Carpal tunnel syndrome treatment. Carpal tunnel syndrome (tunnel syndrome): symptoms and treatment. Infusion of cucumber and wild rosemary

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 pass through the tunnel freely peripheral nerves and vessels. 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 compression-ischemic neuropathies 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, 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 when long-term use 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 individual characteristics 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, analgesics, NSAIDs) are ineffective, but in some cases, if the patient presents at a more advanced stage of the disease and experiences severe pain, it is advisable to immediately offer such a patient this manipulation.

Other methods of anesthesia. There are currently reports of high efficiency injection of meloxicam with hydrocortisone into the tunnel area.
Effective way reduction of 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 1st finger, the back and palmar surfaces of the 2nd–4th fingers, while maintaining sensitivity in the palm of the hand, allows us to confidently differentiate the syndrome carpal tunnel 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.
tunnel syndrome Guyon Canal
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 at radicular syndrome C8 zone of sensory disorders is much larger than with Guyon's canal, and there is no malnutrition 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. Complex treatment includes physiotherapy, the appointment of vasoactive, decongestant and nootropic drugs, antihypoxants and antioxidants, muscle relaxants, ganglion 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.

Pain and other symptoms originate in the median nerve, which provides sensation in the fingers and controls the thumb.

Causes of Carpal Tunnel Syndrome

The immediate cause of carpal tunnel syndrome is compression of the median nerve at the wrist, where the nerve passes through a tunnel (carpal tunnel) formed by the carpal bones and the transverse carpal ligament. Various situations can lead to inflammation and swelling inside the joint, tendons, and muscles inside the carpal tunnel. Most often this is a job that requires frequent repetitive movements. Computer work, typists, pianists and meat packers are particularly predisposed. Other conditions include:

Or other rheumatic conditions affecting the hand and wrist area;
- wrist injury;
- activities that require a strong grip or grip;
- pregnancy or use of contraceptives (in both cases, fluid retention and swelling of the hands are possible);
- tumor of the median nerve;
- diabetes;
- diseases thyroid gland;
- (a rare disease characterized by pathological enlargement of the hands).

Symptoms of carpal tunnel syndrome

Diagnosis is based on motion analysis, which triggers symptoms if there is pressure on the median nerve at the carpal tunnel. The presence of carpal tunnel syndrome is indicated by the positive tests of Tinel (light tapping over the passage of the median nerve in the wrist area, accompanied by a tingling sensation in the fingers and palm) and Phalen (with maximum flexion in the wrist area for about 3 minutes, there is mild soreness and tingling on the wrist). palmar surface of the thumb, index, middle and partially - ring fingers).

In the initial stage, symptoms appear and are of an indefinite painful nature for several months. When they first appear, they are not suspicious, and medical attention is required only when they become more pronounced. Symptoms become permanent and are characterized by severe pain. If left untreated, there is a gradual weakening and exhaustion of the muscles of the thumb.

Complications

From a medical point of view, carpal tunnel syndrome is not a serious health hazard, but it can significantly limit daily activities and may require a change in the nature of work. Early treatment is recommended to avoid irreversible nerve damage.

What can you do

You should distribute your activity during the day in such a way as to avoid situations that can provoke the syndrome. For example, if you write or print, the hand will be in a bent state for quite a long time, which creates additional pressure on the median nerve. You need to take regular breaks and keep the wrist area at rest. When doing housework, ironing should be avoided.

If swelling in the wrist area is associated with the use of oral contraceptives, then other methods should be considered.
If you experience symptoms consistent with carpal tunnel syndrome, see your doctor as soon as possible. With early diagnosis and timely treatment, there is the possibility of a full recovery. Delaying treatment, however, increases the risk of permanent nerve damage. aspirin or other NSAIDs. If these drugs are ineffective, then cortisone injections can be used.
If conservative treatments have failed, then surgery may be required to avoid nerve damage (surgery involves widening the carpal tunnel and freeing the median nerve).

Tunnel syndrome (tunnel neuropathy) - common name groups of neuropathic conditions in which compression of the nerve trunk occurs. The syndrome got its name from the shape of the bone-fibrous structure - the channel (tunnel) of the joints, tendons and bones surrounding the nerve.

Causes of the disease

The nerve, which lies in the canal of hard tissues, is reliably protected from external influences. But at the same time, it can suffer from deformations of the channel, the walls of which surround it. Overstrain of the ligaments and tendons leads to deformations, causing a temporary deterioration in the blood supply to the tissues and a deficiency in them. nutrients. With constant loads on this area, the changes are fixed and become permanent: the tissues of the tunnel thicken, loosen or swell. As a result, there is no free space left in the tunnel and pressure on the nerve trunk increases, after which violations of its functions begin to develop - the conduction of motor signals.

Much less often, carpal tunnel syndrome can be caused by swelling of the nerve itself. This condition can develop due to general intoxication of the body with heavy metal salts, arsenic and mercury derivatives, and other toxic substances. Prolonged course of any disease requiring the use of antibiotics, diuretics and vasodilators can also lead to the development of tunnel neuropathy.

Risk factors

Tunnel syndrome, as a rule, develops in areas subjected to constant or regular stress in the form of monotonous, repetitive movements. But in addition to mechanical irritation of the nerve and its surrounding tissues, other factors can lead to the disease.

The risk group for developing carpal tunnel syndrome includes the following categories of the population:

• people whose professional or daily activities include the same type of flexion-extensor movements (hairdressers, typists, tennis players, sign language interpreters, musicians - most often violinists, guitarists, painters, etc.);
• people over 50 years of age (age-related changes that occur throughout the body invariably affect bone tissue);
• people suffering from endocrine diseases (diabetes, dysfunction of the thyroid gland, pituitary gland), which significantly impair the ability of tissues to recover;
• people who have family history diseases of the musculoskeletal system or suffering from these diseases (arthritis, osteochondrosis, etc.);
• people who are often exposed to microtrauma of the joints and ligaments (loaders, bodybuilders, masons, etc.);
• people with autoimmune diseases (systemic lupus erythematosus, HIV, etc.)

Types of tunnel syndrome

Carpal tunnel syndrome is the most common type of carpal tunnel and is often mistaken for the only form of the disease.

But this condition can develop when the following nerve trunks are infringed:

Compression of any of these nerves is classified as a tunnel syndrome and has similar symptoms.

Symptoms

Compression of the nerve trunk develops gradually and the intensity of symptoms increases at the same pace. In the initial stage, the syndrome practically does not manifest itself: a person may experience only a feeling of discomfort during prolonged stress on the part of the body in which the nerve was pinched. As the canal narrows, more and more significant disturbances in the functions of the nerve occur, which are manifested by the following symptoms:

1. soreness in the affected area, aggravated after physical activity;
2. pain may occur at rest (most often at night);
3. in the peripheral area of ​​\u200b\u200bthe body (the one that is located further than the point of infringement of the nerve), numbness and tingling are felt;
4. when trying to "stretch" the affected joint or ligament, or when tapping this area, the pain intensifies.
5. With a significant narrowing of the tunnel, more pronounced ones join the listed symptoms:
6. stiffness of the affected joint;
7. deterioration of muscle tone in the zone of nerve compression;
8. with simultaneous tension of symmetrical muscles (for example, when both palms are clenched into fists), the muscles on the affected limb are less pronounced, which indicates their atrophy.

One of the distinguishing features of tunnel neuropathy is that when a nerve is pinched in a large joint (scapula, elbow, thigh), pain can occur at a considerable distance from the affected area, which makes diagnosis difficult. So, for example, with pain in the shoulder, accompanied by numbness of the shoulder, forearm, or upper back, compression of the nerve can be both in the elbow joint and in the shoulder blade.

Complications

Most often, tunnel neuropathy progresses to chronic condition when exacerbations of the disease alternate with periods of remission (asymptomatic course of the disease).

The good news for people suffering from carpal tunnel syndrome is that the pathology rarely goes beyond the affected area and the worst that can happen is an increase in symptoms and pain.

Thus, this condition is not life-threatening. But it can greatly affect its quality. Pain that gets worse and worse over time can cause problems with sleep, appetite, extreme irritability, and ultimately lead to other nervous system disorders such as chronic insomnia, anorexia, bulimia, etc.

Diagnostics

First of all, the doctor examining the patient excludes other diseases that have symptoms similar to the clinical picture of tunnel neuropathy. Among such diseases are arthritis, arthrosis, neuralgia, myalgia, etc.

After that, neurological tests are used to clarify the diagnosis, designed to detect damage in the nerve trunk. The most commonly used test is called "Tinel's symptom," in which a doctor taps the skin over a canal that encloses an injured nerve. With carpal tunnel syndrome, the patient feels numbness, tingling, pinpoint itching (the so-called "sense of crawling"). If the syndrome has developed in an area inaccessible for the Tinel test, electromyography may be prescribed to examine the ability of the nerve to conduct impulses.

Treatment

Treatment of tunnel neuropathy is aimed at relieving the inflammatory process and eliminating edema in the affected area, relieving the patient of pain and preventing more severe pinching of the nerve.

Medical treatment

Among medical preparations The following groups have confirmed their effectiveness:

• (NSAIDs), such as Ibuprofen, Ketorolac, Indomethacin, Nimesulide, etc., in addition to relieving inflammation, provide an analgesic effect;
• hormonal preparations(Hydrocortisone, Prednisolone) are injected into the affected area and / or applied to this area in the form of an ointment;
• calcium chloride injected, intravenously, to relieve inflammation and stabilize the reaction immune system;
• vitamin preparations are prescribed to improve the conduction of nerve signals and normalize blood circulation in the area of ​​nerve compression.

Physiotherapy

Therapeutic exercise is prescribed on an individual basis, depending on the results of the examination and the degree of nerve compression - in some cases, with tunnel neuropathy, it is recommended to exclude any load on the affected joint.

Surgery

In cases where conservative treatment of carpal tunnel syndrome has proven ineffective, the doctor may recommend surgical treatment. During the operation, which is carried out under general anesthesia and lasts about an hour, the surgeon excised thickenings in the tissues that compress the nerve, which allows you to restore its function.

The disadvantages of this method of treatment include the fact that it is impossible to predict in advance how effective the operation will be. In a small percentage of cases (about 2-3%) in patients after surgical intervention there is an increase in symptoms.

Lifestyle Correction

Many people prefer the "convenient" treatment option, in which the doctor prescribes effective medications or procedures, and no action is required from the patient himself. Unfortunately, tunnel neuropathy involves the active participation of the patient in the treatment process.

The main condition for recovery or achieving a long-term remission is the elimination of stereotypical movements that led to nerve compression. Often this becomes the only effective measure that alleviates the symptoms of carpal tunnel syndrome.

Try to perform the usual actions with a healthy hand with an elbow, carpal or shoulder nerve entrapment. If this is not possible, minimize the load on the sore hand: perform only the most necessary actions with it, shifting the bulk of the work to a healthy one.

Get into the habit of sleeping on the opposite side of the affected arm, leg, or shoulder blade. This will allow the affected area to "rest" during your night's sleep and thus compensate for the daily stress.

Ever since in life modern people computers appeared, some diseases that were previously considered quite rare became widespread.

One of them is carpal tunnel syndrome, which affects those who spend a lot of time in front of the monitor.

We will talk about how to recognize the disease and how to get rid of it below.

Carpal tunnel syndrome, or carpal tunnel syndrome, occurs due to tissue edema inside the hole formed by the bones of the wrist in the lower part and the transverse ligament in the upper part. Tissues compress the median nerve passing through upper part channel, causing unpleasant symptoms.

In addition to working at a computer, the disease can cause any condition that reduces the volume of the carpal tunnel or promotes tissue growth, these include:

• injuries and fractures of the wrist, accompanied by the formation of hematomas;
• inflammatory diseases of the muscles;
• arthritis of the wrist joint;
• neoplasms in the carpal tunnel;
• diabetes mellitus, which leads to the development of pathologies of the peripheral nervous system;
• thyroid dysfunction;
• bad habits and wrong way of life;
• pregnancy (pregnant women often have a tendency to edema);
• professional activity that is associated with monotonous flexion and extension movements of the hands: assembling cars, playing musical instruments, sign language translation, etc.

To avoid carpal tunnel syndrome office work to hold the mouse correctly. The wrist should be a straight line and in no case should it “fall through” or bend, otherwise the risk of the disease increases significantly.

Symptoms

The initial signs of the disease are discomfort in those places for the innervation of which the median nerve is responsible (wrist, palm, fingers, especially the thumb and forefinger).

As the disease progresses, weakening, numbness and heaviness in the hand appear, which haunt a person throughout the day and make him wake up in the middle of the night.

carpal tunnel syndrome

Subsequently, awkwardness develops when writing and performing normal movements (tying shoelaces, fastening buttons), and any attempt to lift any object causes severe pain. Unpleasant sensations can spread to the entire arm to the forearm and give to the shoulder.

At first, the symptoms of the disease are insignificant and disappear after shaking and rubbing the hands, but as the disease progresses, they become constant companions of the patient.

Why is carpal tunnel syndrome dangerous?

Many patients do not recognize carpal syndrome and ignore its symptoms or try to treat it on their own.

It is important to note that the lack of treatment leads to irreversible changes in the median nerve, complete loss of sensation and motor functions hands, therefore, with the development of the disease, it is necessary to consult a doctor.

Diagnostics

If there are symptoms of compression of the median nerve, it is necessary to contact a neurologist as soon as possible. Diagnosis begins with the collection of anamnesis and patient complaints, after which the doctor conducts physiological tests: when raising the hands, the symptoms of the disease intensify due to increased pressure in the canal, squeezing and tapping on a certain point on the wrist causes backache or tingling in the fingers.

In addition, the following methods are used to make an accurate diagnosis:

• electrodiagnostics determines the functioning of the nerves in the hand;
• Ultrasound can detect damage to tissues and bones;
• radiography excludes other diseases of the hands.

A characteristic sign of carpal syndrome is numbness of the fingers, except for the little finger. In the later stages of the disease, the patient cannot connect the thumb to the little finger.

Carpal tunnel syndrome: treatment

Medications

It is mainly aimed at reducing pain and inflammation of tissues, for which they are used different drugs and their combinations:

1. non-steroidal and steroidal anti-inflammatory drugs. To relieve unpleasant painful symptoms in carpal tunnel syndrome, the canal is used such strong drugs like "Ibuprofen", "Diclofenac", etc. Do not forget that they can cause problems with the gastrointestinal tract, so for patients with gastrointestinal and cardiovascular diseases, these drugs are prescribed as injections, or other treatment regimens are offered (for example, Tramadol in combination with Paracetamol) ;
2. anesthetics and hormones. An effective method in the fight against pain in this disease is novocaine blockade with the simultaneous administration of hydrocortisone;
3. drugs for neuropathic pain. Good result with neuropathic pain, it gives the use of anticonvulsants (Gabapentin, Pregabalin) and antidepressants. It should be noted that similar drugs, unlike anesthetics and anti-inflammatory drugs, do not begin to act immediately, but some time after administration.

In any case, drugs and dosage should be selected by a specialist based on the severity of symptoms and the characteristics of the patient's body.

Folk remedies

Treat carpal tunnel syndrome folk remedies it is possible in the first stages of the disease, when the pain is not too pronounced - in case of acute, burning pains, it is best to consult a doctor:

1. ammonia and camphor alcohol. In a liter of water, dilute 10 g of camphor alcohol and 50 g of ammonia (10%). Rub the mixture on the affected areas. The tool well relieves burning and numbness of the hands;
2. bearberry. A plant called bearberry has an anti-inflammatory and diuretic effect, thanks to which it relieves swelling well and reduces the manifestations of the disease. Take a tablespoon of bearberry, pour a glass of boiling water, insist for several hours. Drink a tablespoon 2-3 times a day;
3. black pepper. Take 100 g of ordinary black pepper, pour them with a liter vegetable oil, then hold on low heat for half an hour. Rub warm oil into sore spots twice a day;
4. sea ​​​​buckthorn. Sea buckthorn berries are one of the most common painkillers among the people. They need to be rubbed well, add a little water, warm up a little (temperature 37 degrees) and dip your hands into the mixture for 30 minutes. After the procedure, wipe your hands well and put on warm gloves. The course of treatment is a month, after which a two-week break should be taken;
5. cabbage. Cabbage leaves are also considered a decongestant and anti-inflammatory agent, which can also be used for tunnel syndrome. Leaves can be applied to the affected areas as a whole or crushed into gruel and make compresses.

People who have to sit at a computer or strain their wrists while working are advised to introduce regular cherries in any form into their diet ( dried berries, jam, natural juice). Substances contained in berries reduce inflammation in the body, thereby significantly reducing the risk of carpal tunnel syndrome.

Surgical intervention

The intervention is carried out local anesthesia(sometimes through endoscopy), during the operation, the doctor cuts the transverse ligament of the wrist, thus reducing pressure on the median nerve.

The recovery period lasts several months and involves a set of rehabilitation measures to restore the functions of the hand.

Prevention

The main preventive measure to prevent the disease is the appropriate organization of the workplace. When working with a mouse, you need to use a special support and monitor the correct position of the wrist, and the desk chair should have armrests.

Correct and wrong position brushes when working with a computer mouse or trackball

When performing any work related to the tension of the hand, you need to give your hands a rest from time to time, lowering them down and shaking them well. Helps well special gymnastics for hands (rotation with brushes, clenching and unclenching fists) and light massage.

Finally, to prevent the disease, one should refuse bad habits, support normal weight body and timely treat inflammatory diseases.

Useful video

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Carpal tunnel syndrome (carpal or carpal tunnel syndrome) is a pathology that occurs due to compression of the median nerve.

As a result, the functionality of the middle, index and thumb(І-ІІІ), the sensitivity of the forearm and hand is lost.

What is the danger of carpal tunnel syndrome in advanced forms of the disease?

Carpal tunnel syndrome begins with mild discomfort, gradually developing into systemic pain, limitation of arm mobility, up to its dysfunction and muscle atrophy . All this is possible with advanced forms of the disease.

Brushes can drag on for several years. In addition, severe cases are at risk of not being able to fully recover.

Causes

carpal tunnel occurs due to swelling of the synovial membranes surrounding the tendons in the wrist, which causes pressure (compression) on the median nerve of the palm.

The causes of this phenomenon can be classified into several groups:

Anatomical. This group includes congenital anomalies in the wrist area, anatomical narrowness of the carpal tunnel, fractures of the carpal bones or malunion bones, etc.

Physiological. The primary factor in this group, provoking the development of carpal tunnel syndrome, is the inflammatory process. Pathology can also occur against the background of other conditions or diseases:

• Obesity;
• Rheumatoid arthritis;
• Gout;
• Hypothyroidism;
• Diabetes;
• Pregnancy or menopause;
• Thyroid dysfunction;
• Tumors or other formations located in the area of ​​the carpal canal.

In addition, hereditary factors, gender and age affect the occurrence of the disease. Women over 50 are more prone to carpal tunnel syndrome.

Acquired. This group includes lifestyle, profession. At risk are employees who systematically perform monotonous and monotonous wrist movements:

• Seamstress;
• Computer work;
• The hairdresser;
• conveyor workers;
• Musicians;
• Builders.

People who abuse alcoholic drinks and smoking are also at risk. This is due to the deterioration of general blood circulation, including in the wrist area.

Among the abundance of causal factors in the appearance of carpal tunnel syndrome, leadership takes work at the computer. Using the keyboard and mouse involves bending the hand at the wrist and a large number of small hand movements. This leads to prolonged tension, impaired circulation and nutrition of the muscles of the hand, swelling and, ultimately, compression of the median nerve. In this regard, carpal tunnel syndrome has acquired another name - computer mouse syndrome.

Diagnostics

Often people are inattentive to their health and do not pay attention to any changes in the functioning of body systems.

As a rule, neglect of one's condition occurs until it becomes difficult to perform ordinary household tasks.

Untimely visit to the doctor significantly prolongs the period of treatment and recovery.

Symptoms of carpal tunnel syndrome at the initial stage are rather mild (if they are not provoked by trauma). However, it is still possible to identify them.

What you need to do for a quick diagnosis at home

In order to recognize carpal tunnel syndrome at home, it is enough to perform a series of simple tests: cuff, oppositional, raised arms, shaking, Tinel, Phalen and Durkan test. These methods are also used in medical diagnostics.

All these tests are carried out in order to find out whether this or that manipulation will cause numbness in the fingers or pain in the wrist and nearby areas, which is typical for hand syndrome.

1. Tinel test. AT medical conditions the test is performed using a neurological hammer. At home, this tool can be replaced with a bent finger. It is necessary to tap the interphalangeal joint of the finger on the inside of the wrist. The test result will be positive if the patient experiences numbness(tingle) or pain shooting in fingers I-III.
2. Durkan test. You need to squeeze your wrist with the other hand. A positive test will be in the same case as in the Tinel test.
3. Phalen test. Flexion or extension of the hand by 90° causes characteristic discomfort. However, in healthy people, this occurs no earlier than a minute later. If the discomfort came earlier, this is a suspicion of carpal tunnel syndrome. It is most convenient to carry out this test simultaneously with both hands: put both palms against each other with the back or palm side, while the forearms should be clearly perpendicular to them (at an angle of 90 °). Doing the test with both hands at the same time will allow you to compare the sensations between them.
4. cuff test. To perform this method, you will need a pressure measuring device. A cuff is applied to the arm approximately in the middle of the forearm (between elbow joint and wrist), and a pressure slightly above the mean arterial pressure is pumped. You need to hold this state for a minute. A positive test is when symptoms of hand syndrome appear during this time. With advanced and severe stages of the disease, the symptoms of the syndrome will occur even with usual location cuffs - above the elbow.
5. Raised hands test. If you suspect this pathology, you need to raise your hands up, and hold the position for a minute. In the presence of the disease, after a maximum of 30-40 seconds, characteristic sensations will appear.
6. Opposition test. Connect the little finger with thumb. If there is a disease, this will be difficult.
7. shaking. In the initial stages of the syndrome, but in the presence of symptoms, shaking the brush will alleviate the condition.

At a positive result any of the tests next step should be referred to a qualified specialist.

IMPORTANT: home diagnostics cannot replace a doctor's consultation. At the slightest suspicion of the development of carpal tunnel syndrome, you need to consult a doctor. If these tests come back negative, you may have.

Symptoms

The clinical picture of carpal tunnel syndrome, depending on the stage and form of the disease, will differ. Symptoms include:

• Numbness, tingling, burning, itching in the palm, forearm and І-ІІІ fingers;
• Decreased sensitivity;
• Painful sensations of the type of lumbago;
• Cramps in the arm;
• Difficulties in holding objects, clenching the palm into a fist;
• Feeling of weakness in the arm;
• Clumsiness and clumsiness of the fingers;
• swelling of the fingers;
• Muscle atrophy (in severe stages of the disease).

Most often, the symptoms worsen at night, when the arm is relaxed and immobilized. for a long time. This is due to the influx of lymphatic fluid to the damaged area.

IMPORTANT: symptoms may be irregular, but over time, without medical attention, they will become permanent.

Complications

Wrist syndrome is not a life-threatening pathology. However, over time, seemingly harmless, the symptoms of the disease will progress: the pain will become more frequent and intensify, the loss of sensitivity will begin to spread throughout the limb, etc.

Destructive processes will lead to irreversible changes in the nerve. The most disappointing result of inaction in terms of treatment is muscle atrophy and loss of hand function. Which, in turn, will greatly affect the quality of life.

With qualified and timely therapy, the outcome of the disease is favorable.

IMPORTANT: self-medication can aggravate the condition and worsen the prognosis for recovery.

Postoperative complications may include:

• infections
• Roughening of the tissues of the palm
• Nerve damage

Hand treatment

Treatment of carpal tunnel syndrome includes 2 main directions: conservative methods or surgical intervention.

conservative methods

Alternative therapy can be used as the only way or as an extra.

The early stages of the identified syndrome in most cases can be cured only by conservative therapy.

The most commonly used are several conservative methods in complex.

Conservative treatments for carpal tunnel syndrome:

1. Immobilization and limitation of movement. A splint or rigid bandage is placed around the wrist to hold it in place and relieve pressure on the median nerve. It is especially appropriate to apply the method at night. Avoid stress and activities that cause pain. If necessary, you need to change professional conditions, at least for a while.
2. Applying cold. Actual at the beginning of the disease with swelling of the limb.
3. Pharmacological preparations. Anti-inflammatory drugs are used. They can be in tablets, in the form of injections or ointments. Usually prescribed: aspirin, prednisone, prednisolone, nimesil, ibuprofen, nurofen, nimesulide, hydrocortisone, etc.
4. Physiotherapy. To alleviate the condition, they carry out: massage, stretching exercises, acupuncture, electrophoresis, warming up.
5. ethnoscience. Partially relieve symptoms cabbage leaves or plantain, contrast hand baths, rubbing the wrist with a mixture of vegetable oil and black pepper, drinking diuretic drinks.

Surgery

In case of neglect of the pathology or ineffectiveness of conservative methods of treatment within six months, surgery is started.

The goal of the surgery is remove tissue, due to which compression occurs on the median nerve.

Surgery for carpal syndrome is performed by one of two options: open or endoscopic incision.

At open operations, an incision is made on the wrist (about 5 cm long) and ligaments along the carpal tunnel. Next, a partial or complete dissection of the carpal ligament is performed.

Endoscopic operations are characterized by a smaller incision area: 2 incisions of 1 cm are made. A camera is inserted into the middle, which displays the entire procedure on the screen. This method provides a short postoperative period.

Both operations are performed under local anesthesia and are most often performed on an outpatient basis.

IMPORTANT: the lion's share of success is postoperative care and compliance with all medical recommendations.

The duration of the recovery period varies depending on the conscientiousness of the patient in the postoperative period.

The criterion for recovery is not only the renewal physical activity, but also the return of the opportunity to carry out the same activity that provoked the disease. Total duration recovery from wrist syndrome reach from 1 month to 1 year.

Latest research in the field of treatment

According to the health-saving website Polismed, the prevalence of carpal tunnel syndrome is about 1.5-3% in the world, 50% of which are active computer users.

Thanks to research in the field of prevention and prevention, special platforms have been developed for working with a keyboard and mouse, as well as a flying computer mouse with a magnetic ring.

These inventions eliminate the burden on the wrist and are ergonomic.

According to the results of research by the American University of Maryland Medical Center, surgical treatment of carpal tunnel syndrome prevails over conservative treatment.

A study of the problem in the UK led to the conclusion that operation with carpal tunnel syndrome in most cases (about 75% of respondents) retains hand function.

Scientist Gwyn Jones discovered the relationship between the age of the patient and the effectiveness of surgical intervention.

Positive dynamics after surgery in persons over 65 years of age is observed for a short time.

Regarding the comparison of the effectiveness of surgical methods, there is no unanimous opinion. However, according to the Russian Science Center neurology, a minimally invasive surgical technique allowed the patient to get to work faster.

Prevention

Preventive measures of carpal tunnel syndrome will prevent the occurrence of this disease. The main rules are rational organization workplace and useful physical activity.

Exercises

The first condition on the way to avoiding hand syndrome and similar pathologies is weight optimization. Overweight body leads to swelling and increased compression on organs in general and nerves in particular. To do this, you need to regularly perform general developmental physical exercises and lead healthy way life.

There are exercises that will help prevent the vulnerability of the wrist and carpal tunnel. All of them are aimed at stretching and strengthening the wrist joint and wrist.

Complex preventive exercises carpal tunnel syndrome:

1. Interlock fingers in the lock: 6-8 circular motions brushes on each side.
2. Straighten and spread your fingers as far as possible: hold the position for 10-15 seconds, repeat 2-3 times.
3. The same, but bend all fingers in all joints.
4. Hands forward, hands up (back to you): hold the position for 10-15 seconds, repeat 2-3 times
5. The same, but brushes down (back side away from you)
6. Circular movements with each finger in both directions, perform with the help of the other hand, repeat 4-6 times for each finger
7. The same, only pull each finger for 2-4 seconds
8. Hands forward, hands in fists, maximum turns of the hands in opposite sides(both fists out): hold the position for 10-15 seconds
9. Hands in front of you, palms touching: without taking your palms apart, lower your hands until you feel tension, hold the position for 10-15 seconds
10. The same, but tilt the brushes forward, alternately to the sides

Workplace organization

Proper organization of the workplace will not give a chance for hand syndrome to appear. This includes:

• Limitation of work with bent wrists when performing movements, holding objects, typing on a computer, etc.
• Desktop environment, taking into account the laws of ergonomics: the correct ratio of the height of the chair to the table, the distance from the eyes to the monitor, the location of the computer mouse, etc..
• During work breaks, instead of smoking breaks, do physical pauses, which include stretching exercises for the musculoskeletal apparatus of the hands
• Shake hands periodically

Video about tunnel syndrome

Be sure to look at Dr. Karpinsky's treatment tips: