Carpal tunnel syndrome treatment. Carpal syndrome - treatment

Compression-ischemic lesion of the median nerve in the carpal (carpal) canal. Manifested by pain, decreased sensitivity and paresthesia in the area of ​​the palmar surface of the I-IV fingers, some weakness and awkwardness when moving the brush, especially if you need a gripping movement thumb. Diagnostic algorithm includes examination by a neurologist, electrophysiological testing, biochemical research blood, x-ray, ultrasound, CT or MRI of the wrist area. Treatment is mainly conservative - anti-inflammatory, anti-edematous, analgesic, physiotherapy. If it fails, an operative dissection of the carpal ligament is shown. The prognosis is favorable, subject to the timeliness of therapeutic measures.

ICD-10

G56.0

General information

Carpal tunnel syndrome (carpal tunnel syndrome) - compression and ischemia of the median nerve with a decrease in the volume of the carpal tunnel in which it passes, passing from the forearm to the hand. In neurology, it belongs to the so-called. tunnel syndromes. The carpal canal is located at the base of the hand from its palmar surface, is formed by the bones of the wrist and the transverse ligament stretched over them. Passing through it, the median nerve enters the palm. In the canal under the trunk of the median nerve, the tendons of the flexor muscles of the fingers also pass. On the hand, the median nerve innervates the muscles responsible for abduction and opposition of the thumb, flexion of the proximal phalanges of the index and middle fingers, and extension of the middle and distal phalanges of the same fingers. Sensitive branches provide superficial sensitivity of the skin of the tenor (elevation of the thumb), the palmar surface of the first three and half of the 4th finger, the rear of the distal and middle phalanges of the 2nd and 3rd fingers. In addition, the median nerve provides autonomic innervation to the hand.

Causes of Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs in any pathological process that leads to a decrease in the volume of the canal. A tendency to disease may be due to congenital narrowness or structural features of the canal. Thus, women have a narrower carpal tunnel, and carpal tunnel syndrome occurs in them much more often than in men.

One of the reasons for the narrowing of the carpal tunnel is a wrist injury: bruise, fracture of the bones of the wrist, dislocation in the wrist joint. In this case, the volume of the canal can decrease not only due to displacement of the bones, but also due to post-traumatic edema. A change in the ratio of the anatomical structures that form the carpal canal due to excessive bone growth is observed in the case of acromegaly. Carpal tunnel syndrome can develop against the background of inflammatory diseases (synovitis, tendovaginitis, rheumatoid arthritis, deforming osteoarthritis, acute and chronic arthritis, joint tuberculosis, gout) and tumors (lipomas, hygromas, chondromas, synoviomas) of the wrist area. The cause of carpal syndrome may be excessive swelling of tissues, which is noted during pregnancy, renal failure, endocrine pathology(hypothyroidism, menopause, condition after oophorectomy, diabetes mellitus), taking oral contraception.

A chronic inflammatory process in the area of ​​the carpal tunnel is possible with constant trauma associated with professional activities involving repeated flexion-extension of the hand, for example, in pianists, cellists, packers, carpenters. A number of authors suggest that prolonged daily work on a computer keyboard can also provoke carpal tunnel syndrome. However, statistical studies have not revealed significant differences between the incidence among keyboard workers and the average incidence of the population.

Compression of the median nerve primarily leads to a disorder of its blood supply, i.e., to ischemia. At the beginning, only the sheath of the nerve trunk suffers, as the pressure increases, pathological changes affect the deeper layers of the nerve. First, the function of sensory fibers is disturbed, then motor and autonomic. Long-term ischemia leads to degenerative changes in nerve fibers, replacement nervous tissue connective tissue elements and, as a result, persistent loss of median nerve function.

Symptoms of Carpal Tunnel Syndrome

Carpal tunnel syndrome manifests with pain and paresthesia. Patients note numbness, tingling, "shooting" in the palm area and in the first 3-4 fingers of the hand. Pain often radiates up the inside of the forearm, but may radiate down from the wrist to the fingers. Nocturnal pain attacks are characteristic, forcing patients to wake up. The intensity of pain and the severity of numbness decrease when rubbing the palms, lowering the brushes down, shaking or waving them in the lowered state. Carpal syndrome can be bilateral, but the dominant hand is more often and more severely affected.

Over time, along with sensory disturbances, there are difficulties in hand movements, especially those that require the grasping participation of the thumb. It is difficult for patients with an affected hand to hold a book, draw, hold on to the upper handrail in transport, hold mobile phone near the ear, drive a car steering wheel for a long time, etc. There is inaccuracy and discoordination of movements with a brush, which is described by patients, as if “everything falls out of their hands”. A disorder of the autonomic function of the median nerve is manifested by a sensation of "swelling of the hand", its cooling or, conversely, a feeling of an increase in temperature in it, hypersensitivity to cold, blanching or hyperemia of the skin of the hand.

Diagnosis of carpal tunnel syndrome

A neurological examination reveals an area of ​​hypesthesia corresponding to the zone of innervation of the median nerve, a slight decrease in strength in the muscles innervated by the median nerve, vegetative changes in the skin of the hand (color and temperature of the skin, its marbling). Additional tests are carried out that reveal: Phalen's symptom - the occurrence of paresthesia or numbness in the hand during its passive flexion-extension for a minute, Tinel's symptom - tingling in the hand that occurs when tapping in the area of ​​the carpal canal. Accurate data on the topic of the lesion can be obtained using electromyography and electroneurography.

In order to study the genesis of the carpal syndrome, a blood test is performed for the RF, blood biochemistry, radiography of the wrist joint and hand, ultrasound of the wrist joint, CT scan of the wrist joint or MRI, if indicated, its puncture. It is possible to consult an orthopedist or traumatologist, endocrinologist, oncologist. It is necessary to differentiate carpal tunnel syndrome from radial nerve neuropathy, ulnar nerve neuropathy, polyneuropathy upper limbs, vertebrogenic syndromes caused by cervical spondylarthrosis and osteochondrosis.

Treatment of carpal tunnel syndrome

The basis of therapeutic tactics is the elimination of the causes of the narrowing of the carpal canal. These include reduction of dislocations, immobilization of the hand, correction of endocrine and metabolic disorders, relief of inflammation and reduction of tissue swelling. Conservative therapy is carried out by a neurologist, if necessary, together with other specialists. The issue of surgical treatment is decided with a neurosurgeon.

Conservative methods of therapy are reduced to immobilization of the affected hand with a splint for a period of about 2 weeks, anti-inflammatory, analgesic, decongestant pharmacotherapy. NSAIDs are used (ibuprofen, indomethacin, diclofenac, naproxen, etc.), in severe cases, they resort to prescribing glucocorticosteroids (hydrocortisone, prednisolone), with severe pain syndrome conduct therapeutic blockade of the wrist area with the introduction of local anesthetics (lidocaine). Decongestant therapy is carried out with the help of diuretics, mainly furosemide. A positive effect is provided by vitamin therapy with drugs gr. B, mud therapy, electrophoresis, ultraphonophoresis, compresses with dimethyl sulfoxide. Vascular therapy with pentoxifylline, nicotinic acid allows to reduce ischemia of the median nerve. After achieving clinical improvement, to restore the function of the nerve and strength in the muscles of the hand, physiotherapy exercises, hand massage, myofascial massage of the hand are recommended.

With the ineffectiveness of conservative measures, carpal syndrome requires surgical treatment. The operation consists in dissection of the transverse ligament of the wrist. It is performed on an outpatient basis using endoscopic techniques. With significant structural changes in the area of ​​the carpal canal due to the impossibility of using endoscopic technique the operation is carried out in an open way. The result of the intervention is an increase in the volume of the carpal tunnel and the removal of compression of the median nerve. 2 weeks after the operation, the patient can already perform hand movements that do not require a significant load. However, it takes several months for the brush to fully recover.

Forecast and prevention of carpal tunnel syndrome

With timely complex treatment carpal tunnel syndrome usually has a favorable prognosis. However, about 10% of cases of compression do not lend themselves to even the most optimal conservative treatment and require surgery. The best postoperative prognosis are cases that are not accompanied by a complete loss of sensitivity and atrophy of the muscles of the hand. In most cases, a month after the operation, the function of the hand is restored by about 70%. However, awkwardness and weakness can be noted after a few months. In some cases, there is a recurrence of carpal tunnel syndrome.

Prevention consists in the normalization of working conditions: adequate equipment of the workplace, ergonomic organization of the work process, changing activities, the presence of breaks. To preventive measures also include a warning and timely treatment injuries and diseases of the wrist area.

Carpal tunnel syndrome is a condition in which the median nerve is compressed at the wrist. It can be said that tunnel syndrome is a disease of the century, which is currently widespread, especially among IT people who work at a computer for a long time. The disease belongs to neurological diseases and is included in the group of tunnel neuropathies.

The syndrome is manifested by very unpleasant symptoms: prolonged numbness of the fingers and acute pain in the wrist. Long pastime at the computer, constant monotonous loads on the hand when working with a mouse lead to a narrowing of the anatomical canal, which infringes and compresses the peripheral nerve in the carpal tunnel.

What is carpal tunnel syndrome

Tunnel syndromes are not an independent disease, but a complex clinical symptoms caused by pinching and compression of the nerve in narrow spaces, the so-called anatomical tunnels. The walls of such tunnels are natural channels that normally allow peripheral vessels and nerves to pass freely. At various pathologies their narrowing occurs, which leads to compression of the vessels and nerves passing through it.

Pathology at all times occurred in women much more often than in men. This is due to the fact that women are more likely to perform monotonous monotonous work, which puts a strain on the muscles of the hand. Among men, the disease affects programmers working at a computer. Compression of the carpal nerve can be caused by thickening of the tendons that are close to the median nerve, as well as damage to the nerve itself: its thickening and swelling.

Carpal tunnel syndrome develops as a result of repetitive movements that involve the same wrist muscles. The first symptoms appear when using a computer mouse, when the hand is in a permanent wrong position. This puts a lot of pressure on the wrist and can be complicated by cubital tunnel syndrome. It is the computer mouse that is responsible for the spread of the disease around the world. And since computers are in every home and young people sit online for many hours, the disease takes on the character of a pandemic.

Causes of the syndrome

Above we have already written about the reasons for the development pathological process. Any pathological processes that reduce the size anatomical canals and contributing to the compaction of tissues inside it, can cause the development tunnel syndrome. There are many additional factors that can provoke the development of the syndrome. These include:

1. Wrist injuries (sprains, fractures, bruises);
2. Pregnancy. In this period female body subject to many phenomena, such as edema. When the body accumulates significant amount fluid, then problems with the nerve fibers arise, since the swelling puts increased pressure on the wrist, which leads to a pinched nerve.
3. Metabolic disorders (diabetes mellitus).
4. Rheumatoid arthritis.
5. Hormonal disruptions. During the period of hormonal changes, mainly in women, there are problems with the joints, which are often accompanied by tunnel neuropathies.

The above problems can cause unpleasant symptoms when you do the following:

• monotonous monotonous actions with hands;
• with an uncomfortable position of the hands;
• while talking on a mobile phone;
• when performing physical exercises with emphasis on the wrist;
• with prolonged vibration (working with the keyboard);
• with prolonged use of the mouse (the brush is in a suspended state).

In addition, bad habits can complicate the situation: smoking, alcohol, obesity.

Symptoms

The primary symptoms that appear at an early stage of the disease are characterized by tingling in the fingers, severe but short-lived pain at the site of the median nerve. As the disease progresses, the symptoms get worse and worse. Most clearly, the symptoms make themselves felt at night, which prevents a person from having a good rest. At the same time, a person cannot fall asleep until the morning due to extremely unpleasant numbness of the hand and severe pain, he develops insomnia and chronic fatigue.

The syndrome has its characteristics. For example, not the whole hand becomes numb, but only three of its fingers: the thumb, index, middle and half of the ring finger, the little finger is never affected in this pathology. In very advanced cases, the functionality of the hand is disrupted, it cannot be clenched into a fist, there are pain when trying to connect the thumb and little finger, a person is not able to take an object in his hand, and then hold it. In other words, fine motor skills are disturbed and the hands stop obeying, which can lead to muscle atrophy and disability.

A person becomes helpless and vulnerable, he cannot drive a car, talk on the phone, work at a computer, perform household activities, and take care of himself.

All symptoms at the initial stage of the disease are reversible and safely eliminated. In advanced cases, it may be necessary surgery, in which the channel is expanded and the excess tendons are removed.

Timeline of symptoms:

1. During monotonous and monotonous movements (for example, at the computer, or when knitting), there is a strong dull pain in the area where the nerve passes, which radiates to the large, index and middle finger. To eliminate the pain, it is enough to stop and shake your hands several times, and also take a half-hour break. The problem occurs due to poor patency of the nerve and circulatory disorders. On the this stage all symptoms are reversible.
2. If the problem was ignored for a long time, then after a certain time, the tingling and burning sensation in the hand no longer goes away on its own, but haunts a person even after hours for several hours, turning into a constant dull pain. Cause constant pain are the compaction of the tendon located around the nerve. It begins to put pressure on the nerve and there are pains on the inside brushes that give into the fingers.
3. The body tries to compensate for unfavorable factors, therefore, an accumulation of lymphatic fluid is observed between the cartilages, which carries away fragments of the affected tissue and cells with the lymph flow. In its natural state, this process is great at troubleshooting, and the fluid is self-absorbing. With constant loads, the inflammatory process is not able to regress and its self-healing is impossible. Therefore, prolonged swelling and stagnation of lymph are irreversible without additional treatment. Swelling and numbness are significant at night, and if they are accompanied severe pain the disease has reached its climax. And soon the only way out will be surgery.

Diagnostics

Diagnosis is carried out by an experienced neurologist or neurosurgeon, since a doctor of another specialization will not be able to distinguish short-term nighttime numbness of the hand from a pathological process. The main diagnostic method is to determine the speed of nerve conduction of impulses. For this purpose, electromyography (EMG) or electroneuromyography (ENG) is performed. The latter allows you to differentiate carpal tunnel syndrome from spinal hernia and osteochondrosis.

How is electromyography performed? The patient, who is sitting in a comfortable chair, is placed on the hand with electrodes, having previously processed them antiseptic. The electrodes are connected to a special electromyograph apparatus. Electrical impulses are passed through the electrodes, and the nerve conduction. The result is displayed on a computer monitor and simultaneously recorded on paper in the form of waves. The result of electromyography is very similar to an electrocardiogram and is performed on the basis of the same principles. The specialist studies and evaluates the result to reach a verdict.

It is also possible to diagnose the disease on the basis of some tests.

Testa Fallen. To perform the test, it is necessary to bend and unbend the brushes by 90 degrees (see figure). A feeling of numbness or tingling occurs immediately within 20 seconds. At healthy person numbness and pain can also be observed, but not earlier than after 1 minute.

Tinel test. When tapping with a neurological hammer, tingling and irradiation of pain in three fingers are felt. Sometimes tapping causes acute pain.

Durkan test. Mechanical compression of the wrist in the area of ​​the nerve causes numbness of the thumb, index, middle and sometimes half of the ring finger.

An oppositional test is also carried out, which consists in the impossibility of connecting the thumb and little finger. This phenomenon develops as a result of thenar weakness (elevation at the base of the thumb).

Treatment of carpal tunnel syndrome

Treatment of the disease is carried out in three directions:

• drug treatment;
• physiotherapy;
• gymnastic exercises;
• surgery.

Medical treatment

At an early stage of the disease, the patient's condition can be improved with the help of medicines. Such treatment is carried out on an outpatient basis. Prescribe drugs of the NSAID group (non-steroidal anti-inflammatory drugs), which quickly relieve inflammation, pain and swelling:

• diclofenac;
• ibuprofen;
• nimesulide;
• analgin.

Use to relieve pressure in the area of ​​a pinched nerve hormonal preparations corticosteroids injected directly into the carpal tunnel. Injections are very effective in dealing with pain, swelling and inflammation.

Vitamin B has a good healing effect, since the vitamin itself has an anti-inflammatory effect.

It should be noted that symptomatic treatment with help medications does not lead to complete healing, but only alleviates the patient's condition. Therefore, along with medicines, it is recommended to wear an orthosis. Wearing an orthosis allows you to remove nighttime symptoms, which are especially exhausting for the patient.

Physiotherapy

As a physiotherapy treatment use:

1. Paraffin baths. A sick hand is lowered into a bath with molten paraffin. Then the procedure is repeated 3-4 more times until the so-called paraffin glove is formed on the hand. Then a special glove is put on the hand with paraffin or the hand is wrapped in a warm towel. Joints and tendons under the influence of hot paraffin warm up, which relieves inflammation, swelling and pain.
2. Ultraviolet therapy. In this treatment, tendons and joints are heated by short-wave electromagnetic waves in the range of several gigahertz.
3. Ultrasonic treatment. Impact sound waves high frequency leads to an increase in temperature in the treated area, which improves the conductivity of the channel, relieves swelling and pain. Two week course ultrasound treatment can significantly reduce the manifestation of symptoms.
4. Manual therapy. During the treatment with this method, improvements in the blood circulation of the hand were noticed.

Gymnastic exercises

Exercises can be performed independently at home, so their advantage is obvious.

Exercise number 1. Dip your hand in the bath with hot water, clench it into a fist and rotate it in the water. Hot water should be the right temperature to keep your hand warm. The duration of the procedure is no more than 15 minutes. After finishing, put on a winter glove or wrap your hand in a warm cloth or scarf.

Exercise number 2. Night warming compress, which is made on the basis of diluted alcohol or vodka. Do not take pure medical alcohol, it can burn the skin on your hand.

Exercise number 3. Massage. It is necessary to massage the entire arm, and not just the hand, starting from the outside of the palm, rising up to the outside of the forearm. Massage should be performed by a professional massage therapist.

Exercise No. 4 Hydromassage. You can do it yourself twice a day. In the morning use cool and warm water and warm in the evening. Massage should affect the collar part, shoulder blades, shoulders, forearms, hands.

Surgery

Carried out in severe neglected cases, when all other methods are ineffective. aim surgical intervention is the excision of a ligament that puts pressure on median nerve.

There are two types of operations:

• endoscopic;
• classic open intervention.

An endoscopic procedure involves the use of an endoscope that is inserted into the carpal tunnel through a pinpoint incision. This is a minimally invasive operation that leaves a small dot on the patient's skin. The recovery period after such a procedure is short and almost painless.

The classic open procedure involves a larger incision on the inside of the palm. After this type of intervention, the scar remains larger and recovery period longer.

radial tunnel syndrome

Represents an increase in pressure on radial nerve, which is located in the muscles and bones of the elbow, as well as the forearm. The causes of this disease can be:

• injury;
• lipomas (benign tumors);
• inflammation of surrounding tissues;
• osteochondrosis;
• spinal hernia.

The symptoms of the disease are sharp pains, which have a burning character on back side brushes and in the upper part of the forearm, appearing when trying to straighten the fingers and wrist. Unlike carpal syndrome, radial tunnel syndrome does not cause numbness or tingling because the radial nerve is responsible for muscle contraction.

Carpal tunnel syndrome is pathological condition that results from sedentary office work. Sedentary work can provoke the development various violations, from eye diseases, ending with diseases of the musculoskeletal system.

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What is carpal tunnel syndrome

Carpal tunnel syndrome is a common neurological pathology.
It is characterized by compression of the median nerve, the appearance of pain and backache in the wrist.

This problem is more often faced by people whose duties include performing routine, monotonous work, which is associated with constant flexion and extension of the hand.

This pathology appears when the tissues that surround the tendons swell and compress the median nerve. These tissues are called synovial membranes. They produce a fluid that lubricates the tendons, facilitating their movement in the sheaths of the tendons.

There are factors that provoke the development of the disease:

• genetic predisposition;
• Hormone imbalance;
• Elderly age;
• The presence of systemic diseases, for example, diabetes;
• Profession;
• Availability bad habits: alcohol abuse, smoking;
• Injuries to the wrist, fracture of the hand;
• The presence of neoplasms growing in the area of ​​the carpal tunnel;
• Overweight, obesity.

With a combination of these factors and the constantly repeated load on the hand, chronic inflammation develops. connective tissue, it swells and thickens. At the same time, the amount of fluid produced by the synovial membranes decreases.

Constant friction of the connective tissues of the tendons during hand movements increases their swelling and leads to compression of the median nerve. This nerve contains fibers that provide sensation to the fingers and toes. motor activity thumb.

An increase in pressure between the sheaths of the tendons leads to venous congestion. As a result of these factors, the blood supply to the nerve is disturbed, and this disease develops.

Manifestations of carpal syndrome

One of the first signs of the presence of the disease is numbness in the area of ​​​​the hand. Symptoms can appear at any time, and it does not matter where the person is. You can sit at the computer or lie on the couch, hold an object in your hands or not - it does not matter.

At any time, there may be:

• Pain in the hand;
• Tingling in one or both wrists of varying intensity;
• Feelings of swelling of the fingers;
• Numbness of hands;
• Periodic "lumbago" in the fingers.

Moving the arms or changing their position leads to a decrease in symptoms. At first, the manifestations of the syndrome are not pronounced, they appear and disappear.

Over time, especially if a person does not seek help from doctors and does not take any measures, muscle atrophy may develop.

As the disease progresses, the symptoms will be permanent. Sleep disturbances can join, up to insomnia.

Weakness and awkwardness provokes a restriction in performing the simplest daily manipulations. It is difficult for a person to tie shoelaces or button a jacket. In the future, this is reflected in the work.

Video

Diagnosis of compression of the median nerve

To quickly eliminate the pathology, you need to see a doctor.
A neurologist will conduct a survey and examination.

To additional methods surveys include:

• Electroneuromyography;
• X-ray of the wrist joint;
• Magnetic resonance imaging.

Seeing a doctor at the first signs of the syndrome helps to identify the disease as soon as possible and recover.

Medical treatment of the disease

It will take a long time to treat this disease.

To eliminate the causes of carpal tunnel syndrome, groups of drugs are prescribed:

• Anti-inflammatory;
• Decongestants;
• painkillers;
• Corticosteroids.
• Diuretic to reduce swelling.

Medicines are enough for a complete recovery, but only if the appeal to a specialist was timely. To get rid of carpal tunnel syndrome, in addition to treatment, a change in occupation will be required.

How to treat a disease with folk remedies

The methods of traditional medicine will be effective and efficient only if they are in addition to the traditional drug treatment.
No drugs folk remedies will provide temporary relief.

No need to self-medicate.
Before using the product, do not official medicine consult your physician.

Healing tincture will help in eliminating the pathology

You will need a few pickles and vodka or rubbing alcohol. Grind the cucumbers, combine them with chopped red pepper, mix well. Fill the mass with 500 milliliters of vodka. Put the container in the cold for fourteen days.

Filter the remedy and rub it into the affected area. This medicine helps to normalize blood circulation and eliminate swelling.

wild rosemary

Pour the dried crushed twigs of the plant apple cider vinegar. Seal the container tightly and leave for seven days in a cool, dry place. Rub this medicine on your fingers.

Pumpkin will help in healing

Cut the pumpkin into small pieces, pour the raw materials into an enameled pan, fill with water and put on fire. Bring to a boil, cool slightly and crush the raw materials to a mushy state.

Apply the finished gruel to the affected area, wrap it with compression paper on top and secure with a bandage. These warming procedures must be done once a day. The duration of treatment is seven days.

The use of salt and ammonia

Dilute a spoonful of table salt in two hundred milliliters of boiled, slightly cooled water. Combine this solution with ammonia and camphor alcohol.

Mix all the ingredients well and treat the affected joint with this remedy before going to bed. The medicine helps to eliminate pain and numbness.

Black pepper and vegetable oil

Pour 100 grams of ground black pepper with a liter vegetable oil. Put the composition on fire, wait for it to boil.

Simmer over low heat for thirty minutes. Cool the product and rub it into sore fingers 2 times a day.

Parsley will relieve puffiness

Grind parsley rhizomes and brew 20 g of raw materials in three hundred milliliters of boiled water. Remove the container with the composition in the cold for ten hours. Take a sip of the medicine every 2 hours.

Preparation of a diuretic

Dry and chopped birch leaves, about 15 grams, brew in two hundred milliliters of boiled water. Infuse the product in a dark, cold room for 4 hours. Consume 1/3 cup of the infusion four times a day.

Surgical intervention for pathology

When all attempts to control and reduce symptoms have been in vain, surgery is performed to relieve pressure on the median nerve.

There are several different methods for reducing pressure.

But they have one thing in common - the restoration of the blood supply to the nerve and the improvement of the patient's condition.

Open surgery is one of the most common and effective. During surgery, an anesthetic is used, which provokes a blockage of the nerve of a certain part of the limb. A small incision is made in the palm of the affected limb, usually no more than five centimeters.

In the surgeon's incision, palmar fixation can be seen. being cut transverse ligament wrist.

Stitched only skin covering, and the ends of the bundle remain free. This results in less pressure on the nerve. Gradually, the scar tissue fills the space between the two ends of the ligament.

Such a surgical intervention is performed on an outpatient basis, and after it is completed, the patient can go home. The operation is effective and after 3-4 weeks the patient feels a noticeable improvement.

After surgery, it is important not to strain the arm and limit activities that require repetitive movements.

If you suddenly feel a slight backache or numbness of a limb, you may be developing carpal syndrome. Contacting a specialist early stage will eliminate the disease without resorting to surgery. If left untreated, the consequences will be deplorable, up to the complete loss of limb performance.

Nutrition Features

It is possible to get rid of pathology only with drug treatment or surgical intervention. But for treatment and postoperative rehabilitation gave results, you still need to choose the right nutrition.

The carpal tunnel is located on the wrist, which is surrounded by a large number of bundles fibrous tissue. These same bundles perform a supporting function for the joint. And most of all, calcium helps for healthy joints and tendons. AT daily diet for carpal tunnel syndrome, calcium-fortified foods, fresh vegetables and fruits should be included.

Here is a sample list of such products:

• Sour-milk (cottage cheese, kefir, yogurt, cheese, etc.);
• Pumpkin Dishes;
• Lean fish;
• Legumes, cereals, pasta.

In addition to these products, it will be useful for such a pathology to consume more ice cream, 100 grams of it contains up to 200 mg of calcium.

And it will be useful for such patients to often use pizza with cheese and tomatoes, because with such ingredients it contains up to 800 mg of a substance necessary for the joints.

Meals should be 4 or 5 times a day, that is, eat food in small quantities and often, so as not to overload the stomach. Now, let's talk about an approximate diet:

1. Breakfast - pumpkin porridge, a sandwich with cheese and sausage, tea with lemon.
2. The second breakfast is kefir, oatmeal cookies and some fruit.
3. Lunch - cabbage soup from fresh white cabbage, boiled pasta with any low-fat fish, fresh vegetable salad, dried fruit compote, 1 orange.
4. Snack - medium-fat cottage cheese, kefir.
5. Dinner - boiled potatoes with fish cake, cheesecake with pumpkin, compote of fresh berries and any fruit.

And remember that with such a problem, food should contain as little salt as possible. Highly salty food retains water in the body, which leads to swelling of the limbs - and the carpal region.

Gymnastics, massage, physiotherapy

If a person has a problem with the wrist, then the doctor, in addition to drug treatment or surgical operation, may prescribe courses of exercise therapy, massage or physiotherapy.

The task of such methods of treatment is to restore the function of joint mobility, to give strength to atrophied muscles.

It so happens that therapeutic gymnastics administered together with electrical stimulation. Let's talk about some gymnastic exercises of 2 recovery stages.

First stage:

1. We place our hand on the table. We make quick flexion and extension movements with all fingers, and then the same thing, only with each finger.
2. Place your hand on the table surface. We hold the proximal phalanx in one position, the phalanx with a healthy hand, then quickly bend and unbend the interphalangeal joints.
3. We focus with our elbows on the surface of the table, the hands are pressed together and directed upwards. We bring and spread our fingers, but we help with a non-sick hand.
4. With fingertips we reach different points the same palm.
5. In the next exercise, you need to try to grab objects of different sizes with the fingers of a sore hand.
6. With the fingers of a sore hand, roll a small ball on the table in different directions.

All these exercises should be done slowly and repeated up to 8 times.

This gymnastics can be done in the pool, the arm to the shoulder should be completely immersed in water.

The second stage of gymnastic classes:

1. We make finger clicks on various objects, for example, on a soft pillow, a tree, a ball, and so on.
2. We stretch the rubber bands on the fingers.
3. We throw or catch a small ball with the fingers of a sore hand.
4. Throw up the balls.

And in order for such exercises to give the best result, you need to bandage your hand before going to bed. This ensures a quick recovery, facilitating the labor process up to full recovery joint performance.

And well during carpal tunnel syndrome, brush massage helps.

It is held:

1. First, put your hand in a relaxed position on the table, inside up. We touch with two fingers of a healthy hand to the place where the pulse is felt, and slowly tap, and then we grab this place with a healthy hand and make small turns.
2. We place our hand on the table to the very elbow and stroke it with gentle movements, first from the outside, and then from the inside.
3. Then you need to hang your sore hand off the table a little, grab it with a healthy one and make quick circular motions in different directions.
4. We place the hand on the table outside up and do it with the index and middle fingers of a healthy hand.
5. Then we hold the hand in the same position and make small tingling over the entire surface of the hand.
6. At the end of the massage, gently stroke the hand on both sides.

Besides massage and gymnastic exercises, the attending physician sometimes prescribes physiotherapy, which is selected for each individual patient, taking into account the neglect of the disease and the nature of the nerve damage.

Such treatment can be carried out by magnetotherapy, laser therapy, interference pulsed currents, ultrasound, manual therapy. Physiotherapy, of course, is a good way to get rid of such a problem, but it is far from suitable for all people, due to the effect of various devices on the skin, some patients often develop allergies.

Consequences and complications

The disease does not pose a great danger to human life. But, if a person’s wrist hurts for a long time, then this leads to a complete loss of strength and sensitivity in it.

Only proper treatment and daily activities can improve the functioning of the hand.

And as a consequence of this disease, there can only be severe damage to the median nerve and disruption of the hand.

Prevention of pathology

1. Make a suitable desktop height. The normal height of the table should coincide with the level of the armrests of the chair, the forearms during work should lie on the armrests, and not hang.
2. Create the desired height of the monitor so that the text being read or written is at eye level. If the monitor is very low, then you will constantly lower your head, and if the monitor is very high, on the contrary, you will raise your head. This will strain the muscles of the neck excessively, which will worsen blood circulation in the cervical region of the spine, worsening blood circulation in the hands.
3. When working at a computer, sit so that your back is fully touching the back of a chair or chair, and your shoulders are relaxed. Sit relaxed, do not pull your head into your shoulders.
4. Use only a comfortable mouse and keyboard. Choose a small computer mouse so that it is completely covered by your hand. And the keyboard should be with a stand so that the keys on it are slightly raised. Joystick-style computer mice are commercially available and are great for people with this wrist problem. Mice do not load the hand at all.

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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 the same occupational disease, called carpal tunnel syndrome (synonyms: carpal tunnel syndrome or carpal tunnel syndrome). We will tell further about the causes, symptoms and treatment of this disease.

Every person has a wrist common channel or an anatomical tunnel, the intended purpose of which is to conduct peripheral nerves, tendons and 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 its 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 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 algorithm for the development of the syndrome is most often as follows:

• A person makes monotonous movements with a brush for a long time (typing on the keyboard, manipulating a computer mouse, doing needlework - sewing or knitting something). In this case, the wrist, as a rule, is half-bent, and the hand is constantly tense - this creates the conditions for the occurrence of the so-called repetitive load injury. In English medical literature he also calls it “chronic injury from repetitive stress.”
• As a result of constant tension in the tissues of the wrist, congestion and inflammation occur. The situation is aggravated by emerging microtraumas of ligaments, muscles, tendons.
• Injured tissues become inflamed, 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:

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

The likelihood of 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 leading (working) hand if the trigger for the development of the syndrome was "chronic injury from repetitive stress."

If the syndrome is due to a systemic connective tissue disease or endocrine disorders, both hands may be affected at the same time.

• The syndrome is formed gradually - at first there are violations of sensitivity, then motor and trophic dysfunctions.
• On the early stages all characteristic symptoms disturb the patient at night or in the early morning. They pass after shaking or kneading the affected limb.
• sensitive and movement disorders apply only to the part of the hand innervated by the median nerve - the inner surface of the fingers from the thumb to the ring finger, the back surface of the middle and index fingers.

The range of symptoms of carpal tunnel syndrome includes:

1. Domestic embarrassment due to violation fine motor skills. The patient has difficulty in performing precise movements with his fingers - fastening buttons, peeling vegetables.
2. Sensory disorders - pain, numbness, "goosebumps", a tingling sensation in the fingertips. pain symptom it can be either minor, not causing severe discomfort, or acute, spreading throughout the arm. Periodically occurring numbness of the fingers over time is replaced by chronic.
3. Movement disorders when episodes muscle weakness and discoordination of finger movements are replaced by paresis of the hand, muscle atrophy.
4. Obvious symptoms of trophic disorders in the limbs are a change in the temperature of the affected areas of the hand, hair loss, yellowness and brittle nails, blue skin.

Diagnostic studies

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

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

Used instrumental methods research:

1. , with which you can accurately determine the degree of conduction of the median nerve;
2. radiography, ultrasound, tomography are necessary to exclude others.

Treatment of carpal tunnel syndrome

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

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

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

1. Endoscopic dissection of the carpal ligament.
   Under local anesthesia The transverse palmar ligament is cut through two small incisions in the palm. As a result, the canal space expands, the nerve ceases to be compressed.
2. Open surgery for dissection of the carpal ligament and reconstruction of the carpal tunnel.

Surgical treatment, carried out as a rule on an outpatient basis, is very effective: in the vast majority of cases, the motor functions of the wrist joint, the 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.

Although carpal tunnel syndrome is not fatal dangerous diseases, 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 full recovery and restoration of hand function.

Carpal Tunnel Syndrome (CTS) is a condition caused by high blood pressure on the median nerve at the level of the wrist.

Compression of the median nerve at the level of the wrist results in numbness, tingling, and pain in the hand, palm, and fingers. There is a space in the wrist called the tunnel, which is about as wide as the thumb.

When this tunnel is pressurized, it compresses the nerve passing through the (median nerve) tunnel, causing the hand and fingers to malfunction due to pain and numbness. Several tendons and blood vessels also pass through this tunnel.

The median nerve is the most important component of the tunnel. It gives the feeling of the thumb, index and middle fingers of the hand. Any condition that damages the flexor tendons of the forearm while passing through the carpal tunnel causes them to become inflamed.

This causes compression or irritation of this nerve, resulting in carpal tunnel syndrome.

Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) are used to control pain. Carpal tunnel syndrome can be avoided by doing simple exercises.

Carpal tunnel syndrome is a major cumulative work-related injury to the wrist, usually caused by a deformity in the hand. When you bend your wrist, at a right angle, the carpal tunnel becomes narrower. Most activities, from playing the guitar to typing, eating, pushing the swing, require bending the wrist.

Repetitive bending or keeping the wrist flexed for long periods time, compresses the median nerve, leading to carpal tunnel syndrome. T

just as stepping on a garden hose slows the flow of water through it, compression of the median nerve fibers by swollen tendons and thickened ligament slows transmission. nerve signals through the carpal tunnel. The intensity, frequency, duration of work, and their association with carpal tunnel syndrome are unknown.

To the number at risk, include computer workers, carpenters, assemblers, meat packers, musicians, and mechanics because their activities involve repetitive flexion and extension of the wrist. Activities such as gardening, needlework, golf, and canoeing can also lead to symptoms.

The six key workplace risk factors for developing carpal tunnel syndrome include:

1. Repetition;
2. High strength;
3. Uncomfortable joint posture;
4. direct pressure;
5. vibration;
6. Prolonged restricted posture.

Women are affected 3 times more often than men. Hormonal changes associated with also make women more prone to this disorder. General terms in which this condition is manifested include:

• Pregnancy;
• Rheumatoid arthritis;
• Injuries;
• Endocrine disorders such as diabetes, hypothyroidism;
• External fracture;
• In some cases, the presence of a tumor. It can also cause compression of the median nerve.
• Some other causes that lead to inflammation of the tendons are hypothyroidism, pregnancy, diabetes.

Repetitive activities that cause tendon inflammation

• Increased movements of the hands, wrists;
• Driving;
• Letter;
• Painting;
• Sewing;
• Increased use of musical instruments;
• Work related to production on assembly lines;
• Using tools that vibrate or are hand held;
• Sports: tennis or squash.

Diseases that cause abnormal substances in the carpal tunnel

• Alcoholism;
• External arthritis, bone fractures;
• Leukemia;
• Diabetes;
• Obesity;
• multiple myeloma;
• Acromegaly;
• kidney failure;
• Menopause;
• Amyloidosis;
• Pregnancy;
• Infections, injuries;
• Hypothyroidism;
• Sarcoidosis.

signs

At first, symptoms often occur at night. Many people have a habit of sleeping with their wrist crooked, which can cause pain.

As symptoms worsen, tingling may be felt in daytime, along with pain running from the wrist to the fingers. The pain is usually felt on the palmar side of the hand. Another symptom is hand weakness, which worsens over time.

Fingers feel swollen, even if they are not. If left untreated, there will be loss of sensation in some fingers and permanent weakness of the thumb. There is a problem with sensing the difference between hot and cold temperature.

Symptoms

• Numbness or tingling in the hand, fingers, especially the index and middle.
• Pain in the wrist, palms, forearm.
• Numbness or pain that gets worse at night.
• Unbearable pain experienced in the middle of the night can wake you up.
• Increased pain when using the hand or wrist.
• Inability to hold items.
• Loss of sensation of heat and cold.
• Weakness of the thumb.