Carpal tunnel syndrome on the left treatment. Pathology of office workers, or carpal tunnel syndrome. Tunnel syndrome - operation

tunnel syndrome wrist (carpal tunnel syndrome) is a disease that is accompanied by numbness and pain in the fingers, due to compression of the median nerve. Are added and drawing pains with tingling of fingers, hand and wrist.

Belongs to a group neurological diseases tunnel neuropathy. Most often it is a secondary process against the background of an existing underlying disease.

The treatment of this disease is considered the most expensive, as in the United States people annually spend billions of dollars on its treatment. Statistics show that in America, over 450,000 operations are performed annually to compress the nerves of the wrist.

In the case of such a disease, people need a long-term restriction in work, sick leave lasts up to 30 days or more. It is believed that this is the longest restriction.

The disease mainly develops from the monotonous and monotonous work performed during the day. It is typical for cashiers working in grocery stores who scan the barcodes of products non-stop and in large volumes.

This disease occurs quite often among computer scientists who do not let the mouse out of their hands all day.

Causes of the disease

There are many factors that cause the disease. The immediate cause of symptoms is compression of the median nerve in the carpal tunnel. This channel is formed by ligaments, bones and tendons of the muscles of the wrist and is quite narrow. Therefore, many processes that are accompanied by swelling and narrowing of the carpal tunnel can lead to symptoms of the disease.

Computer work

It is a common cause of this disease. Imagine that when typing 40 words per minute, a person presses the keys 12,000 times per hour of work. It is not difficult to calculate how many clicks it produces in 2 hours of work or in 8 hours. With a full working day (8 hours), pressing a key with a force of 225 g, a person can withstand a load of 16 tons. And if a person prints at a speed of 60 words per minute, then it increases to 25 tons.

Therefore, constant work at the keyboard causes this syndrome. But scientists note that computer scientists and typists still have a risk of developing this disease (3.5%), which is much lower compared to people engaged in physical, hard work.

But the trend of increasing injuries of the hands, shoulders and forearms has become noticeable. And this is due to making the keyboard flat, with easy to press and sensitive keys that increase the speed of pressing them.

Prolonged holding of the mouse in the hand is also a risk of this disease. Joysticks and trackballs have the same effect when playing on consoles.

And the problem often lies in the fact that people forget about rest during work or play. Breaks to rest your hands are essential. And in between, you can perform several exercises to relax the muscles.

The most common causes of the syndrome are:

• hereditary predisposition;
• Pregnancy (due to both hormonal changes and fluid retention)
• Wrist injuries;
• Occupational hazards (for people who do monotonous work with their hands at a computer for a long time, sewing, collecting packages, cutting meat, with vibrating tools, musicians, etc.);
• Rheumatoid arthritis;
• Diabetes mellitus and prediabetes;
• Obesity, especially in young people;
• Prolonged alcohol abuse;
• Hypothyroidism (insufficient function thyroid gland);
• Acromegaly (increased levels of growth hormone in adults); tendon canal tumors (lipomas, gangliomas, vascular tumors).
• Amyloidosis (accumulation of abnormal protein in various organs and tissues, which disrupts metabolism).

More often, carpal tunnel syndrome occurs in women, especially after 50-55 years, which is associated with hormonal changes that occur after menopause.

Symptoms, characteristic signs, diagnosis and testing

Signs of the disease include numbness, tingling and burning in the zone of innervation of the median nerve (1,2,3 and partially 4 fingers of the hand).

Less typical symptoms are pain and muscle weakness in this area. Discomfort may extend to the area wrist joint sometimes even on the forearm.

More often, symptoms occur or worsen at night.

In the initial stages, they can appear and disappear, in the future, they can become permanent.

How testing is done

To make a diagnosis, objective, so-called provocative tests are used:

Phalen test(bend the hand as much as possible, and after 60 seconds there is tingling and numbness in 1-4 fingers of the hand). The earlier the symptoms appear, the more severe the stage of the disease. This test is considered the most reliable;

Tinel test- percussion (tapping) is carried out over the place where the nerve passes, in case of damage to it, tingling, numbness or, less often, pain occurs.

Durkan test– carpal pressure test (pressure on the palm at the symptomatic site that causes tingling and numbness in the fingers and palm after 30 seconds or less);

Hand up test (when raising the arms above the head, after 2 minutes there is numbness and tingling in the fingers and palms).

Instrumental diagnostics

From instrumental research the following methods can be used:

Radiography of the wrist joint - to exclude injuries, deformities and tumors that can lead to carpal tunnel syndrome:

Electroneuromyography - it is used to assess the conductivity of nerves and muscles and the severity of damage to the median nerve. If this study shows no change, treatment should still be given if symptoms persist.

The final diagnosis is made by the doctor based on the following criteria: numbness and tingling in the median nerve area, nocturnal symptoms, muscle weakness or atrophy, test results and electroneuromyography.

What treatment does medicine offer?

Which doctor should you contact if you suspect carpal tunnel syndrome? Most often, this disease is diagnosed and treated by a neuropathologist or an orthopedic traumatologist, if necessary, a consultation of related specialists is appointed.

If the immediate cause or disease that led to the appearance of the syndrome is identified, then this particular pathology should be treated by the appropriate specialist. It is important to have a balanced healthy diet, as well as the timely intake of B vitamins that are beneficial for the nerves.

How to treat this syndrome

There are such methods of treatment:

Independent (conservative method). It is necessary to wear an orthosis or a bandage to fix the brush in the correct position. A tire is also used during work, which provokes symptoms of the disease. Symptoms are significantly reduced after a month of using the splint.

What exactly is suitable for a particular patient, the doctor will tell you. It is also necessary to reduce the load on the affected hand, if possible, do not perform dangerous work for it. Anti-inflammatory drugs, such as those based on aspirin, ibuprofen, nimesulide, etc., can be used to alleviate symptoms. They help relieve pain but do not cure the disease;

Medical blockade of the carpal tunnel. Injection of corticosteroid drugs (prednisone, dexamethasone) or local anesthetics(lidocaine, novocaine) directly into the carpal tunnel. This helps reduce swelling and pain in the hand. It is recommended to start with one injection, with the return of symptoms, it is possible to re-administer;

Physiotherapy. Methods such as shock wave therapy, laser therapy, UHF (treatment with ultra-high frequencies), electrophoresis with anti-inflammatory and decongestants, massage, exercise therapy. It helps both reduce symptoms and restore physical strength and movements in the fingers and hand. As a rule, these treatments are carried out for a long time to achieve the desired effect.

Surgery. Which doctor performs the operation? Surgical treatment performed by an orthopedic traumatologist. It is carried out when other methods are ineffective, or when advanced stages diseases. The essence of the operation is to cut the ligaments around the carpal tunnel, thus reducing pressure on the median nerve.

This is a simple operation that does not require a hospital stay and is performed under local anesthesia. There are two ways of operation.

• The first one is open. An incision about 5 cm in size is made to access the ligaments, and dissection of the ligaments or other structures compressing the carpal tunnel.
• The second way is endoscopic surgery. Two small incisions about 1 cm in size are made through which a camera is inserted for imaging and surgical instrument. This allows you to quickly eliminate discomfort in postoperative period and achieve faster hand recovery after surgery.

After surgery, it is necessary to reduce the load on the hand for several weeks or months.

L treatment during pregnancy. Pregnancy is accompanied by hormonal changes and fluid retention in the body. Since this condition is temporary, after childbirth, the symptoms that develop with this disease should go away. You should not resort to surgical intervention or taking medication as it could harm the baby. If symptoms cause significant discomfort, there are some treatments that a doctor can recommend.

Treatment with folk methods

There are non-medical interventions to treat carpal tunnel syndrome. Treatment at home should be used after prior consultation with a doctor.

• infusions :

- infusion of rosemary marsh apple cider vinegar. It is necessary to take one part of wild rosemary and three parts of vinegar, leave for a week. After that, rub into the fingers three times a day;

- infusion on the roots of parsley. Helps reduce swelling in the carpal tunnel. Method of preparation 1-2 tbsp. roots pour two cups of boiling water. Leave for a day, then drink in small sips throughout the day

- infusion of bearberry. Its leaves reduce inflammation and swelling. 1 tbsp Leaves pour a glass of boiling water, put overnight in a dark place. Consume a tablespoon of infusion every few hours

• Decoctions:

- birch leaves and buds, rosemary have a decongestant effect, horsetail, cranberries, wild rose. You can prepare both individual decoctions of these plants, and their mixture.

- pour one tablespoon of nettle into a glass hot water. Drink during the day for 3-4 times

- boil in a glass of water 1 tbsp. l. anise, consume 2-3 times a day

• Compresses:

- a warm compress on alcohol. To do this, take one part alcohol and two parts water, or use vodka. Wrap your hand at night.

• Rubbing:

- mix one tablespoon of birch buds with 500 ml of vodka, rub the brush.

Treatment folk remedies will alleviate the course, but will not be able to cure the disease, since this is just a symptomatic help.

Exercises for Carpal Tunnel Syndrome

It should be noted that exercises should not cause pain and discomfort. Shake the brush several times before doing the exercise.

1. Strongly squeeze and unclench your fingers into a fist. Do the exercise ten times.
2. Clench your fingers into a fist, raise your thumb. Rotate them for 30-60 seconds.
3. You can compress and decompress the rubber ball.
4. Use your thumb to resist the rest of your fingers. Do the exercise for 1-2 minutes.
5. Prepare a container with hot water. Lower your hand, clench your fingers into a fist and slowly perform rotational movements. Do the exercise for at least 10 minutes. Then wrap your still warm hand in a towel.
6. Clench your fingers into a fist, perform rotational movements in both directions for 1-2 minutes.

Do these exercises for 3-4 weeks.

Preventive measures

First of all, you need to reduce the load on the hand if the work is associated with long monotonous movements. This can be observed in typists, musicians, plasterers, assemblers of parts, or those who work at the computer for a long time, especially if you constantly hold the mouse in your hand.

When working with a mouse, try to keep your hand straight. A wrist support can be effective, which reduces the load on the hand. There are special orthopedic mice for the prevention of the syndrome.

If you feel tired in your hands, you need to stop work and do hand exercises, or lightly massage your hands. You can use a specially designed ergonomic keyboard.

For the purpose of prevention, isometric exercises are effective. To do this, place your palm on a hard, flat surface, press your fingers firmly against the surface and hold for a few seconds. The same exercises include squeezing and unclenching the fingers in a fist.

To reduce the risk of disease, it is worth buying an ergonomic keyboard. It costs more, but is adapted to maintain the physiological position of the hands during operation. Now there are a huge variety of them on sale: wired and wireless, with and without illumination, galvanic, ultra-thin, portable, waterproof and even bamboo.

Doctors jokingly call such a keyboard a long-term investment in their health.

carpal tunnel syndrome — pathology is not uncommon. For a complete and correct diagnosis and treatment, it is recommended to consult a doctor, which will help to avoid complications and preserve the function of the hand.

Health to you, dear readers!

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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 one side, the 8th small bones wrists 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 increased risk development of 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 clinical manifestations 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 during professional activities, including those with vibration (typists, milkmaids, dentists, seamstresses, pianists, equipment assemblers, carvers, carpenters, masons, miners, and so on). additional role hypothermia of the hand plays;
• 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, which 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 body.

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, develops hormonal changes organism.

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 rails in public transport, drives a car with the hands fixed on the steering wheel, holds the phone in his hand when talking - all this provokes numbness and makes you change your 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 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 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 labor activity may last several months. Of course, a timely appeal for medical care and timely diagnosis with subsequent 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, 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 hand 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, there are typical symptoms carpal tunnel syndrome;
• 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 the 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 others may be needed. additional methods research.

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 medications and non-drug methods together with some manipulations in the canal zone, it 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).

From medicines use:

• 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 application gives therapeutic effect by reducing tissue swelling;
• drugs that improve blood flow, and hence the nutrition of the median nerve (Pentoxifylline, A nicotinic acid, Vinpocetine, Nicergoline and others);
• B vitamins (Combilipen, Milgamma, Neurovitan, Neurorubin and others).

If these measures are not enough, then they resort to injection of glucocorticoids with anesthetics into the carpal tunnel (Hydrocortisone or Diprospan with Novocaine or Lidocaine). 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 positive result, and the diagnosis is 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 carried out 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. Possibly also endoscopic conduction surgical treatment. 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. Scar in case endoscopic surgery smaller, and not as 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. It 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 specifications work to avoid the occurrence of this disease. Breaks in work, the absence of exceeding vibration levels, 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 timely handling for 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":

When carpal tunnel syndrome occurs, pain, numbness and weakness of the thumb appear, pain and weakness can be observed in the remaining fingers - this is caused by a lesion of the median nerve. As a rule, the syndrome is a consequence of excessive fascination with social networks and computer games. Damage to the median nerve leads to unpleasant sensations in the thumb, index and middle fingers. The median nerve runs through the wrist between the tendons, muscles, and bones. With the appearance of edema or a change in the position of the surrounding tissues, the median nerve is compressed and irritated. The result is pain, numbness and tingling.

Carpal tunnel syndrome is very common and occurs in 15 percent of the population. For individuals at risk, the incidence rises to 50 percent. Women get sick more often than men. Most often occurs in people aged 45 to 60 years. The disease is related to the professional activities of patients, most at risk exposed to people working in conditions where frequently repeated power movements are used.

Pathophysiology of carpal tunnel syndrome

The carpal tunnel is a small passage through which nerves and muscle tendons pass from the forearm to the hand. It passes between the bones of the wrist and is covered with a sheath of connective tissue. The carpal tunnel is quite narrow and is located closer to the palmar surface. The structures located in it are thus located very close to each other. The carpal tunnel contains nine tendon muscles and the median nerve.

All nerves have an outer protective sheath of myelin, which improves signal transmission along them. Conditions that cause nerve damage or demyelination lead to impaired nerve signaling. In the carpal tunnel, there is strong pressure on the median nerve due to the fact that the tendons located in it swell due to overuse. Compression of the median nerve results in pain, numbness, and a tingling sensation. It should be remembered that the main characteristic of the pathophysiology of carpal tunnel syndrome is damage to the median nerve.

Symptoms of Carpal Tunnel Syndrome

Carpal tunnel syndrome begins with mild pain in the wrist that may radiate to the forearm or hand. People suffering from the disease are treated with the following symptoms carpal tunnel syndrome.

Pain location.

Most often, the thumb, index, middle and ring fingers suffer, the little finger is less often affected by pain. Both hands are equally susceptible to carpal tunnel syndrome.

Feel.

Tingling or numbness of the fingers is the main symptom of the disease. Feeling disturbed after sleep or after certain activities such as driving a car, reading a book. Also, the patient may complain that his hand is cold or hot all the time.

Pain.

Carpal tunnel syndrome is characterized by pain in the wrist that spreads upward to the forearm and shoulder or descends down to the hand and fingers. The pain intensifies with power loads or the product of monotonous repetitive movements.

Weakness.

There is muscle weakness. The patient cannot hold objects in his hands for a long time or they simply fall out of his hands. The grip strength of the hand is reduced, which is determined in the course of research.

Other Symptoms of Carpal Tunnel Syndrome: Some sufferers report joint stiffness and discoloration. skin in the region of the joints.

Causes of carpal tunnel syndrome

The main cause of carpal tunnel syndrome is compression of the median nerve. However, there are other mechanisms for the occurrence of the disease as a result of traumatic injury. Although mechanical damage does not cause carpal tunnel syndrome in pure form the same symptoms appear, so they must also be considered for differential diagnosis with carpal tunnel syndrome.

anatomical factors.

They arise as a result of wrist fractures, bruises leading to tissue dislocation, as a result of which the internal space of the tunnel changes. At the same time, it appears great pressure on the median nerve without swelling of the muscle tendons.

Certain diseases, such as alcoholism and diabetes, increase the risk of damage to the median nerve.

Inflammation of the carpal tendons due to rheumatoid arthritis or infectious diseases, can cause symptoms similar to carpal tunnel syndrome.

Tumors close to the median nerve can also put pressure on it and cause pain and numbness.

Diseases associated with fluid retention in the body can also cause compression and irritation of the median nerve.

Certain occupational activities that increase pressure on the median nerve.

Among other factors provoking the development of pathology: hypodynamia, pregnancy, breast-feeding, use of a wheelchair.

Risk factors.

Monotonous power movements of the hand are by far the most significant risk factor for the onset of the disease. Other risk factors include:

• advanced age.
• female.
• heredity.
• sudden increase in body weight.
• square wrist.
• short limbs and small stature.

Complications of the disease and diagnosis

tunnel carpal syndrome is not deadly disease, however, if left untreated, it can lead to irreversible damage to the median nerve. As a result, the functions of the affected hand are lost. As a result, a person becomes disabled. Timely diagnosis this disease avoids unpleasant complications.

Symptoms along with the clinical picture indicate the occurrence of carpal tunnel syndrome. Certain functional tests along with clinical research confirm the diagnosis. Little finger numbness when holding a newspaper or phone can be a symptom of carpal tunnel syndrome.

The sensitivity of the fingers and the strength of the muscles of the hand are being studied. An x-ray of the wrist can rule out a fracture or arthritis of the wrist. An electromyogram measures electrical impulses in the muscles of the wrist, thanks to its results, it is found out if there is any damage to the muscles of the wrist. The study of the conduction of the median nerve shows the condition of the median nerve. In the affected nerve, the passage of electrical impulses is slow. An increase in wrist thickness may also indicate the occurrence of carpal tunnel syndrome.

Treatment of carpal tunnel syndrome

Treatment depends on the severity of the symptoms. Treatment for carpal tunnel syndrome can range from a simple healthy lifestyle to surgery:

• simple immobilizing devices can alleviate the symptoms of the disease.
• physiotherapy and physical education also prevent the development of the disease and facilitate its manifestations.
• non-steroidal anti-inflammatory drugs provide temporary relief from pain that occurs.
• corticosteroids reduce swelling and pressure on the median nerve, resulting in pain and inflammation.
• treatment of the underlying disease such as diabetes or arthritis can relieve the symptoms of carpal tunnel syndrome.
• pain medications also temporarily relieve symptoms that occur when the median nerve is compressed.

Exist surgical methods treatment of carpal tunnel syndrome. They are used in case of a long-term severe course of the disease. It consists in cutting during surgery the ligaments that compress the nerve. Can be done as open operation or endoscopically.

Prevention of carpal tunnel syndrome

The best prevention for carpal tunnel syndrome is healthy lifestyle lifestyle and fitness activities - they can alleviate or completely get rid of the symptoms of the disease. It is also possible to wear a splint on the wrist, gymnastics when performing monotonous work. When trying to completely stop physical exercise on hand, the condition worsens. If it is not possible to change the activity that caused carpal tunnel syndrome, you need to rest your hands more often and do relaxation exercises.

carpal tunnel syndrome(CTS, carpal tunnel syndrome) is a disease that is characterized by pain, tingling, numbness and weakness of the fingers.

Carpal tunnel syndrome results from compression of the median nerve, which supplies the thumb, index, middle, and ring fingers.

The carpal tunnel is a well-defined space, the walls of which are formed by two bones that support the wrist. The bottom of the carpal tunnel is the thick palmar ligaments. The median nerve passes through this canal. When the surrounding tissue swells and thickens, pressure inside the carpal tunnel increases, cutting off the normal blood supply to the median nerve.

This pressure is especially felt when the arm is fully flexed.

Syndrome prognosis

daily activity

Disease prevalence

The occurrence of the disease

Symptoms of Carpal Tunnel Syndrome

Pain and numbness in the arms, especially at night.
. Pain, tingling, numbness of the thumb, index and middle fingers.
. Periodic tingling sensation in whole arm.
. Pain extends upwards, sometimes to the shoulder.
. Numbness in the morning, which is relieved by shaking the arm.
. Episodes of weakness in the arm and incoordination, especially in the morning.
. Feeling of swelling of the fingers, and sometimes swelling is noticeable visually.

Disease progression

Among the possible options:

Diabetes.
. Diseases of the thyroid gland.
. Inflammation of the joints.
. Pregnancy.
. The use of COC.
. Amyloidosis.
. Aging.

Causes of Carpal Tunnel Syndrome

The following are some diseases and injuries that can cause carpal tunnel syndrome:

1. Inflammatory diseases joints, including rheumatoid arthritis. These diseases cause pain and swelling of the joints in different parts body. The swelling leads to carpal tunnel syndrome.
2. Injuries such as swipe on the wrist. Injuries can not only cause swelling of the tissues, but also fractures of the bones of the wrist, leading to damage to the median nerve.
3. Various types activities and hobbies that involve constant, repetitive finger movements, especially when combined with strong grasping or vibration (power tools).

It can be:

Cutting fish or meat.
. Construction and carpentry work.
. Working with electronic circuits.
. Work in auto repair shops.
. Forestry work.
. Scanning and counting money.
. The work of hairdressers.
. Manual agricultural work.
. Embroidery and knitting.
. Computer set.

Diagnosis for Carpal Tunnel Syndrome

Experts from the US Arthritis Foundation recommend using the following tests to diagnose carpal tunnel syndrome:

Tinel test. The doctor should gently tap on the arm at the site of the median nerve. Tingling or pain on percussion may indicate carpal tunnel syndrome.
. Phalen test. The doctor will ask you to bend your arm as much as possible and hold it in this position from 15 seconds to 3 minutes. The appearance of tingling, numbness, or pain during the test may indicate damage to the median nerve.
. Nerve conduction study (NVC). In this procedure, the doctor sends impulses to the muscles and with the help special device fixes their speed. With carpal tunnel syndrome, the speed slows down.
. A study that combines nerve conduction assessment and electromyography (EMG/NCV) is used to study nerve function, confirm the diagnosis and assess the severity of the disease. This test is also prescribed to detect diseases that masquerade as carpal tunnel syndrome.
. x-ray, CT scan hands and blood tests will help the doctor rule out numerous diseases and injuries that we talked about above.

Treatment of carpal tunnel syndrome

1. Home measures.

Managing your daily activities is important step for the prevention and relief of symptoms of the disease.

Here are some easy ways:

Rest your hands and fingers periodically.
. Change activities to relieve pressure on your hands.
. Delegate some household chores to your family.
. Review your hobbies, including those related to the computer.

If you think the syndrome is related to your professional activity, and you do not want to change it, then talk to your doctor and your boss. Together, you can develop a plan that will allow you to relieve symptoms by relieving certain stresses. In many Western clinics, such issues are dealt with by occupational therapists who adapt the patient to certain working conditions so that they do not affect his illness.

2. Diet.

Carpal tunnel syndrome is associated with vitamin B6 deficiency, although this is not necessarily the case - many patients with CTS are not severely deficient in vitamins. Try multivitamin complexes to exclude this option.

3. Medicines.

Oral non-steroidal anti-inflammatory drugs (NSAIDs for short), including aspirin, ibuprofen, and naproxen, can reduce inflammation, swelling, and pain in carpal tunnel syndrome. These drugs can be taken without a doctor's prescription, but only for a short time.

4. Surgical treatment.

For moderate to severe cases of the disease, American doctors recommend surgical treatment. If tires and medicines do not alleviate the condition, then more radical treatment is needed. Otherwise, after months, nerve damage may become irreversible.

In traditional surgery, a transverse incision is made in the ligament, which enlarges the space inside the carpal tunnel. This operation can be performed using a limited incision in the palm or endoscopically - using two miniature (1 cm) incisions in the palm and wrist, into which flexible instruments are inserted. The procedure takes place under local anesthesia.

In the latter case, the scars are smaller, and the recovery period is shorter. Both are simple surgical procedures that are performed on an outpatient basis. After the procedure, you will have to limit the use of the affected arm for a couple of weeks. Usually full recovery the working capacity of the hand takes from 6 to 10 weeks, and for people who are engaged in heavy physical labor - from 3 to 4 months.

Your restrictions after the procedure may be as follows:

Driving: Most operated patients can drive a car within 1-2 days after the procedure.
. Writing: Of course, you will be able to hold a pen after the procedure, but you should rest 4-6 weeks before serious writing.
. Grasping, shaking: slight activity is possible after 6-8 weeks, but full force such actions can be performed after 3 months. American observations show that full strength is achieved within the first year.

Possible side effects surgical treatment of carpal tunnel syndrome:

Pain and inflammation at the incision site.
. Possible return of symptoms.
. Accidental nerve injury (extremely rare).

5. Intra-articular injections.

Injections of corticosteroids (anti-inflammatory hormones) into the joint can relieve inflammation and swelling by reducing pressure on the median nerve. These injections provide significant relief for most people with carpal tunnel syndrome.

6. Immobilizing splints and bracelets.

Such wrist devices can be used to keep the wrist in the correct position during sleep. They prevent too much jerky movements brushes, so your doctor may ask you to wear them throughout the day. An occupational therapist can order immobilization devices specifically for your needs, based on the work performed. They should be worn for weeks or months.

Konstantin Mokanov

Carpal tunnel syndrome is a complex of symptoms resulting from compression of the median nerve in the carpal tunnel.

The course of the disease, which is called carpal syndrome, is accompanied by weakness of the hand and numbness of the fingers. This is the general name for neuropathic conditions in which the nerve trunk is compressed.

The nerve is located in a canal of hard tissues that protect it from external influences. However, he suffers from deformation of the walls of the canal, which leads to overstrain of the tendons and ligaments, causing a deterioration in trophism in the tissues. If the overvoltage is constant, then the tissues of the carpal tunnel become thicker, looser and more edematous.

As a result, there is no free space in the canal and pressure on the nerve increases. This leads to dysfunction of the nerve, it ceases to conduct motor signals. Sometimes carpal tunnel syndrome can be caused by swelling of the nerve. This is due to the poisoning of the body with salts. heavy metals, arsenic, mercury vapor.

Causes of the disease

There is a carpal syndrome often due to a monotonous, regular load on the arm.

But in addition to mechanical factors, there are several more:

• professional activity with the same type of extensor-flexion movements;
• age changes. After the age of 50, changes in bones and bone structures occur;
• genetic factor. If there is a family history of arthritis, arthrosis, osteochondrosis, the risk of the disease increases;
• disease endocrine system. In the presence of diabetes, thyroid dysfunction reduced tissue regenerative capacity;
• wrist microtrauma.

Before the start of active computerization of the population, carpal tunnel syndrome was diagnosed in 3% of women and 2% of men. But after the firm entry of computers into our lives, the disease was called occupational.

Carpal tunnel syndrome is the most common type of carpal tunnel. But such a condition develops when various nerve trunks are infringed (suprascapular, digital plantar, median, palmar, ulnar, radial, median carpal).

Compression of any of the above nerves leads to carpal syndrome and has similar symptoms. Symptoms will increase gradually, as the disease also does not develop immediately.

At initial stage there is a feeling of slight discomfort when the joint is overloaded. As the disease progresses, the canal narrows and more and more dysfunction of the nerve occurs.

Varieties of the disease

Carpal syndrome is of several types.

Carpal tunnel syndrome or compression-ischemic neuropathy of the median nerve of the wrist

This syndrome most often occurs and develops on the dominant hand. It appears more often in women. It is caused by severe physical work with constant overload of the hands and forearms, congenital narrowness of the carpal tunnel.

Other concomitant diseases (myxelema, rheumatoid arthritis, venous congestion) also lead to such a disease.

An important role is played by previous injuries of the wrist, after which the formation of callus in the area of ​​the wrist. Often, carpal tunnel syndrome appears during pregnancy, during menopause.

A person begins to be disturbed by a feeling of tingling, numbness, "goosebumps", which are felt in the thumb, index, middle fingers, may be in the ring finger, but never affect the little finger. Pain may radiate to the shoulder or forearm.

Because of such unpleasant symptoms it is very uncomfortable for a person to sleep, he has to constantly get up and shake or rub his hand to get rid of the feeling of numbness.

When lowering the brush, the pain subsides, and when raised, it intensifies. Pain occurs when performing work associated with the tension of the wrist joint.

pronator syndrome

Caused by the transfer of heavy constant pressure on the forearm. To characteristic symptoms include: pain in the forearm, aggravated by writing or raising the arm up.

Characterized by numbness, crawling sensation in the fingers and palms. Weakness arises short muscles abducting the thumb, the sensitivity of the hand is disturbed.

Shoulder supracondylar process syndrome

It is also called love paralysis, as the disease often occurs as a result of the pressure of the head of the sleeping partner on the arm bent at the elbow.

Cubital Syndrome

The cubital canal of the elbow joint of the hand is infringed. Therefore, the disease is called cubital tunnel syndrome.

The lesion occurs due to regular flexion and extension of the elbow joint. Often diagnosed in thin women. Also if there was an elbow injury.

Moreover, cubital syndrome can develop after a sufficiently long period of time. There is pain in ring finger, little finger, in the elbow area when trying to bend or straighten it. Pain worse in cold weather.

Guyon's bed syndrome

This syndrome leads to the constant use of canes, crutches, tightening nuts. This type of syndrome is characterized by atrophy of the muscles of the hand and disorders of its sensitivity.

Diagnostics

First of all, it is necessary to exclude other diseases that have a similar picture with tunnel neuropathy. These are neuralgia, myalgia, arthrosis, arthritis.

Initially, an anamnesis is collected. The doctor asks about the existing diseases in order to differentiate the carpal syndrome. Finds out if there were any injuries in the area of ​​the wrist, shoulder and neck.

He will ask about the profession in order to understand whether the tunnel syndrome is caused by the result of professional activity. Then the wrist, hands, forearms and shoulders are tested.

Phalen test

The patient is asked to raise the elbow to shoulder level, turn the back of the wrist inward, making sure that the wrists of both hands touch, and in this position the hands should be held for a minute.

If symptoms such as pain, numbness, or tingling occur during the test, this indicates carpal tunnel syndrome.

In this position, maximum pressure is created on the area of ​​the median nerve and on the carpal tunnel. When bending and unbending the hand, the patient feels numbness, pain, "goosebumps" in the palms and fingers.

Tinel test

The doctor taps the skin of the hand over the place where the nerve passes. If at the same time tingling is observed in the fingers, then this indicates the beginning of nerve regeneration.

cuff test

A tonometer cuff is put on the arm, the pressure is increased slightly above normal. Hold for 60 seconds. If during this time there is numbness and tingling in the fingers, carpal tunnel syndrome is confirmed.

Sometimes other diagnostic methods are required.

1. Electrodiagnostic. Fixes the speed of electrical conduction of the nerve.
2. MRI. Allows you to get detailed clinical picture states internal organs. In this case, an MRI cervical spine.
3. Radiography of the wrist joint. Allows you to exclude arthrosis, the consequences of injuries.
4. ultrasound. It is necessary to measure the width of the median nerve in order to properly perform injections.

Treatment of tunnel syndromes

At minor symptoms carpal tunnel syndrome can be treated at home.

primary goal home treatment- ensuring complete rest for the sick hand, alleviating existing symptoms.

Treatment for early stages allows you to stop the progression of carpal syndrome and prevent irreversible nerve damage.

home treatment

At home, you should follow a number of rules:

• stop activities that cause unpleasant symptoms;
• rest your wrist more often;
• apply ice to the wrist 2 times a day;
• take anti-inflammatory drugs as directed by your doctor nonsteroidal drugs to relieve pain;
• rest is created for the diseased hand and the elimination of the prerequisites for traumatizing the nerve in the tunnel. For this, the imposition of a languette is provided. It will help relieve pressure from the median nerve. Putting it on at night, you can fix the affected joint in a neutral position. This prevents compression of the median nerve at night during sleep. Tires may also be worn during work that aggravates symptoms. The neutral position of the wrist is considered to be flat or slightly curved. If after a couple of weeks of treatment at home, the symptoms do not become weaker, or even intensified, you should consult a doctor.

Conservative treatment

Treatment of the underlying disease

If carpal tunnel syndrome is caused by other diseases, then it is worth treating them. Treatment for hypothyroidism hormone therapy. If the syndrome is associated with professional activities, then you should change jobs. Usually, after this, the functions of the brush are restored.

Medicines

Prescribe treatment with vascular, analgesic, dehydration agents. Apply novocaine blockades, as well as blockade with hydrocortisone, lidase into the tissues surrounding the nerve or into the canal.

At the same time, anesthetics and corticosteroids are injected into the carpal tunnel. After the first injections, a person already feels a strong relief, and three injections are enough for recovery.

Non-steroidal anti-inflammatory drugs are being treated: Ibuprofen, Indomethacin, to relieve pain and inflammation.

Hormonal preparations that are injected into the affected area with a syringe or smeared with ointment. Calcium chloride in the form of injections to eliminate inflammation and stabilize the reactions of the immune system.

Physiotherapy

A good effect is given by manual effects on the hand, which are necessary for recovery. correct location wrist bones. Well help phonophoresis, electrophoresis. Applications with lidase, Dimexide + Hydrocortisone.

If conservative methods of treatment do not help, then neurosurgical treatment is prescribed.

Operation

Surgical treatment is necessary when the severity of the carpal syndrome does not allow doing homework or professional activities.

During the operation, the ligament located on top of the carpal canal is cut. This leads to an increase in the channel and there is a weakening of pressure on the nerve.

Surgery eliminates unpleasant symptoms, completely eliminates side effects. This is an open operation. A minimally invasive technique consists in endoscopic dissection of the carpal ligament, performed through a small incision using a camera and special surgical instruments.

Therapy with folk remedies

Treatment of carpal syndrome with folk remedies at home is aimed at eliminating all the unpleasant symptoms of the disease.

Sea buckthorn infusion

Sea buckthorn berries are mixed with water. Then the resulting mixture is heated to 37 degrees. Soak your hands in the resulting mixture for 30 minutes.

After the procedure, the hands are thoroughly wiped and put on warm mittens. The brushes should be treated in this way for a month, then take a break for a couple of weeks.

Ammonium chloride and alcohol

A tablespoon of salt is poured with 50 grams of 10% ammonia and 10 grams of camphor alcohol are added. Everything is dissolved in a liter of water. The resulting remedy is rubbed with diseased limbs, or used in the form of baths. The tool will help get rid of numbness in the fingers and the feeling of goosebumps.

pepper rub

100 grams of ground black pepper pour a liter vegetable oil, heat for half an hour over low heat. The agent in the form of heat is rubbed into the sore brush several times a day.

Prevention

Preventive measures include a number of rules:

• When working at a computer, you should use the mouse less often. If it is impossible to work without a mouse, then you need to purchase a special mouse pad with a special wrist rest.
• The arm from the elbow to the hand should lie on the table. The computer chair must have armrests.
• If you feel tired in the wrist area, you need to do a little gymnastics for the hands and give them a rest. You can lock the fingers of both hands into the lock and rotate the brushes in different directions. You can squeeze a rubber ball.
• Before you sit down long work associated with tension in the wrists, it is necessary to warm up the hands with gymnastics.
• Avoid the same type of movements that led to nerve compression. All movements are best performed with a healthy hand.
• It is better to sleep on the side opposite to the affected arm. This will allow the affected limb to rest.

Carpal (carpal) syndrome, although it does not pose a danger to human life, but significantly complicates life.

Basically life modern man creates all the conditions for the development of this disease.

Without a computer it is already impossible to imagine your life. Namely, its use in most cases leads to the occurrence of carpal syndrome.

But if you follow the rules of prevention, use folk remedies, then you can protect yourself from this pathology or relieve symptoms if they have already begun to appear.