Carpal tunnel syndrome treatment. Tunnel syndrome - treatment at home. Means for local treatment

Carpal tunnel syndrome is a condition that develops when the median nerve is pinched or injured within the carpal tunnel of the hand. In this case, the movements and sensitivity of the fingers are disturbed (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 (they work with a computer mouse and keyboard).

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

Statistics

The overall prevalence of carpal tunnel syndrome in the world is between 1.5 and 3%. Moreover, about 50% of all sick people 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 of the onset of the disease occurs between the ages of 40 and 60 years. 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 old.

It is believed that people who work daily and long hours on the computer are most susceptible to developing carpal tunnel syndrome. According to one study, every sixth examined has it. Users who, while working with a keyboard and a computer mouse, have their hand extended by 20 ° or more in relation to the forearm are at the 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, nowadays, when Personal Computer firmly entered the life of modern man, carpal syndrome has become almost the nature of an epidemic. However, science does not stand still. Therefore, there is great news for active users of a personal computer: a special platform and a flying computer mouse with a magnetic ring have been developed that can withstand the weight of a human hand. A stylish novelty can be used both for the treatment of carpal tunnel syndrome and for the prevention of its development.

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) that lie outside the central nervous system (for example, spinal nodes - near the spine).

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

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

The structure of a nerve cell (neuron)

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

Body nerve cell contains a core, and outside it is limited by a wall, which consists of two layers of fats. Due to this, only substances that dissolve in fats (for example, oxygen) enter the cell.

Neurons have a different shape (spherical, spindle-shaped, stellate and others), as well as the number of processes. Depending on the function performed, neurons are sensitive (they 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 (carry out communication between sensory and motor neurons).

body of the nerve cell incapable of reproduction (division) and recovery in case of damage. However, when the axon or dendrite is cut, the cell ensures the restoration of the dead section of the process (growth).

axon and dendrites

axon- a long process of a nerve cell that transmits excitation and information from a neuron to executive body or tissues (e.g. 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 of an axon with a target cell is called a synapse. Between the axon and the cell is the synoptic cleft.

At the end of each branch of the axon there is a thickening, in which there are vesicles with a special substance - a mediator. Before a certain moment he is in a dormant state.

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

Myelin fibers are characteristic of the peripheral nervous system.

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

The structure of the nerve

Nerve - a structure in which bundles of nerve fibers (mainly axons) are woven together, running parallel to each other.

Outside, the nerve is covered with three layers:

1. Endoneurium, in which pass the capillaries (small vessels) that feed the nerve fibers.
2. Perineurium, "dressing" bundles of nerve fibers, since it contains collagen (the protein - the basis of connective tissue), which performs a supporting function.
3. The epineurium is an outer layer of dense connective tissue that surrounds a nerve.

Nerves carry out the transmission of impulses from the brain, as well as the spinal cord to the cells of the organs and tissues of the body.

How is a nerve impulse transmitted?

it difficult process, which 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 a complex structure (membrane), thanks to which sodium and potassium ions can enter and leave the axon. As a result, an impulse is formed, which is transmitted from the axon to other cells.

How is momentum transmitted?

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

However, when an impulse arrives at the axon from the dendrite, the situation changes: sodium moves inside the axon, and potassium goes outside. As a result, the internal environment of the axon acquires for a short period positive charge leading to the cessation of the influx of sodium 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 contributing to the 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.

Such impulse transmission is quite slow (for example, the signal sent by the brain will reach the hand in a minute). However, thanks to the myelin sheaths, it speeds up as it "jumps" over Ranvier's intervals.

However, the impulse must hit the neighboring cell. To do this, having reached a thickening at the end of the neuron, it promotes the release of mediators from the vesicles, which enter the synoptic gap. Further, mediators are connected to special receptors on the cell of the target organ (muscles, glands, and others). As a result, an action occurs: movement of the hand, fingers, turning of the head, and so on.

Anatomy of the hand, wrist and forearm

A hand is a part of a human hand that has three sections:

All bones of the hand are interconnected by joints, ligaments and muscles. Due to this, movements in the hand, which are controlled by the nervous system, become possible.

forearm - the part of the human hand that is made up of two tubular bones(length prevails over width): radial and ulnar. From the top it is limited elbow joint, and from below - the wrist.

The structure and functions of the median nerve

Features of the passage

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

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

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

Superficial and deep flexor of the fingers, which are responsible for bending the II-V fingers
The muscle that promotes flexion and rotation of the forearm is the pronator teres
Flexor wrist muscle - flexes and abducts the hand
Muscle that flexes nail phalanx first finger
Long palmar muscle that flexes the hand and strains 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 the rotation of the hand and forearm
Muscle that abducts the thumb
The muscle that opposes the thumb of the hand to all the rest
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 during inside, flexion of the fingers, bringing the elevation of the first finger to the rest of the fingers, rotation of the hand and forearm.

Also, the median nerve innervates the skin on the palmar surface of the first, index and middle hands, as well as parts of the ring fingers, and on dorsal surface brush 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 damage to the median nerve

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

Prolonged work at the computer (using a computer mouse and keyboard)

Most often leads to the development of carpal tunnel syndrome, since this type of activity causes a small chronic injury to the soft tissues of the hand, as well as tendons passing in the carpal tunnel. The reason is the repetitive same type of fast and frequent movements of the hand and arm. As a result, aseptic (not bacterial) inflammation of the tendons that pass in the carpal tunnel occurs, which leads to their edema and infringement by the retainer.

However, studies have shown that not all frequent PC users develop carpal tunnel syndrome. Certain conditions are necessary for its occurrence. For example, people who are most often at risk are those who have III-IV degrees of obesity (due to fat, the lumen of the carpal tunnel narrows), female sex (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, inflammatory response 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, so its lumen narrows.

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

Acute wrist injuries

Become the cause of the development of carpal tunnel syndrome in about 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 large quantity side effects (for example, sleep disturbance, the formation of ulcers in the stomach and intestines). Therefore, they are used with caution, especially in certain diseases (for example, diabetes mellitus). In addition, they suppress the activity of the immune system, so they are not prescribed in the presence of infections.
There is one more bad moment: after the abolition of corticosteroids, the "rebound" syndrome may develop: all symptoms quickly return again.

Local treatment

It is considered the most effective for relieving acute symptoms.

The introduction of medicinal mixtures

It is inserted into the carpal tunnel with a special long needle. medicinal mixture an anesthetic (Lidocaine or Novocaine) with a corticosteroid hormone (Diprospan or hydrocortisone). As a rule, after the introduction of drugs into the cavity of the carpal tunnel, 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, after the first injection, the condition of patients improves. If the symptoms do not disappear completely, then two more procedures are performed with a two-week interval between them.

With a relapse of the disease (the appearance of symptoms again), 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 more than 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 that are performed under local anesthesia:

After the operation, the wrist area is superimposed gypsum bandage for several days. As rehabilitation treatment physiotherapy and physiotherapy(finger movements should be carried out with a fixed wrist).

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

After recovery, the patient can return to their usual activities. However, if you do not change the working conditions (proper arrangement of the workplace, the use of cuts), 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.

With hypothyroidism hormone replacement therapy is prescribed: L-thyroxine, Euthyrox.

With menopause physiological or artificial (removal of the ovaries) for replacement therapy appointed hormonal preparations containing estrogen (female sex hormone). However, such treatment is possible only if the woman's last menstruation was no later than 10 years ago, and she is under 60 years old.

If a menstruating woman 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 in large numbers substances that damage neurons. However, treatment has its own characteristics depending on the type of disease.

Type I diabetes is treated with insulin (short-, long-, or intermediate-acting). The dosage and scheme of application is individual, depending on the severity of the disease and the level of sugar in the blood.

In type II diabetes, hypoglycemic drugs (Glucophage, Metformin) are prescribed, which increase the sensitivity of 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 the 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 (Thiogamma, Berlition) are prescribed to improve tissue nutrition. They improve the uptake of glucose by tissues, bind free radicals (unstable molecules that damage other normal cells in the body), especially the cells of the nervous system.

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

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

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.

With high blood pressure, drugs are used that regulate it: ACE inhibitors(Diroton, Captopril), calcium antagonists (Verapamil) and others.

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

Physiotherapy procedures

They have proven themselves both in the treatment of medicines and during the rehabilitation period after surgery.

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

General contraindications for physiotherapy procedures

Tumor processes
Pregnancy
Severe III degree of heart failure
Any infectious viral diseases in the acute period (presence of elevated body temperature)
Severe diabetes mellitus high numbers Sahara)
Increased arterial pressure- temporary contraindication. After its normalization, the procedure can be carried out.
Presence of a pacemaker
Epilepsy with frequent seizures, hysteria and psychosis
Reduced clotting blood and tendency to bleed
Severe cardiac arrhythmia: severe atrial fibrillation (asynchronous contraction of the ventricles and atria) and severe extrasystole (in this disease, the heartbeat)
The presence of pustular inflammation on the skin (the site of exposure to the device)

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

Ultraphonophoresis

It is performed along with medications.

During the procedure, the impact on the body is carried out using ultrasonic vibrations, which contribute to the penetration medicines inside the cell.

In addition, the effect of ultrasound itself is therapeutic: it dilates blood vessels and accelerates blood flow in the capillaries. Due 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 drugs that ultrasound destroys: novocaine, B vitamins, ascorbic acid and other substances.

Goals - reducing pain and inflammation, accelerating tissue repair.

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 officer wipes the skin area to be treated with a disinfectant solution. Next, a drug is applied to the skin, then an apparatus is applied to the site of exposure, which delivers ultrasonic waves.

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 that perceived by the human ear - infrasound. These waves have a high amplitude of energy and a 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, they begin to disintegrate. bone growths, and new vessels grow at the site of the lesion.

The method is so effective that with the timely start of treatment, it is equated with the result that is available after the operation.

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, hernia and protrusion of the intervertebral discs, heel spur
Stones in the gallbladder and kidneys
Slow healing of fractures
Soft tissue injuries: muscles, ligaments, tendons
Cicatricial contraction of muscles, tendons and ligaments, therefore, free movements (flexion, extension) in the limb are limited
Pain with bruises, fractures, sprains
Burns and trophic ulcers
Chronic muscle pain due to prolonged and frequent overwork

Contraindications

(addition to general)

Age up to 18 years, since the waves act on the growth zones of the bones. Whereas when they are damaged, irreversible changes develop that adversely affect the development of the child's skeleton.

Methodology

The medical officer helps the patient to get comfortable on the couch, then wipes the skin area, disinfecting and degreasing it. Then he adjusts the device depending on the field of application and the disease (there are several programs). Next, he applies a special gel to the skin, after which he applies a sensor to the site of exposure, which sends healing impulses.

The course of treatment is 5-7 procedures, each of which lasts 20-30 minutes. Procedures are carried out with an interval 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 a few months.

On a note

It is impossible to act with shock waves on 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 in last years has increased since the personal computer has firmly entered the life of a modern person. However, the formation of the disease can be prevented.

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

Arrange your workplace
Select the height of the computer desk so that the armrests of the chair are at the level of its surface. In this position, during work (typing or moving a computer mouse), the forearms lie quietly on the table or armrests, and are not in a suspended state. Therefore, the hands are relaxed during work, and the hand in the wrist area does not bend. At the same time, there is no additional load on the canal and the median nerve is not clamped.

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

Try not to strain or pinch. Make sure that the head does not retract between the 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 the movements in them are free. However, if the keyboard is located high, then you have to keep your hands above it in a suspended position. In this position, the load on the carpal tunnel increases. Therefore, it is better to purchase a special hand mat or a tilted keyboard.

Pick up a computer mouse so that it "lies" in the palm of your hand while you work. So the hand gets tired less and 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 mouse pads that have a roller (it is better to choose with a helium filler) at the level of the wrist. In this position, during operation, the carpal tunnel is in a straightened state and is loaded minimally.

The position of the brushes at work

Adjust the angle and height of the monitor

So that during operation the text is at eye level. Since if the monitor is 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.

Repeated sprains and fractures, unusual anatomy of the wrist, arthritis, and some other conditions can reduce the space in the carpal tunnel, thereby increasing the risk of CTS. From accompanying symptoms you can often get rid of at home, but sometimes for complete cure medical assistance is required.

Steps

Part 1

CTS treatment at home

Try not to pinch the median nerve. The carpal tunnel is a narrow tunnel made up of small bones wrists connected by ligaments. This channel protects the nerves, blood vessels and tendons. The main nerve responsible for the movement of the palm and its sensitivity is called the median. Therefore, activities that compress and irritate the median nerve should be avoided, such as frequent flexing of the wrist, lifting heavy objects, sleeping with crooked wrists, and punching hard surfaces.

Watch to wrist watch and the bracelets were loose enough on the wrist - if they were too tight around the wrist, it could irritate the median nerve.
In most cases of CTS, it is difficult to identify a single cause. Typically, CTS is caused by a combination of factors, such as frequent wrist strain combined with arthritis or diabetes.
The anatomy of the wrist can also contribute - in some people, the bones of the carpal tunnel at the same or not quite the right shape.

Stretch your wrists regularly. Stretching your wrists daily can help reduce or eliminate the symptoms of CTS. In particular, stretching the wrists helps expand the median nerve space within the carpal tunnel by stretching the ligaments surrounding the carpal tunnel. The best way stretching both wrists at the same time is to take the “prayer pose”. Place your palms together at a distance of about 15 cm from your chest and raise your elbows until you feel a stretch in both wrists. Hold this position for 30 seconds, then lower your elbows again. Repeat the exercise 3-5 times a day.

Shake your palms. Feeling numb or aching pain in one or both palms (or wrists), shake them well for 10-15 seconds, as if shaking off water from them. In this way, you will achieve a quick, albeit temporary, improvement. This shaking will increase blood circulation and improve blood flow to the median nerve, causing symptoms to temporarily disappear. You can do this exercise, which helps fight the symptoms of CTS, many times a day, literally taking a few seconds off your work.
- Symptoms of CTS most often appear (and first appear) in the thumb, index and middle fingers, as well as in part ring finger. This is why CTS sufferers seem clumsy and often drop objects.
- Only the little finger is not affected by CTS symptoms, since it is not associated with the median nerve.
Wear a special wrist support bandage. This semi-rigid bandage or splint will help avoid symptoms of CTS throughout the day by keeping the wrist in a natural position and preventing it from bending too much. A wrist splint or bandage should also be worn during activities that can aggravate CTS symptoms, such as working at a computer, carrying heavy bags, driving a car, or playing bowling. Wearing a supportive bandage while you sleep can help prevent nighttime symptoms, especially if you have a habit of slipping your palms under you while you sleep.
- You may need a support bandage for several weeks (day and night) in order to noticeably reduce the symptoms of CTS. However, in some cases, the supporting bandage has a negative effect.
- Wrist splints are also helpful if you have CTS and are pregnant, as your hands (and feet) are more likely to swell during pregnancy.
- Support bandages and wrist splints can be purchased at a pharmacy or health supply store.
Consider changing the position in which you sleep. Certain positions can significantly aggravate the symptoms of CTS, reducing sleep duration and quality. The worst posture is one in which your fists are tightly clenched and/or your palms (with arched wrists) are tucked under your body; the posture in which the hands are above the head is also unfavorable. Instead, try to sleep on your back or on your side with your arms close to your body, with your wrists straight and your palms open. Such a posture will ensure normal blood circulation in the wrists and blood supply to the median nerve.
- As noted above, using supportive bandages while you sleep helps prevent misalignment of the hands and wrists, but it will take some time to get used to.
- Don't sleep on your stomach with your hands under the pillow, as this will compress your wrists. Sleeping in this position, people upon awakening often experience numbness and tingling in the palms.
- Most wrist bands are made of nylon and fasten with Velcro, which can irritate your skin. In this case, place a sock or piece of thin cloth under the bandage to reduce skin irritation.
Take a look at your workplace. In addition to poor sleep posture, CTS symptoms can be caused or exacerbated by poor workplace layout. If a computer keyboard, mouse, desk, or chair is placed inappropriately and inconsistently with your height and build, it can put strain on your wrists, shoulders, and mid-back. Make sure the keyboard is positioned so that you don't have to bend your wrists all the time while typing. Get an ergonomic keyboard and mouse designed to reduce the strain on your hands and wrists. Your employer may reimburse the costs.

Take over-the-counter medications. The symptoms of CTS are often associated with inflammation and swelling in the wrist, which further irritates the median nerve and adjacent blood vessels. Therefore, non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Aliv) often help reduce symptoms of CTS, at least in the short term. Pain relievers such as paracetamol (Tylenol, Panadol) can also be taken to relieve pain caused by CTS, but they do not reduce inflammation and swelling.

Part 2
Medical care for CTS
1. Make an appointment with a doctor. If you experience any of the symptoms listed above in your wrist/hand for several weeks or more, you should see a doctor. The doctor will examine you and probably prescribe x-ray examination and blood tests to rule out possible diseases and injuries whose symptoms resemble CTS, such as rheumatoid arthritis, osteoarthritis, diabetes, a stress fracture in the wrist, or problems with the blood vessels.
  
  See a physical therapist or massage therapist.
  
  Try corticosteroid injections. To relieve pain, inflammation, and other symptoms of CTS, your doctor may recommend injections of a corticosteroid drug (such as cortisone) into your wrist or the base of your hand. Corticosteroids are powerful and fast-acting drug, which can relieve swelling in the wrist and relieve pressure on the median nerve. They can also be taken orally, but this is considered to be much less effective than injections and also causes more severe side effects.
  - Other steroid drugs such as prednisolone, dexamethasone, and triamcinolone are also used in the treatment of CTS.
  - Corticosteroid injections can lead to complications such as local infection, profuse bleeding, tendon weakening, muscle atrophy and nerve damage. Therefore, they are usually made no more than twice a year.
  - If steroid injections do not lead to a significant improvement in the condition, surgery should be considered.
2. Carpal tunnel surgery should be considered as a last resort. If other treatments have failed to relieve the symptoms of CTS, a doctor may recommend surgery. Surgery is only used as a last resort because there is a risk of worsening the condition even more, although for many patients, surgery helps to completely eliminate the symptoms of CTS. The purpose of this operation is to relieve pressure on the median nerve by cutting the main ligament pressing on it. In CTS, the operation is carried out with two various methods: endoscopic and open.
  - At endoscopic surgery uses a thin, telescope-like device with a camera on the end (called an endoscope) that is inserted into the carpal tunnel through an incision in the wrist or palm. With the help of an endoscope, the surgeon sees the channel and can incise the ligament pressing on the nerve.
  - Typically, endoscopic surgery results in less pain and less side effects, and promotes faster healing.
  - Unlike endoscopic surgery, open operation involves a larger incision in the palm and wrist in order to get to the problem ligament and release the median nerve.
  - The risks associated with surgery include nerve damage, infection, and scar tissue formation. All this can lead to a worsening of the situation with the SZK.
3. Keep patience during postoperative recovery. During this period, you will be advised to keep your operated arm above heart level and move your fingers more often, which will help reduce swelling and prevent stiffness. Mild pain, inflammation, and stiffness may occur in the palm and wrist for up to six months after surgery, and full recovery may take up to a year. For the first 2-4 weeks after surgery, you will be asked to wear a wrist support, although you will be advised to work your hand.

Carpal tunnel syndrome is a condition that develops as a result of injury or compression of the median nerve located in the carpal tunnel. Sometimes this syndrome is called tunnel syndrome, but this is not quite the right term, because there are other tunnel syndromes. With the development of this disease, there is a violation of the sensitivity and movements of the first three and part of the fourth finger.

In this article, we will introduce you to the causes, symptoms, and treatments for carpal tunnel syndrome. This information will help you make a timely decision about the need for its treatment, and you can prevent the development of irreversible damage to the median nerve.

In the world, carpal tunnel syndrome is detected in 1.5-3% of the population and in half of the cases patients are active computer users. This disease is considered occupational, because people who, due to their professional activity are forced to make frequent and monotonous flexion and extension movements of the hand (for example, office workers who work at the computer for a long time, tailors, musicians, etc.).

This syndrome is more often observed in people 40-60 years old, but can also develop at a younger age. According to statistics, in 10% of cases the disease is detected in people under 30 years of age.

Experts believe that those people who work at the computer for a long time are most susceptible to the development of this syndrome. According to one of the numerous studies, it is detected in every sixth active PC user. According to various sources, the syndrome is 3-10 times more likely to develop in women.

The reasons

The main cause of carpal tunnel syndrome is compression of the median nerve as it passes through the tunnel formed by the transverse ligament and carpal bones. Compression is caused by inflammation and swelling of the joint, tendons, and muscles in the joint itself or inside the carpal tunnel. In most cases, the cause of such damage to the median nerve is work that requires frequent and repetitive movements.

In addition to professional factors, the development of carpal tunnel syndrome can be triggered by other diseases and conditions:

. With bruises or sprains, swelling of the ligaments and muscles of the hand occurs, which causes compression of the nerve. Dislocations or fractures, in addition to swelling of the soft tissues, may be accompanied by displacement of the bones. Such damage compresses the nerve. With proper treatment of a dislocation or fracture, compression is eliminated, but with bone deformity or muscle contractures, joint disorders can become irreversible.
and other rheumatic joint disorders. The inflammation and swelling that occurs with these diseases cause compression of the nerve by the soft tissues of the carpal tunnel. With prolonged progression of the syndrome cartilage tissue the joint ages, loses its elasticity and wears out. Wear and tear of cartilage leads to fusion of joint surfaces and their deformation.
Tenosynovitis (inflammation of the tendons). Tendons are affected pathogenic bacteria and inflame. The tissues in the wrist area swell and compress the nerve. Sources of infection can be: festering wounds on the hands, panaritium, etc. In addition, inflammation of the tendon tissues can be non-bacterial and be caused by chronic stress injuries: frequent movements of the hand and arm, prolonged stress, exposure to cold.
Diseases and conditions accompanied by fluid retention in the body. Swelling of soft tissues (including in the carpal tunnel) can be observed when taking oral contraceptives, pregnancy, kidney pathologies or.
tumor of the median nerve. Such neoplasms are rare. These can be schwannomas, neurofibromas, perineuromas, and malignant tumors sheaths of the nerve. Their growth causes displacement and compression of the nerve.
Diabetes. The course of this disease is accompanied by the accumulation of fructose and sorbitol in nerve tissues. When they are activated by the enzyme protein kinase C, damage to neurons and their processes occurs. In addition, metabolic disorders lead to insufficient blood flow to the nerves and a decrease in their nutrition. All these consequences cause non-infectious inflammation of the nerves (including the median one). Nerves become swollen and can be compressed in narrow areas such as the carpal tunnel.
. This disease develops for a long time and is accompanied by growth to a disproportionate size of the bones of the face and limbs. In addition to bone changes, soft tissue proliferation is observed. Enlargement of the carpal bones causes a narrowing of the lumen of the carpal tunnel, and the median nerve is infringed.
genetic predisposition. Compression of the median nerve can be observed with such anatomical features of the hand as a "square wrist", congenital insufficiency in the production of lubrication by the tendon sheaths, or congenital thick transverse carpal ligament.

Symptoms

The first sign of the disease may be numbness of the fingers.

Carpal tunnel syndrome develops gradually. In most cases, one hand is affected, i.e. "working" (for right-handers - the right, for left-handers - the left). Sometimes nerve compression is observed in both hands (for example, when endocrine disorders or pregnancy).

Paresthesia

Tingling and numbness of the fingers is the first sign of the syndrome. Paresthesias are felt by the patient immediately after awakening, but are completely eliminated by noon. With the development of the syndrome, they begin to appear at night, and then during the day. As a result, the patient cannot long time hold the hand in the air (when putting the phone to your ear, holding the handrail in public transport, etc.). When trying to perform such holdings, paresthesias intensify and the person changes his hand to perform the action (shifts the phone to the other hand, changes its position, etc.).

Pain

Initially, the patient develops pains of a burning or tingling nature. Arising at night, they disturb sleep, and a person has to wake up in order to put his hand down or shake his hand. Such actions contribute to the normalization of blood circulation in the fingers, and pain is eliminated.

Pain does not occur in certain joints, but is widespread. They capture the entire finger - from the base to the tip. In the absence of treatment, pain begins to appear during the day. Any movement of the hand causes their strengthening, and the patient cannot fully work. At severe course pain syndromes can capture the entire palm and spread up to the elbow, making it difficult to diagnose.

Clumsy hand movements and loss of strength

With the aggravation of the syndrome, the patient develops weakness in the arm, and he cannot perform precise movements. It is difficult for him to hold small objects (a needle, a button, a pen, etc.), and such actions are accompanied by a feeling that they themselves fall out of his hand.

In some cases, there is a decrease in the strength of opposition of the thumb to the rest. It is difficult for the patient to take it away from the palm and actively grasp objects.

Desensitization

This symptom appears with a significant lesion of the median nerve. A third of patients complain of a reaction to a sudden change in temperature or cold: a burning sensation or painful numbness is felt in the arm. Depending on the severity of the disease, the patient may not feel a light touch on the hand or prick with a pin.

Amyotrophy

This muscle change appears in the absence of treatment on late stages syndrome. The patient has a visual decrease in muscle size. AT advanced cases there is a deformation of the hand, and it becomes like a monkey's paw (the thumb is brought to a flat palm).

Change in skin color

Violation of the innervation of skin cells leads to a violation of their nutrition. As a result, the skin of the fingers and the area of the hand innervated by the median nerve acquires a lighter shade.

Diagnostics

For the diagnosis of carpal tunnel syndrome, the patient needs to consult a neurologist. The patient examination plan includes special tests, instrumental and laboratory methods.

Tests for carpal tunnel syndrome:

Tinel test. Tapping from the side of the palm in the area of the narrowest part of the carpal tunnel causes the appearance of tingling in the fingers.
Phalen test. The patient should bend the arm as much as possible in the wrist area and hold it like that for a minute. With carpal tunnel syndrome, there is an increase in paresthesia and pain.
Cuff test. Between the elbow and wrist is put on the cuff of the apparatus for measuring pressure. It is inflated with air to significant figures and left in this position for one minute. The syndrome manifests tingling and numbness in areas innervated by the median nerve.
Raised hands test. Hands are raised above the head and held for a minute. With the syndrome, after 30-40 seconds, the patient feels paresthesia in the fingers.

Such tests can be used for preliminary self-diagnosis at home. If during the implementation of even one of them appear discomfort then you need to see a doctor.

To clarify the diagnosis, the patient is assigned the following instrumental methods examinations:

electroneuromyography;
radiography;

To identify the causes of carpal tunnel syndrome (for example, rheumatoid arthritis, diabetes mellitus, autoimmune diseases, hypothyroidism, etc.), the patient may be recommended such laboratory methods diagnostics:

blood biochemistry;
blood and urine tests for sugar;
analysis for thyroid-stimulating hormones;
clinical analysis of urine and blood;
blood test for rheumatic tests (rheumatoid factor, C-reactive protein, antistreptolysin-O);
blood test for CEC (circulating immune complexes);
blood test for antistreptokinase.

Treatment

Treatment of carpal tunnel syndrome always begins with guarding to take the stress off the wrist. In the absence of such measures, therapy is ineffective.

Guard mode for carpal tunnel syndrome:

When the first signs of the syndrome appear, the hand should be fixed with a special fixative. Such an orthopedic product can be purchased at a pharmacy. It allows you to reduce the range of motion and prevent further tissue trauma.
Completely refrain from activities that cause or worsen symptoms for two weeks. To do this, it is necessary to temporarily change jobs and exclude movements that cause increased pain or paresthesia.
Apply cold for 2-3 minutes 2-3 times a day.

The further treatment plan for carpal tunnel syndrome depends on the severity of its symptoms. If necessary, it is supplemented by therapy for the underlying disease that causes compression of the median nerve (for example, rheumatoid arthritis, trauma, hypothyroidism, renal pathologies, diabetes, etc.).

Local treatment

This type of therapy allows you to quickly eliminate acute symptoms and discomfort disturbing the patient.

Compresses

To perform compresses, various multicomponent compositions can be used to eliminate inflammation and swelling of the tissues of the carpal tunnel.

One of the composition options for compresses:

Dimexide - 60 ml;
Water - 6 ml;
Hydrocortisone - 2 ampoules;
Lidocaine 10% - 4 ml (or Novocain 2% - 60 ml).

Such compresses are performed daily. The duration of the procedure is about an hour. The resulting solution of drugs can be stored in the refrigerator for several days.

Injection of drugs into the carpal tunnel

The doctor, using a special long needle, introduces a mixture of solutions into the carpal tunnel local anesthetic(Lidocaine or Novocaine) and glucocorticosteroid hormone (Hydrocortisone or Diprospan). After the introduction of such a composition, pain and other unpleasant sensations are eliminated. Sometimes they can increase in the first 24-48 hours, but after that they begin to gradually regress and disappear.

After the first administration of such a composition, the patient's condition improves significantly. If the symptoms of the syndrome return again after some time, then two more such procedures are performed. The interval between them should be at least 2 weeks.

Medical therapy

The choice of drugs, dosage and duration of their administration depend on the severity of the disease and comorbidities. The drug treatment plan for carpal tunnel syndrome may include the following:

vitamins of group B (B1, B2, B5, B6, B7, B9 and B 12): Milgamma, Neurobion, Neurobeks, Doppelherz active, Benevron, etc .;
non-steroidal anti-inflammatory drugs: Xefocam, Dicloberl, Aertal, Movalis, etc.;
vasodilators: Pentylin, Nicotinic acid, Trental, Angioflux;
: Hypothiazide, Furosemide, Diacarb and others;
anticonvulsants: Gabapentin, Pregabalin;
muscle relaxants (drugs for relaxing muscles): Sirdalud, Mydocalm;
glucocorticosteroids: Metipred, Hydrocortisone, Prednisolone;
antidepressants: duloxetine, venlafaxine.

Physiotherapy

Physiotherapeutic methods of treatment can be used against the background of drug therapy or for the rehabilitation of patients after surgical operation.

The following can be used to treat carpal tunnel syndrome:

acupuncture;
manual therapy techniques;
ultraphonophoresis;
shock wave therapy.

The appointment of physiotherapy procedures is possible only if there are no contraindications to them.

Surgery

Surgery for carpal tunnel syndrome is recommended if other methods of therapy are ineffective and the symptoms of the disease persist for six months. The purpose of such surgical interventions is to expand the lumen of the canal and relieve pressure on the median nerve.

Tunnel neuropathy is a group of diseases that occur due to pinched nerves in their channels. The most common compression of the median nerve passing through the wrist.

Both carpal and treatment are quite easy.

The disease significantly reduces the quality of life. Due to the growing pain, a person can come to nervous exhaustion, irritability, bulimia, anorexia.

(we will also analyze the treatment in detail) is determined by the numbness of 3 fingers (thumb, index, middle) after sleep. With fluid retention in the body, edema occurs, as a result of which the physiological channel on the wrist squeezes the median nerve passing through it, which prevents the nerve impulse from propagating at a normal speed.

Tunnel neuropathy of the hand

The deformation of the canal leads to excessive tension of the tendons and ligaments, the cessation of the supply of nerves. As a result, the tissues of the tunnel swell, thicken or become loose. It rarely happens when the nerve trunk itself swells. It may be caused by poisoning heavy metals, taking antibiotics, vasodilators and diuretics.

Metabolic diseases (diabetes, obesity) and endocrine system(pregnancy, menopause, long-term use of oral contraceptives, hyperfunction thyroid gland) also lead to fluid retention. The disease is promoted by weight loss (due to the depletion of adipose tissue that dampens the nerve), heredity (narrow channels), age after 50 years, diseases of the musculoskeletal system (injuries, operations) and blood. Bad habits impair blood supply to tissues.

The main symptoms of tunnel neuropathy are pain, sensory disturbance and motor function limbs.

At the beginning of the disease, during physical exertion, discomfort may be felt in the affected area of the body, as the bone canal narrows, the following symptoms occur:

soreness at night;
change in skin color;
clumsiness when trying to take something;
tingling in the opposite part of the body from the lesion;
increased pain when "stretching" or tapping on the ligament;
low mobility of the diseased joint;
loss of muscle tone in the area of compression.

Pain can spread over long distances. For example, "goosebumps" in the shoulder or upper back may be due to compression of the suprascapular or ulnar nerve.

If there is no treatment, the skin turns pale, “dries out”, with the pathology of the hand, the hand becomes like a monkey.

1% of the population suffers from carpal tunnel syndrome, it occurs in half of the cases of all other tunnel neuropathies.

Fixation of the wrist joint

With a pathology such as tunnel syndrome, home treatment is primarily based on immobilizing the hand, providing it with complete rest. To do this, use special bandages. An orthosis is put on at night - a device that fixes the hand in an anatomical position. Wear a tire during the day.

All fixation devices maintain maximum joint mobility when it is rigidly fixed in order to achieve its correct position.

Types of wrist clamps:

View	Description	Application	Functionality
Bandage	Miscellaneous glove	Minor joint injury, prevention	Creates slight pressure, distributes the load on the joint, relieves swelling, pain, fixes the joint, or wrist, or fingers, or palm
orthosis	Long glove with thumb lock and straps	In serious cases, treatment of injuries, arthrosis, arthritis, paralysis, osteochondrosis	It relieves the load from the damaged area, pain and swelling, limits movement
Tutor	Long glove to the middle of the palm with finger separators, grips the thumb	Rehabilitation after injuries, treatment, prevention	Promotes blood circulation, tight fixation of the wrist, wrist joint, fingers, relieves pain and swelling

The correct means of fixation will be selected only by a doctor.

There are special gadgets for the wrist joint when working on a computer: vertical mice, silicone toys placed under the wrist when manipulating the mouse.

Medical treatment

The therapy has 3 goals: removal of inflammation, reduction of edema, prevention of aggravation of the situation.

Most often, the following groups of drugs are used: painkillers, non-steroidal anti-inflammatory drugs (Nimesulide, Ibuprofen, Ketolorac), stabilizing immune system intravenous injections of calcium chloride, which improve blood circulation in the area of nerve compression and the conduction of nerve impulses vitamins.

Ibuprofen

The most effective method is local administration of the medicinal substance. With the help of a needle, the de-edema molecule is injected directly into the tunnel. Inflammation, pain and numbness go away. 3-5 blockades every other day gives a very long-lasting effect.

Carpal syndrome is observed at the age of 30-45, more often in women, because. their wrists are thinner.

Change of professional conditions

Nerve entrapment is often associated with professional or sports activities. For remission, it is important to exclude the same type of movement. Sometimes this is the only way to return to a full life.

It is necessary to carry out all the usual actions with a healthy hand, and the patient should be loaded to a minimum. Need to sleep on healthy side so that the affected area of \u200b\u200bthe nerve "rests".

Patients will have to change jobs or hobbies. You can not work in professions that require monotonous flexion and extension movements (tennis player, painter, guitarist, violinist, cellist, pianist, stenographer, hairdresser, sign language interpreter, driver, programmer), as well as those associated with increased injury (bodybuilder, loader, bricklayer), not get involved in knitting.

The most common cause development of carpal tunnel syndrome - work with a computer mouse.

Steroid injections

The introduction of drugs based on glucocorticosteroids (Prednisolone, Hydrocortisone) - synthetic adrenal hormones - is used in advanced cases. Injections are carried out directly into the nerve canal. However, hormones have more side effects than non-steroidal anti-inflammatory drugs.

Sometimes steroids are used in the form of an ointment.

Treatment at home

Treatment of carpal tunnel syndrome at home is to perform the following simple exercises:

clench into a fist and unclench your fingers with force;
squeeze the ball
rotate fists in both directions;
put your palms together, spread your elbows to the sides. Lower the palms as low as possible, without opening them and without taking them far from the body;
spread your arms in front of you, "hanging" the brush, and press one palm on the other.

Rubbing the affected area relieves pain, shaking the hands helps with hand syndrome.

In advanced cases, the following exercises are suitable:

leave an alcohol compress on the wrist overnight;
hand massage with outside palms to the outside of the forearm;
put your hands in hot water on the wrist, clench into fists and rotate them under water for 10-15 minutes. Then wrap your hands in a towel until dry.

Treatment of tunnel syndrome with folk remedies is based on the use of the following recipes:

mix diced 3 pickles and 3 pods of hot pepper, pour 0.5 liters of water and leave in a dark place for a week. Strain the infusion and rub it on the wrist;
50 g of 10% ammonia and 10 g camphor alcohol dissolve in 1 liter of water. Rub sore spots;
1 tbsp parsley root pour 0.5 liters of boiling water and leave overnight. Drink throughout the day in a sip to reduce swelling.

With a pathology such as carpal tunnel syndrome, treatment with folk remedies is only an addition to the recommendations prescribed by the doctor, but does not replace them.

Surgical intervention

Surgical treatment of carpal tunnel syndrome is prescribed when, after 6 months traditional therapy did not bring results, as well as in cases of injury, fracture.

The operation is carried out under general anesthesia about an hour. The doctor cuts the transverse ligament of the wrist and removes tissue compressing the nerve.

Modern endoscopes allow the operation to be performed without a large incision.

This cardinal method is not without drawbacks: it is impossible to predict in advance how effective the treatment will be.

In 2-3% of cases, after surgery, there is an increase in symptoms.

Recovery

The postoperative recovery period lasts up to 3 months. The patient may feel slight pain, stiffness, swelling of the hand. To avoid these consequences, the doctor develops an individual program for normalizing the functioning of the hand. During this period, it is important to eat right and exercise.

Long term results

Recovery can take up to a year and depends on the severity of the disease.

The good news is that the disease does not spread beyond the affected area.

Correction of the tunnel syndrome is impossible without the active participation of the patient, his desire to be cured and the efforts made.

Therefore, only drugs and physiotherapy can not do.

If the treatment of carpal neuralgia is not started in time, a complete loss of the functions of the hand is possible.

carpal tunnel syndrome

tunnel syndrome wrist (carpal tunnel syndrome) is a complex of symptoms caused by compression of the median nerve in the carpal tunnel. Accompanied by numbness of the fingers and weakness of the hand.

The carpal tunnel is quite narrow. The lower and two side walls form the bones of the wrist. Top part The tunnel is covered by a dense carpal ligament (transverse carpal ligament).

The median nerve passes through the carpal tunnel and the flexor tendons of the fingers. The median nerve carries sensory branches to the first three fingers and half of the fourth, as well as motor branches to the short muscles of the first finger.

Causes of carpal tunnel syndrome

Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist become swollen and put pressure on the median nerve. These tissues are called synovial membranes. Synovial membranes produce a fluid that lubricates the tendons, facilitating their movement in the tendon sheaths.

Many things contribute to the development of carpal tunnel syndrome:

Heredity is the most common factor in carpal tunnel syndrome.
Hormonal changes associated with pregnancy or menopause can cause water retention in the synovial membranes.
Age - the disease is more common in women after 50-55 years.
Some systemic diseases can be the cause. Such as diabetes mellitus, rheumatoid arthritis, thyroid dysfunction.

Fragment of the program "Health". Tunnel Syndrome (from Youtube.com)

Other factors that can lead to carpal tunnel syndrome include:

A fragment of the program "Miracle of Technology" (from Youtube.com)

Rheumatoid arthritis
Fractures of bones and arthrosis of the joints of the wrist
Cysts or tumors that grow in the area of the carpal tunnel
infections

Signs and symptoms of carmal tunnel syndrome:

Symptoms of Carpal Tunnel Syndrome may appear at any time. Finger numbness often occurs during sleep. During the day, symptoms often occur when the patient is holding something in their hand: a phone, or while reading a book, or while driving. Changing hand positions or shaking helps reduce symptoms.

Symptoms initially come and go, but they can become permanent over time. Feelings of awkwardness or weakness can limit fine finger movements such as buttoning a shirt, tying shoelaces, etc. This condition may affect the professional activities of the patient.

During the examination, the doctor may determine:

Numbness in the palms thumb, index, middle finger and half of the ring finger.
Tapping over the carpal tunnel area usually results in "shooting" in the fingers (this is called Tinel's sign)
Maximum wrist flexion for 60 seconds usually results in numbness, tingling, or weakness (called the Phalen test)

Additional diagnostic methods:

ElectroNeuroMyography (ENMG)
Nerve conduction velocity
An x-ray of the wrist joint is performed to exclude other diseases (eg, arthrosis, the consequences of injuries)

Treatment of carpal tunnel syndrome

There are the following treatments for carpal tunnel syndrome (carpal tunnel syndrome):

1. Conservative treatment

If the disease is diagnosed and treated for early stages, tunnel syndrome can be stopped without surgery.

If a conservative methods not effective within 6 months, recommended surgery carpal tunnel syndrome.

2. Surgery

The decision to have surgery is based primarily on the severity of the symptoms.In more severe cases, surgery is done right away because conservative carpal tunnel treatments are unlikely to help.

There is a traditional method of operation - "open", when the skin is cut directly above the carpal ligament. And there is a minimally invasive technique that is performed through a mini access using a camera and special tools.

Surgical technique.In most cases, the operation is performed on an outpatient basis.conditions under local anesthesia.

During the operation, the carpal ligament (transverse carpal ligament) is dissected, thereby decompressing the median nerve.

Recovery.Minor pain, swelling, and stiffness in the hand can be expected after surgery. To reduce possible postoperative consequences, individual rehabilitation programs will be developed for you, including whole complex measures for the qualitative restoration of the function of the brush.

Minor pain in the palm usually persists for several months after surgery. This is the time the nerve fibers need to recover.

Driving a car, your daily activities can be resolved by the doctor just a few days after the operation. The doctor will also determine when you can return to work.