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Definition of concepts, terminology

Tunnel Syndromes

Tunnel syndromes (tunnel neuropathies) are a group of lesions of peripheral nerves due to prolonged compression and trauma in the musculoskeletal canals by chronically inflamed surrounding tissues. There are tunnel syndromes of damage to the nerves of the arms, legs, torso, neck.

Very often, "carpal tunnel syndrome" is called carpal tunnel syndrome, which is not entirely true - this is just one of the many tunnel syndromes that has received the greatest fame. Even in the wrist area, other tunnel syndromes are distinguished, for example, compression syndrome of the deep branch of the ulnar nerve.

carpal tunnel syndrome

The most common and well-known carpal tunnel syndrome is carpal tunnel syndrome (CTS). compression of the median nerve (Latin nervus medianus) under the transverse ligament of the wrist. Nerve compression occurs between three bony walls and a tight ligament that holds the tendons of the muscles that flex the fingers and hand.

Carpal tunnel syndrome is more common in women than in men (3-10 times according to various sources). The peak incidence occurs between the ages of 40 and 60 years (although the disease can occur at any age, only 10% of those suffering from this disease are under 31). The risk of developing carpal tunnel syndrome is about 10% in a lifetime, 0.1-0.3% per year in adults. The overall prevalence of the syndrome is up to 1.5-3%, and the prevalence among certain risk groups is up to 5%. The syndrome is more common in representatives of the Caucasian race, in some African countries it practically does not occur.

Chronic Repetitive Strain Injury (RSI)

In English texts, the concept of carpal tunnel syndrome is often identified with the concept of chronic repetitive strain injury (RSI; the term has many synonyms: repetitive stress disorder, cumulative trauma disorder, occupational overuse injury, etc.). In fact, RSI is a much broader group of diseases, and some authors even exclude carpal tunnel syndrome from it (eg Dennis L. Ettare).

Diseases of this group are found in many professions, including in such industries as construction, mining, engineering, and agriculture. They are caused by chronic functional overstrain, microtraumatization, performance of fast movements of the same type.
In particular, such diseases of a professional nature, in addition to the "acclaimed" carpal tunnel syndrome, include:

• myositis (inflammation of the muscles) and crepitant tendovaginitis (inflammation of the tendon sheaths with a characteristic crunch)
• stenosing tendovaginitis (de Quervain's disease)
• stenosing ligamentitis
• snap finger
• styloiditis (inflammation of the styloid process of the radius)
• bursitis (inflammation of the joint bags)
• epicondylitis of the shoulder (inflammation of the condyle humerus, more often external, the so-called "tennis elbow")
• deforming osteoarthritis of the joints of the hand (gradually increasing deformation of the bones and joints)
• periarthrosis of the shoulder joint dystrophic changes soft tissues of the shoulder near the joint)
• osteochondrosis of the spine (damage to the intervertebral discs and other tissues of the spine)
• diseases nervous system overvoltage

Professions in which chronic repetitive hand movements are observed are characterized by de Quervain's disease and stenosing ligamentitis.

Stenosing tendovaginitis

Chronic stenosing tendovaginitis (synonym: de Quervain's disease, French de Quervain, named after a Swiss surgeon) is a peculiar form of chronic inflammation of the tendon sheaths, which is characterized by muscle tendon damage thumb brushes. In this case, the tendon sheath thickens, and the gap between the sheath and the tendon, filled with fluid to reduce friction (synovial cavity), narrows. This disease is characterized by pain during abduction and extension of the thumb, which can radiate to the forearm and shoulder, swelling along the affected tendons.

Stenosing ligamentitis

Close to de Quervain's disease clinical manifestations stands stenosing ligamentitis of the fingers - reactive inflammation of the ligamentous apparatus of the hand. It can occur both with repetitive trauma and with some infectious diseases (for example, with influenza). Ligaments between the phalanges of the fingers and near the joints connecting the fingers to the metacarpus are usually affected. This disease is characterized by inflammatory changes in the area of ​​the affected ligaments (pain on movement, swelling, swelling, redness and local increase in skin temperature). It is even possible necrosis of the ligaments with a violation of the sliding of the tendon and difficulty in flexing and unbending the finger with a characteristic clicking (the so-called "snapping finger"). Carpal tunnel syndrome in a large number of cases is also actually a ligamentitis, but in the area of ​​the wrist, and with a characteristic neurological picture.

Carpal tunnel anatomy

carpal tunnel

The carpal tunnel is located at the base of the hand and is surrounded by three parties bones of the wrist, and in front - the transverse ligament of the wrist. The median nerve, flexor tendons of the fingers and hand, as well as the synovial membranes of these tendons, pass through this canal.

The synovial sheath of the tendon connective tissue surrounding part of the tendon. In the gap between this sheath and the tendon, there is a small amount of lubricant to reduce friction (synovial fluid), which is produced by synovial cells (lining the sheath cavity from the inside).

Transverse carpal ligament

The transverse ligament of the wrist is a strong strand of dense connective tissue, which is attached on one side to the ulnar, and on the other - to the radial eminence of the wrist. This ligament also has a different name: "retainer of the tendons of the flexor muscles" (Latin retinaculum flexorum). It transforms the carpal sulcus into a carpal tunnel, in which the flexor tendons of the fingers and the median nerve pass.

median nerve

The median nerve (lat. nervus medianus) is one of three main nerves of the hand (the other two are the radial and ulnar nerves). It comes from the brachial plexus. On the hand, this nerve brings sensory fibers to the skin of the tubercle of the thumb, the palmar surface of the thumb, index, middle and half ring fingers and fibers of internal sensitivity to some muscles of the hand (responsible for coordinating movements with these muscles), motor fibers to these muscles of the hand, as well as vegetative fibers to local arteries (affects the narrowing and expansion of blood vessels, for example, depending on temperature) and sweat glands.

Etiology and pathogenesis

Possible the following reasons carpal tunnel syndrome:

• Activities that require repeated flexion/extension of the hand or are accompanied by exposure to vibration (for example, assembling machinery).
• Swelling or injury of any kind (such as fractures) that compresses the median nerve.
• Compression of the median nerve with edema in pregnant women or women taking contraceptives.
• There is a strong relationship between excessive body weight and the presence of carpal tunnel syndrome. In addition, people of short stature are more prone to the disease.
• Acromegaly, rheumatoid arthritis, gout, tuberculosis, kidney failure, decreased thyroid function, early post-menopause (and post-ovarian removal), amyloidosis, possible association with diabetes mellitus.
• The syndrome is characterized by a genetic predisposition, in part due to multiple inherited characteristics (eg, square wrist, transverse ligament thickness, build).

Carpal tunnel syndrome is caused mainly by compression of the median nerve at the wrist due to thickening or swelling of the synovium of the flexor muscles. As a result of chronic inflammation of the connective tissue due to constant repetitive stress, it becomes rougher, thicker, swollen, which increases the pressure inside the carpal tunnel. High blood pressure causes venous stasis, edema, which leads to ischemia (impaired blood supply) of the nerve.

First, damage occurs to the sensory, and only then - to the motor fibers of the nerve. It is also possible damage to the fibers of the autonomic nervous system (responsible for sweating, expansion / narrowing of blood vessels, etc.).

Cold exposure plays a role in the development of carpal tunnel syndrome. According to Irenio Gomes et al., the frequency of diagnosis of carpal tunnel syndrome was significantly higher in the cold season.

Prolonged typing and carpal tunnel syndrome

Carpal tunnel syndrome has traditionally been considered an occupational disease for activities that require repeated flexion/extension or twisting of the hands, or accompanied by exposure to vibration. It is widely believed that prolonged daily computer work that requires constant use of the keyboard is a risk factor for developing carpal tunnel syndrome.

Row scientific research indicates the absence of significant differences in the incidence of this syndrome in the group of constantly working with the keyboard when compared with general population. Simply put, carpal tunnel syndrome is not usually the result of prolonged keyboard work.

At the same time, Liu et al draw different conclusions based on their own research, and claim that carpal tunnel syndrome occurred in one in six computer users they examined. According to them, those users who, when working with the keyboard, are at greater risk of being extended by 20 ° or more in relation to the forearm.

Diagnostics

Clinical picture

As a rule, carpal tunnel syndrome is manifested by numbness, paresthesias (tingling, burning sensations, etc.) and pain in the region of innervation of the median nerve. These symptoms may or may not be accompanied by objective changes in the sensitivity and muscle strength of the tissues of the hand, the innervation of which is provided by the median nerve.

Main complaints:

• Numbness and tingling. Most often, patients complain of hands "turning off" or that objects fall out of their hands unwillingly, as well as numbness and a "tingling" sensation on the skin of the hand, usually in the thumb, index, middle, and sometimes in the ring fingers of the hand. Symptoms tend to be intermittent and associated with certain activities (eg, driving, reading a newspaper, drawing). Due to the resulting numbness and pain, the patient sometimes cannot hold on to the upper handrails in public transport; talking on the phone for a long time, because of which he has to shift the phone to the other hand; hold the steering wheel of the car for more than 10 minutes while driving; read a book or newspaper, holding them in front of you, etc.
• Pain. The above sensitivity disorders are often accompanied by pain sensations of a burning nature on the palmar surface of the wrist and in 1-3 or 1-4 fingers. The pain may radiate ("radiate") towards the palm and fingers, or, more commonly, towards the palmar surface of the forearm. Pain in the area of ​​the epicondyles of the elbow joint, shoulder or neck is more often associated with other lesions of the musculoskeletal system, which are sometimes combined with carpal tunnel syndrome.
• The place where the symptoms are felt. Complaints usually concern the palmar surface of the first to fourth fingers and the palm adjacent to them (which corresponds to the zone of innervation of the palm by the median nerve). If the numbness occurs mainly in the little finger or extends to the back of the hand, this indicates another disease. In many patients, numbness spreads higher due to damage to the autonomic nerves.
• Night symptoms. Carpal tunnel syndrome is characterized by nocturnal onset of symptoms that may wake the patient, especially if the patient is able to relieve them by shaking the hand and wrist. The patient may be relieved by lowering and rubbing the hands, waving them in the lowered position. There may be a feeling of stiffness in the fingers of the hands in the morning.
• Side of defeat. Bilateral involvement is common, although the dominant hand (i.e. right hand in a right-hander, left in a left-hander) is usually affected earlier and more severe degree than the second hand.
• Vegetative symptoms. Often, patients have complaints about the entire hand. Many patients with carpal tunnel syndrome also report a feeling of tightness and swelling in the hands and/or changes in temperature (i.e. persistently hot or cold hands). This is due to local dysregulation of vasoconstriction/dilation. A number of patients develop sensitivity to changes in ambient temperature (more often with cold temperature) and skin discoloration. V rare cases there are local disorders of sweating. All these symptoms are associated with damage to the autonomic fibers (the median nerve carries the autonomic fibers for the entire hand).
• Weakness / inaccuracy of movements. Patients with carpal tunnel syndrome experience loss of hand muscle strength (particularly when gripping with the thumb); however, in practice, loss of feedback due to sensory disturbance and pain are more important causes of weakness and inaccuracy of movement than loss of motor function as such. At the same time, the coordination of movements and the strength of the hand are disturbed ("everything falls out of hand").

Objective signs

Tinel's symptom - tapping over the passage of the nerve causes a sensation of tingling in the fingers.

Phalen's test - passive flexion and extension of the wrist in the wrist joint increases sensations of numbness, tingling and pain. Some authors express doubts about its diagnostic value.

Cuff test - when applying a cuff to measure blood pressure above the place of compression, pumping it up to the level of normal systolic blood pressure and holding for 1 minute in the presence of carpal tunnel syndrome, paresthesias appear in the zones that supply this nerve.

"Square wrist" - predisposing to the development of carpal tunnel syndrome anatomical feature structures of the wrist. It represents an increase in the anteroposterior size of the wrist in relation to the medial-lateral (i.e., approaching the "square" cross-sectional shape).

At objective research there may be a violation of the abduction of the 1st finger of the hand and a decrease in pain sensitivity.

Additional research methods

Additional research methods are also used, in particular electromyography - the study of muscle contractions depending on the level of electrical stimulation. An electromyographic study allows you to objectively determine the localization of a nerve lesion, in particular, to identify another cause other than compression in the carpal tunnel.

Complications

Carpal tunnel syndrome, if left untreated, can lead to complete, irreversible damage to the median nerve, followed by severe impairment of hand function.

Prevention

Scientific research in the field of prevention

Lincoln et al published a review article in 2000 on twenty-four method studies primary prevention(i.e. prevent the occurrence of) carpal tunnel syndrome. They distinguish the following groups of methods for preventing the occurrence of this disease:

• engineering solutions (alternative designs of keyboards, computer mice, wrist rests, keyboard attachment systems, etc.);
• personal solutions (ergonomics training, wearing a support splint on the wrist, electromyographic feedback systems, exercises during work, etc.);
• multi-component solutions, or "ergonomic programs" (workplace redevelopment, accounting for ergonomics in the workflow, periodic change of activity within the position, ergonomic training and load limits).

Multicomponent programs have been associated with a reduction in the incidence of carpal tunnel syndrome, but the results are inconclusive because potential confounding factors have not been adequately considered. Some of the engineering solutions positively affected the risk factors associated with carpal tunnel syndrome, but these studies did not measure incidence. None of the "personalized" decisions were accompanied by significant changes in symptoms or risk factors. The authors concluded that none of the studies they reviewed had strong evidence that these solutions prevent carpal tunnel syndrome in workers.

Many popular sources on carpal tunnel syndrome include different kind recommendations for the prevention of carpal tunnel syndrome. Usually these recommendations are based on "common sense" and ideas about the pathogenesis of the disease and do not refer to evidence-based studies. However, even if these tips are useless for the prevention of the disease in question, they are unlikely to bring any harm.

The main tips from the field of ergonomics and exercises can be classified into the following groups:

1. Correct hand position. These include: the direct position of the hand in relation to the forearm, avoiding the extensor position of the hand, the right angle of the bend of the arm at the elbow joint, the presence of an emphasis for the hand (the hand should lie on the table, and not be in a position suspended in the air).

2. Correct fit, posture and location of the workplace: there should be a right angle between the lower back and hips. Typed text should be at eye level to prevent bending of the neck during work (sometimes it is advised that upper edge the monitor was located at eye level, or no more than 15 centimeters lower). You should sit, leaning on the back of the chair, with relaxed shoulders. Feet should be firmly planted on the floor or on a footstool.

3. Periodic breaks in work. It is advised to take a break, for example, every 30-60 minutes for 3-5 minutes.

4. Exercises for the hands (for example, they can be performed during breaks): shaking the hands, clenching the hands into a fist for a few seconds, rotational movements of the fingers, massaging the fingers of the other hand, bringing the shoulder blades together, deep breathing etc.

5. Tips for choosing furniture, keyboards, mice. It is recommended that the work chair be height-adjustable, have a comfortable backrest and armrests. Pressing the keyboard buttons should not require additional effort. Hands and wrists during work should remain relaxed. There are studies stating that the use of a mouse carries a greater risk for the occurrence of this disease, so some authors advise replacing the mouse with a trackball. It is advised to use all kinds of brush holders for the keyboard and mouse pad. Some people recommend keeping the mouse as close to the keyboard and torso as possible to minimize shoulder movement. While holding the mouse, the hand should be as relaxed as possible. Some people cut the mouse pad in half to restrict mouse movement. Various "alternative" ergonomic designs for keyboards and mice are often promoted.

Treatment

Treatment of carpal tunnel syndrome should be started as early as possible and under medical supervision. The underlying causes, such as diabetes or arthritis, should be treated first. Without treatment, the course of the disease tends to progress.

Drug therapy

In some cases, various medicines can relieve the pain and inflammation associated with carpal tunnel syndrome. Non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and other over-the-counter pain relievers can relieve symptoms that are recent or brought on by strenuous activity. Oral diuretics help reduce swelling. Perhaps the introduction of corticosteroids (prednisone, hydrocortisone) or lidocaine ( local anesthetic) by injection directly into the wrist or (for corticosteroids) by mouth to relieve pressure on the median nerve and provide rapid temporary relief in individuals with mild or intermittent symptoms. (Caution: Individuals with diabetes, as well as those who may be predisposed to diabetes, should be aware that long-term use corticosteroids complicates the selection of the dose of insulin. Corticosteroids should not be taken without a doctor's prescription.) In addition, some studies show that vitamin B6 (pyridoxine) preparations can relieve the symptoms of carpal tunnel syndrome.

Non-drug conservative therapy

Initial treatment generally consists of limiting weight bearing on the affected hand and wrist for at least 2 weeks, avoiding activities that may aggravate symptoms, and immobilizing the wrist with a splint to prevent further injury from twisting or flexion. If present inflammatory response, then ice packs can be used to relieve swelling.

Physical exercise

For those patients whose symptoms have improved, stretching and strengthening exercises may be helpful. Such exercises can be supervised by a physiotherapist who is trained in the use of exercises to treat physical injuries, or an occupational health professional who is trained in examining patients with physical injuries and helping them learn skills to improve their own health and well-being.

Alternative Treatments

Some patients confirm that they have been helped by acupuncture, manual therapy, chiropractic, but the effectiveness of these techniques remains unproven by scientific methods. An exception is yoga, which has been shown to reduce pain and improve grip strength in patients with carpal tunnel syndrome.

Surgery

Carpal tunnel release is one of the most common surgical procedures performed in the United States of America. Surgery is usually recommended if symptoms last more than 6 months, and surgery involves cutting the bundles of connective tissue surrounding the wrist to relieve pressure on the median nerve. The operation is performed under local anesthesia and does not require a long stay in the hospital (in the US it is performed on an outpatient basis). Many patients require surgery on both hands. There are two types of carpal tunnel opening surgery:

1. Open surgery, a traditional intervention used in the treatment of carpal tunnel syndrome. It consists in making an incision up to 5 cm long on the wrist, after which the carpal ligament is cut to increase the volume of the carpal tunnel. The operation is usually performed under local anesthesia in outpatient settings unless there are exceptional medical circumstances.

2. It is believed that endoscopic intervention allows to achieve a faster recovery of function and less postoperative discomfort compared to traditional open canal opening surgery. The surgeon makes two incisions (about 1-1.5 cm each) on the wrist and palm, inserts a camera connected to a special tube, and examines the tissue on the screen, after which it dissects the ligament of the wrist. This endoscopic surgery, performed through two punctures, is usually performed under local anesthesia, is effective and is accompanied by minimal scarring and little or no pain in the scar area. There are also methods for performing endoscopic intervention for carpal tunnel syndrome through a single puncture.

Although relief of symptoms may occur immediately after surgery, full recovery after intervention on the carpal tunnel can last for months. Some patients may experience infection, nerve damage, stiffness, and pain in the area of ​​the scar. Sometimes, due to the dissection of the ligament of the wrist, there is a loss of strength. To restore strength, patients should undergo physical therapy in postoperative period. Some patients require a change in appearance labor activity or even change jobs while recovering from surgery.

Recurrence of carpal tunnel syndrome after treatment is rare. Usually, 80-90% of patients completely get rid of the symptoms of the disease after dissection of the transverse carpal ligament. In some cases, during the operation, neurolysis is performed - excision of scarred and altered tissues around the nerve, as well as partial excision of the tendon sheaths.

Sometimes, with prolonged and severe compression of the nerve, irreversible damage occurs. In these cases, the symptoms of the disease may persist and even intensify after surgery. In some cases, annoying pain may be due to the presence of tendovaginitis or arthritis of the joints.

Controversial status as an occupational disease in several countries

In addition to the popularity of coverage of carpal tunnel syndrome as an occupational disease in the United States, similar movements are emerging in other countries. In Australia, regulations were passed in the early 1980s establishing the status of carpal tunnel syndrome as a occupational pathology(in Australia, "repetitive strain injury" was commonly referred to - "chronic injury from repetitive stress", abbreviated as RSI). Subsequently, from 1983 to 1986, an "epidemic" of RSI was noted. Growing skepticism about the accuracy of the diagnosis of RSI has led to widespread public debate regarding the influence of social and psychological factors on the occurrence and diagnosis. After Supreme Court Australia dismissed the claims of the plaintiffs, not finding signs of RSI in the worker (case Cooper vs Commonwealth of Australia), the frequency of detection of RSI decreased significantly. For example, the number of reported cases of RSI in South Australia dropped from 1000 cases in 1984-1985 to 600-700 in 1986-1987. Some attributed the decline to the mentioned court decision, while others attributed the decline to improvements in workplace ergonomics.

During the last years of the Clinton presidency, OSHA (Occupational Safety and Health Administration, occupational safety and Occupational Health and Safety) proposed an ergonomics improvement program that was to cover 102 million jobs and made employers responsible for employees who presented with work-related injuries of the musculoskeletal system, obliging employers to provide free medical care, limit workload, wage reimbursement; and ergonomic modification of workplaces. This new ergonomic initiative has generated considerable controversy. The proposed standard was resisted by the business community; according to them, the new rule defined "production-caused lesions of the musculoskeletal system" too vaguely, creating the basis for fraud. Although the Clinton administration estimated the cost of the program at only US$4.5 billion, business lobbyists have argued that it would cost the budget more than US$100 billion to adopt the changes required by the ergonomics program. Intense business lobbying led to the proposed ergonomics program being rejected by Congress in March 2001.

Sources of information and links

1. Large medical encyclopedia 3rd ed., Article "Tunnel Syndromes" (T. 25, p. 458); article "Tendovaginitis" (T. 24, p. 539).
2. Carpal tunnel syndrome, article in the English version of Wikipedia.
3. Carpal Tunnel Syndrome. Article by Jeffrey G. Novell, MD, Mark Steele, MD. The article contains a concise description of background clinical information about the disease, written by a medical specialist in emergency care.
4. Carpal Tunnel Syndrome. Article by Nigel L. Ashworth. Another help article on carpal tunnel syndrome written by a physiotherapist.
5. The frequency of carpal tunnel syndrome in computer users at a medical facility J. Clarke Stevens et al. Neurology 2001; 56:1568-1570. Article about statistics occurrence of the disease.
6. Computer Use and Carpal Tunnel Syndrome. A 1-Year Follow-up Study. Johan Hviid Andersen et al. Study of the relationship between carpal tunnel syndrome and computer work.
7. Relationship between carpal tunnel syndrome and wrist angle in computer workers. Liu CW et al. Kaohsiung J Med Sci. 2003 Dec;19(12):617-23. Study of factors contributing to the development of carpal tunnel syndrome when working on a computer.
8. Seasonal distribution and demographical characteristics of carpal tunnel syndrome in 1039 patients. Irenio Gomes et al. Arq. Neuro-Psiquiatr. vol.62 no.3a Sao Paulo Sept. 2004 Article about the study of the statistical patterns of the occurrence of the disease.
9. Association of occupational and non-occupational risk factors with the prevalence of self-reported carpal tunnel syndrome in a national survey of the working population. Shiro Tanaka et al. American Journal of Industrial Medicine, Volume 32, Issue 5 , Pages 550 - 556
Study of risk factors for the development of carpal tunnel syndrome.
10. Tunnel neuropathy. A review article on tunnel neuropathies, written in a fairly simple language, with illustrations.
11. Interventions for the primary prevention of work-related carpal tunnel syndrome. Lincoln LE et al. Am J Prev Med. 2000 May;18(4 Suppl):37-50. Efficiency Study various methods prevention of carpal tunnel syndrome.
12. Carpal tunnel syndrome (CTS) or carpal tunnel syndrome (CTS). "Popular science" article about carpal tunnel syndrome. Includes advice on prevention.
13. Tunnel syndrome or carpal tunnel syndrome. Another popular science article with tips and exercises.
14. Carpal Tunnel Syndrome - Prevention. An overview of the prevention of carpal tunnel syndrome, including prolonged use of the computer.
15. Occupational diseases due to overvoltage of individual organs and systems. Brief descriptions various kinds diseases associated with chronic trauma.
16. "Computer" pain. An article about the harmfulness of the wrong posture and ergonomics in a popular science style (albeit with elements of advertising "own development").
17. Clinical study. Basic principles for diagnosing tunnel neuropathies. Review article on tunnel neuropathies.
18. Brachialgia. G. R. Tabeeva. A review article on the various causes of arm pain.
19. Carpal Tunnel Syndrome Fact Sheet. Useful information about carpal tunnel syndrome in questions and answers.
20. Diseases of the periarticular tissues of the hand area. A. G. Belenky. A review article on diseases of the tissues surrounding the joints of the hand.
21. Carpal Tunnel Syndrome As an Occupational Disease. Stephanie Y Kao. An article on the status of carpal tunnel syndrome as an occupational disease.

Carpal tunnel syndrome is a neuralgia of the carpal nerve, which is called carpal tunnel syndrome, carpal tunnel syndrome, carpal tunnel syndrome or carpal tunnel syndrome.

The carpal nerve is a kind of neural cable emanating from the carpal ganglion, which is a connection of all the nerves of the lower part of the arm to one point of the wrist ganglion for the transmission of generalized signals. The carpal nerve passes at the beginning of the hand through a tunnel of three carpal bones and a transverse tendon ligament with the fourth. Together with the carpal nerve, the flexor tendons of the fingers pass through this place.

The carpal nerve is also one of the central main nerves of the hand (there are only three of them, there are also radial and ulnar nerves), which runs through the entire arm to the nerve plexus in the shoulder.

The carpal nerve is responsible for the sensitivity of the longitudinal middle of the palm from the thumb to the middle of the ring finger and for controlling the movements of the hand and the secretion of sweat glands. Roughly speaking, this nerve is responsible for the manipulation of the hand. Each hand has its own carpal nerve.

Tunnel syndrome or tunnel syndrome is a syndrome of neuralgia of nerves caused by their compression or injury by the surrounding muscles, tendons or musculoskeletal canals, as well as inflammation of the nerve canal from the surrounding tissues of the body.

The carpal tunnel is the opening or pathway for the passage of the nerve from the forearm to the fingers, through the wrist. In other words, this is the channel through which the neurons that make up the median nerve, also known as the carpal nerve, pass.

Carpal tunnel syndrome is a disease of the median nerve - neuralgia or neuritis.

Nerve neuralgia is a sharp pain caused by atypical irritation of the nerve, which can be caused by its squeezing, clamping, inflammation of the surrounding tissues, as well as the nerve itself, prolonged exposure cold, salt deposits in nearby tissues, toxins and allergic reactions. This disease does not carry changes or damage to the nervous tissue, but only causes severe anguish with impaired functioning of the nerve itself.

Neuritis is a severe complication of neuralgia or an independent disease that leads to the death of neurons, and sometimes the entire nerve.

This ailment can be unilateral, if it affects one arm, and bilateral, when two nerves of both arms hurt.

Complications of the disease are represented by the possibility of damage to the nervous tissue with the possibility of its complete atrophy.

Symptoms

In carpal tunnel syndrome, the symptoms are typical signs neuralgia or neuritis, manifested in the initial stages by tingling like small needles or nettle burning, gradually turning into pain in the first three to four fingers of the hand, starting with the thumb.

Over time, the sensitivity of the zone of responsibility of the median nerve begins to decrease until it is completely lost.

Loss of sensation causes motor impairment of the entire hand or only the fingers.

Sometimes SZK is accompanied by disturbances in the microcirculation of fluids with whitening or blue skin, coldness of the diseased hand to the touch, malfunctions in sweating, disorders appearance nails. Another sign - temporary relief can bring light movements of the fingers with the hand lowered.

Diagnostics

To distinguish CTS from other diseases that can cause pain reactions, diagnostic tests are performed:

The Tinnel test consists of lightly tapping with a special neurological mallet over the area above the median nerve pathway along the arm above the wrist. At positive reaction there is tingling of the fingers and painful electrical shootings in the hand, and sometimes there is pain in the area of ​​tapping. Such a diagnosis is carried out in severe cases of CTS with increased pain syndrome.

Test for flexion-extension of the carpal joint, when the hand is maximally bent at the wrist and held for a minute. If during this interval a tingling of the area of ​​\u200b\u200bresponsibility of the nerve appears, then the test is positive.

Conducting an electromonography to study the contractility of muscles and identify the causes of neuralgia, not related to nerve compression by surrounding tissues.

Cuff test with the imposition of a tonometer cuff with maximum pressure build-up above and below the wrist with the observation of paresthesia in case of a positive diagnosis. Paresthesia is a violation of sensitivity with false sensations of tingling, goosebumps, burning, etc.

Inspection for a "square wrist", i.e. the anatomical structure of the joint with a natural increase in thickness and approximation to a square shape. Such anatomical structure often cause natural compression of the nervous tissue.

Causes of SZK

Carpal tunnel syndrome, which most often occurs in elderly or mature people, almost never in children and less often in young people, can be caused by the following reasons:

• Work associated with an increased load on the hands or vibrational influence on them (this type also includes prolonged work on the keyboard).
• Squeezing by surrounding tissues in case of edema or hand injuries.
• Obesity causing pressure on adipose tissue.
• genetically determined individual characteristics structures - "square wrist", increased thickness of the transverse ligament and other changes in the structure of the joint).
• Arthritis, gout, bone tuberculosis and other inflammatory diseases of the joints that can be transmitted to the nerve.
• Influence of diabetes mellitus, vitamin deficiency, hormonal disorders, deviations of the nervous system.

The above external causes carpal nerve neuralgia cause internal reactions, which are directly SZK:

• Most often, the pain reaction of the nerve in carpal syndrome is caused by compression of a large number of surrounding tissues that are closely adjacent to the nerve. Tissue enlargement can be caused by edema, inflammation, sprains, hematomas.
• In second place are all kinds of inflammation of the surrounding tissues, which can cause pain both by themselves and transmitted directly to the nerve itself.
• Hypothermia of the joint, provoking a pain reaction or inflammation of the joint.
• Various deposits, tumors, hematomas, aneurysms near the nerve, squeezing it or irritating it.
• Circulatory disorders caused by obstruction of any vessels of the hand and provoking edema or lack of nutrition of the tissues of the hand with corresponding consequences.

Treatment of carpal tunnel syndrome

How to treat carpal tunnel syndrome is decided by a neurologist after the necessary examination with an accurate diagnosis of the causes of the disease.

The traditional treatment for carpal tunnel syndrome is to heal without surgical intervention and begins with complete rest of the diseased limb up to plastering with a plaster splint. Further, certain groups of drugs are prescribed: first of all, anti-inflammatory, then dehydrating diuretics that help relieve tissue edema, drugs that restore the microcirculation of intraorganism fluids. Maybe, local administration injections of glucocorticoids, designed to urgently reduce swelling and relieve inflammation. Ends traditional treatment the appointment of physiotherapeutic procedures of a constant magnetic field with acupuncture therapy to improve metabolic processes and nerve stimulation.

As a rule, traditional methods are sufficient, but sometimes surgery is necessary to cut the transverse ligament of the wrist, release the nerve and relieve its pressure on the nerve and tendon, as well as restore blood circulation if it pinched the vessels.

Unconventional measures to relieve carpal tunnel syndrome - treatment with folk remedies is even more popular than medical ones due to a frivolous attitude to such an ailment. Elderly people are especially fond of resorting to them - the main risk group for this disease.

The essence of traditional medicine methods is the same as traditional medicine: removal of edema, inflammation, stimulation of the nerve, return of hand functions.

Treating CTS at home is a dangerous undertaking due to complications in the form of neuritis, overlooking the treatment of the most serious causes, such as arthritis or bone tuberculosis, and other diseases, however, having a very effective effect in relieving symptoms.

The first remedy for carpal tunnel syndrome is a special hand gymnastics, which allows you to both relieve pain and prevent the onset of the disease:

• With all your strength, first clench your fist, and then unclench it as much as possible, stretching your fingers.
• Rotation with clenched fists in all directions.
• Show with the application of force a kind of OK sign by alternately applying all fingers to the thumb.
• Put your palms together with straight elbows in the form of a Chinese greeting and try to lower as low as possible without moving your elbows and without moving your arms away from your body.
• Grasp the wrist of one hand from the back with the palm of the other in the transverse direction and bend the clasped arm. Now you need to try with all your might to unbend it, while providing maximum resistance with your clasped hand.

Rubbing and compresses are made with various warming compositions and compositions that improve blood circulation, promote the outflow of excess fluids from the limb and have an anti-inflammatory effect. Such compositions may contain components from burning products, for example, pepper, mustard, such vitamin-containing and healing products as sea buckthorn and aloe, relieving swelling - cucumber, salty products.

Despite the availability and effectiveness of alternative methods, self-appointed diagnosis and treatment should be checked and agreed with a neurologist in order to avoid complications, and also not to miss any factors that caused the disease.

Prevention

If earlier carpal tunnel syndrome worried primarily the elderly, whose limbs were distorted by arthritis, gout and suffered from disorders of the circulatory and nervous system, and secondly, workers engaged in very hard and harmful physical labor, for example, logging, which is associated with hypothermia and the impact of blows to the joints, today the main contingent of patients with this disease has changed dramatically. Now carpal tunnel syndrome affects most of the people, regardless of age, among which there are even schoolchildren.

This is caused by the general long-term work on the computer, during which the hands are in strong tension and almost unchanged posture. Having got used to it, a person may not notice the unpleasant sensations from overexertion, but a negative impact can cause improper development of muscles and ligaments with squeezing by them of both nerves and others. internal parts brushes. For the prevention of SZK, you can use very simple tricks:

• When working at the computer for a long time, use the touchpad instead of the mouse, as it requires more movements and helps to knead the hand and the area of ​​the carpal joint.
• Use a wrist support that aligns the position of the hand while working on the keyboard and does not allow pinching the nerve.
• From time to time, carry out carpal preventive gymnastics, which was described above.
• Before prolonged work, the wrists must be warmed up by stimulating blood circulation with gymnastics or a warm hand bath.
• Children and adolescents should not be allowed to work on a computer for a long time, as this will cause not only impaired development of the carpal joint, but also vision, as well as the musculoskeletal skeleton. During work, you need to do a little general gymnastics every half hour.

In the modern world, most professions are inextricably linked with working on a computer, and it is precisely such static work, with repetitive actions of the hands, keeping them in one position for a long time, contributes to the development of many so-called occupational ailments. These diseases include carpal tunnel syndrome (tunnel syndrome).

What is carpal tunnel syndrome? This is an ailment from which the patient loses tactile abilities in the area of ​​​​the thumb, index, middle and sometimes ring fingers. A milder form of this ailment is characterized by numbness of the indicated area, and the person has to rub the brush regularly in order, as he thinks, to resume the blood supply to the fingers. But the whole point is not in blood circulation, but in squeezing the median nerve, located inside the carpal tunnel or tunnel (hence the name), passing through the arm from the forearm to the wrist.

This tunnel is formed from bone tissue and several tendons pass through it, which are responsible for flexion and extension of the fingers, as well as the median nerve itself. The canal itself is quite narrow, and in case of any injury or damage to the membrane, the nerve is compressed, which leads to numbness and loss of sensation.

Causes of compression of the median nerve in the canal

The reason for the development of carpal tunnel syndrome is the compression of the nerve passing through the canal. Direct compression can occur for several reasons:

Naturally, swelling and inflammatory processes may be caused by an external disease. So, diseases that one way or another can provoke corporal syndrome include:

• diabetes;
• arthritis;
• arthrosis;
• Raynaud's disease;
• hypothyroidism;
• tendovaginitis (inflammatory processes in the tendons);
• tumor processes directly of the median nerve (schwannoma, neurofibroma, perineuroma, etc.);
• acromegaly.

As for injuries, any, even a minor injury to the hand, can provoke this syndrome. For example, a person received a minor sprain of the tendons, or a bruise in the area of ​​\u200b\u200bthe hand. As a rule, such injuries are accompanied by edema, which reduces the cross section of the corporal canal on one side or on both sides. Such a decrease in the cross section leads to compression of the nerve and the occurrence of carpal tunnel syndrome.

At risk are:

Despite the fact that, according to statistics in the world, only 45% of working women account for the bulk of those suffering from this disease.

As for the reasons related to professional activities, the risk zone includes persons:

• having a specific position of the body or wrist (cashier);
• working with repetitions of actions in which wrist joint(programmer, IT specialist);
• working with high temperatures (steelmaker);
• workers in conditions of constant vibration (road workers, operators of drilling machines).

The presence of such work increases the risk of this syndrome, and in combination with a genetic predisposition, the chances of acquiring corporal syndrome increase several times.

Symptoms

Due to the fact that the patient does not pay attention to the manifestations of this syndrome for a long time, in the advanced stage everything can be rather sad. So, the symptoms of carpal syndrome develop progressively, and at the very beginning of the disease main feature- this is a loss of sensation in the thumb, index and middle fingers (sometimes the ring finger), as well as part of the palm.

Before loss of sensitivity, the patient may notice the presence of extraneous crunches or crackles during torsion or flexion of the wrist or carpal joint, which is one of the signs of a future disease.

The patient may not feel a prick, cold or heat. Gradually. To this is added numbness of the fingers, itching and pain, which begins to spread along the hand and is called wrist pain.

Most severe attacks happen in the morning, after waking up a person. Often, the patient is forced to rub the brush even at night to relieve the pain symptom, but this is a temporary measure.

Gradually, as the syndrome progresses, the patient may even develop partial paralysis of the fingers. The patient will not be able to perform the simplest actions with his right or left hand (take a mug, fasten a button, shake hands), as his fingers will stop clenching.

At the very last stage, the development of contractures on the arm is possible.

Contracture - restriction of passive movements in the joint.

Diagnostics

To diagnose this disease, you need to contact a neurologist. The doctor will conduct a series of diagnostic procedures with which he can make the correct diagnosis.

The doctor must first examine the patient and conduct a survey about the sensations that he experienced in connection with the complaint.

After that, a neurological examination will be performed, which includes several simple tests:

• raised hands test - in the presence of an ailment, after 30 seconds of being in a position with raised hands, the patient will experience tingling sensations and “goosebumps” on a sore arm;
• cuff test - a special device (cuff) is put on the area from the elbow to the wrist, which resembles a device for measuring pressure. This cuff is inflated with air, and the person begins to feel the same as during the test of raised hands;
• Phalen's test - bending the arm in the carpal joint on and holding it in this position. After a while, the patient feels tingling and even pain;
• Tinel's test - tapping the palm with a hammer. These actions cause tingling in the fingers.

In addition, there is such a thing as a lidocaine test. This analysis allowed only when severe pain. So, if the pain did not subside with the introduction of lidocaine, then the cause is a pinched nerve.

Undoubtedly, some of the tests can be carried out at home to decide whether it is advisable to visit a doctor.

In addition to a neuralgic examination, the doctor will refer the patient for tests, which include:

• blood chemistry;
• blood and urine tests for sugar levels;
• analysis for thyroid-stimulating hormones and rheumatic tests;
• clinical analysis of blood and urine;
• tests for circulating immune complexes and antistreptokinase.

In addition, in some cases, there may be following methods diagnostics:

• x-ray (needed to rule out arthritis or a broken limb);
• electromyography;
• Magnetic resonance imaging;
• nerve conduction analysis.

Treatment

So, how to treat carpal tunnel syndrome? As with any disease, there are several ways to treat it:

1. Medical.
2. Folk means.

The drug method, in turn, is divided into:

1. Conservative.
2. Operational.

Conservative

In order to recover from this syndrome, it is not enough to take the medicine prescribed by the doctor; the basis of treatment is the guard mode for the affected hand (wrist).

The main requirement is the complete exclusion of the load on the affected arm within two weeks. This means that the employee cannot perform his duties for at least two weeks (if they are related to work with his hands).

You can be treated for this syndrome as much as you like and continue to work, but there will be no result.

Security mode includes:

• fixing the wrist with a special restraint (reminiscent of a wristband and sold at a pharmacy);
• refusal of physical activity.

In the event that it is not possible to completely refuse to do your work, it is necessary to consult a physiotherapist who will tell you how to minimize the load on the arm in your particular case.

Some hand exercises and correct work positions

In addition, the doctor may prescribe physiotherapy, which includes:

• electrophoresis with nicotinic acid;
• phonophoresis;
• paraffin applications;
• mud treatment;
• laser treatment;
• balneotherapy;
• massage;
• manual therapy.

Moreover, to relieve pain, the doctor can prescribe to the patient drugs that relieve pain. pain syndrome and reduce swelling (aspirin, ibuprofen).

In addition, if the compression of the nerve was due to a third-party ailment, the doctor prescribes medications to combat these diseases, or even prescribes complex therapy.

A cold compress gives a good effect, but this is a temporary phenomenon.

If none of the above helped, surgical intervention is necessary, namely, endoscopic surgery.

Endoscopic option surgical intervention represents surgical treatment through a small hole in the human body. Now there is no need to make wide incisions, doctors have learned to operate on people without it.

Surgical intervention, as a rule, implies the elimination of the cause of compression of the median nerve. The doctor, using x-rays and other diagnostic procedures, determines exactly where the compression occurred.

If possible, an endoscopic incision is made, if not, a normal one. Further, the cause of compression is eliminated (dissection of the ligament, expansion of the tunnel, etc.).

In the case of an endoscopic type of operation, the surgeon makes a microscopic incision, and then, using a special video camera, performs the treatment.

If we are talking about the usual dissection, then in this situation the effect will be the same, but the recovery after such an operation will take longer.

In any case, during the operation, a dissection of the ligament occurs, and the larger the incision, the greater the dissection.

Recovery

The recovery process proceeds depending on the severity of the compression. As a rule, after the operation, the patient is forbidden to do any exercises for 1.5 months, and it is for this reason that carpal tunnel syndrome has an unspoken name - the most expensive syndrome (usually during the recovery period, the employee loses a lot of money without working).

As a rule, after a day, the patient can already move his fingers a little, but nothing more. Even an ordinary mug for such a patient during the recovery period is an unbearable burden.

Fixing device for hand

After 5-6 weeks, the patient notices that the control of the hand and fingers has completely returned, and the state of health has improved markedly.

After 6 months, you can start physiotherapy and special gymnastic exercises.

How can you relieve the symptoms yourself

Often, the symptoms of this disease are taken by surprise, and you want to overcome discomfort as soon as possible, what can you advise in such a situation?

• regular breaks will avoid numbness and tingling or a banal change of activity, the main thing is that the hands take a different position;
• a small exercise for 1-2 minutes can relieve some of the symptoms (rotational movements in one direction and the other, sipping movements with the palms and the usual children's exercise for the fingers);
• if the pain is intense, you can take a painkiller (ibuprofen, ketanov);
• if discomfort began to visit you regularly - use a splint or wristband during sleep, which is worn on a sore arm;
• do not put your hands under your head, as this will only aggravate the situation by squeezing the nerve.

Folk remedies

Naturally, this syndrome can be treated with folk methods at home. Treatment of carpal tunnel syndrome with folk remedies should in no case exclude visits to the doctor, as he must control the healing process and, if necessary, correct the treatment.

Below are some recipes from the arsenal of our grandmothers.

Hypericum tincture

2-3 leaves of this herb are boiled for 10-15 minutes. After that, the chilled decoction can be taken 1-2 tsp per day in the morning and at bedtime.

Linseed oil

This oil can be purchased at any grocery store. Within 15 days it is necessary to take 1 tsp per day. Reception of oil promotes removal of inflammatory processes.

It has been proven that the increased content of vitamin B group has a beneficial effect on the elimination of the disease.

A great way to relieve tension is cold compresses, which can be applied to the wrist for 10-15 minutes three times a day.

In addition to traditional medicine, there are alternative treatments that include:

• mud treatment;
• acupuncture;
• yoga.

Prevention

There are three options for preventing carpal tunnel syndrome:

• engineering;
• personal;
• multicomponent.

Engineering

This solution includes local improvement of the workplace. In particular, at present there are many options for so-called health-safe items (orthopedic keyboards, mice, special wrist rests).

Personal

This decision includes what concerns the employee, namely paying attention to the position of his body (posture), regular training in the process of work. In addition, you can use special devices, which will control the time spent in a static position and give a signal that it is necessary to warm up and do gymnastics for the hands or fingers.

Multicomponent

This solution is the most radical and involves either a change of job, or a less painful option for the employee - the restructuring of the workplace (repair, redevelopment, etc.).

According to the studies, it was the engineering plan solutions that provided the greatest preventive benefit. While the personal option was not particularly effective.

But, this does not mean that it is impossible to combine an engineering option with a personal or multi-component one; in combination, the result will be much better than if you do nothing at all.

So, carpal syndrome is an unpleasant and in some cases annoying ailment, which can be eliminated both conservatively and operational ways. However, it is better not to bring to the hospital, and to prevent the disease in advance. Work right!

The carpal tunnel is located on the palmar side of the hand at the junction of the forearm to the hand and is formed by the bones of the wrist on one side and the transverse carpal ligament on the other.

The tendons of the flexor muscles of the fingers and the median nerve pass through the carpal tunnel.

When the contents of the carpal tunnel are compressed, the median nerve, which is the least resistant to damage compared to the tendons, first of all suffers. Therefore, neurological symptoms come to the fore.

carpal tunnel syndrome- one of the types of tunnel neuropathies (nerve diseases), in which peripheral nerves are damaged as a result of prolonged compression and constant trauma in the musculoskeletal canals by chronically inflamed surrounding tissues.

Carpal Tunnel Syndrome is also known as carpal tunnel syndrome or carpal tunnel syndrome.

Causes of the disease

The reasons that can cause the development of carpal tunnel syndrome are varied:

• Swelling of tissues as a result of injury to the forearm and hand (fractures, dislocations, bruises);
• Swelling of tissues in pregnant women, especially in late pregnancy, and in women taking oral contraceptives;
• Chronic inflammation and swelling of the structures of the carpal tunnel with constant occupational trauma (similar repetitive flexion-extension movements with constant tension of the hands, work associated with constant vibration);
• Tissue edema as a result of a number of diseases internal organs(renal failure), endocrine diseases (decreased thyroid function, early menopause, post-ovarian removal, diabetes mellitus);
• Narrowing of the synovial sheaths (shells) of the tendons and thickening of their walls as a result of acute or chronic inflammation in systemic diseases of the connective tissue (rheumatism,), metabolic disorders (), with tuberculosis;
• A discrepancy between the size of the canal and the size of its contents as a result of genetically inherited characteristics (square wrist, thick transverse ligament, narrower canal in women, etc.), or pathological growth bones of the hand and wrist (acromegaly);
• tumor of the median nerve;
• There is an observation that the diagnosis of carpal tunnel syndrome is more often made in the cold season, which proves the role of cold and hypothermia in the development of this disease.

Symptoms

At the onset of the disease, there are sensations of tingling, burning and pain in the thumb, index, middle, and less often ring fingers. The pain is most often dull, aching, can spread to the hand and forearm, is felt in the deep tissues of the arm. Often there is numbness of the skin of the hand and fingers in the morning immediately after waking up, which is accompanied by a decrease or loss of pain sensitivity.

First, sensitivity is lost on the palmar surface of the index and middle fingers, over time, numbness also captures the palmar surfaces of the thumb and ring fingers. The feeling of numbness usually goes away within a few hours after waking up.

Pain, numbness, and tingling usually go away when you put your hand down and move your fingers lightly. But after a while, the symptoms reappear.

As the disease progresses, movement disorders appear: it becomes difficult for the patient to hold small objects in his fingers, inaccuracy of movements appears, periodically objects can fall out of the hands against the will of the person, the force of grasping objects with a brush with the participation of the thumb decreases.

Often there are symptoms of impaired microcirculation of the diseased hand in the form of blanching of the skin or the appearance of a bluish tint due to vasospasm, cooling of the skin of the fingers to the touch, impaired sweating (increased or vice versa decreased sweating). As a result of constant vasospasm, the nutrition of the skin and nails is disrupted, with a significant deterioration in their appearance.

Diagnostics

Diagnostic tests and electromyography are used to confirm the diagnosis of carpal tunnel syndrome.

Diagnostic tests

1. Flexion and extension test. The arm is held in the position of maximum flexion or extension for 1 minute. In carpal tunnel syndrome, during this time, tingling appears in the skin of the thumb, index and middle fingers.
2. Tinnel test. Light tapping on the carpal tunnel causes tingling and pain in the fingers. The Tinnel test is positive, usually with severe disease.

Electromyography studies the ability of muscles to contract under the influence of electrical impulses. Allows you to confirm the diagnosis of carpal tunnel syndrome or suspect another cause of median nerve disease other than carpal tunnel compression.

Treatment of carpal tunnel syndrome

The stage of the disease and the predominant symptoms determine how to treat carpal tunnel syndrome, which techniques are preferred in a particular patient, and whether surgery can be avoided.

Conservative (without surgery) treatment:

1. Restriction of movements in the diseased hand for a long time up to the imposition of a splint on the wrist or a plaster splint;
2. Medications:
   • non-steroidal anti-inflammatory drugs to reduce pain;
   • dehydrating action (removing water from the body), namely diuretic drugs to relieve edema;
   • injection of glucocorticoids into the carpal tunnel to local reduction tissue edema and inflammation relief;
   • drugs that improve blood circulation through the vessels to restore the blood supply to the tissues of the diseased hand and restore the function of the median nerve.
3. Physiotherapy treatment: permanent magnetic field, acupuncture to improve metabolic processes in damaged tissues.

Surgical treatment is used in case of ineffectiveness of conservative and consists in dissection of the transverse ligament of the wrist. The operation is performed under local anesthesia. The transection of the transverse ligament of the wrist allows you to relieve pressure on the tendons of the flexors of the fingers and the median nerve, restore normal blood supply to the tissues of the hand.

After the operation, the diseased arm is immobilized with a plaster splint for 10-12 days. In the postoperative period, the patient is prescribed physical therapy, massage, thermal procedures, vitamins of group B. The function of the hand and the patient's ability to work are fully restored 4-5 weeks after the operation.

People who work a lot at the computer, or those who, by the nature of their activities, often have to bend and unbend the brush (playing the piano, cello, construction works, sports, etc.) often face a problem such as carpal tunnel syndrome, which occurs from excessive squeezing or pinching of the median nerve. The most susceptible to carpal tunnel syndrome are people who have somatic diseases. In addition, this problem is more common in women than in men, since their carpal tunnel is narrower.

Although carpal tunnel syndrome does not pose a health risk, the condition negatively affects the quality of life and work. In some cases, you may even need to change the type of activity. Therefore, at the first sign of illness, you should consult a doctor.

Causes of the disease

The following factors can be attributed to the causes of this disease:
- professional activity a person associated with constant monotonous hand movements;
- various injuries, fractures, dislocations of the hand, resulting in compression of the median nerve;
- stagnation of fluid in the body due to pregnancy or taking hormonal contraceptives;
- genetic predisposition;
- thyroid disease;
- diabetes;
- inflammatory and rheumatic diseases of the hand;
- abnormal bone growth (acromegaly).

Symptoms of the disease

The first symptoms of the onset of the disease are pain, tingling, burning and numbness of the fingers. At first they appear from time to time and quickly disappear, but after a while the patient begins to feel them constantly. With the further development of carpal tunnel syndrome, pain occurs in the fingers at night, which can radiate to the forearm and elbow joints. After rubbing or shaking the brush, the discomfort disappears. In addition, the sensitivity of the fingers may decrease in the patient, the muscles become weaker, it becomes difficult for a person to hold small objects.

Diagnosis of carpal tunnel syndrome

It is difficult for a non-specialist to diagnose neurological diseases whose symptoms are similar. And only an experienced doctor, based on a survey and examination, will be able to make the correct diagnosis.

Diagnosis of carpal tunnel syndrome mainly consists of three tests:

1. Tinel test. With light tapping on the wrist with inside the patient feels tingling in the fingers.

2. Phalene test. If, during flexion and extension of the hand, for less than one minute, the patient begins to feel pain and numbness in the palm and fingers, then the diagnosis of carpal tunnel syndrome is confirmed.

3. Cuff test. A blood pressure cuff is placed on the patient's arm. When pressure in it is slightly higher than normal and held for about a minute, a person with this disease feels numbness and tingling in the fingers.

Other research methods may be required, such as:

1. Electrodiagnostic, during which the speed of electrical conduction of the median nerve is measured and recorded.
2. MRI - a method that allows you to get a detailed picture of the state of human organs without internal interference using magnetic waves. In this case, take pictures cervical spine.
3. X-ray - a study using radiation. use this method to take pictures of the bones.
4. Ultrasound is a method that uses sound waves to measure the width of the median nerve. This may be needed, for example, to guide injections for pathologies such as carpal tunnel syndrome.

Treatment

First of all, it is necessary to treat neurological diseases that underlie the formation of carpal tunnel syndrome. For example, in hypothyroidism, replacement therapy, while the restoration of detuned functions occurs quite quickly. For women using birth control pills, another method of contraception is offered. If, as a result of professional stress, carpal tunnel syndrome has arisen, treatment involves a change in the type of activity.

Physiotherapeutic methods give a good effect: electrophoresis with nicotinic acid, phonophoresis with hydrocortisone, laser therapy, mud therapy.

Good results are obtained by manual manipulations of the hand, which are carried out in order to restore the correct position of the bones of the wrist, as well as the introduction of a mixture of anesthetic (lidocaine, novocaine, etc.) with corticosteroid hormone (diprospan, hydrocortisone) into the carpal tunnel. Usually, after the first injection, the patient feels significant relief. For recovery, as a rule, three injections of the drug are enough.

In situations where carpal tunnel syndrome is chronic, persistent, surgeons recommend surgical treatment.

Surgery

The operation is performed under local anesthesia in a day hospital.
There are two types of surgical treatment: endoscopic procedure or open surgery. Depending on the condition of the patient, the doctor decides what kind of intervention is necessary. During open surgery, the skin is cut from the wrist to the palm and the broad ligament of the wrist is excised, which limits the space in which the median nerve is located. After all the necessary manipulations, the wound is sutured.

Endoscopic surgery is no less effective, in addition, with such an intervention, the scar is not particularly noticeable. With the help of an endoscope, which is inserted into the skin incision, the surgeon performs excision of the ligament.

Postoperative period

The operated arm must be kept elevated to avoid swelling. To improve the mobility of the fingers will help special exercises. After the effect of anesthesia wears off, the sensitivity of the hand will gradually recover.

Self-absorbable sutures applied to the wound disappear within 10 days. If the sutures were performed with non-absorbable sutures, they will be removed in the clinic after 10-14 days.

The rehabilitation process takes approximately two months. Most patients return to normal life after surgery. A person with carpal tunnel syndrome, treatment surgically completely relieves the symptoms of the disease, relapses are very rare.

Folk remedies for the treatment of carpal tunnel syndrome

Home remedies have been used by people for many years to treat conditions such as carpal tunnel syndrome. Symptoms will not bother you if you change your position while working and take a break for 15 minutes. If your muscles rest more, then your health will improve. You can perform simple exercises, such as squeezing a rubber ball. A good effect is refusing to apply ice to the wrist area. In some cases, various plants are used for treatment, the use of which helps to reduce pain in the fingers. Of course, before doing this, you need to consult a doctor.

Infusion of cucumber and wild rosemary

Excellent folk remedy, which helps to normalize blood circulation and relieve numbness in the fingers. Pickled cucumbers (3 pieces) should be cut into small pieces and mixed with three pods of red pepper. All this is filled with vodka (0.5 l). The infusion must be put in a dark place for 7 days, then strain and rub the sore wrist.

Sea buckthorn treatment

Sea buckthorn is a good remedy for hand pain for people with a condition such as carpal tunnel syndrome. The treatment is as follows. The berries are crushed and mixed with water. The resulting mixture should be opaque. Then it must be heated to 37 degrees and soar hands for half an hour. It is good to do a light massage before this.

After the procedure, the hands must be thoroughly wiped and insulated. You can use woolen mittens or gloves. Treatment is carried out for a month, then you need to take a break for two weeks.

pumpkin compress

A wonderful remedy that can alleviate the condition of the patient is pumpkin. A compress of pumpkin porridge is applied to the sore hand, wrapped with cellophane on top and wrapped in a warm woolen scarf. Such warming wraps are done once a day. The duration of treatment is five to six days.

Treatment with ammonia and salt

From numbness of fingers and burning sensation in carpal tunnel syndrome, this relieves healing remedy: a tablespoon of salt, 50 grams of ten percent ammonia and 10 grams camphor alcohol dissolve in 1 liter of water.

Pepper oil rub

Black ground pepper able to overcome carpal tunnel syndrome. How to treat using this remedy? The recipe is simple: pour 100 grams of pepper with a liter of vegetable oil and heat over low heat for at least half an hour. The resulting product in a warm form is rubbed into the affected joint several times a day.

Cowberry decoction

Relieves pain in the hands and swelling of such a folk remedy as a decoction of lingonberries. The leaves of the plant (several teaspoons) should be poured with water (one glass) and boiled for 15 minutes. The product removed from the stove must be filtered. Take one sip several times a day.

How to Reduce Puffiness

Swelling is another unpleasant symptom of a condition such as carpal tunnel syndrome. Treatment consists in the use of diuretic infusions. The use of an infusion of parsley roots gives an excellent result. One tablespoon of raw materials should be poured with boiling water (0.5 l) and left to infuse until morning. Healing infusion is drunk during the day in a sip.

A similar effect has a remedy from the leaves of white birch. A few tablespoons of leaves should be poured with boiling water (one glass) and brewed for about three hours. The infusion should be consumed in four doses of 1/3 cup before meals.

Bearberry has excellent diuretic and anti-inflammatory properties. The medicine is prepared in this way: the leaves of the plant (1 tablespoon) are brewed with one glass of boiling water for several hours. Means drink a tablespoon several times a day.

Prevention of carpal tunnel syndrome

To reduce your chances of developing a condition such as carpal tunnel syndrome, consider the following guidelines.

When working at a computer, give preference to the touchpad, trying to use the mouse less often. If it is impossible to refuse to use the mouse, try to keep the brush straight while working. Pay attention to the position of the arm - from the elbow to the hand, it should lie on the table.

Use comfortable mouse and keyboard models, a wrist support is a good purchase, which will reduce the strain in the hand when working. If you have to spend a lot of time at the computer, change your chair to one that has armrests.

If you often type text on a laptop or netbook keyboard, connect a keyboard from a desktop computer to them from time to time.

If you start to feel tired, take a break for a little gymnastics so that your hands rest. Squeeze and unclench your fingers several times, make rotational movements with your hands in different sides, clap your hands, interlock your fingers. You can keep a toy on your desktop that will remind you of the need to warm up and which can be used for gymnastics. The rosary is great for this purpose, sorting through the beads one at a time, you will relieve tension in your hands. You can roll two balls in the palm of your hand.

If you know that you have to for a long time load your wrist, pre-warm up your hands by doing gymnastics. You can take a bath with hot water.

Carpal tunnel syndrome makes life much more difficult. In most cases, we earn it by doing our normal business. Using our advice, you can protect yourself from this pathology or alleviate your condition if the symptoms of the disease have already manifested themselves.