Carpal tunnel syndrome of the right hand. Tunnel syndromes of the hand (carpal tunnel): treatment methods

Carpal tunnel syndrome is a condition that develops when the median nerve inside the carpal tunnel is pinched or injured. In this case, the movements and sensitivity of the fingers are impaired (the first three and part of the fourth fingers are affected).

Carpal tunnel syndrome is considered occupational disease, since it most often develops in people of certain professions, whose activities are associated with monotonous flexion and extension of the hand. For example, musicians, tailors, secretaries (work with a computer mouse and keyboard).

Carpal tunnel syndrome has two other names: carpal tunnel syndrome And carpal tunnel syndrome. Although the last name is not entirely correct, since there are other tunnel syndromes (for example, compression syndrome of the deep branch of the ulnar nerve).

Statistics

The overall worldwide prevalence of carpal tunnel syndrome ranges from 1.5 to 3%. Moreover, about 50% of all patients are active users of a personal computer.

According to various sources, carpal tunnel syndrome is 3-10 times more common in women than in men.

The peak onset of the disease occurs between 40 and 60 years of age. However, this does not mean that people younger age are not susceptible to this disease: according to statistics, 10% of all cases are under 30 years of age.

It is believed that people who work long hours on a computer every day are most susceptible to developing carpal tunnel syndrome. According to one study, every sixth person examined has it. Users whose hand is extended by 20° or more in relation to the forearm while working with a keyboard and computer mouse are at greatest risk. Carpal tunnel syndrome is a relatively “young” disease. For the first time, a disease similar to carpal tunnel syndrome was described by the English surgeon Sir James Paget in 1854 in a patient with a fracture. radius at wrist level.

A little later it turned out that the disease can develop in workers performing monotonous movements.

Well, in our time, when the personal computer has firmly entered into life modern man, carpal tunnel syndrome has almost become an epidemic. However, science does not stand still. Therefore, there is great news for active personal computer users: a special platform and a flying computer mouse with a magnetic ring have been developed that can withstand the weight of a human hand. This stylish new product can be used both to treat carpal tunnel syndrome and to prevent its development.

The structure and function of nerves

There are about 85 billion nerve cells in our body. They are located in the brain and spinal cord (central nervous system - CNS), as well as in nodes (clusters of nerve cells) lying outside the CNS (for example, spinal ganglia - near the spine).

The processes extending from the nerve cells gather together and form bundles - nerves.

Together, all the nerves form the peripheral nervous system, whose task is to transmit impulses from the brain and spinal cord organs and tissues. Moreover, each nerve is responsible for its own area or organ.

Structure of a nerve cell (neuron)

Nerve cell(neuron) - structural highly specialized unit nervous system, which has body(somu) and shoots(axon and dendrites).

Body nerve cell contains a core, and is limited on the outside by a wall, which consists of two layers of fat. Due to this, only fat-soluble substances (for example, oxygen) enter the cell.

Neurons have different shapes(spherical, spindle-shaped, stellate and others), as well as the number of processes. Depending on the function they perform, neurons are sensitive (receive impulses from organs and transmit them to the central nervous system), motor (send commands from the central nervous system to organs and tissues), and intercalary (communicate between sensory and motor neurons).

Nerve cell body incapable of reproduction (division) and restoration when damaged. However, when an axon or dendrite is cut, the cell ensures restoration of the dead portion of the process (growth).


Axon and dendrites

Axon- a long process of a nerve cell that transmits excitation and information from the neuron to the executive organ or tissues (for example, muscles).

Most nerve cells have only one axon. However, it can divide into several branches that connect with other cells: muscle, nerve or glandular. This connection between the axon and the target cell is called a synapse. Between the axon and the cell there is a synoptic cleft.

At the end of each axon branch there is a thickening in which there are vesicles with a special substance - a mediator. Until a certain point, it is in a “sleeping” state.

On the outside, most axons are covered with Schwann cells (perform a supporting and nutritional function), which form the myelin (pulp) sheath. Between the Schwann cells there are nodes of Ranvier - an area where the myelin sheath is interrupted. However, some axons lack Schwann cells - unmyelinated fibers.

The peripheral nervous system is characterized by myelin fibers.

Dendrites- short branched processes of a neuron, with the help of which it receives information from body cells and other nerve cells.

Nerve structure

A nerve is a structure in which there are intertwined bundles of nerve fibers (mainly axons) running parallel to each other.

On the outside, the nerve is covered in three layers:

1. The endoneurium contains capillaries (small vessels) that supply nerve fibers.
2. The perineurium, which “dresses” bundles of nerve fibers, since it contains collagen (a protein that is the basis of connective tissue), which performs a supporting function.
3. The epineurium is the outer layer formed of dense connective tissue that surrounds the nerve.

Nerves transmit impulses from the brain and spinal cord to the cells of organs and tissues of the body.

How is a nerve impulse transmitted?

This is a complex process that is carried out using a sodium-potassium pump. What does this mean? The fact is that the wall of the outer layer of the axon is complex structure(membrane), thanks to which sodium and potassium ions can flow both into and out of the axon. As a result, an impulse is formed, which is transmitted from the axon to other cells.

How does impulse transfer occur?

Normally, the axon is at rest and does not conduct impulses. Therefore, potassium ions move inside the axon body, and sodium ions move out (much like if a fresh cell is placed in a salty solution).

However, when an impulse arrives at the axon from the dendrite, the situation changes: sodium moves inside the axon, and potassium moves out. As a result internal environment axon acquires on short period a positive charge leading to the cessation of sodium influx into the cell. But at the same time, potassium continues to leave the axon.

Meanwhile, sodium ions inside the cell spread to other parts of the axon, changing the permeability of its membrane, thus facilitating further propagation of the impulse. When it passes through a certain point in the axon, the body of the nerve cell receives a “command” to relax, so it returns to a state of rest.

This impulse transmission is quite slow (for example, a signal sent by the brain reaches the hand after a minute). However, thanks to the myelin sheaths, it speeds up as it “jumps” through the intervals of Ranvier.

However, the impulse must reach an adjacent cell. To do this, having reached the thickening at the end of the neuron, it promotes the release of mediators from the vesicles, which enter the synoptic cleft. Next, the mediators connect to special receptors on the cell of the target organ (muscles, glands, etc.). As a result, an action occurs: movement of the hand, fingers, turning the head, and so on.

Anatomy of the hand, wrist and forearm

The hand is a part of the human hand that has three sections:

All the bones of the hand are connected to each other by joints, ligaments and muscles. Thanks to this, movements in the hand become possible, which are controlled by the nervous system.

Forearm - part of a person's hand that consists of two tubular bones(length prevails over width): radial and ulnar. It is limited on the upper side elbow joint, and below - with the wrist.

Structure and functions of the median nerve

Features of the passage

The median nerve begins in the shoulder area from branches formed by fibers of the spinal nerves (sixth to eighth cervical and first thoracic). Then it goes to the hand, but does not give any branches at the level of the shoulder and ulnar fossa.

Having reached the forearm area (from elbow to hand), median nerve gives off several branches. Then it passes in the carpal tunnel under the transverse carpal ligament and branches into terminal branches.

Along its course, the median nerve innervates the following muscles:

• Superficial and deep flexor digitorum, which are responsible for flexing fingers II-V
• The muscle that helps flex and rotate the forearm is the pronator teres.
• Flexor carpi muscle - flexes and abducts the hand
• The flexor muscle nail phalanx first finger
• The palmaris longus muscle, which flexes the hand and tenses the palmar aponeurosis (a wide tendon plate that covers the muscles of the hand from the palmar surface)
• The quadratus muscle, which is responsible for rotating the hand and forearm
• Abductor pollicis muscle
• The muscle that opposes the thumb to all the others
• Muscle that flexes the thumb
• Muscles that bend II-III fingers.

Functions of the median nerve

Based on the areas of innervation, the median nerve is involved in flexion and abduction of the hand to the inside, flexion of the fingers, bringing the elevation of the first finger to the other fingers of the hand, rotation of the hand and forearm.

The median nerve also innervates the skin on the palmar surface of the hand of the first, index and middle fingers, as well as parts of the ring fingers, and on the dorsum of the hand the skin of the terminal phalanges of the index and middle fingers.

Thus, the median nerve provides both movement and sensation to the hand.

Causes of median nerve damage

The lumen of the carpal tunnel is quite narrow. Therefore, any factor that leads to its narrowing or provokes the growth of tissue inside it can cause the development of carpal tunnel syndrome, since this compresses the median nerve between the bones and tendons of the wrist.

Working at a computer for a long time (using a computer mouse and keyboard)

Most often leads to the development of carpal tunnel syndrome, since this type of activity causes minor chronic injury to the soft tissues of the hand, as well as the tendons running in the carpal tunnel. The reason is repeated, similar, fast and frequent movements of the hand and arm. As a result, aseptic (non-bacterial) inflammation of the tendons passing in the carpal tunnel occurs, which leads to their swelling and pinching by the retinaculum.

However, studies have shown that not all frequent personal computer users develop carpal tunnel syndrome. Certain conditions are necessary for it to occur. For example, people with III-IV degree of obesity are most often at risk (due to fat, the lumen of the carpal tunnel narrows), female gender (anatomically narrower carpal tunnel) and some other factors.

Arthritis: rheumatoid, psoriatic or gouty arthritis, as well as other rheumatic diseases affecting the joints

At the onset of the disease there is inflammatory reaction in the joints of the wrist area. Besides, systemic diseases(affect the body as a whole) lead to the development of inflammation and swelling of soft tissues, including muscles and tendons passing in the carpal tunnel, therefore its lumen narrows.

Then, over time, as the course of the underlying disease worsens, aging of the articular cartilage occurs. Therefore, they lose their elasticity and cracks appear on them. As a result, the cartilage gradually begins to wear away, and in some places so much so that the bone is exposed. Such changes lead to the death of cartilage and fusion of articular surfaces. Therefore, deformations occur, as a result of which the normal anatomical structure of the hand and carpal tunnel is disrupted.

Acute wrist injuries

They cause the development of carpal tunnel syndrome in approximately 10% of all cases of the disease. Quickly suppress the production of inflammatory mediators in tissues (histamine, prostaglandins). Therefore, pain and swelling are reduced, and tissue sensitivity is improved.

However, systemic corticosteroids have more side effects(for example, sleep disturbance, formation of ulcers in the stomach and intestines). Therefore, they are used with caution, especially for certain diseases (for example, diabetes). In addition, they suppress the activity immune system, therefore, in the presence of infections they are not prescribed.
There is one more unpleasant moment: after corticosteroid withdrawal, “rebound” syndrome may develop: all symptoms quickly return.

Local treatment

Considered most effective for relieving acute symptoms.

Introduction of medicinal mixtures

A medicinal mixture of an anesthetic (Lidocaine or Novocaine) with a corticosteroid hormone (Diprospan or hydrocortisone) is injected into the carpal tunnel using a special long needle. As a rule, after administering medications into the carpal tunnel cavity, pain and other symptoms of the disease disappear after some time. However, in some cases, the pain may increase, but after 24-48 hours it gradually decreases.

With this method of treatment, the patient’s condition improves after the first injection. If the symptoms do not disappear completely, then two more procedures are performed with a two-week interval between them.

If the disease relapses (symptoms reappear), the course of treatment is repeated.

Local compresses with a complex composition

One of the composition options:

• Dimexide - 50 ml
• Lidocaine solution 10% - 2 ml, or Novocaine 2% - 30 ml
• Hydrocortisone solution - 1 ampoule
• Water - 30 ml

The compress is applied for 40-60 minutes.

The prepared composition can be stored in a cool place and used for several days.

Carpal tunnel syndrome: surgery

Surgery is recommended if symptoms persist for 6 months.

The purpose of the intervention is to reduce pressure on the median nerve by expanding the lumen of the carpal tunnel.

There are two types of surgery, which are performed under local anesthesia:

After the operation, a plaster cast for a few days. Physiotherapy and therapeutic exercises(finger movements should be carried out with a fixed wrist).

3 months after surgery, hand function is restored by 70-80%, and after 6 months - completely.

After recovery, the patient can return to his normal activities. However, if you do not change working conditions (proper arrangement of the workplace, use of cuttings), there is a high risk of relapse (return of symptoms of the disease)

Non-drug treatment

To treat carpal tunnel syndrome, many doctors use acupuncture, manual therapy and other techniques.

For hypothyroidism Hormone replacement therapy is prescribed: L-thyroxine, Eutirox.

During menopause physiological or artificial (removal of ovaries) for replacement therapy hormonal medications containing estrogen (female sex hormone) are prescribed. However, such treatment is only possible if the woman had her last menstruation no later than 10 years ago and she is under 60 years of age.

If a menstruating woman has taking hormonal contraceptives, carpal tunnel syndrome has developed, then they are canceled or changed to another drug.

Treatment of diabetes aimed at preventing jumps in sugar levels during the day. Since it is in this case that the large quantities substances that damage neurons. However, treatment has its own characteristics depending on the type of disease.

For type I diabetes, insulin (short-, long- or medium-acting) is prescribed. The dosage and regimen of use is individual, depending on the severity of the disease and blood sugar levels.

For type II diabetes, hypoglycemic drugs (Glucophage, Metformin) are prescribed, which increase sensitivity cell walls to insulin, improving the intake of glucose. In addition, they reduce the formation of glucose in the liver, as well as its absorption in the intestine.

While maintaining partial function of the pancreas, drugs are used that stimulate the production of insulin by its cells. These are sulfonylurea derivatives: Chlorpropamide, Gliquidone and others.

Regardless of the type of diabetes, thioctic acid preparations (Tiogamma, Berlition) are prescribed to improve tissue nutrition. They improve the absorption of glucose by tissues, bind free radicals(unstable molecules that damage other normal cells of the body), especially cells of the nervous system.

For chronic renal failure treatment is aimed at improving function and blood circulation in the kidneys, eliminating excess liquid from the body and end products of protein metabolism.

For this purpose, drugs that thin the blood and improve blood circulation in small vessels are used (for example, Warfarin, Angioflux).

Sometimes diuretics are prescribed (depending on the degree of preservation of kidney function).

Sorbents (Polysorb, Enterosgel and others) are used to remove the end products of protein metabolism.

For high blood pressure, medications are used to regulate it: ACE inhibitors(Diroton, Captopril), calcium antagonists (Verapamil) and others.

In case of severe renal failure (stages III-IV), the patient is connected to an artificial kidney apparatus.

Physiotherapeutic procedures

They have proven themselves well both during treatment with medications and during the rehabilitation period after surgery.

However, despite their effectiveness, they are not suitable for everyone.

General contraindications to physiotherapeutic procedures

• Tumor processes
• Pregnancy
• Heavy III degree heart failure
• Any infectious viral diseases in the acute period (presence of elevated body temperature)
• Severe course diabetes mellitus (high sugar levels)
• High blood pressure is a temporary contraindication. After its normalization, the procedure can be carried out.
• Presence of a pacemaker
• Epilepsy with frequent seizures, hysteria and psychosis
• Decreased clotting blood and tendency to bleed
• Severe heart rhythm disturbance: severe atrial fibrillation (contraction of the ventricles and atria is asynchronous) and severe extrasystole (with this disease the heart rate)
• Presence of pustular inflammation on the skin (site of device exposure)

Physiotherapeutic procedures are prescribed both for the treatment of carpal tunnel syndrome and the diseases that led to its development.

Ultraphonophoresis

Performed together with medications.

During the procedure, the body is affected by ultrasonic vibrations, which facilitate the penetration of drugs into the cell.

In addition, the therapeutic effect of ultrasound itself: it dilates blood vessels and accelerates blood flow in the capillaries. Thanks to this, pain decreases or disappears, swelling decreases and hematomas resolve.

Dimexide, painkillers, hormones and other drugs are used as medicines. An exception is some medications that ultrasound destroys: novocaine, B vitamins, ascorbic acid and other substances.

The goals are to reduce pain and inflammation, accelerate tissue restoration.

Indications

• Diseases of the musculoskeletal system: osteochondrosis, arthrosis, arthritis, (vascular disease)
• Active pulmonary tuberculosis
• Individual intolerance to drugs for ultraphonophoresis

Method of application

First, the medical worker wipes the area of ​​skin that is subject to the procedure with a disinfectant solution. Next, the medicine is applied to the skin, then a device that delivers ultrasonic waves is applied to the site of treatment.

The duration of one procedure is from 10 to 30 minutes. Course - 8-12 sessions. After a few months, if necessary, the course of treatment is repeated.

Shock wave therapy

The method is based on the action of acoustic shock waves (generated by a special sensor), the frequency of which is lower than those perceived by the human ear - infrasound. These waves have a high energy amplitude and short duration, due to which they propagate in soft tissues without damaging them. At the same time, they restore metabolism and promote cell renewal.

As a result, blood circulation in the affected area improves, pain decreases, and sensitivity is restored. Moreover, after several procedures, bone growths begin to disintegrate, and new vessels begin to grow at the site of the lesion.

The method is so effective that if treatment is started in a timely manner, it is equal to the result obtained after surgery.

Goals

Treatment of acute and chronic pain caused by trauma, diseases of the musculoskeletal system (osteochondrosis, arthritis and others) and the nervous system.

Indications

• Arthrosis, arthritis, osteochondrosis, hernias and protrusions intervertebral discs, heel spur
• Gallbladder and kidney stones
• Slow healing of fractures
• Soft tissue injuries: muscles, ligaments, tendons
• Scar tightening of muscles, tendons and ligaments, so free movements (flexion, extension) in the limb are limited
• Pain from bruises, fractures, sprains
• Burns and trophic ulcers
• Chronic muscle pain resulting from prolonged and frequent overwork

Contraindications

(in addition to the general ones)

Age up to 18 years, since the waves act on the growth zones of bones. Whereas when they are damaged, irreversible changes develop that have a bad effect on the development of the child’s skeleton.

Methodology

The medical worker helps the patient get more comfortable on the couch, then wipes the area of ​​skin, disinfecting and degreasing it. Then it configures the device depending on the area of ​​application and the disease (there are several programs). Next, a special gel is applied to the skin, after which a sensor is applied to the site of treatment, which sends therapeutic impulses.

The course of treatment is 5-7 procedures, each of which lasts 20-30 minutes. The procedures are carried out at intervals of 3-7 days. After treatment, about 90% of patients have a significant improvement in their condition. If necessary, the course of treatment is repeated after several months.

Note

Do not apply shock waves to the area of ​​the head, intestines, large blood vessels and lungs.

Prevention of carpal tunnel syndrome

According to statistics, the number of patients with carpal tunnel syndrome has increased in recent years, as the personal computer has become firmly established in the life of a modern person. However, the formation of the disease can be prevented.

So, what to do based on the mechanism of development of the disease?

Arrange your workplace
Select the height of the computer desk so that the armrests of the chair are level with its surface. In this position, while working (typing or moving a computer mouse), the forearms rest quietly on the table or armrests, and are not suspended. Therefore, the hands are relaxed while working, and the hand at the wrist does not bend. In this case, there is no additional load on the canal and the median nerve is not pinched.

In addition, while working, try to ensure that the lower back is positioned at an angle of 90° in relation to the hips, and the angle between the shoulder and forearm is also 90°.

Try not to strain or squeeze. Be careful not to pull your head between your shoulders.

Choose a comfortable keyboard and computer mouse
If the position of the hands is correct during work, then the hands lie calmly above the working surface, so movements in them are free. However, if the keyboard is located high, then you have to hold your hands above it in a suspended position. This position increases the load on the carpal tunnel. Therefore, it is better to purchase a special hand mat or an inclined keyboard.

Choose a computer mouse so that it fits in your palm while you work. This way the hand gets tired less and is relaxed. For people who have already developed carpal tunnel syndrome, special computer mice have been developed that are shaped like a joystick. When working with them, the carpal tunnel is practically not loaded.

In addition, there are special computer mouse pads that have a cushion (it is better to choose one with a gel filler) at wrist level. In this position, during work, the carpal tunnel is in a straightened state and is minimally loaded.

Position of the brushes when working

Adjust the angle and height of your monitor

In such a way that the text is at eye level while working. Because if the monitor is located low, then you have to constantly tilt your head down, if it is high, then raise it up. With such movements, blood circulation in the cervical spine and arms worsens.

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

Introduction

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

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

Anatomy

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

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

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

Reasons

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

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

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

These risks include:

• use of force;
• body position;
• wrist position;
• repetition of action;
• temperature;
• vibration.

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

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

Any condition that causes abnormal pressure in the canal can contribute to the symptoms of SBS. Various types of arthritis can cause swelling and pressure in the carpal tunnel. A fracture of the wrist bone may subsequently cause SBS if bone fragments will lead to the appearance of an abnormal position of the flexor tendons.

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

Symptoms

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

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

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

Diagnosis

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

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

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

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

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

Treatment options

Conservative treatment

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

Wrist bandage

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

Drug treatment

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

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

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

Physiotherapy

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

Surgical treatment

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

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

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

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

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

Rehabilitation

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

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

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

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

Carpal tunnel syndrome is a pathology in which the median nerve is compressed in the wrist area. We can say that carpal tunnel syndrome is the disease of the century, which is currently widespread, especially among IT workers who work at the computer for a long time. The disease refers to neurological diseases and is included in the group of tunnel neuropathies.

The syndrome manifests itself with very unpleasant symptoms: prolonged numbness of the fingers and acute pain in the wrist. Spending a long time at the computer, constant monotonous loads on the hand when using a robot with a mouse lead to a narrowing of the anatomical canal, which pinches and compresses the peripheral nerve in the carpal tunnel.

What is carpal tunnel syndrome

Tunnel syndromes is not an independent disease, but a complex of 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 freely allow peripheral vessels and nerves to pass through. With various pathologies, their narrowing occurs, which leads to compression of the vessels and nerves passing through it.

Pathology has always been found in women much more often than in men. This is due to the fact that women more often perform monotonous work, which puts stress on the hand muscles. Among men, the disease affects programmers who work on a computer. Compression of the carpal nerve can be caused by tightness 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 use the same wrist muscles. The first symptoms appear when using a computer mouse, when the hand is in a constant incorrect position. This places 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 throughout the world. And since computers are in every home and young people spend many hours online, the disease takes on the character of a pandemic.

Reasons for the development of the syndrome

We have already written above about the reasons for the development pathological process. Any pathological processes that reduce the size anatomical canals and promoting compaction of the tissues inside it can cause the development of 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. During this period female body susceptible to many phenomena, for example, edema. When a significant amount of fluid accumulates in the body, problems arise with the nerve fibers, since swelling affects high blood pressure on the wrist, which leads to nerve pinching.
3. Metabolic disorders ( diabetes mellitus).
4. Rheumatoid arthritis.
5. Hormonal imbalances. During the period of hormonal changes, mainly in women, joint problems arise, which are often accompanied by tunnel neuropathies.

The above problems can cause unpleasant symptoms when doing the following:

• monotonous, monotonous hand actions;
• with awkward hand position;
• while talking on a mobile phone;
• when performing physical exercises while resting on the wrist;
• during prolonged vibration (working with the keyboard);
• when using the mouse for a long time (the hand is in a suspended state).

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

Symptoms

The primary symptoms, which 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 become more complicated and multiply. Symptoms make themselves felt most clearly at night, which prevents good rest person. In this case, 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 own characteristic features. For example, not the entire hand goes numb, but only three of its fingers: the thumb, index, middle and half of the ring finger; the little finger is never affected by this pathology. In very advanced cases, the functionality of the hand is impaired, it is impossible to clench it into a fist, pain occurs when trying to connect the thumb and little finger, the person is not able to take an object in his hand and then hold it. In other words, it is violated fine motor skills 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 on a computer, perform household activities, or take care of himself independently.

All symptoms on initial stage diseases are reversible and can be safely eliminated. In advanced cases, surgical treatment may be required, in which the canal is widened and excess tendons are removed.

Chronology of symptoms:

1. During monotonous and monotonous movements (for example, at the computer, or when knitting), a strong dull pain occurs in the area where the nerve passes, which radiates to the thumb, index and middle finger. To eliminate the pain, just stop and shake your hands several times, and also take a half-hour break. The problem arises due to poor nerve patency and poor circulation. On at this stage all symptoms are reversible.
2. If the problem is 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 the person even after hours for several hours, turning into a constant dull pain. Reason constant pain are a thickening of the tendon located around the nerve. It begins to put pressure on the nerve and pain occurs on the inside brushes that extend into the fingers.
3. The body tries to compensate for unfavorable factors, so between the cartilages there is an accumulation of lymphatic fluid, which carries away fragments of the affected tissue and cells with the lymph flow. In its natural state, this process perfectly eliminates problems, and the liquid resolves on its own. Under constant loads inflammatory process is unable to regress and its self-healing is impossible. Therefore, long-term swelling and lymph stagnation are irreversible without additional treatment. Swelling and numbness are significant at night, and if they are accompanied by severe pain, then the disease has reached its climax. And soon the only way out there 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 night 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 makes it possible to differentiate tunnel syndrome from spinal hernia and osteochondrosis.

How is electromyography performed? The patient, who is sitting in a comfortable chair, has electrodes applied to his hand, having pre-treated them antiseptic. The electrodes are connected to a special electromyograph apparatus. Electrical impulses are passed through the electrodes and the nerve conduction. The results are 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 based on the same principles. The specialist studies and evaluates the result to make a verdict.

The disease can also be diagnosed based on certain tests.

Testa Fallen. To perform the test, you need to bend and straighten your hands 90 degrees (see picture). The numbness or tingling sensation occurs immediately within 20 seconds. U healthy person Numbness and pain may also be observed, but not earlier than after 1 minute.

Tinell test. When tapped with a neurological hammer, a tingling sensation is felt and pain radiates to three fingers. Sometimes tapping causes sharp pain.

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

An opposition test is also performed, which consists of the impossibility of connecting the thumb and little finger. This phenomenon develops as a result of weakness of the thenar (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;
• surgical treatment.

Drug treatment

At an early stage of the disease, the patient’s condition can be improved with the help of medications. This treatment is carried out on an outpatient basis. NSAIDs (non-steroidal anti-inflammatory drugs) are prescribed, which quickly relieve inflammation, pain and swelling:

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

To reduce pressure in the area of ​​the compressed nerve, hormonal drugs (corticosteroids) are used as injections directly into the carpal tunnel. Injections are very effective in treating pain, swelling and inflammation.

Vitamin B has a beneficial effect therapeutic effect, since the vitamin itself has an anti-inflammatory effect.

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

Physiotherapy

Physiotherapeutic treatment is used:

1. Paraffin baths. The sore hand is lowered into a bath of molten paraffin. Then the procedure is repeated 3-4 more times until a 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 are warmed up under the influence of hot paraffin, which relieves inflammation, swelling and pain.
2. Ultraviolet therapy. In this treatment, the tendons and joints are heated with short-wave electromagnetic waves in the range of several gigahertz.
3. Ultrasound treatment. Exposure to high-frequency sound waves leads to an increase in temperature in the treated area, which improves the conductivity of the canal, relieves swelling and pain. Two week course ultrasound treatment can significantly reduce the manifestation of symptoms.
4. Manual therapy. When treated with this method, improvements in blood circulation in the hand were noticed.

Gymnastic exercises

The exercises can be done independently at home, so their advantage is obvious.

Exercise No. 1. Place your hand in the bath with hot water, squeeze 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 No. 2. Night warming compress, which is made on the basis of diluted alcohol or vodka. You should not take pure medical alcohol, it can burn the skin on your hand.

Exercise No. 3. Massage. You need to massage the entire arm, not just the hand, starting from the outside of the palm, moving up to outside forearms. The massage must be performed by a professional massage therapist.

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

Surgical treatment

It is carried out in severe advanced cases when all other methods are ineffective. The purpose of surgery is to excise the ligament that puts pressure on the median nerve.

There are two types of operations:

• endoscopic;
• classical open intervention.

The endoscopic procedure involves the use of an endoscope, which is inserted into the carpal tunnel through a pinpoint incision. This is a minimally invasive surgery 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 lasting.

Radial tunnel syndrome

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

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

Symptoms of the disease are sharp pains, which have a burning character on back side hand and upper 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.

1. Vitamin B12. Useful for increasing the body's defenses, reducing paresthesia and chilliness.
2. Vitamin B6. Restores nerve fibers, reducing swelling in the joint area and pain symptoms.
3. Vitamin WITH. It has an anti-inflammatory and strengthening effect, enhances the effectiveness of B vitamins.
4. Vitamin D3.
5. Vitamin E.

The most popular complexes:

• "Dihydroquercetin Plus" - contains a valuable natural antioxidant – dihydroquercetin , obtained from the bark of the Siberian larch. As part of the drug, the effect of dihydroquercetin is enhanced by vitamin C and vitamin E, the combined action of which helps restore blood microcirculation in the affected area of ​​the hand and wrist.

• "Osteo-vit" – contains vitamin D3 And drone brood. D3, when combined with B6, participates in the mineral metabolism of the body.

3. Local treatment - injection of drugs into the joint

Direct injection of medication into the carpal tunnel– most effective way treatment of carpal syndrome. To do this, a mixture of painkillers Lidocaine and Novocaine with the addition of corticosteroids is injected into the carpal tunnel with a special long needle. Most often, after introducing the medicine into the cavity, the pain will disappear.

In some cases, it may intensify, but after a day or two it will go away completely. The course of treatment is up to three weeks and consists of two injections.

If the pain does not go away at all, the procedure is repeated at two-week intervals.

4. Non-drug treatment

Besides medicinal method effects, doctors use other techniques to achieve good results. The most common impact options include: acupuncture, manual therapy and yoga.

5. Treatment of the disease that led to the syndrome

For treatment to be truly effective, care must first be taken to rid the patient of the diseases that caused carpal syndrome (if any). Otherwise, the applied techniques will not give any results, and a relapse may occur. For each type of pathology you will need individual treatment:

• Treatment of rheumatoid diseases associated with damage to the hand joint;
• Hypothyroidism requires hormone replacement therapy;
• During menopause it is prescribed hormone therapy, but provided that the woman is not yet 60 years old and her last menstruation was no later than 10 years ago;
• For diabetes mellitus, treatment is used that is aimed at preventing surges in the patient's sugar level;
• Chronic renal failure involves helping the patient to improve the process of removing fluid from the body or end products of protein metabolism;
• For high blood pressure, HMF inhibitors are used.

6. Physiotherapy

IMPORTANT: This technique cannot be used for people with contraindications (oncology, heart failure, pregnancy and other problems).

Prescribed as physiotherapeutic treatment various procedures, for example, electrophoresis or local cryotherapy.

7. Ultraphonophoresis

The procedure is carried out in conjunction with medications and is a technique in which special ultrasonic vibrations influence the body. This leads to better penetration of drugs into cells, and also allows you to accelerate blood flow in the capillaries. With this treatment of the carpal tunnel, the vessels dilate, pain disappears and swelling subsides. Dimexide is used as a medicine.

The procedure aims to reduce pain and inflammation in the treatment of carpal tunnel syndrome. One session takes up to 30 minutes, and the treatment course is 8–12 sessions.

8. Shock wave therapy

This method of treating carpal tunnel syndrome has proven itself to be a fairly effective and proven technique.

UVT has a complex effect on the entire body and promotes breaking down calcium and uric acid deposits, which narrow the canal in rheumatic diseases. The therapy has a positive effect on the blood supply to the affected area, allowing swelling to be relieved and the patient to be relieved of pain.

CAUTION: SWT cannot be prescribed to patients under the age of 18 to avoid problems associated with pathology of bone development.

Surgery

Surgery is recommended only when all other methods have failed. Surgery required in case when the form of carpal syndrome is advanced, and the patient experiences constant relapses or muscle atrophy.

The operation involves dissection of the carpal ligament, and in some cases, excision of scar tissue. Surgical intervention May be open or endoscopic. The second option is more gentle a technique after which the scar is practically absent.

With open surgery, the surgeon has full access to the damaged area, which provides more opportunities to relieve pressure on the carpal tunnel.

This operation is not considered difficult, so the likelihood of complications is minimal.

As a result of numerous operations, experts came to the conclusion that it is worth giving preference to the endoscopic technique under local anesthesia. This approach requires less time for patient rehabilitation.

Diet

Proper nutrition for carpal tunnel syndrome is very important for the patient, because it will make up for the lack of vitamins, minerals and essential trace elements. It is best to supplement the menu with products rich calcium And vitamin B. This will strengthen the bone and nerve tissue. Fast food should be excluded from the menu, everything fatty, fried, spicy and overly salty.

Treatment at home

If you diagnose the problem in a timely manner and begin treatment at home, then it is quite possible to exclude the development of irreversible complications. In addition to the described methods, doctors recommend that patients do special therapeutic exercises to train their arms. Going to the pool gives excellent results. It is important that the water is warm and covers the entire limb up to the shoulder. Also, experts recommend do yoga, or other types therapeutic techniques aimed at developing the joint.

Even if you have mild symptoms of carpal syndrome, it is important to stop doing the work that caused the disease.

This alone will give you much more than all the pills, believe me. If you work at home (for example, at the computer) and have problems with the carpal tunnel, take a break. Do something that relaxes the tension in the channel:

• Wash the dishes. Warm water perfectly relaxing.
• Do a wet cleaning of the floor. Be sure to use your hands and warm water.
• Wash the windows.

And be sure to do it regular physical exercise, which strengthen the joint and muscles of the wrist.

Folk remedies

Before turning to folk medicine, you should first visit an experienced doctor. Only he can advise on this or that folk recipe. Folk remedies may not give the desired result or even cause complications. If folk recipe can really help, it's worth trying. The most famous ones include:

1. Tincture from a string. The composition of string, burdock leaves, hop cones, birch leaves, verbena and elderberry flowers should be brewed in a thermos and left for 2-3 hours, and then taken 150 ml four times a day.
2. White clay. Dilute white clay water, transfer the pulp onto gauze and apply to the affected area of ​​the wrist.
3. Make a compress from fresh goat milk.
4. Tincture of cucumber and wild rosemary. Grind 2-3 red peppers and 3 cucumbers in a blender, add half a liter of water and let it brew for about a week. Rub it on your wrist: the tincture will improve blood circulation and relieve the feeling of numbness in your fingers.
5. Pumpkin compress. Turn the pumpkin into a mushy state and apply it to your wrist, wrapping it in cellophane.
6. Sea ​​buckthorn. Grind the berries, add water and heat. Soak your hands in the broth, and then be sure to wipe them so that they do not cool down.
7. Pepper rub. pour 150 grams of pepper vegetable oil and simmer over low heat for half an hour. Once it cools down, rub it into your wrist.

Last time various pathologies musculoskeletal disorders are increasingly occurring in young people. One such problem that affects the function of the hand is carpal tunnel syndrome. The pathology is also known as carpal tunnel or carpal tunnel syndrome. It is characterized by compression of the median nerve of the hand in the wrist area. This can happen when various violations associated with narrowing of the carpal tunnel. But most often this happens with constant increased loads on the hand. Therefore, the pathology occurs mainly among manual workers, and women are more often susceptible to it.

General characteristics

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

A particularly narrow tunnel is located in the wrist. Here, in a small space between the three bones of the hand and the transverse carpal ligament, there are several tendons, many blood vessels and the median nerve, which provides innervation to the palm and three fingers of the hand. Therefore it 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 carpal ligament.

When this canal narrows, a tunnel, or carpal, syndrome occurs. This is the name of a condition in which inflammation or compression of the median nerve occurs. Ischemia occurs, that is, a disruption of the blood supply. At the same time, the speed of nerve impulses slows down and the normal innervation of the hand is disrupted. Various movement disorders And neurological symptoms. If the pressure on the nerve is not immediately relieved, scar tissue gradually forms inside it and thickens. Over time, the chances of recovery decrease, as its atrophy may develop.

Reasons

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

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

• monotonous movements, as when typing on a computer keyboard;
• incorrect hand position when working, for example, with a computer mouse;
• use 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, office workers, musicians, tailors, equipment assemblers, and builders are most often susceptible to narrowing of the carpal tunnel. 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 hardening of the synovial membrane. This is often caused by tendinitis, arthritis, especially rheumatoid or gouty arthritis, and rheumatism. Narrowing of the canal can also be caused by bad habits, frequent consumption of caffeine, obesity, and impaired peripheral circulation. Some medications, such as hormonal birth control, sometimes cause swelling.

Certain types of internal diseases. These are mainly those that cause fluid accumulation in the tissues. Edema often occurs during pregnancy, kidney or heart problems. Carpal tunnel syndrome can also be caused by diabetes mellitus, hypothyroidism, peripheral neuropathy and other pathologies. This sometimes happens to women menopause due to hormonal changes in the body.

Symptoms

One of the first signs of carpal tunnel syndrome is paresthesia in the hand, which is especially noticeable in the morning. The patient feels numbness, tingling in the fingertips, burning, and coldness. This symptom gradually intensifies, the patient can no longer hold the hand suspended, and the sensitivity of the skin is impaired. Then a burning pain appears. It can occur only at the site of nerve innervation in the hand or spread throughout the entire 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, the thumb especially suffers. Therefore, the grasping movements of the hand are disrupted. It is difficult for the patient to hold various objects in his hand, even light ones. Therefore, difficulties arise when performing the most ordinary actions. Objects begin to fall out of the patient's hand; he cannot fasten buttons or hold a spoon. Gradually, muscle atrophy intensifies, and hand deformation occurs. Autonomic disorders may also occur. In this case, there is a cooling of the hand, paleness of the skin, and on the palm it becomes coarser and thicker. Possible sweating problems and changes in nail color.

A feature of 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 from a hernia cervical region spine or Arnold-Chiari malformation, which can also cause pain and numbness in the hand.

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

Treatment

To cure carpal tunnel syndrome, it is necessary to begin therapy as early as possible. Otherwise, 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 or replace the bones as quickly as possible. It is also necessary to immediately begin treatment for diseases that lead to swelling or inflammation.

If the cause of the pathology is increased loads, then the main treatment method will be to avoid them. Stop using vibrating tools, avoid repetitive movements, and avoid working with a bent or bent wrist. Lifestyle changes are required for 1-2 weeks. A special bandage effectively limits unnecessary movements. It prevents wrist flexion and keeps the carpal tunnel straight. Thanks to this, compression of the nerve is relieved and pain goes away. Sometimes a custom made bandage may be required. 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 one get rid of this syndrome.

If such symptoms occur, you should consult an occupational hygienist. He will advise in what position to hold your hand when working, how best to use the tools in order to avoid similar problems in the future. Usually, if you follow all the doctor’s recommendations, recovery occurs in 4-6 weeks. But then you need to wear the bandage at night for some time to avoid bending the wrist and squeezing the nerve.

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

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

At severe pain, which cannot be treated with conventional medications, a Cortisone injection is prescribed. This remedy, injected directly into the canal, quickly relieves pain and swelling. But for a doctor such an injection can become additional way diagnostics If the pain does not go away after the injection, then it is not caused by carpal tunnel syndrome, but by another pathology. A combination of Diprospan and Lidocaine can also be used for injection. But this cannot be considered effective treatment, because it only removes external symptoms. And to completely relieve nerve compression, it is necessary to eliminate its causes.

Except for internal use medicines The following methods are used to treat carpal tunnel syndrome:

• on initial stages It is recommended to apply ice for 2-3 minutes several times a day;
• local treatment using compresses with Dimexide, Lidocaine or Hydrocortisone;
• physiotherapeutic treatment using shock wave therapy, ultraphonophoresis, acupuncture;
• massage;
• therapeutic exercises;
• in the most difficult cases It is indicated to release the pinched nerve through surgery.

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

Operation

If conservative therapy does not help relieve pressure in the carpal tunnel, surgical treatment may be recommended. During surgery, the transverse carpal ligament is most often cut, which increases the size of the canal and frees the nerve. This treatment is performed on an outpatient basis through a small incision in the palm using local anesthesia.

After surgery, rehabilitation takes several months. Usually, carpal tunnel symptoms disappear immediately when the pressure on the nerve is relieved, but it is necessary to repair the ligament and wait for the incision to heal. At first, the hand is held in a scarf; it is better to keep it higher in the first days. Ice and NSAID tablets can be used to prevent pain and swelling. After the stitches are removed, physiotherapeutic procedures are used for rehabilitation.

To speed up healing, ice wraps, magnetic therapy, and ultrasound are used. Massage and special exercises are useful. Finger movements should be carried out from the first day after surgery. And it’s better to start more serious classes with modeling from special soft plasticine. Then you can perform movements with your fingers and hand, gradually increasing their intensity.

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