carpal tunnel syndrome. Symptoms, treatment, prevention. Carpal tunnel syndrome. What is carpal tunnel syndrome and how is it treated?

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

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

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

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

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

The reasons

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

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

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

Symptoms

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

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

Paresthesia

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

Pain

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

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

Clumsy hand movements and loss of strength

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

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

Desensitization

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

Amyotrophy

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

Change in skin color

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

Diagnostics

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

Tests for carpal tunnel syndrome:

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

Such tests can be used for preliminary self-diagnosis at home. If during even one of them there are unpleasant sensations, then an appeal to the doctor is necessary.

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

electroneuromyography;
radiography;

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

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

Treatment

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

Guard mode for carpal tunnel syndrome:

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

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

Local treatment

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

Compresses

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

One of the composition options for compresses:

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

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

Injection of drugs into the carpal tunnel

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

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

Medical therapy

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

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

Physiotherapy

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

The following can be used to treat carpal tunnel syndrome:

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

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

Surgery

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

People who work a lot at the computer, or those who, by the nature of their activities, often have to bend and unbend the hand (playing the piano, cello, construction work, sports, etc.) often face such a problem as carpal tunnel syndrome, which occurs from excessive compression or pinching of the median nerve. People with somatic diseases are most susceptible to carpal tunnel syndrome. 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 of 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, 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 a light tap on the wrist from the 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 is 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, pictures of the cervical spine are taken.
3. X-ray - a study using radiation. This method is used to take pictures of 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 case of hypothyroidism, substitution therapy is carried out, while the restoration of disturbed 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.

For successful treatment, it is recommended to limit the load, give the affected arm a rest for at least a couple of weeks. In some cases, a splint is placed on the wrist to prevent it from bending. As painkillers and anti-inflammatory drugs, drugs such as aspirin, ibuprofen, diclofenac, nimulide, etc. are used. Cold compresses are applied to reduce swelling of the hands, and diuretics are also used.

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, surgical treatment completely eliminates 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

An excellent folk remedy that 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 the fingers and burning sensation in case of tunnel syndrome, such a healing agent relieves: a tablespoon of salt, 50 grams of ten percent ammonia and 10 grams of camphor alcohol are dissolved in 1 liter of water.

Pepper oil rub

Black pepper is able to defeat 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 tbsp) 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 directions, clap your hands, clasp your fingers in the lock. 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 will have to load your wrist for a long time, 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.

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 of the 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 evidenced 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 fail, surgery may be required to avoid nerve damage (surgery involves widening the carpal tunnel and freeing the median nerve).

The modern world cannot exist without new technologies. The computer and the Internet have become everyday companions of almost every person, young and old. We spend a significant part of the time at the computer: someone on duty, and someone as a leisure activity. Regardless of the reason, we use a computer mouse when operating this device for convenience. It would seem that a very convenient and harmless invention. But it was not there. Regular use of the mouse can cause pain and numbness, as well as weakness in the hand. Fingers become naughty, cannot hold objects and hurt at night. These symptoms are due to the occurrence of carpal tunnel syndrome. This is what the pathological result of using a computer mouse is called.

This condition occurs not only when working at a computer, but also as a result of a number of other reasons. Prior to the age of computer technology, carpal tunnel syndrome arose mainly in people employed in production with intensive use of the hands (frequent flexion and extension). Similar symptoms can also appear during pregnancy, some somatic diseases. From this article, you can find out what carpal tunnel syndrome is, when it develops, how it manifests itself, how to deal with it, and what measures can be taken to prevent its occurrence.

Carpal tunnel - what is it?

Carpal tunnel syndrome, or carpal tunnel syndrome, is a pathology of the peripheral nervous system. It is based on compression of the median nerve in the region of a specific anatomical canal in the wrist (a kind of tunnel), from where the name of the disease comes from.

The carpal tunnel is located at the junction of the forearm and hand on the palmar side. Its walls are formed by the bones of the forearm (radius and ulna) on the one hand, 8 small bones of the wrist on the other, between which the transverse ligament of the wrist is thrown. Inside this kind of tunnel are the median nerve and tendons of the muscles of the hand. The size and shape of the canal, the thickness of the transverse carpal ligament is initially different for each person. Those people who have a narrow canal and a thick ligament have an increased risk of developing carpal tunnel syndrome. There is an interesting pattern: carpal tunnel syndrome practically does not occur in representatives of the Negroid race. This disease predominantly affects Europeans. It is possible that the dark-skinned representatives of humanity initially have a rather wide canal, so their median nerve is not infringed in this area.

That part of the median nerve that passes directly through the canal provides sensitive innervation of the palmar surface of the first three fingers of the hand and half of the ring finger (the side facing the thumb), as well as motor innervation of the muscles that ensure the movement of the thumb (abduction and opposition of it relative to the palm and other fingers). Compression of the median nerve in the canal area leads to a change in sensitivity in these areas and a decrease in muscle strength, which is the basis of the clinical manifestations of carpal tunnel syndrome.

Causes of compression of the median nerve in the canal

Normally, the median nerve feels quite at ease in the carpal tunnel. However, some conditions can cause a change in the lumen of the canal, thereby provoking compression of the nerve and tendons located in it. The narrowing of the lumen of the canal occurs as a result of swelling of the muscles of the hand and tendon sheaths, impaired blood supply to the muscles. These changes occur when:

a large number of monotonous movements of flexion-extension of the hand in the course of professional activities, including those with the effect of vibration (typists, milkmaids, dentists, seamstresses, pianists, assemblers of equipment, carvers, carpenters, masons, miners, and so on). An additional role is played by hypothermia of the hand;
prolonged stay of the brush in a position of excessive flexion or extension. Most often this occurs when working at a computer using a mouse with the wrong posture. Curving the hand more than 20° in relation to the forearm when a person uses a computer mouse leads to the development of carpal tunnel syndrome. In order to ensure that the hand stays in a straight line with the forearm, it is necessary to use a special mat-stand on wheels. The mat ensures the correct position of the hand when working with a computer mouse;
traumatic injuries in the wrist area (fractures, dislocations);
pregnancy (due to a tendency to edema);
taking hormonal contraceptives (which is also the cause of the formation of edema in the carpal tunnel area);
other diseases of the body and pathological conditions that lead to edema or a decrease in the lumen of the canal. These are diabetes mellitus, rheumatoid arthritis, hypothyroidism (decreased thyroid function), amyloidosis, acromegaly, menopause, gout, kidney failure, overweight.

It cannot be said that all these conditions will necessarily provoke the development of carpal tunnel syndrome. They increase the risk of its development, serve as an impetus, a prerequisite for its occurrence, but nothing more.

Clinical manifestations of carpal tunnel syndrome

The disease is more susceptible to the female sex. According to statistics, women suffer from this disease 10 times more often than men. Most often, carpal tunnel syndrome develops at the age of 40-60 years, when the ability of tissues to bear the load decreases, hormonal changes in the body develop.

Symptoms appear gradually, gradually gaining momentum. The main signs of carpal tunnel syndrome are:

numbness of the first three fingers of the hand (sometimes even half of the ring finger), which appears in the morning and with certain movements of the hand. If the patient often holds on to the upper handrails in public transport, drives a car with the hands fixed on the steering wheel, holds the phone in his hand while talking, all this provokes numbness and makes him change his position, shift the phone to the other hand, and so on. If the profession requires constant brush movements, then this also provokes numbness;
paresthesia - discomfort in the palm and first three fingers. It can be tingling, crawling, burning sensation;
pain in the area of 3-4 fingers of the hand (except for the little finger), palms, wrist, radiating to the forearm, elbow joint. The fingers hurt as a whole, and not just in the joints (as in other diseases). The pains have a burning tinge. As the disease progresses, pain along with numbness begin to disturb the patient at night, making it difficult to sleep. Patients rub, shake their hands, lower them down from the bed, which somewhat alleviates the condition (during these actions, blood flow improves somewhat);
clumsiness of the fingers and hand. At first, this symptom is associated with a violation of the sensory innervation of the fingers by the median nerve. Objects fall out of the hands, fingers do not obey, become wadded, rigid. It is difficult to hold a pen and write, type on the keyboard (fingers do not hit the right keys). Later, such clumsiness also exists due to weakness in the individual muscles of the hand;
an objective decrease in sensitivity in the zone of innervation of the median nerve (all the same first 3.5 fingers and a section of the palm) - hypesthesia. The feeling of a light touch (with a cotton wool or feather) is lost, the difference between a sharp and blunt touch. With prolonged existence of compression of the median nerve, gross violations of sensitivity develop, sensations do not arise even from injections;
with damage to the autonomic fibers that make up the median nerve, trophic disorders develop. This is manifested in a change in the temperature of the affected hand (more often it becomes cold to the touch), a change in color (blanching more often develops), a sweating disorder (increase or decrease), thickening of the skin on the palm, clouding of the nails. A decrease in ambient temperature is accompanied by blanching and cooling of the affected hand;
weakness of the muscles that move the thumb. Abduction and opposition of the thumb suffers predominantly. The patient cannot grab an object with a brush (for example, it is impossible to hold a bottle, a glass in his hand due to their specific shape). If the compression of the median nerve exists for a long time, then it is even possible to develop hypotrophy (thinning) of the muscles of the elevation of the thumb (the part of the palm directly adjacent to the first finger).

Depending on the cause that caused the carpal tunnel syndrome, localization of changes can be unilateral or bilateral. If the prerequisite was to work with a computer mouse, then only the working hand will suffer. If the narrowing of the channel is caused by pregnancy or some other disease, then, most likely, the involvement of both limbs in the process. As a rule, the predominant limb (right for right-handers and left for left-handers) suffers more.

Despite the fact that carpal tunnel syndrome does not pose a threat to a person's life, its occurrence, however, makes a person disabled. Moreover, the inability to carry out labor activity can last for several months. Of course, timely seeking medical help and a timely diagnosis, followed by appropriate therapy, lead to recovery. The prolonged existence of the disease without adequate treatment can permanently disrupt the functioning of the hand and fingers.

Diagnostics

Carpal tunnel syndrome is a disease where the diagnosis can be established directly at the first visit to the doctor for medical help. Carefully collected complaints, a neurological examination and a number of some symptom-provoking tests help the doctor not to make a mistake. What kind of tests are carried out during the examination? They are quite simple and do not require any specific equipment. It:

test, or Tinnel's symptom. Its essence is as follows: tapping (light tapping) at the level of the skin fold in the area of the wrist joint causes pain and paresthesia in the area of the first 3 fingers (3.5, to be more precise), palms spreading to the forearm (that is, in those places where these sensations disturb the patient outside of tapping);
Phalen test. To conduct this test, it is necessary to bend the wrist in the wrist joint at a right angle and hold it in this position for 1-2 minutes. This position provokes the occurrence of numbness, paresthesia and pain in the fingers and hands;
tourniquet (cuff) test. The shoulder of the affected arm is squeezed with a tonometer cuff until the pulse disappears and is held in this position for 1 minute. As a result, typical symptoms of carpal tunnel syndrome appear;
postural provocation - raising straightened arms above the head and holding in this position for 1 minute. The result is the same as in other tests.

If there are still some doubts about the correctness of the diagnosis, then the patient is prescribed an additional research method - electroneuromyography. This method allows you to confirm the dysfunction of the median nerve and clarify the location of its lesion, as well as to distinguish carpal tunnel syndrome from other diseases of the peripheral nervous system (including osteochondrosis of the spine).

All of the above is valid only in relation to carpal tunnel syndrome, that is, to clarify this particular diagnosis. If the syndrome itself is the result of some other disease (diabetes mellitus, arthritis, and so on), then other additional research methods may be needed.

Treatment

Successful treatment of carpal tunnel syndrome requires consideration of the underlying cause. If this is a professional activity, then it is necessary to stop it for the duration of treatment. If the cause lies in the presence of another disease, then it must be treated along with carpal tunnel syndrome, otherwise recovery will not occur.

Proper treatment of carpal tunnel syndrome is always complex. The use of drug and non-drug methods, along with some manipulations in the canal zone, almost always gives a positive result, and the disease recedes.

From non-drug measures apply:

acupuncture;
compresses with dimexide and anesthetic, non-steroidal anti-inflammatory drugs (Diclofenac);
applying ice cubes for a few minutes 1-2 times a day (helps reduce swelling in the canal area).

Of the drugs used:

non-steroidal anti-inflammatory drugs (Diclofenac, Nimesulide, Ibuprofen, Meloxicam and their analogues). Drugs relieve pain, reduce inflammation and swelling in the carpal tunnel;
diuretics (Furosemide, Lasix, Diakarb). Their use gives a therapeutic effect by reducing tissue swelling;
funds that improve blood flow, and hence the nutrition of the median nerve (Pentoxifylline, Nicotinic acid, Vinpocetine, Nicergoline and others);
B vitamins (Combilipen, Milgamma, Neurovitan, Neurorubin and others).

If these measures are not enough, then they resort to injections of glucocorticoids with anesthetics (Hydrocortisone or Diprospan with Novocaine or Lidocaine) into the carpal tunnel. Manipulation is carried out with a special needle in a certain place. Usually, even a single injection is enough for the manifestations of carpal tunnel syndrome to decrease dramatically. And two or three manipulations, carried out with an interval of several weeks, allow you to completely get rid of the disease.

If the introduction of a hormone with an anesthetic did not give a positive result, and the diagnosis was established correctly, then there is only one way out - surgical treatment.

Surgical treatment of carpal tunnel syndrome is to cut the transverse carpal ligament. The operation is performed under local anesthesia. A skin incision 5 cm long is made in the wrist area, and then the ligament is dissected and the median nerve is released. Endoscopic surgery is also possible. In this case, two incisions of 1-1.5 cm are made and, using a special tube, an instrument is brought to the ligament, with the help of which the ligament is dissected. The scar in the case of endoscopic surgery is smaller, and not so painful. However, for the complete disappearance of the symptoms of carpal tunnel syndrome after surgery, some time (sometimes several months) must pass. Throughout this period, the patient is undergoing physiotherapeutic procedures aimed at restoring the median nerve, and physiotherapy exercises are also prescribed.

Sometimes carpal tunnel syndrome is not completely cured even after surgical treatment. This happens when the nerve is irreversibly damaged (compression was too long and strong). In such cases, some of the symptoms remain with the patient forever.

Prevention

If your professional activity is related to working at a computer, then there are a number of recommendations, the implementation of which allows you to avoid the occurrence of carpal tunnel syndrome:

correct working posture (a right angle between the hips and the lower back, between the shoulder and forearm. The hand and forearm should be on the same straight line. The hand should lie on the table and not hang in the air. Special stands on wheels are used to support the forearm.);
periodic breaks in work (every 30-60 minutes for 5-10 minutes). During breaks, it is necessary to do gymnastics for the brushes: shake them, squeeze and unclench your fingers into a fist, massage the brushes, use an expander. This improves blood flow, reduces venous congestion, which serves as a prevention of tissue edema;
the ability to adjust the height of the table, monitor, armrests, support on the back of the chair.

In addition, today, there are computer mice in the form of a joystick, which significantly reduces the load on the carpal tunnel. This is somewhat unusual, but introducing them into office life can significantly reduce the risk of developing carpal tunnel syndrome.

As for other professions, employment in which can lead to the development of carpal tunnel syndrome, it is necessary to observe sanitary and hygienic and technical working conditions in order to avoid the occurrence of this disease. Breaks in work, the absence of exceeding vibration indicators, the appropriate length of working time without overtime, and similar measures serve to prevent the occurrence of carpal tunnel syndrome.

Thus, it becomes clear that carpal tunnel syndrome is not a dangerous, but very unpleasant disease. It is not life threatening at all, but it causes a lot of inconvenience both at work and in everyday activities. Don't ignore the symptoms you now know about. The key to successful treatment of this pathology is in timely seeking medical help.

Neurologist M. M. Shperling (Novosibirsk) talks about what carpal tunnel syndrome is:

Channel One, the program "Health" with Elena Malysheva on the topic "Tunnel Syndrome":

Moisov Adonis Alexandrovich

Orthopedic surgeon, doctor of the highest category

Moscow, Balaklavsky prospect, 5, Chertanovskaya metro station

Moscow, st. Koktebelskaya 2, bldg. 1, metro station "Dmitry Donskoy Boulevard"

Moscow, st. Berzarina 17 bldg. 2, metro station "October field"

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Education and professional activities

Education:

In 2009 he graduated from the Yaroslavl State Medical Academy with a degree in general medicine.

From 2009 to 2011, he underwent clinical residency in traumatology and orthopedics at the Clinical Emergency Hospital named after. N.V. Solovyov in Yaroslavl.

Professional activity:

From 2011 to 2012, he worked as a traumatologist-orthopedist at the emergency hospital No. 2 in Rostov-on-Don.

Currently works in a clinic in Moscow.

Internships:

May 27 - 28, 2011 - Moscow city- III International Conference "Surgery of the Foot and Ankle" .

2012 - training course in foot surgery, Paris (France). Correction of deformities of the forefoot, minimally invasive operations for plantar fasciitis (heel spur).

February 13-14, 2014 Moscow - II Congress of traumatologists and orthopedists. “Traumatology and orthopedics of the capital. Present and Future".

June 26-27, 2014 - took part in V All-Russian Congress of the Society of Hand Surgeons, Kazan .

November 2014 - Advanced training "Application of arthroscopy in traumatology and orthopedics"

May 14-15, 2015 Moscow - Scientific and practical conference with international participation. "Modern Traumatology, Orthopedics and Disaster Surgeons".

2015 Moscow - Annual international conference.

May 23-24, 2016 Moscow - All-Russian Congress with international participation. .

Also at this congress he was a speaker on the topic Minimally invasive treatment of plantar fasciitis (heel spurs) .

June 2-3, 2016 Nizhny Novgorod - VI All-Russian Congress of the Society of Hand Surgeons .

June 2016 Assigned . Moscow city.

Scientific and practical interests: foot surgery and hand surgery.

carpal tunnel syndrome

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

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

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

Causes of carpal tunnel syndrome

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

Many things contribute to the development of carpal tunnel syndrome:

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

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

Other factors that can lead to carpal tunnel syndrome include:

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

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

Signs and symptoms of carmal tunnel syndrome:

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

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

During the examination, the doctor may determine:

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

Additional diagnostic methods:

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

Treatment of carpal tunnel syndrome

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

1. Conservative treatment

If the disease is diagnosed and treated early, carpal tunnel syndrome can be managed without surgery.

If conservative methods are not effective within 6 months, surgical treatment of carpal tunnel syndrome is recommended.

2. Surgery

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

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

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

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

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

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

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

Long term results.The symptoms of carpal tunnel syndrome in most patients improved immediately after surgery, but full recovery may be gradual.

Full recovery can take from 1 month to a year if the disease has a long history and severe symptoms.

Read also the article about the disease:Dupuytren's contracture.

Do not self-medicate!

Only a doctor can make a diagnosis and prescribe the right treatment. If you have any questions, you can call orask a question on .