Tunnel syndromes of the hand. Tunnel syndrome: signs, prevention, treatment

Have you noticed that you often get (or don't go away) tingling and numbness in your hands during pregnancy? Most likely, these sensations are caused carpal tunnel syndrome(TSZ).

Typically, TSM affects people whose occupations require repetitive hand movements (such as computer programmers or assembly line workers), but pregnant women are also very susceptible.

Symptoms of carpal tunnel syndrome may include numbness, tingling, pain, or a dull ache in your fingers, hand, or wrist. These symptoms tend to come and go and often get worse at night. Sometimes discomfort can spread to the forearm and shoulder area, and even completely to the entire arm! In severe or chronic cases, the hand becomes clumsy and weak, and patients complain of spontaneous unclenching of the fingers.

Symptoms can appear on one or both arms, and can appear at any time, but they are more likely to first appear in the second half of pregnancy, when most women experience. Symptoms of TSZ usually disappear gradually after childbirth, along with swelling.

What causes carpal tunnel syndrome in pregnant women?

The wrists are bony channels formed on three sides by the bones of the wrist and the ligament that runs through the wrist. Fluid retention and swelling, common in pregnant women, increases pressure in this relatively narrow and inflexible space, resulting in compression of the median nerve that runs through the wrist.

The median nerve sends nerve impulses to the thumb, index, middle and ring fingers, and is responsible for the movement of the muscles at the base of the thumb. The pressure exerted on this nerve is what causes the symptoms.

How to relieve pain in carpal tunnel syndrome?

Try to identify which activities are causing (or exacerbating) your problem, and avoid those activities as much as possible.

Sometimes you can make changes to your daily activities to protect your hands. For example, if , adjust the chair height so that your wrists are flat on the table, not hanging down. Try to buy an ergonomic keyboard, which in many people reduces the symptoms of TSD. And be sure to take short breaks to move your arms and stretch them.

If your symptoms bother you at night, try keeping your wrist in a neutral position (so it doesn't bend), which can be done with a splint. Avoid sleeping on your arms. If you wake up in pain, try squeezing and unclenching your hand until the pain or numbness goes away.

In what situations should you call a doctor?

Check with your doctor if pain and numbness keep bothering you, interfering with sleep and daily activities. Do not start taking any painkillers without a doctor's prescription! Instead of pills, your doctor may suggest that you wear a splint on your wrist or on your lower arm, a treatment that has helped many people with carpal tunnel. If your symptoms are persistent and severe (persistent numbness, muscle weakness, or loss of sensation), then you will be referred to a specialist.

TSZ in most cases resolves on its own a few months after childbirth. If the symptoms do not go away after three to four months after the birth of the child, go for a consultation with an orthopedic surgeon. The surgeon will likely suggest splinting and NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen.

In the absence of a positive result from conservative methods of treatment carpal tunnel syndrome, the next step is a course of cortisone injections. In severe cases, simple surgery may be needed to relieve pressure on the median nerve.

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How to diagnose and prevent this professional disease of typists, programmers and musicians

With unpleasant sensations in the "working" hand, everyone who is forced to do manual labor for a long time, requiring small finger movements, is faced. The constant tension of the hands, especially the right hand in right-handers and the left hand in left-handers, disrupts blood circulation in the hands, contributes to the occurrence of osteochondrosis, deformities of the spine, joints of the hands - from the shoulder to the fingers.

As a result - swelling, pain, goosebumps, spasms and weakness in the muscles. In advanced cases, there may be a loss of sensitivity in the palm and fingers, a decrease in joint mobility.

In the 20th century, this disease was called the "typist's hand" - the joints of the hands suffered the most from constant vibration when typing on a typewriter, leading in severe cases to disability and the need to change profession. In the 21st century, the disease has moved to offices and gaming clubs - the risk of getting tunnel syndrome is especially high for everyone who spends more than 3-4 hours a day at the computer, intensively typing or moving the mouse. In addition to white-collar workers, drivers, hairdressers, cashiers, some musicians (violinists, pianists) and photographers are susceptible to tunnel syndrome. The average age of onset of the disease is 40-60 years, but the disease, alas, is getting younger, and with due disregard for one's health, one can begin to complain of pain in the hands at the age of 25.

Diagnosis: Overworked!

The disease occurs as a result of constant monotonous work, without rest and industrial gymnastics. An uncomfortable posture, lack of support for the elbows or wrists, working hours of more than 6-8 hours, work experience of more than 5 years contribute to the formation of pathological changes. With menopause, pregnancy, persistent minor injuries (from playing basketball, etc.) or a poorly healed fracture of the radius, diabetes, gout, arthritis, rheumatism, the chance of getting sick increases.

Alarm signals that you should pay attention to in the first place are a weakening of muscle strength by the end of the working day, a feeling of numbness in one or both hands, from fingers to the elbow and shoulder, stiffness of movements. After rest, the symptoms do not go away, it happens that unpleasant sensations do not allow to fall asleep and wake up at night. If you do not take treatment, or at least do not take a long vacation, the problems intensify:
pains appear, at first light, then painful, fettering. Up to the point that the patient cannot hold a spoon or pencil, hold on to the handrail, do manual work for more than 10-15 minutes.

Important symptoms to distinguish carpal tunnel syndrome from other diseases:

* The palm is affected, 1-4 fingers, less often the arm up to the elbow. If the little finger or the back of the hand hurts, the reason is different.

* Both hands suffer, but the working one is larger.

* Exacerbations occur at night, wake up the patient, are removed by massage, vigorous shaking of the hands.

* There is weakness of the fingers, poor coordination of movements - handwriting changes, it is difficult for the patient to thread a needle, lift a full kettle with one hand, etc.

* There are changes in sensitivity (tingling, burning, loss of sensitivity in the fingertips), changes in thermoregulation of the hands (constantly hot or cold hands).

* There is a strong fatigue by the end of the working day, hands cease to obey.

* Other organs and systems are not affected - does not change, for example, gait, sense of smell, pressure, speed of reactions.

All disease from the nerve

The cause of carpal tunnel syndrome is a pinched nerve in the carpal tunnel (the full name of the disease is carpal tunnel syndrome, Carpal Tunnel Syndrome - CTS). Typically, the nerve is pinched at the wrist, pressed against swollen transverse carpal ligament or tendons. Or it swells itself due to a higher pinch point. The patency of nerve signals is disturbed, the inflamed nerve first causes pain, and then dies, with all the ensuing consequences.

The elimination of the tunnel syndrome in the expressed stage should be dealt with by specialist doctors. Treatment is to reduce swelling and pain, which helps the nerve regain sensitivity and take its rightful place in the carpal tunnel. As a rule, anti-inflammatory drugs, hormones and painkillers are used. In severe cases, an operation is necessary - the surgeon opens the affected canal, cleans it from overgrown fibrous tissue and restores the normal position of the nerve. The operation is increasingly performed through an endoscopic incision and does not cause much harm to the patient. But, of course, it is better not to bring the matter to the operating table and treat carpal tunnel in the early stages.

Sick, heal yourself!

Home treatment, of course, cannot replace drug therapy. However, in the early stages of the disease, home remedies are enough to restore health and performance. The simplest tool used by our great-great-grandmothers is mitts, that is, gloves with cut off fingers, knitted from natural wool, best of all dog. The heat from the gloves will relieve pain, the prickly wool will provide a constant massage, and the elastic cuff on the wrist will work as a fixing bandage and relieve the load from the joint. Compresses and rubbing with warming or cooling oils - camphor, eucalyptus, mint - will give a good effect. Hot sea salt hand baths can help relieve swelling, relax muscles, and reduce inflammation. In the summer on the beach, for the same purpose, it is very useful to use heated sand and twist warm, rough pebbles in your fingers.

Massage and self-massage of the forearms and hands is a necessary component of the treatment of carpal tunnel syndrome. It is necessary to rub fingers, palms and wrists daily with massage cream or baby oil, and two or three times a year take courses of general preventive back massage - pain in the hands can be the result of osteochondrosis or pinching of the muscles of the shoulder girdle.

Occupational hygiene and a well-thought-out mode of work are very important for the prevention of the disease. Every hour you should take a break, at least for 3-5 minutes, raise your hands up and do a little exercise - wave and twist your palms in different directions, squeeze and unclench your fingers, fold them into a lock or fan, twisting, like in a children's game.

An excellent prevention of carpal tunnel syndrome are soft and elastic "anti-stress" toys that can be crushed right at the workplace. The same role is played by metal balls and ordinary rosaries - it is extremely useful to touch large beads with your fingers. Carpal expanders are useful for the prevention of the disease, however, with a developed tunnel syndrome, it is better to avoid unnecessary stress.

Carefully monitor your workplace - is it comfortable for you to sit, are there any handrails at the desk, an anatomical tubercle under the palm on the mouse pad (this allows you to relax your wrist). It is very important to make sure that the room is not too cold or damp, you would not sit in a draft - colds and cold air do not have the best effect on such diseases.

From sports activities with tunnel syndrome, swimming for short distances, table tennis and all kinds of children's games with a rope, the so-called "putanki", are useful. An interesting way of prevention is dancing, in which hand gestures are actively involved - Indian, gypsy, "belly dance". It is better to refrain from sports that involve a lot of stress on the hands and wrists, especially handball games, athletic gymnastics, shooting, power sports. Carrying heavy objects, bags, packages in your hands is also not recommended.

Sometimes doctors advise patients to switch to household chores, change the type of activity. Washing dishes and washing in hot water, sewing and knitting, collecting mosaics and puzzles help to relax your wrists. You can use the "Cinderella recipe" - mix, say, peas and beans, and then slowly disassemble them, rolling the grains in your palms.

But the most important thing in the treatment of carpal tunnel syndrome is not to start it. Avoid overtime and time troubles, 12-hour workdays, overly loose or tight keyboards, uncomfortable desks and computer mice. Go on vacation in time, give your hands a rest on weekends. And see a doctor as soon as you have unpleasant symptoms. The sooner you start fighting the disease, the faster and easier it is to get rid of it.

1
1 FGAOU VO First Moscow State Medical University. THEM. Sechenov of the Ministry of Health of Russia (Sechenov University), Moscow
2 FGAOU HE "First Moscow State Medical University named after A.I. THEM. Sechenov” of the Ministry of Health of Russia (Sechenov University), Moscow; Neurological Center. B.M. Gekhta DZ Russian Railways, Moscow
3 FGAOU VO First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of Russia (Sechenov University)

For citation: Golubev V.L., Merkulova D.M., Orlova O.R., Danilov A.B. Tunnel syndromes of the hand // BC. 2009, p. 7

Under the tunnel syndrome (synonyms: compression-ischemic neuropathy, tunnel neuropathy, trapped neuropathy, trapping syndrome) it is customary to designate a complex of clinical manifestations (sensory, motor and trophic) caused by compression, pinching of the nerve in narrow anatomical spaces (anatomical tunnel). The walls of the anatomical tunnel are natural anatomical structures (bones, tendons, muscles), and normally peripheral nerves and vessels pass freely through the tunnel. But under certain pathological conditions, the channel narrows, a neuro-canal conflict arises [Al-Zamil M.Kh., 2008].

Tunnel neuropathies account for 1/3 of diseases of the peripheral nervous system. More than 30 forms of tunnel neuropathies have been described in the literature [Levin O.S., 2005]. Various forms of compression-ischemic neuropathy have their own characteristics. We will first consider their general characteristics, then we will focus on the most common forms of hand tunnel syndrome (Table 1).

The reasons

Clinical manifestations

Movement disorders occur as a result of damage to the motor branches of the nerve and manifest themselves in the form of a decrease in strength, rapid fatigue. In some cases, the progression of the disease leads to atrophy, the development of contractures ("clawed paw", "monkey paw").

With compression of the arteries and veins, the development of vascular disorders is possible, which is manifested by blanching, a decrease in local temperature, or the appearance of cyanosis and swelling in the affected area. With an isolated nerve lesion (in the absence of compression of the arteries and veins), trophic changes are most often insignificantly expressed.

Diagnostics

Principles of treatment

Stop the impact of the pathogenic factor. Immobilization

Change the habitual locomotor stereotype and lifestyle

Pain therapy

Anti-inflammatory therapy. Traditionally, NSAIDs with a more pronounced analgesic and anti-inflammatory effect (diclofenac, ibuprofen) are used for tunnel syndromes. It should be remembered that with prolonged use of drugs in this group there is a risk of gastrointestinal and cardiovascular complications. In this regard, for moderate to severe pain, it is advisable to use a combination of low doses of the opioid analgesic tramadol (37.5 mg) and the safest analgesic / antipyretic paracetamol (325 mg). Thanks to this combination, a multiple increase in the general analgesic effect is achieved with a lower risk of side effects.

Effects on the neuropathic component of pain. Often, with tunnel syndromes, the use of analgesics and NSAIDs is ineffective (just in these cases, patients go to the doctor). This may be due to the fact that the dominant role in the formation of pain is played not by the nociceptive, but by the neuropathic mechanism. When pain is the result of neuropathic changes, it is necessary to prescribe drugs recommended for the treatment of neuropathic pain: anticonvulsants (pregabalin, gabapentin), antidepressants (venlafaxine, duloxetine), plates with 5% lidocaine. The choice of a particular drug should be made taking into account the clinical manifestations and the individual characteristics of the patient (possibility of developing side effects). It is important to inform the patient that drugs used for neuropathic pain, unlike "classical painkillers", do not begin to act immediately (it is necessary to titrate the dose, the effect occurs after a few days or even weeks after the start of the drug).

Injections of anesthetic + hormones. A very effective and acceptable treatment for most types of tunnel neuropathies is a blockade with the introduction of an anesthetic (novocaine) and a hormone (hydrocortisone) into the area of ​​infringement. Special guidelines describe the techniques and doses of drugs for various tunnel syndromes [Zhulev N.M., 2005]. This procedure is usually resorted to if other measures (cold compresses, the use of analgesics, NSAIDs) are ineffective, but in some cases, if the patient is referred at a more advanced stage of the disease and is experiencing severe pain, it is advisable to immediately offer such a patient this manipulation.

Other methods of anesthesia. Currently, there are reports of high efficiency of injecting meloxicam with hydrocortisone into the tunnel area.
An effective way to reduce pain and inflammation is electrophoresis, phonophoresis with dimexide and other anesthetics. They can be carried out in a clinic setting.
symptomatic treatment. In tunnel syndromes, decongestants, antioxidants, muscle relaxants, drugs that improve trophism and nerve functioning (ipidacrine, vitamins, etc.) are also used.

Surgical intervention. Surgical treatment is usually resorted to when other options for helping the patient have been exhausted. At the same time, according to certain indications, it is advisable to immediately offer the patient surgical intervention. Surgical intervention usually consists in releasing the nerve from compression, "reconstruction of the tunnel."
According to statistics, the effectiveness of surgical and conservative treatment does not differ significantly a year later (after the start of treatment or surgery). Therefore, after a successful surgical operation, it is important to remember other measures that must be taken to achieve complete recovery (prevention of relapses): changing locomotor stereotypes, using devices that protect against stress (orthoses, splints, bandages), performing special exercises.

carpal tunnel syndrome

Clinical manifestations

The following tests are offered to verify the diagnosis of carpal tunnel syndrome.
Tinel's test: tapping with a neurological hammer on the wrist (above the passage of the median nerve) causes a tingling sensation in the fingers or irradiation of pain (electric lumbago) in the fingers (Fig. 2). Pain may also be felt in the area of ​​tapping. A positive symptom of Tinel is found in 26–73% of patients with carpal tunnel syndrome [Al Zamil M.Kh., 2008].
Durkan's test: compression of the wrist in the area of ​​the median nerve causes numbness and / or pain in fingers I-III, half of the IV fingers (as with Tinel's symptom).
Phalen test: Flexion (or extension) of the hand 90 degrees results in numbness, tingling, or pain in less than 60 seconds (Figure 3). A healthy person may also develop similar sensations, but not earlier than after 1 minute.
Oppositional test: with severe thenar weakness (which occurs at a later stage), the patient cannot connect the thumb and little finger (Fig. 4); or the doctor (researcher) can easily separate the closed thumb and little finger of the patient.

Differential Diagnosis

Treatment

Pronator teres syndrome (Seyfarth's syndrome)

Pronator teres syndrome sometimes occurs in nursing mothers. They have compression of the nerve in the area of ​​the round pronator occurs when the baby's head lies on the forearm, he is breastfed, lulled and the sleeping person is left in this position for a long time.

Clinical manifestations

Pronator-flexor test. Pronation of the forearm with a tightly clenched fist while creating resistance to this movement (resistance) leads to increased pain. Increased pain can also be observed when writing (prototype of this test).
In the study of sensitivity, a violation of sensitivity is revealed, capturing the palmar surface of the first three and a half fingers and the palm. The sensitive branch of the median nerve, which innervates the palmar surface of the hand, usually passes above the transverse carpal ligament. The occurrence of a violation of sensitivity on the palmar surface of the first finger, the back and palmar surfaces of the II–IV fingers, while maintaining sensitivity in the palm, allows us to confidently differentiate carpal tunnel syndrome from pronator teres syndrome. Thenar atrophy in pronator teres syndrome is usually not as severe as in progressive carpal tunnel syndromes.

Shoulder supracondylar process syndrome (Strather's ribbon syndrome, Coulomb's, Lord's and Bedosier's syndrome)

Cubital Canal Syndrome

Clinical manifestations

Diagnostics

Treatment

If the effectiveness of these measures was insufficient, then the operation is performed. There are several techniques for surgical release of the nerve, but all of them in one way or another involve moving the nerve anteriorly from the internal epicondyle. After the operation, treatment is prescribed, aimed at the speedy restoration of conduction along the nerve.
Guyon's tunnel syndrome
Guyon's tunnel syndrome develops due to compression of the deep branch of the ulnar nerve in the canal formed by the pisiform bone, hook of the hamate, palmar metacarpal ligament and short palmar muscle. There are burning pains and sensitivity disorders in the IV-V fingers, difficulty in pinching movements, adduction and spreading of the fingers.

Ulnar tunnel syndrome is very often the result of prolonged pressure from working tools, such as vibrating tools, screwdrivers, tongs, and therefore occurs more often in certain professions (gardeners, leather carvers, tailors, violinists, jackhammer workers). Sometimes the syndrome develops after using a cane or crutch. Pathological factors that can cause compression also include enlarged lymphatic ganglia, fractures, arthrosis, arthritis, aneurysm of the ulnar artery, tumors, and anatomical formations around Guyon's canal.
differential diagnosis. The difference between Guyon's canal syndrome and cubital tunnel syndrome is indicated by the fact that when a nerve is damaged in the hand, pain occurs in the hypothenar region and the base of the hand, as well as intensification and irradiation in the distal direction during provocative tests. Sensitivity disorders in this case occupy only the palmar surface of the IV-V fingers. At the back of the hand, sensitivity is not disturbed, since it is provided by the dorsal branch of the ulnar nerve, which extends from the main trunk at the level of the distal third of the forearm.

In the differential diagnosis with radicular syndrome (C8), it should be taken into account that paresthesias and sensitivity disorders can also appear along the ulnar edge of the hand. Paresis and hypotrophy of the hypothenar muscles are possible. But with C8 radicular syndrome, the zone of sensitive disorders is much larger than with Guyon's canal, and there is no hypotrophy and paresis of the interosseous muscles. If the diagnosis is made early, then activity restriction may help. Patients can be advised to use fixators (orthoses, splints) at night or during the day to reduce trauma.
In case of failure of conservative measures, surgical treatment is carried out, aimed at reconstructing the canal in order to release the nerve from compression.

Radial nerve compression syndrome

Treatment includes general etiotropic therapy and local effects. Consider the possible connection of carpal tunnel syndrome with rheumatism, brucellosis, arthrosis of metabolic origin, hormonal disorders and other conditions that contribute to compression of the nerve by surrounding tissues. Locally, in the area of ​​nerve infringement, anesthetics and glucocorticoids are injected. Comprehensive treatment includes physiotherapy, administration of vasoactive, decongestant and nootropic drugs, antihypoxants and antioxidants, muscle relaxants, ganglionic blockers, etc. Surgical decompression with dissection of tissues compressing the nerve is indicated when conservative treatment fails.
Thus, tunnel syndromes on the hand are a type of damage to the peripheral nervous system, caused by both endogenous and exogenous influences. The outcome depends on the timeliness and adequacy of treatment, the correct preventive recommendations, the patient's orientation in choosing or changing a profession that predisposes to the development of tunnel neuropathy.

The article uses drawings from the book by S. Waldman. Atlas of common pain syndromes. – Saunders Elsevier. – 2008.

The term "tunnel syndrome" (compression-ischemic neuropathy) combines a group of peripheral nerve diseases that are not associated with infection and vertebrogenic factors. This pathology is not as rare as it is rarely diagnosed. Tunnel syndromes are poorly understood, poorly recognized and detected. Often they are mistakenly interpreted as vascular diseases and so on. That is why the issues related to these diseases are relevant in our time. Consider the main types of tunnel syndromes of the nerve trunks of the extremities.

Causes

Tunnel syndrome can be caused by a narrowing of the bone or muscle channels through which nerve fibers pass. This condition may develop:

• in diseases of the connective tissue due to its excessive growth;
• due to dishormonal age-related restructuring of the connective tissue (with);
• with metabolic disorders in the body (, myxedema);
• as a result of soft tissue edema in case of injury;
• due to thickening of the nerve (amyloidosis, leprosy);
• with prolonged monotonous overstrain of muscles and ligaments.

Sometimes bone canals have congenital narrowing.

Certain types of labor activity can lead to compression of peripheral nerves. This disease is more common in miners, wrappers, masons, athletes, agricultural workers, drivers, dentists, etc.

If compression-ischemic neuropathy (CIN) is caused by common factors, then nerve damage is usually bilateral. If the cause is occupational hazards, then in right-handed people this syndrome develops on the right, and in left-handed people it develops on the left.

carpal tunnel syndrome

The carpal tunnel is a narrow channel formed by the bones of the wrist and the transverse ligament, in which the median nerve passes along with the vessels and tendons of the flexors of the fingers. With a narrowing of this channel or an increase in the volume of its contents (tendovaginitis, collagenoses), compression of the fibers of the median nerve and the arteries that feed it occurs.

Clinically, this syndrome is manifested by pain and paresthesia in the area of ​​I, II, III fingers. These symptoms usually appear at night or early in the morning. Decreased sensitivity to the hand in the zone of nerve innervation, hypotrophy of thenar muscles are characteristic. Often there are trophic disorders of the type.

For differential diagnosis, the following tests are performed. The patient is offered to clench his fist, scratch the second finger on the table, cover the bottle, start the watch, fasten the buttons. If the median nerve is damaged, these actions cannot be performed. It is difficult to oppose the first finger of the brush. The test with arms raised up, forced flexion of the wrist at the wrist joint, dorsiextension of the hand and fingers are used. With a delay in one of the positions for a minute, symptoms of ischemia appear. A test is applied with squeezing the shoulder with a tonometer cuff until the pulse on the radial artery disappears, which also leads to ischemia.

round pronator syndrome

This pathology occurs as a result of compression of the median nerve on the forearm in the muscular-fascial tunnel formed by two muscle bundles - the pronator of the forearm (pronation - turning inward). Musicians are more likely to suffer from this syndrome. Patients are concerned about pain in the upper third of the forearm, wrist, first three fingers. When squeezing the specified muscle with the hands, the pain intensifies. A diagnostic test is the introduction of novocaine, hydrocortisone into the pain point.

Ulnar carpal tunnel syndrome

This is a disease that occurs due to compression of the ulnar nerve and blood vessels in the bone canal located at the level of the first row of carpal bones. Patients are concerned about paresthesia and pain in the wrist, extending to the fourth and fifth fingers of the hand. Pain increases with movement or at night, decreases after local administration of hydrocortisone. For diagnostic purposes, provocation of symptoms by tapping in the canal area is used.

Cubital Canal Syndrome

In some cases, the ulnar nerve can be compressed above the wrist at the level of the elbow joint, causing pain along the inner surface of the forearm and hand. In this area, the nerve is subject to various kinds of damage. It is subjected to compression during prolonged work at the table, resting on the elbows, pressing the hand against hard objects. The cause of this syndrome can also be stenosis of the cubital canal due to arthritis, tumor growth. It is characteristic that in the zone of innervation (the inner surface of the forearm and hand, the fourth and fifth fingers), sensitivity decreases and muscles atrophy. With pronounced changes, the hand takes on the appearance of a clawed paw.

spiral channel syndrome

The radial nerve on the shoulder passes in the groove of the same name and, under certain circumstances, can be pressed down in this area and injured. This is possible during a long sleep on a hard bed (after physical overstrain, in a state of alcoholic or drug intoxication), with a fracture of the humerus. Symptoms are characterized by a decrease in sensitivity along the back of the shoulder, difficulty in flexing the elbow joint, paralysis of the supinator of the forearm (supination - turning outward), as well as paralysis of the extensor muscle of the hand and forearm.

Arch support syndrome

This is a pathology caused by compression of the radial nerve between the bundles of the supinator muscle of the forearm. It is clinically manifested by pain in the area of ​​the elbow joint and the back surface of the arm below the elbow. Sensitivity is not affected. It is necessary to differentiate this pathology with arthritis and arthrosis of the elbow joint. In contrast to these diseases, with compression of the radial nerve, some movements, namely, extension of the forearm, together with abduction of the hand and extension of the fingers, sharply increase the pain.

Roth disease

The external cutaneous nerve of the thigh can be damaged at the point of its exit to the thigh (at the level of the anterior superior iliac spine). This may be the result of trauma with a tight belt, pressing on the edge of the table, etc. Often this pathology occurs during pregnancy or obesity. The disease is manifested by persistent pain and paresthesia on the outer surface of the thigh. The condition worsens when walking, standing.

tarsal tunnel syndrome

In the tarsal canal, located on the inner surface of the ankle joint, the tibial nerve passes with vessels and tendons. When squeezing the tibial nerve in this canal, patients develop pain and impaired sensitivity in the area of ​​the plantar side of the foot and fingers, which can spread upward to the lower leg. The pain is aggravated by pressure or tapping in the ankle joint.

CIN of the common peroneal nerve

It occurs as a result of compression of the peroneal nerve at the level of the head of the fibula (the upper outer part of the lower leg) when working with support on a bent knee, prolonged squatting or throwing a leg over the leg. It can also occur during deep sleep after anesthesia. The nerve can be pressed down by a tumor tightly applied with a plaster cast. Patients develop hypesthesia (decrease in sensitivity) and pain along the lateral surface of the lower leg and foot.

Therapeutic measures

1. Eliminate the cause of compression (if necessary, surgically).
2. Limb immobilization.
3. Physiotherapy procedures.
4. Anti-inflammatory and painkillers (nimesulide, diclofenac, meloxicam, ibuprofen).
5. Diuretics (furosemide).
6. The introduction of corticosteroids (hydrocortisone) and anesthetics (novocaine) into the place of compression.
7. B group vitamins.

Treatment with physical factors

It is prescribed to reduce the symptoms of the disease, accelerate recovery processes and recovery in general.

During his life, almost every person is faced with certain pathologies. Someone suffers from allergies, the other complains of more serious chronic diseases.

Tunnel syndrome is one of the rather unpleasant ailments that fall into the category of nephropathy. This disease is characterized by prolonged pain and severe numbness of the fingers. Let us consider in more detail the features of this disease, methods of its treatment, symptoms and preventive measures.

Reasons for the appearance

It should be said right away that today there is no clearly formulated list, which includes the main reasons for the development of this pathology. However, there are several factors that can cause compression of the nerves in the carpal tunnels. For example, stretching or swelling caused by injuries can lead to such an ailment.

In addition, carpal tunnel syndrome may appear in those people who perform the same physical manipulations daily. For example, those who constantly work in the office, on the computer or for builders. A similar ailment can also be caused by a special state of the body in the event of a failure in metabolic processes or with deformation changes in the tissues of channels or tendons.

Often, carpal tunnel syndrome occurs in pregnant women, people with diabetes, rheumatoid arthritis and other pathologies. If tumors have formed on the nerves that penetrate the canal, then this can also lead to a similar ailment.

In addition, some experts point out that due to prolonged smoking, a person's blood supply may be disturbed, which is also the cause of carpal tunnel syndrome. And some suggest that this disease can develop even against the background of obesity. Regardless of the reasons, it is worthwhile to pay attention to the disease in a timely manner and begin treatment.

Tunneling initial stage

First of all, unpleasant symptoms begin to appear only during work, that is, when the hands are maximally loaded. In this case, numbness of the fingers occurs. Also, some patients complain that at night during sleep they experience problems with 3, 2, 1 and half 4 fingers. In this case, not only unpleasant pain sensations are observed, but also tingling, as well as the appearance of goosebumps. Also, many note that their hands are greatly weakened.

Subsequent symptoms

If at the initial stages timely treatment is not started, then in this case the lesions pass to the muscles. Their functioning is carried out due to the occurrence of pathology, experts note weakness, atrophy and other movement disorders. And in some situations, the disease can spread to other parts of the arm, such as the forearm, shoulder, and beyond. In this case, the cubital tunnel syndrome will have to be treated.

Diagnostics

To correctly diagnose the disease, specialists conduct several different tests. First of all, they tap on the wrists at a certain point and try to detect tingling or painful shootings.

The doctor also asks the patient to squeeze his wrists and talk in detail about his feelings. If there is tingling or pain, this may be the first sign of developing carpal tunnel syndrome.

You can also check for the presence of the disease by raising your hands. If the pressure in the carpal tunnels increases and the unpleasant symptoms increase, then there is a small chance that the patient really suffers from this syndrome.

Differential Diagnosis

Very often, this pathology appears against the background of other diseases. At risk are those people who suffer from diabetic polyneuropathy, arthritis and cervical sciatica. Also in medical practice there is such a thing as alcoholic epilepsy. This pathology can also cause the development of subsequent carpal tunnel syndrome.

Treatment Options

After consultation, the doctor may prescribe an independent course of therapy for the patient. However, only those whose illness is still at an early stage can count on such an outcome. In this case, as a rule, special warming ointments are used in the treatment, in some situations - bandages for the wrists. Thanks to these things, it becomes possible to alleviate painful sensations, especially when a person is at rest.

Also, the doctor can prescribe medication using the simplest anti-inflammatory drugs that have a positive effect on the body, relieve pain and eliminate discomfort. In some situations, steroid injections are prescribed, but they are used only as a temporary solution, with an exacerbation of the disease.

It will also be helpful to talk to a physical therapist. This doctor will help you choose the right course of exercises, advise on how to properly sit or position yourself at the workplace during the day.

If the patient has more pronounced symptoms of carpal tunnel syndrome, treatment may require surgery. This cardinal method of therapy is prescribed only in the situation when the patient is practically unable to move the hand. An open surgery is performed, during which a small incision is made on the transverse carpal ligament.

It is also worth noting that there are a number of practical procedures that can alleviate the patient's condition. For example, experts advise applying cold to a sore spot. With the initial degree of development of carpal tunnel syndrome, a decrease in daily stress helps. In some situations, other treatment may be prescribed using a variety of medications. It all depends on the specific situation, the age of the patient and the individual characteristics of his body.

Alternative treatments for carpal tunnel syndrome

As a rule, this disease develops for quite a long time, so patients have time to seek help even before the disease has passed into the chronic stage. In this case, some private practitioners offer simple hand exercises, massages and mobilization techniques. However, other doctors agree that these methods are not as effective as drug treatment.

Medications

Thanks to specialized tools, you can significantly reduce pain and get rid of swelling. Under the influence of drugs, the compressed channel takes on the usual dimensions, due to which negative symptoms are eliminated. In this case, we are talking about drugs that stop inflammation. Accordingly, in this case, the doctor prescribes non-steroidal anti-inflammatory drugs.

Additionally, you can use topical ointments and gels, which will quickly reduce swelling and anesthetize the most problematic areas. If we talk about the best means, then, as a rule, experts recommend "Nise", "Diclofenac", "Indomethacin" or "Movalis". Also, a positive effect is observed after the use of "Ibuprofen", "Naprofen" and acetylsalicylic acid.

However, before treating carpal tunnel syndrome, it is imperative to consult a doctor. All of these drugs have certain contraindications. You should also be careful when using anti-inflammatory drugs. Often they negatively affect the work of the intestines and other internal organs. Also in this situation, hormonal agents are prescribed that allow you to get rid of the pain syndrome. It is also not recommended to use them without a doctor's prescription. If the patient accidentally starts taking the wrong hormones, then in this case he risks provoking a malfunction in the body. This is fraught with a hormonal imbalance and other ensuing and not the most pleasant consequences.

If the tunnel syndrome of the hand has not reached the chronic stage, then in this case you can use folk remedies. There are several useful recipes that will help get rid of an unpleasant ailment. However, before embarking on self-treatment, it is worth asking the doctor's opinion about the selected herbs or recipes.

To date, the most effective and harmless are several options for home treatment.

Contrast baths

In this case, it is recommended to prepare a special composition of chamomile decoction or sage infusion. All these components have a positive and soothing effect on the condition of the hands. In addition, natural substances reduce swelling and soothe inflamed areas.

To prepare a therapeutic bath, you need to pour one tablespoon of the dry mixture with a liter of boiling water and leave for an hour. After that, you need to strain the liquid and dip your hands into it. The duration of the procedure should be no more than 15 minutes.

You can also prepare a bath with sea salt. To do this, the component must be mixed with two liters of warm water. In this case, 2 tablespoons of salt is enough.

Compress with horseradish leaves

In order to reduce soreness, it is necessary to wash the prepared foliage. After that, horseradish sheets are put into boiling water for 60 seconds (no more). At the next stage, it is enough to shake the liquid from the foliage and wrap the affected areas of the hands with it. Horseradish must be left in this position for 45 minutes. After the procedure, it is advisable to use a nourishing cream. This is due to the fact that horseradish dries the skin quite strongly.

diuretic tea

The disease is caused by excessive pressure, so it is necessary to remove this symptom. Teas and herbal decoctions, which contribute to the rapid removal of excess fluid from the body, do an excellent job with this task. Dill, lingonberries and parsley are best suited. Also, corn stigmas and wild strawberries are distinguished by similar properties.

Prevention

It is worth noting that today most of the people use a computer. Based on this, the most convenient preventive methods will be those that are aimed at the correct location of the person himself and the organization of the workplace, where he spends the most time. Thanks to the correct arrangement of things, the appearance of carpal tunnel syndrome can be prevented.

It is necessary to properly adjust the height of the chair and desktop. These parameters depend on the height and weight of the person. It is also advisable to purchase a chair for work, which will be equipped with armrests. Additionally, you can install a homemade or ready-made wrist rest.

In addition, within an hour it is necessary to give your hands a rest for a few minutes. It is also worth doing some gymnastic exercises, they can be done directly while sitting at the computer. Experts recommend the following:

• With force, clench your hands into fists and with the same force unclench your palms as quickly as possible.
• Rotate each finger in turn clockwise, and then against its movement.
• Forcefully clench your hands into fists and make circular movements with your wrists.
• Strongly squeeze the palms of the hands in the chest area and slowly spread them apart.

Finally

It is necessary to take care of your health and in case of such unpleasant symptoms, contact a specialist as soon as possible. Any problems with the movement of the limbs can develop into more serious chronic pathologies.

It is better to prevent this and start treatment in the early stages. Also, do not assume that carpal tunnel syndrome can develop exclusively in older people. Today, this disease is also found with an enviable frequency in representatives of the younger generation. Therefore, it is better not to bring the situation to a critical point and timely seek help from experienced professionals.