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Carpal tunnel syndrome: symptoms and treatment

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Education and professional activities

In 2009 he graduated from the Yaroslavl State Medical Academy with a degree in medical business.

From 2009 to 2011 he underwent clinical residency in traumatology and orthopedics at the Clinical Emergency Hospital. N.V. Soloviev in the city of Yaroslavl.

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

Currently working in a clinic in Moscow.

2012 - Foot Surgery training course, Paris (France). Correction of anterior foot deformities, minimally invasive surgery for plantar fasciitis (calcaneal spur).

February 13-14, 2014 Moscow - II Congress of Traumatologists and Orthopedists. “Traumatology and orthopedics of the capital. Present and future. ”

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

May 14-15, 2015 Moscow - Scientific-practical conference with international participation. "Modern traumatology, orthopedics and disaster surgeons."

2015, Moscow - The annual international conference "Artromost".

Causes of Tunnel Syndrome

Tunnel syndrome occurs for reasons when the tissues surrounding the flexor tendons in the wrist swell and exert pressure on the median nerve. These tissues are called synovial membranes. In the synovial membranes, a fluid is produced 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 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 cause it. Such as diabetes mellitus, rheumatoid arthritis, thyroid dysfunction.

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

Other factors that can lead to carpal tunnel syndrome include:

  • Occupation (work at the computer)

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

  • Alcohol abuse
  • Rheumatoid arthritis
  • Bone fractures and arthrosis of the wrist joints
  • Cysts or tumors that grow in the area of ​​the carpal canal
  • Infections
  • Obesity

Signs and symptoms of karmal canal syndrome:

  • Painful nightly tingling in one or both hands, often causing sleep disturbance,
  • Numbness in the fingers
  • Sensation that fingers are swollen (swollen)
  • Loss of strength in the muscles of the tenar, their atrophy,
  • Periodic backache in the fingers (like an electric shock).

Symptoms of carpal tunnel syndrome may appear at any time. Often numbness of the fingers occurs in a dream. During the day, symptoms often occur when the patient is holding something in his hand: the phone, or while reading a book, or driving. Changing hands or shaking helps reduce symptoms.

Symptoms initially come and go, but over time they can become permanent. Feeling uncomfortable or weak can limit the execution of subtle movements with your fingers, for example, it will be difficult to fasten your shirt, tie shoelaces, etc. This condition can affect the patient's professional activities.

During the examination, the doctor can determine:

  • Numbness in the palm of the hand, in the thumb, forefinger, middle finger and half of the ring finger.
  • Rattling over the area of ​​the carpal tunnel, as a rule, leads to "backache" in the fingers (this is called a symptom of Tinel)
  • A maximum flexion of the wrist in the wrist joint for 60 seconds usually results in numbness, tingling, or weakness (the so-called Phalen test)

Additional diagnostic methods:

  • ElectroNeuroMioGraphy (ENMG)
  • Nerve conduction velocity
  • Radiography of the wrist joint is performed in order to exclude other diseases (e.g. arthrosis, consequences of injuries)

Wrist Tunnel Syndrome Treatment

The following treatments are available for tunnel syndrome (carpal tunnel syndrome):

1. Conservative treatment

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

  • Wrist joint fixation: put on an orthosis at night to fix the hand in a physiological (neutral) position. This prevents night compression of the median nerve, which occurs when the hand is bent in the wrist during sleep. Tires can also be worn during work, which exacerbate symptoms.
  • Drug treatment: Simple drugs can help reduce pain, anti-inflammatory drugs (NSAIDs), such as nimesil, nurofen.
  • Change of professional conditions: To avoid the position of the brush and actions that exacerbate the symptoms in your professional activity, your doctor may suggest changing your job. This can slow down or even stop the progression of the disease.
  • Steroid injections: corticosteroid drugs often provide relief, but symptoms may return. The drug is injected directly into the carpal canal.

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

The decision to perform an operation is based mainly on the severity of symptoms. In more severe cases, surgery is performed immediately, because conservative methods of treating tunnel syndrome are unlikely to help.

There is a traditional method of surgery - “open”, when the skin is dissected directly above the carpal ligament. And there is a minimally invasive technique for endoscopic dissection of the carpal ligament. which is performed through mini access using a camera and special tools.

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

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

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

Slight palm pain usually lasts for several months after surgery. This time is needed for nerve fibers to recover.

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

  • Long term results. Symptoms of carpal tunnel syndrome in most patients decreased immediately after surgery, but full recovery can be gradual.

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

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

Do not self-medicate!

Only a doctor can determine the diagnosis and prescribe the correct treatment. If you have any questions, you can callorask a question by email.

Symptoms of carpal tunnel syndrome

In the case of carpal tunnel syndrome, the patient develops compression-ischemic neuropathy of the median nerve. Pathology is characterized by a chronic long course. Among the first signs of neuropathy can be noted pain in the area of ​​the corresponding innervation, paresthesia (tingling, crawling, numbness), which appear mainly at night and often cause a person to awaken. As the disease progresses, these symptoms bother both day and night.


Median nerve innervation zone

At the next stage of the disease progression, the sensitivity of the skin gradually decreases and motor disturbances appear - a decrease in the muscle strength of tenor muscles, malnutrition and atrophy of muscle tissue, weakness in the hand, inability to perform the usual movements and even hold objects.

Pain in carpal tunnel syndrome is characterized by spreading not only to the hand, but also to the forearm, shoulder, and even to the neck. Painful sensations decrease when rubbing and shaking hands (improves blood supply to the damaged nerve).

Recommended reading: Symptoms of ulnar tunnel syndrome

Simple tests for diagnosing carpal tunnel syndrome:

  • Tinel test - with percussion in the area of ​​a damaged nerve, the appearance or intensification of pain and paresthesia in the zone of its innervation is observed.
  • Test with raising the upper limb - for this you need to raise and extend straight arms above your head, hold in this position the limbs for 60 seconds. Due to a decrease in blood flow intensity in a patient who has carpal tunnel syndrome, pain and paresthesia occur.
  • Bending test - for this you need to bend the hand as much as possible in the wrist joint and hold it in this position for a minute. Subsequently, when the arm is extended, pain and paresthesia occur in the innervation zone of the median nerve.
  • Test with a bottle - becomes positive only in case of the addition of motor disorders. In this case, the patient cannot raise and hold the bottle by the neck with the thumb and forefinger.

In the case of gross pathological changes in the late stage of the disease, the appearance of the hand changes significantly. The skin becomes very pale, tenor muscles atrophy, the hand begins to resemble a primate's paw.


Arrows indicate atrophy of tenor muscles in a patient with carpal tunnel syndrome

Cubital tunnel syndrome

Among tunnel syndromes of the upper extremity, the syndrome of the cubital canal, which occurs as a result of the infringement of the ulnar nerve in the cubital canal, should be distinguished.


The cubital channel contains the ulnar nerve, which can be impaired with the development of compression-ischemic ulnar neuropathy

Due to the superficial passage of the nerve fiber at this site and the great mobility of the elbow, the ulnar nerve is prone to damage in the zone of the cubital canal. This pathology is in second place among the tunnel syndromes after damage to the carpal tunnel.


Ulnar nerve innervation zone

The most common cause of the development of pathology is damage to the nerve fiber due to prolonged static overstrain and pressure on the nerve, for example, the habit of talking on the phone for a long time, resting the elbow on the table, etc. Metabolic and endocrine diseases, injuries, operations on the elbow joint also contribute to the disease, arthritis and arthrosis of this joint.

Symptoms of neuropathy also include three main points:


The characteristic position of the hand with neuropathy of the ulnar nerve according to the type of "clawed paw"

  • pain in the area of ​​innervation of the ulnar nerve,
  • sensitive disorders - insemination, paresthesia, decreased sensitivity,
  • motor disorders that occur as the disease progresses - weakness of the 4th and 5th fingers of the hand, atrophy of the muscles of the hypotenor and interosseous muscle fibers, the characteristic position of the hand as a clawed paw.

In the treatment of such a pathology, both conservative and surgical methods are used. It is important to fix your hands in an extended position, for this there are special tires that can be worn at night while sleeping at home. In the complex of therapy, medications, physiotherapy, folk remedies, physiotherapy exercises are used.

The operation is prescribed in case of failure of conservative treatment. During the manipulation, the ligament is cut, which covers the cubital channel from above and, thus, the nerve is released, which gradually restores its functions on its own (if the disease has not gone too far).

Radial neuropathy

The radial nerve can be compressed in several places along its course, but most often this happens at the level of the distal sections of the brachial canal.
In this case, there are signs of complete damage to the shaft of the radial nerve:

  • paralysis of the muscles that extend the wrist and fingers (“hanging hand”),
  • sensitive disorders on the back of the forearm and on the back of the radial half of the hand (1 and 2 fingers),
  • pain on palpation of the affected area.


Radial neuropathy is manifested by a hanging brush syndrome

This disease is also called Saturday night paralysis, honeymoon paralysis.

How to treat radial nerve neuropathy? Treatment can be conservative and surgical. If the complex of various therapeutic measures is ineffective, they resort to surgery.

Peroneal neuropathy

Most often, an infringement of this nerve occurs between the head of the fibula and the edge of the long tibial muscle. This situation is observed with a sharp plantar flexion of the foot, in case of ankle sprain.

The result is a trauma to the fibular nerve, which can become chronic with the development of neuropathy. Also, nerve compression can be observed when performing some types of work squatting, sitting in a foot-to-foot position, when applying a tight plaster cast.

In this case, paralysis of muscles that extend the foot and toes, a decrease in the sensitivity of the outer surface of the lower leg, back of the foot and 1-4 fingers is observed. If neuropathy persists for a long time, atrophies of the anterior and posterior groups of the leg muscles develop. On palpation and percussion of the affected area, the patient feels pain and the occurrence of paresthesia.

Roth's disease

This is one of the common tunnel syndromes of the lower limb. In this case, compression-ischemic lesion of the lateral cutaneous femoral nerve occurs. The nerve performs only a sensitive function and does not contain motor fibers, innervates the skin of the anteroposterior surface of the middle third of the thigh.


With Roth disease, the lateral cutaneous nerve of the thigh is compressed

The main symptom of pathology is numbness and burning pain in the corresponding innervation zone. In the later stages of the development of pathology, a complete loss of sensitivity of this area of ​​the skin is observed. When the hip is extended, the pain intensifies, when bent, it decreases.

As a rule, this violation does not cause serious inconvenience to the patient, but in some cases the pain becomes very pronounced. This situation is an indication for surgery in the groin ligament.

It is interesting that Sigmund Freud suffered from neuropathy of the lateral cutaneous nerve of the thigh, believing that this pain is psychogenic.

Tarsal canal syndrome

In the case of the development of tarsal canal syndrome, the tibial nerve is compressed. Compression occurs mainly in the area of ​​the bone-fibrous tarsal canal (tarsal).


Most often, the pathology develops due to injuries in the ankle joint, in some cases it is not possible to determine the cause of the compression

The main symptom of the disease is pain, which is felt in the area of ​​the sole of the foot and fingers. Painful sensations arise or intensify when walking, a symptom of intermittent claudication occurs. Also, pain occurs independently at night and contributes to the awakening of the patient. Very often, the pathology is bilateral in nature.

Piriformis syndrome

In the case of the development of compression-ischemic neuropathy of the sciatic nerve, they speak of piriformis syndrome. It arises as a result of the spastic contraction of the latter, due to which the sciatic nerve is pressed against the sacrospinous ligament. A similar situation is often observed in patients with degenerative-dystrophic lesions of the spine.

Among the signs of the disease can be noted burning pain, the development of paresthesia in the innervation zone of the common tibial nerve. Also, patients record a decrease in the Achilles tendon. Over time, weakness of the leg muscles develops.

The development of tunnel syndrome significantly affects the quality of life of patients. But the prognosis with a timely diagnosis and proper treatment is favorable. That is why you do not need to delay a visit to the doctor if you are concerned about the symptoms described in the article. It should be understood that there are a lot of diseases of the peripheral nervous system, while only a specialist can figure out the cause and make an accurate diagnosis.

Carpal tunnel syndrome

This disease affects the carpal tunnel. It occurs as a result of squeezing the median nerve with carpal ligaments with repeated bending-extension of the hands. More often, such a disease is diagnosed in women. Ladies have a much thinner wrist. In addition, with age, serious hormonal changes begin in their body. All this serves as a favorable factor for the development of carpal tunnel syndrome.

There are several groups of professions in which this ailment is diagnosed more often than usual. Туннельный синдром грозит людям, занимающимся таким родом деятельности:

  • музыкантам,
  • художникам,
  • программистам,
  • геймерам и увлеченным пользователям ПК,
  • кассирам,
  • production workers performing monotonous monotonous hand movements.

How to treat tunnel syndrome?

Before prescribing therapy, the doctor will conduct a full examination. This procedure will allow you to accurately diagnose. If a doctor suspects tunnel syndrome of the wrist in an incoming patient, he will definitely study its symptoms, as well as perform other manipulations. To make a diagnosis, the following provocative tests are carried out:

  1. Falen test - you need to bend the brush as much as possible. After a minute, a tingling sensation will appear. The earlier these unpleasant symptoms begin in time, the more severe the stage of the disease.
  2. Tinel test - you need to tap on the site with the affected nerve. If the patient has carpal tunnel syndrome, tingling, numbness, and pain will occur.
  3. Durcan test - squeeze the brush and wait about half a minute. If there is an orthopedic pathology, the fingers become numb and tingling is felt.

Tunnel syndrome treatment provides for a comprehensive, but before prescribing it, the patient is recommended to undergo such procedures:

How to treat carpal tunnel syndrome?

Therapy of this ailment is aimed at minimizing the inflammatory process and eliminating swelling in the affected area. In addition, treatment should relieve pain. In the fight against the defeat, medical, non-medical and surgical methods can be used. The first two methods are effective at the initial stage of the disease. If the disease has acquired a protracted form, surgical intervention is indispensable.

Conservative therapy involves the appointment of such drugs:

  • anti-inflammatory non-steroidal drugs (Movalis, Diclofenac),
  • diuretics (Veroshpiron or Furosemide),
  • B vitamins,
  • corticosteroids (hydrocortisone, prednisone),
  • vasodilators (Trental),
  • muscle relaxants (Midokalm).

If carpal tunnel syndrome is confirmed during the diagnosis, treatment at home can be carried out using drugs prescribed by the doctor. Self-healing is not permissible! The doctor should monitor the patient's condition at all stages of treatment. However, there are a number of criteria that indicate that conservative therapy for the patient will be ineffective. These factors include:

  • if the applicant is more than 50 years old,
  • the patient complains of constant tingling of the hands,
  • symptoms of the disease appear for about a year.

Ulnar tunnel syndrome - treatment

The therapy for this ailment is similar to that used to combat carpal disease. In addition to medical treatment, physiotherapeutic procedures can also be prescribed. If tunnel syndrome of the elbow joint is diagnosed, such manipulations are prescribed simultaneously with the drugs:

  1. Ultraphonophoresis

    Paresthesia

    Tingling and numbness of the fingers is the first sign of the syndrome. Paresthesia is felt by the patient immediately after awakening, but is 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 for a long time on weight (when applying the phone to the ear, holding the handrail in public transport, etc.). When you try to perform such holdings, paresthesias are strengthened and the person changes his hand to perform the action (transfers the phone to the other hand, changes its position, etc.).

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

    Painful sensations do not occur in certain joints, but are common. They capture the entire finger - from the base to the tip. If untreated, pain begins to appear in the afternoon. Any movement of the hand causes them to intensify, and the patient cannot fully work. In severe cases of the pain syndrome, they can seize the entire palm and spread up to the elbow, making diagnosis difficult.

    Clumsy brush movements and loss of strength

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

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

    Sensitivity reduction

    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 hand. Depending on the severity of the disease, the patient may not feel a light touch on the hand or a prick with a pin.

    Diagnostics

    To diagnose carpal tunnel syndrome, a patient needs a consultation with a neurologist. The patient examination plan includes special tests, instrumental and laboratory methods.

    Tests for carpal tunnel syndrome:

    1. Tinel test. Tapping from the palm of the hand in the area of ​​the narrowest section of the wrist channel causes tingling in the fingers.
    2. Falen test. The patient should bend the arm as much as possible in the wrist and hold it like this for a minute. In carpal tunnel syndrome, an increase in paresthesia and pain appears.
    3. Cuff test. Between the elbow and wrist, the cuff of the pressure measuring device is put on. It is pumped up by air to significant figures and remains in this position for one minute. With the syndrome, tingling and numbness is manifested in areas innervated by the median nerve.
    4. Hands up 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 you need to contact a doctor.

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

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

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

    Treatment of carpal tunnel syndrome always begins with compliance with the protective regime, which eliminates the load from the wrist. In the absence of such measures, therapy is ineffective.

    Guard mode for carpal tunnel syndrome:

    1. When the first signs of the syndrome appear, the brush should be fixed with a special fixative. Such an orthopedic product can be purchased at the pharmacy. It allows to reduce the amplitude of movements and prevent further tissue trauma.
    2. For two weeks, completely abandon the activity leading to the appearance or intensification of symptoms. To do this, it is necessary to temporarily change jobs and exclude movements that cause increased pain or paresthesia.
    3. 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.

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

    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 from the preparations can be stored in the refrigerator for several days.

    The introduction of drugs into the wrist channel

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

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

    Drug therapy

    The choice of drugs, dosage and duration of their administration depend on the severity of the disease and associated pathologies. Such drugs may be included in the drug treatment plan for carpal tunnel syndrome:

    • B vitamins (B1, B2, B5, B6, B7, B9 and B 12): Milgamma, Neurobion, Neurobeks, Doppelherz asset, Benevron, etc.,
    • non-steroidal anti-inflammatory drugs: Xefocam, Dicloberl, Aertal, Movalis and others,
    • vasodilators: Pentilin, Nicotinic acid, Trental, Angioflux,
    • diuretics: Hypothiazide, Furosemide, Diacarb, etc.,
    • anticonvulsants: Gabapentin, Pregabalin,
    • muscle relaxants (drugs for muscle relaxation): Sirdalud, Midokalm,
    • glucocorticosteroids: Metipred, hydrocortisone, prednisone,
    • antidepressants: duloxetine, venlafaxine.

    Physiotherapy

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

    For the treatment of carpal tunnel syndrome can be used:

    • acupuncture,
    • manual therapy techniques
    • phonophoresis,
    • shock wave therapy.

    The appointment of physiotherapeutic procedures is possible only in the absence of 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.

    The operations are performed under local anesthesia and can be performed using the following methods:

    1. Open way. An incision is made in the wrist area (about 5 cm) and the intersection of the carpal ligament is performed.
    2. Endoscopic surgery. Two small (up to 1.5 cm) incisions are made in the wrist area. A special endoscope is inserted into one of them, and the instrument for cutting the wrist ligament is inserted into the other. When using another method, such an intervention can be carried out only through one small incision.

    After the operation is completed, a plaster cast is applied on the arm for fixation for several days. For rehabilitation, the patient is prescribed physiotherapy and physiotherapy. 3 months after the intervention, the functions of the brush are restored by 70-80%, and six months later, completely.

    After completing treatment, the patient may again return to normal work, but in the absence of changes in working conditions, there remains a high risk of a new relapse of the disease.

    Which doctor to contact

    If you suspect the development of carpal tunnel syndrome, you need to seek help from a neurologist. To diagnose and clarify the causes of the disease, the doctor can prescribe various instrumental and laboratory examination methods: electroneuromyography, radiography, ultrasound, MRI, blood tests, etc. If necessary, the doctor will appoint a consultation with the surgeon or other specialists.

    Carpal tunnel syndrome is becoming an increasingly common disease due to the introduction of computers in many areas of activity. The modern start of treatment and the adoption of measures to prevent its re-development in many cases allows us to get rid of it or to develop a stable remission.

    Surgeon N. A. Karpinsky talks about carpal tunnel syndrome:

    Neurologist M. M. Sperling talks about carpal tunnel syndrome:

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