nerve within the carpal tunnel because it stretches the ligaments surrounding the tunnel. The best way To stretch both wrists at the same time is to assume a “praying pose.” Place your palms together about 6 inches from your chest and lift your elbows until you feel a stretch in both wrists. Hold this position for 30 seconds, then lower your elbows again. Repeat the exercise 3-5 times a day.

   Shake your palms. Feeling numb or aching pain in one or both palms (or wrists), shake them thoroughly for 10-15 seconds, as if shaking off water from them. By doing this, you will achieve quick, albeit temporary, improvement. This shaking will stimulate circulation and improve blood flow to the median nerve, causing symptoms to temporarily disappear. You can do this type of exercise, which helps combat the symptoms of CTS, many times a day, just taking a few seconds away from your work.

   • Symptoms of CTS most often appear (and first appear) in the thumb, index and middle fingers, as well as part of the ring finger. This is why people with CTS seem clumsy and often drop things.
   • Only the little finger is not affected by CTS symptoms because it is not connected to the median nerve.

2. Wear a special wrist support bandage. This semi-rigid brace or splint will help you avoid the symptoms of CTS throughout the day by keeping your wrist in a natural position and preventing it from bending too much. A wrist splint or brace should also be worn during activities that may aggravate symptoms of CTS, such as computer work, carrying heavy bags, driving, or bowling. Wearing a support bandage while you sleep can help prevent nighttime symptoms, especially if you have a habit of tucking your hands under your body while you sleep.

   • You may need a support bandage for several weeks (day and night) to noticeably reduce the symptoms of CTS. However, in some cases, the support bandage has a negative effect.
   • Wearing wrist splints is also helpful if you have CTS and are pregnant, since your palms (and feet) are more likely to swell during pregnancy.
   • Wrist supports and splints can be purchased at a pharmacy or medical supply store.

3. Consider changing the position in which you sleep. Some postures can significantly worsen the symptoms of CTS, which reduces sleep duration and quality. The worst posture is one in which your fists are tightly clenched and/or your palms (with curved wrists) are tucked under your body; The posture in which the arms are above the head is also unfavorable. Instead, try sleeping on your back or side with your arms close to your body, wrists straight, and palms open. This position will ensure normal blood circulation in the wrists and blood supply to the median nerve.

   • As noted above, using support bands while sleeping can help prevent hand and wrist misalignment, but it will take some getting used to.
   • Avoid sleeping on your stomach with your arms under the pillow, as this will cause your wrists to become pinched. People sleeping in this position often experience numbness and tingling in their palms upon awakening.
   • Most wrist supports are made of nylon and are secured with Velcro, which can irritate your skin. In this case, place a sock or piece of thin cloth under the bandage to reduce skin irritation.

4. Take a closer look at your workplace. In addition to poor sleep posture, symptoms of CTS can be caused or exacerbated by poor workplace design. If your computer keyboard, mouse, desk, or chair is positioned poorly and without consideration for your height and body type, it can cause tension in your wrists, shoulders, and mid-back. Make sure the keyboard is positioned in such a way that you don't have to bend your wrists all the time when typing. Buy an ergonomic keyboard and mouse designed to reduce stress on your hands and wrists. Your employer may cover the costs.

   Take over-the-counter medications. Symptoms of CTS are often associated with inflammation and swelling in the wrist, which further irritates the median nerve and adjacent blood vessels. Therefore, non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Aleve) are often helpful in reducing the symptoms of CTS, at least in the short term. You can also take painkillers such as acetaminophen (Tylenol, Panadol) to relieve pain caused by CTS, but they do not reduce inflammation and swelling.

   Part 2

   Medical care for CTS

   1. Make an appointment with your doctor. If you experience the symptoms listed above in your wrist/hand for several weeks or more, you should see a doctor. The doctor will examine you and probably prescribe X-ray examination and a blood test to rule out possible diseases and injuries whose symptoms resemble CTS, such as rheumatoid arthritis, osteoarthritis, diabetes, a stress fracture in the wrist, or blood vessel problems.

      Visit a physical therapist or massage therapist.

      Try corticosteroid injections. To relieve pain, inflammation, and other symptoms of CTS, your doctor may recommend injections of a corticosteroid drug (such as cortisone) into your wrist or heel of your hand. Corticosteroids are a powerful, fast-acting medication that can relieve swelling in the wrist and relieve pressure on the median nerve. They can also be taken orally, but this is considered much less effective than injections and also causes more severe side effects.

      • Others are also used in the treatment of CTS. steroid drugs, such as prednisolone, dexamethasone and triamcinolone.
      • Corticosteroid injections can lead to complications such as local infection, profuse bleeding, weakening of tendons, muscle atrophy and nerve damage. Therefore, they are usually done no more than twice a year.
      • If steroid injections do not significantly improve the condition, surgery should be considered.

   2. Carpal tunnel surgery should be considered as a last resort. If other treatments have failed to relieve the symptoms of CTS, your doctor may recommend surgery. Surgery is only used as a last resort because there is a risk of making the situation worse, although for many patients surgery helps to completely relieve the symptoms of CTS. The purpose of this surgery is to relieve pressure on the median nerve by cutting the main ligament that is pressing on it.

Carpal tunnel syndrome- these are traumatic changes caused by constant tension when the median nerve is compressed. The disease usually resolves against the background of an inflamed tendon.

The result may be:

• Numbness and soreness in the wrist or entire arm;
• Feeling of weakness in the fingers and arm, mainly during night rest.

It is believed that this state associated with the performance of professional duties.

Causes of the disease

The cause of the disease can be a narrowing of the carpal tunnel of the wrist or an increase in tissue inside. When a wrist is fractured, the carpal tunnel may be affected by the bone.

The risk group also includes people performing professional duties related to:

• By applying effort;
• Uncomfortable wrist position;
• Vibrating instruments;
• Monotonous repetition of monotonous movements.

With a combination of risks, the likelihood of developing the disease increases.

The cause of the disease can be inflammation of the synovial membrane. As pressure increases, the nerve stops functioning normally.

What happens when a nerve is compressed?

The blood supply to the outer sheath of the nerve slows down and blood stops flowing. This condition is called ischemia. At first, the outer sheath of the nerve is affected, but as its pressure increases inner part becomes thicker as new cells - fibroblasts and scar tissue - are formed.

As a result, the patient feels pain and the hand becomes numb. When the pressure normalizes, the symptoms quickly subside. With absence timely treatment chances of recovery are reduced or lost.

Diagnostics

The diagnosis can be made by interviewing and examining the patient based on characteristic areas of numbness and pain symptoms. A characteristic indicator is night pain and numbness of the hand.

Important information for diagnosis is the absence of damage to the little finger. To check, the patient is recommended to pinch his little finger.

The next group of complaints is numbness during certain activities - driving a car or sweeping.

If symptoms occur after injury, it is performed to exclude a fracture.

To obtain additional data, electrical stimulation is also prescribed, with the help of which the performance of the nerves of the hand and the speed of passage of impulses through the nerve are checked.

It is important to exclude other types of problems that provoke an increase in symptoms - pain in the shoulder, elbow or neck.

How is treatment carried out?

There are several types of treatment for carpal tunnel syndrome, which the doctor prescribes depending on the individual characteristics clinical picture.

Conservative

It is necessary to eliminate or change the activity that caused the existing symptoms:

• Do not perform repetitive brush movements;
• Do not hold vibrating tools;
• Do not perform activities that require you to bend your wrist.
• It is recommended to quit smoking and lose excess weight.
• In the early stages, the situation will be made easier by wearing a brace to hold the wrist in the correct position.

Medication

Anti-inflammatory medications and vitamin B-6 are prescribed.

Cortisone injections relieve swelling and temporarily reduce symptoms.

Physiotherapy

Specific exercises can help prevent or control symptoms.

The goal is to get rid of excess pressure in the carpal tunnel.

A physiotherapist will analyze the performance of official duties for risks and advise how to normalize the situation.

Surgical treatment

If restoration attempts using conservative methods fail, surgery using local anesthesia is recommended:

• An incision is made in the palm (≤ 5 cm) to see connective tissue;
• Transverse ligament cut;
• The skin is sewn together.

Over time, the free space between the ends of the ligaments becomes scarred.

Rehabilitation after surgery

At successful treatment after 1.5-2 months relief is felt.

A physical therapist can advise you on how to avoid the problem recurring in the future.

Treatment of carpal tunnel syndrome is carried out in Moscow, at the clinic of the Central Clinical Hospital of the Russian Academy of Sciences. You can make an appointment online. The price of treatment and other information can be found by calling the specified phone number.