Carpal tunnel syndrome—prevention and treatment. Carpal tunnel syndrome - causes and symptoms, treatment and prevention of carpal tunnel syndrome

Carpal tunnel syndrome occurs when the median nerve is compressed. The pathological process is accompanied negative symptoms. Carpal (wrist syndrome) develops more often in women, but men also suffer from this pathology.

Damage to the median nerve is often associated with professional activity, often develops against the background bad habits. How to protect your hands from nerve compression? How to recognize carpal tunnel syndrome in time? Let's figure it out.

general information

The carpal tunnel in the hand area is formed by the transverse ligament on the upper side, the carpal bones below and on the sides. Damage to the median nerve occurs when the anatomical canal is compressed. With absence pathological changes nerves and tendons pass inside the tunnel, excess pressure provokes a narrowing of the cavity, damage to the sensitive branches responsible for the innervation of the fingers.

Why do women suffer from carpal tunnel syndrome more often than men? The carpal tunnel in the fair sex already, throughout life female body experiences many phenomena associated with hormonal changes: menopause, pregnancy, taking hormonal contraceptives.

Reasons for the development of the disease

Doctors do not give an exact answer to the question about the origin of pathological processes in the carpal tunnel area. There are many factors that increase the risk of median nerve compression in the hand. With age, the risk of pathological changes increases. Often there are several negative factors, and the disease is more acute.

Compression of the nerve in the wrist area occurs in the following cases:

microtrauma due to constant impact on the hand area (construction, repair work, the need for prolonged use of a computer);
swelling of tissues, stretching due to injury to the hand;
negative processes accompanied by deformation of the tendons and carpal tunnel against the background hormonal imbalances and some diseases (hypothyroidism, the appearance of osteophytes, menopause, pregnancy);
high degree of obesity;
poor blood supply to tissues due to smoking;
tumors in the wrist or carpal tunnel (lipoma, hemangioma, neurofibroma).

Many doctors consider carpal tunnel syndrome to be an occupational disease of programmers, system administrators, and webmasters. Previously, the pathology was diagnosed at the age of 40 and later, now problems with the hands, compression of the median nerve are often found in young people under 35 years of age.

First signs and symptoms

Negative signs initially appear only after prolonged exercise. As it progresses pathological process, with significant narrowing of the canal, the symptoms become more acute.

It is worth paying attention to the following signs:

numbness of fingers. Negative symptoms appear only at night, fingers from first to fourth are affected;
there is pain in the hand area, tingling;
Often patients feel as if they have “goosebumps” inside;
hands become weak.

With further compression of the nerves and tendons, new signs are added:

muscles atrophy;
It is more difficult to perform habitual hand movements than before;
it is impossible to make small, precise movements with your fingers;
if the case is severe, discomfort spreads to the forearm, elbow area, and shoulder.

Diagnostics

The following tests can help confirm or refute the diagnosis of carpal tunnel syndrome:

Durkana.
Falena.
Tinelya.

Also carried out:

electrodiagnostics;
opposition test;
shaking your fingers to control sensitivity.

It is important to differentiate carpal tunnel syndrome from pathologies that have similar symptoms:

cervical radiculopathy;

Effective treatments

If compression of the anatomical canal in which nerves and tendons pass is confirmed, the doctor recommends complex therapy. The pathology is treated by a traumatologist-orthopedist and a neurologist.

Not only drug therapy is required, but also physiotherapy, therapeutic exercises, and limiting the load on the problem area. During treatment, you cannot engage in professional activities that involve monotonous movements of the arm and hand.

Medications

Effective medications reduce pain and eliminate swelling. The action of the compositions allows the compressed canal to return to its usual size and eliminates the cause for the development of negative symptoms.

drugs that relieve inflammation - . Potent tablets, ointments, gels prevent the spread inflammatory process to new areas, reduce swelling, and relieve pain in the problem area. Effective compositions: Diclofenac, Nise, Voltaren, Indomethacin, Acetylsalicylic acid, Ibuprofen, Ketoprofen, Naprofen. The selection of drugs is carried out by the attending physician: medications have contraindications for use; many formulations in tablet form irritate the mucous membranes of the stomach and intestines and have a negative effect on the liver;
hormonal drugs to eliminate pain, break the chain of the inflammatory process. A short course of active treatment using Hydrocortisone and Prednisolone is recommended. Intra-articular injections – effective method eliminate inflammation, reduce pain. Hormonal drugs have more side effects than NSAIDs, long-term use often leads to irreversible damage in various parts of the body.

Other treatment methods supplement the use of medications:

electrophoresis with hydrocortisone and analgesics;
wearing special splints and orthoses to fix the affected hand in a physiological position;
at an early stage of pathology, weak pain syndrome Applying cold helps, reducing the load on the hands and fingers.

Folk remedies and recipes

Proven recipes:

compress from cabbage leaf to relieve swelling and reduce inflammation. The effectiveness of the procedure is increased by applying thin honey to the surface of a cut cabbage leaf. Combination of beekeeping product and cabbage juice provides positive effect not only with carpal tunnel syndrome, but also with arthritis, rheumatism, gout, periarthritis of the shoulder joint;
contrast baths with chamomile decoction, sea salt, sage infusion. Each product has a positive effect on the condition of the hands, reducing swelling and inflammation. To prepare a decoction of medicinal herbs, pour a tablespoon of the raw material into a liter of boiling water, let it brew for an hour, and strain. Hand bath with sea salt – 2 liters warm water plus two tablespoons useful product. The duration of the procedure is no more than a third of an hour, the water temperature is no higher than +36 degrees;
compress with horseradish leaves. Another simple way to reduce pain in a problem hand. Before use, dip the washed leaves in boiling water for a minute, shake off the water, cool, wrap the affected area, and leave for 45 minutes. After the procedure, apply nutritious cream. If the skin of your hands is tender and flaky, it is advisable to lubricate your hands with vegetable oil before the treatment session;
diuretic tea against tissue swelling. Stopping excess pressure on the anatomical tunnel is the main goal of therapy. There are many recipes for teas and herbal decoctions, accelerating the removal of excess fluid from the body. They do the job well medicinal herbs, fruits and berries: dill, lingonberries, parsley, cornflower, bearberry. Useful action Corn silk, wild strawberry, horsetail, and knotweed provide benefits. Diuretic berries and herbs are used with caution. There are limitations: in particular, active removal of fluid using means traditional medicine and drugs are prohibited during pregnancy.

Important! Usage traditional methods complements drug therapy and physiotherapy, but does not replace them. In difficult cases it only helps surgery. The operation removes compression of the problem area. The surgeon partially or completely cuts the transverse ligament, and the lumen of the anatomical canal is restored.

Possible complications

Not all patients turn to a neurologist and orthopedist-traumatologist on time, especially with mild pain in the hand of a periodic nature. The longer the start of treatment is delayed, the higher the risk of severe damage to the median nerve.

In advanced cases, the nerve fibers atrophy, and the mobility of the fingers is impaired due to the lack of innervation. Untimely therapy often leads to loss of sensory and motor function of the fingers.

Find out more about characteristic features and methods of treating the knee joint.

Effective Treatment Options rheumatoid arthritis at home using folk remedies are described on the page.

Go to the address and read about the benefits and use of the decoction bay leaf for joints.

Prevention measures

Carpal tunnel syndrome interferes with normal activities and manifests itself as discomfort in the hand. Every person should know preventive measures to reduce the risk of pathological changes in the hand area.

How to proceed:

stop smoking: lack of nutrition worsens the condition of blood vessels and nerve fibers;
take breaks from working at the computer, remember to take a five-minute rest every hour, and do not forget about exercises for your hands and fingers;
relax your arms and hands more often when painting and plastering. Builders and repairmen should massage their hands and, after a shift, apply ointments and gels with a cooling, decongestant effect;
properly equip workplace to minimize stress on the hands. When working at a computer for a long time, armrests to support your elbows are required;
be sure to use a mouse pad, place the brush further from the edge, maintain the bend angle in the elbow area at 90 degrees;
exercise every day, do exercises. Good condition musculoskeletal system, the elasticity of the ligaments reduces the risk of developing carpal tunnel syndrome;
control body weight. The less extra pounds, the lower the load on joints and cartilage tissue;

Video. Elena Malysheva about carpal tunnel syndrome:

Numbness in the fingers and pain in the wrists often bother people who work at a computer or perform monotonous manual work. Having learned to recognize the symptoms of the disease, having learned about the causes of its occurrence, modern methods treatment can prevent or stop the progression of the disease.

What is carpal tunnel syndrome

People don’t pay attention when they feel discomfort in their joints, numbness in their fingers at night, or when their wrists start to hurt, but this could be a serious illness. Carpal tunnel syndrome is neurological disease, which belongs to the group of modern diseases. It also has another name – compression-ischemic neuropathy. This diagnosis is made by about 45% of people whose work involves long-term tension in certain muscle groups, so it is worth learning more about the problem in order to avoid it or stop the development of the pathology.

Carpal tunnel syndrome - causes

The disease manifests itself more often at older ages in women. The cause of carpal tunnel syndrome is explained by the peculiarities of female anatomy, age-related changes. IN menopause, and also occur during pregnancy hormonal changes, tissue swelling, causing compression in the canals peripheral nerves. There are other causes of diseases in people of different genders and ages.

Factors causing the development of tunnel neuropathy:

congenital anomaly (canal narrowness);
overexertion from monotonous movements, microtraumas;
presence of chronic renal failure, diabetes mellitus, hypothyroidism, rheumatoid arthritis, etc.

Carpal tunnel syndrome

Pain in the fingers and numbness in the hands may indicate the development of a disease such as carpal tunnel syndrome. This is explained by compression of the compacted carpal ligament of the median nerve with constantly repeated flexion and extension of the hand, prolonged immobility wrist joint in a bent state (after sleep, when professional work).

Carpal syndrome develops more often in women. Their wrists are thinner, and with age, hormonal changes and tissue swelling occur. Carpal tunnel syndrome affects people whose profession involves constant stress on certain muscles:

for workers performing monotonous movements;
musicians (pianists, cellists, violinists, drummers, etc.), artists;
from people who work long time at the computer (programmers, gamers, enthusiastic users).

Ulnar nerve tunnel syndrome

Due to excessive pinching of the nerve, cubital tunnel syndrome occurs. What other nuances are there? Injuries to the elbow joint can cause pathologies such as neuropathy ulnar nerve. Inflammation occurs, the affected tendon arch becomes thicker, the channels narrow, pressure on the nerve causes pain and numbness. Cubital syndrome develops with constant compression and trauma to the ulnar nerve, which occurs in athletes and people who constantly flex and extend the elbow joint while performing work.

Carpal tunnel syndrome - symptoms

How to determine that the symptoms of carpal tunnel syndrome have begun? A feeling of muscle stiffness in the limbs, numbness in the fingers, and a desire to take a more comfortable position may indicate the development of neuropathy. More often similar symptoms appear in the hands, but can develop both in the upper and in lower limbs. Problems first appear in the morning after long periods of immobility or severe compression.

Numbness and pain in the palms, wrists, and fingers often indicate that carpal tunnel syndrome is developing. Discomfort in groin area speaks of neuropathy of the femoral nerve, and numbness of the leg or foot - of damage to the tibial and peroneal nerves. The discomfort goes away after a few hours, but if a complication of the disease begins, it needs to be treated before deformation of the bones and joints begins.

Carpal tunnel syndrome - treatment

You should start as soon as possible earlier treatment tunnel syndrome - early prevention will help prevent the development of the disease. The first symptoms call for you to pay attention to your health - if possible, change your profession or work in a safer position, do therapeutic exercises. If the disease begins to progress, then anti-inflammatory drugs are prescribed; for hypothyroidism - replacement therapy. Vasoactive and diuretic drugs are effective, physical therapy is recommended, water treatments, in difficult cases - surgery.

Carpal tunnel syndrome - treatment at home

Experts assure that treating carpal tunnel syndrome at home is quite possible. First of all, when working, you need to change your position or take a break every 15 minutes to rest your muscles. It is useful to perform special exercises:

Compress rubber ball or practice using a wrist or hand expander.
Do various rotational movements and exercises to overcome resistance.
From time to time, do self-massage of the limbs, moving from bottom to top, first along the back and then along the inside of the limb.
Accept cold and hot shower or baths, you can apply it at night alcohol compress to the problem area.

Treatment of carpal tunnel syndrome with folk remedies

Appropriate to use folk remedies for carpal tunnel syndrome - they will help reduce pain and numbness. The use of sea buckthorn baths is effective. Instructions:

Mash the berries well and add water to a thick paste.
Heat the mixture to a temperature of 37 degrees.
Immerse your hands (wrists or elbows) in the bath and leave for half an hour.
Wipe your hands with paper napkins and wrap them in a warm natural cloth.
Repeat the procedure daily or every other day for a month. After a two-week break, the course of treatment can be repeated if necessary.

Filming unpleasant symptoms and compresses that are used before bedtime during exacerbation of the disease. To prepare this product, mix:

salt – 1 tbsp. l.;
ammonia(10%) – 50 ml;
camphor alcohol– 10 ml;
water – 1000 ml.

Treatment is supplemented with lingonberry decoction. Method of its preparation:

Pour 2-3 teaspoons of lingonberry leaves into 1 tbsp. water.
Boil the mixture for 15 minutes and let it brew.
Strain the warm broth and drink one tablespoon 5-6 times a day.

The treatment complex proposed by the doctor along with home remedies, therapeutic exercises, massage will stop the development of compression-ischemic neuropathy and get rid of painful symptoms. People who spend a lot of time at the computer doing monotonous manual work should think about disease prevention, because preventing a disease is much easier than curing it.

Video: Tunnel Neuropathy

Ecology of health: Carpal tunnel syndrome is especially common in older women. Why is that? This syndrome is considered occupational disease those workers who perform monotonous monotonous flexion-extension movements with their hands

Carpal tunnel syndrome has other names such as carpal tunnel syndrome and also carpal tunnel syndrome. This is a neurological disease, it manifests itself with prolonged numbness and pain in the fingers. The cause of carpal tunnel syndrome is compression of the median nerve between the bones and muscle tendons located in the wrist.

It belongs to the category of tunnel neuropathies, in a nutshell we can say that they arise due to compression of the nerve in the osteofibrous as well as fibromuscular canals.

Carpal tunnel syndrome is especially common in older women. Why is that? This syndrome is considered an occupational disease of those workers who perform monotonous monotonous flexion-extension movements with their hands or prolonged forced flexion of the hand. So what professions are at risk? These are pianists, cellists, drummers, bowlers, experienced artists, motorcycle racers, sign language interpreters, those who work as a jackhammer, a hairdresser, embroiderer, and typewriter. IN Lately, when the computer is no longer a rarity and more and more professions are connected with it, there are many more people suffering from carpal tunnel syndrome.

It is believed that long-term work at the computer has become a risk factor provoking the development of this disease. According to the results of one study, every 6th person working at a computer was diagnosed with this carpal tunnel syndrome. Users whose hand is bent relative to the forearm by 20° or more are at greater risk.

Other studies contradict this and indicate that there are no significant differences in the occurrence of this disease in people who work at a computer and those who do not work on it.

Causes of Carpal Syndrome

There is a nerve in the carpal tunnel, and when it gets pinched, wrist pain occurs. Natural causes of pinching of this nerve are considered to be swelling of the tendons located next to the nerve and swelling of the carpal tunnel.

The reason for pinching this nerve lies in prolonged static load on the same muscles. Causes stress a large number of monotonous movements and often awkward hand position. For example, when working on the same computer keyboard, a person’s hand is under constant tension.

Symptoms of Carpal Tunnel Syndrome

It is characterized by pain, numbness and tenderness (paresthesia) in the area of the median nerve.

On initial stage With wrist syndrome, a person feels trembling, itching, and tingling in the fingers. Moreover, at first he does not connect this with activity on the computer, since these symptoms manifest themselves several hours after finishing, for example, typing.

At further, later stages, numbness, pain and heaviness in the hands begin to appear, tingling in the palms, fingers, wrists, sensitivity in the wrist area is impaired, tissue irritation and swelling may form. In the morning, your fingers may feel stiff. People with carpal tunnel syndrome may also experience indirect symptoms such as insomnia due to pain and wrist cramps.

The advanced stage of wrist syndrome often leads to atrophy of the muscles of the thumb. The ability to tightly clench your hand into a fist disappears, thumb does not bend. Hands and fingers may become unruly.

When a person with carpal tunnel syndrome tries to lift a rather heavy object, this can cause pain or loss of arms - the object will simply fall out of their hands. A person with this syndrome loses the ability to talk on the phone for a long time, read a book holding it in front of him in his hands, or hold the steering wheel of a car for more than 10 minutes.

Diagnosis of carpal tunnel syndrome

A neurologist sometimes examines a patient to determine the degree of damage to the wrist muscles caused by working at a computer or other professional activity.

However, a person is able to independently identify this disease. To diagnose carpal tunnel syndrome, the Tinel test and the Phalen test are used.

The first test involves percussion (tapping) in the wrist area above the place where the median nerve passes. If the test is positive, it is accompanied by paresthesia in the palm and fingers.

The second test is maximum flexion for three minutes, i.e. connected back sides the hands are lowered down, and the elbows should be directed to the sides. You will get something like the letter “T”. If during this time this test causes paresthesia and tenderness on the palmar surface of the 1st, 2nd, 3rd and partially 4th fingers.

Prevention

Since a person is not always able to refuse or significantly reduce the time he spends working at the computer and other things, it is worth thinking about preventive measures. Prevention of carpal tunnel syndrome is also the correct convenient organization of the workplace. Thanks to this approach, you can avoid almost any problems that arise for a person with his hands working at a computer.

One of the main preventive measures should be ergonomics and proper sitting position at the computer. It is advisable to have a chair for work with a back position and height that can be adjusted (it is very good to have a table with an adjustable height). A properly adjusted table and chair make it possible to assume a position where the lower back is located at an angle of 90 degrees with respect to the hips. The shoulder and forearm should form a right angle, and the hands should lie on the keyboard. Basically, the keyboard is located at a height of 65-75 centimeters.

Important preventive measures are also:

Chairs and computer chairs must be equipped with armrests.
Ergonomic keyboard. It should be positioned so that when bending your arms at the elbow, they form a right angle. A correctly positioned keyboard allows your hands to rest when they rest on it.
When working with the mouse, your elbow should be on the table, and your straight hand should be positioned as far as possible from the edge of the table.
The mode of working on the computer is also fundamentally important. It only takes a few minutes to rest the tendons and restore the required volume of synovial fluid. But a person with diabetes will have to increase the duration of rest. The best option is an hourly rest for 10-15 minutes. Rest should not be spent passively. Since a person rests not because he is tired from moving, but because he is working at the keyboard. In this case, the ideal option would be to do arm exercises.

Treatment for Carpal Tunnel Syndrome

Required for early stages begin treatment for carpal tunnel syndrome caused by prolonged use of a computer keyboard. First of all, you need to eliminate the root cause, for example, diabetes or arthritis. If the disease is not treated, as a rule, it progresses.

In the early stages of the syndrome, a sufficient measure will be to conservative therapy, which is expressed in limiting the load on the affected wrist (minimize work at the computer), or immobilize it with a fixed splint. When symptoms subside, begin physical exercises designed to stretch and strengthen the wrist muscles. It is advisable to carry out physical therapy under the supervision of a physician.

In severe cases of carpal tunnel syndrome, accompanied by sharp pains And severe inflammation, medication treatment is required.

At proper nutrition, capable of fully saturating the body with important bioactive substances, treatment of carpal tunnel syndrome can become very effective and the recovery process will become much faster, the rehabilitation period will be shortened and the ability to work will return faster. Specialist for short term will return to his work.

Among alternative methods Yoga turned out to be one of the most effective methods of treatment. It helps reduce pain and also improves grip strength.

Set of exercises

Complex 1

Slowly clench your hands into fists and then slowly unclench them. Repeat 5 times.
Place your palms on the table and press your palms onto its surface. Then bend your fingers one by one.
Raise and lower your arms several times. Describe the same number of circles, first with your hands, then with each finger.
Make rotational movements with your brushes, then move your fingers. With your hands clenched into fists, rotate around the axis.
Shake your hands.
Clasp your hands together and press the fingers of one hand onto the fingers of the other hand.

Complex 2

You need to raise your arms and lower them several times, shake your hands.
Clench your fists tightly for a few seconds, then unclench and relax them. Repeat the exercise 5-7 times.
Make rotational movements with your brushes (10-12 times) in each direction.
Stretch your arms out in front of you and actively move your fingers for one minute.
Place your palms towards each other and turn your fingers towards you, i.e. wrists away from you. Try to slowly press from the palm of your hand with the fingers of one hand onto the fingers of the other.

Complex 3

Rub the inner and outer surfaces of your palms until you feel warmth.
On your right hand, bend each finger using the thumb on your right. Perform four presses on each finger. For right hand repeat the same thing.
Turn your palms towards each other internal parties and connect them between soda, palms slightly turned out. Press your fingers into each other, then shake your hands, relaxing them.
Slowly clench your fist. Shake your hands to loosen them.
Slowly clench your fist, then quickly and sharply unclench it, throwing out your fingers. Lower your arms and shake your hands.

When working at a computer, if you are still not always able to fully perform a set of exercises, still take breaks, raise your arms up and rotate your hands. If you notice symptoms of carpal tunnel syndrome in your wrist, you need to perform such rotations very carefully and slowly. Periodically relax your muscles by shaking your arms. published

Carpal (or carpal) tunnel syndrome is a condition that develops when the median nerve located in the carpal tunnel is injured or compressed. Sometimes this syndrome is called tunnel syndrome, but this is not quite the correct term, because there are others tunnel syndromes. With the development of this disease, the sensitivity and movements of the first three and part of the fourth finger occur.

In this article, we will introduce you to the causes, symptoms, and treatment of carpal tunnel syndrome. This information will help you make a timely decision about the need for 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 occupational, because it is much more often encountered by 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 the computer for a long time, tailors, musicians, etc. ).

This syndrome is most often observed in people 40-60 years old, but can develop at older ages. at a young 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 a computer for a long time are most susceptible to developing this syndrome. According to one of numerous studies, it is detected in every sixth active user PC. According to various sources, the syndrome develops 3-10 times more often in women.

Causes

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 bones of the wrist. Constriction is caused by inflammation and swelling of the joint, tendons and muscles within the joint or within 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 occupational factors, the development of carpal tunnel syndrome can be provoked 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 injuries put pressure on the nerve. At proper treatment dislocation or fracture, the compression is eliminated, but with bone deformation or muscle contractures, disorders in the joint can become irreversible.
and other joint lesions of a rheumatic nature. The inflammation and swelling that occurs with these diseases causes compression of the nerve soft tissues carpal tunnel. With prolonged progression of the syndrome cartilage tissue The joint ages, loses its elasticity and wears out. Wear and death of cartilage leads to fusion of joint surfaces and their deformation.
Tenosynovitis (tendon inflammation). Tendons are affected pathogenic bacteria and become inflamed. The tissue in the wrist area swells and puts pressure on the nerve. Sources of infection can be: purulent wounds on the hands, panaritium, etc. In addition, inflammation of the tendon tissue can be non-bacterial and caused by chronic stress injuries: frequent movements of the hand and arm, prolonged stress, 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, kidney pathologies or.
Median nerve tumor. Such neoplasms are rarely observed. These can be schwannomas, neurofibromas, perineuromas and malignant tumors 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 the nerve tissues. When they are activated by the enzyme protein kinase C, damage occurs to neurons and their processes. 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 nerve). Nerves become swollen and can become compressed in narrow areas such as the carpal tunnel.
. This disease develops over a long period of time and is accompanied by growth of the bones of the face and limbs to disproportionate sizes. In addition to bone changes, soft tissue growth is observed. Enlargement of the carpal bones causes a narrowing of the carpal tunnel, and the median nerve is pinched.
Genetic predisposition. Compression of the median nerve may occur with such anatomical feature hands, like a “square wrist”, congenital deficiency production of lubricant by the tendon sheaths or congenital thick transverse carpal ligament.

Symptoms

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

The development of carpal tunnel syndrome occurs gradually. In most cases, one hand is affected, i.e., the “working” hand (for right-handers - the right, for left-handers - the left). Sometimes nerve compression occurs in both arms (for example, with endocrine disorders or pregnancy).

Paresthesia

Tingling and numbness in the fingers is the first sign of the syndrome. Paresthesia is felt by the patient immediately after waking up, but is completely eliminated by noon. As the syndrome develops, they begin to appear at night, and then during the day. As a result, the patient cannot hold the hand suspended for a long time (when putting the phone to the ear, holding the handrail in public transport and etc.). When trying to perform such holds, paresthesia intensifies and the person changes his hand to perform the action (transfers the phone to the other hand, changes its position, etc.).

Pain

Initially, the patient experiences burning or tingling pain. Occurring at night, they disturb sleep, and a person has to wake up in order to lower his arm down or shake his hand. Such actions help normalize blood circulation in the fingers, and pain is eliminated.

Painful sensations do not occur in specific joints, but are widespread. They capture the entire finger - from base to tip. If left untreated, pain begins to appear during the day. Any movement of the hand causes them to intensify, and the patient cannot work fully. At severe course Pain syndromes can involve the entire palm and spread all the way to the elbow, making diagnosis difficult.

Clumsy hand movements and loss of strength

As the syndrome worsens, the patient develops weakness in the arm and is unable to 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 the feeling that they are falling out of the hand.

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

Decreased sensitivity

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

Amyotrophy

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

Change in skin color

Violation of the innervation of skin cells leads to disruption 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

To diagnose carpal tunnel syndrome, the patient needs to consult a neurologist. The patient's examination plan includes special tests, instrumental and laboratory methods.

Tests for carpal tunnel syndrome:

Tinel test. Tapping from the palm of the hand in the area of the narrowest part of the carpal tunnel causes tingling in the fingers.
Phalen test. The patient should bend the arm as much as possible at the wrist and hold it there for a minute. With carpal tunnel syndrome, increased paresthesia and pain occur.
Cuff test. A blood pressure cuff is placed between the elbow and wrist. It is inflated with air to significant figures and left in this position for one minute. The syndrome causes 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, discomfort, then you need to see a doctor.

To clarify the diagnosis, the patient is prescribed the following: instrumental methods examinations:

electroneuromyography;
radiography;

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

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

Treatment

Treatment for carpal tunnel syndrome always begins with a protective regimen that removes stress from the wrist. In the absence of such measures, therapy is ineffective.

Security mode for carpal tunnel syndrome:

When the first signs of the syndrome appear, the hand should be fixed using a special clamp. Such an orthopedic product can be purchased at a pharmacy. It allows you to reduce the range of motion and prevent further tissue trauma.
For two weeks, completely avoid activities that cause or worsen symptoms. To do this, it is necessary to temporarily change jobs and eliminate 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 by therapy for the underlying disease causing 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 unpleasant sensations 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 from the preparations can be stored in the refrigerator for several days.

Injecting drugs into the carpal tunnel

The doctor uses a special long needle to inject a mixture of solutions into the carpal tunnel. local anesthetic(Lidocaine or Novocaine) and glucocorticosteroid hormone (Hydrocortisone or Diprospan). After the introduction of this composition, pain and other unpleasant sensations are eliminated. Sometimes they can get worse 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 signs 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.

Drug therapy

Choice medicines, the dosage and duration of their use depend on the severity of the disease and concomitant pathologies. To plan drug therapy Carpal tunnel syndrome may include the following:

B vitamins (B1, B2, B5, B6, B7, B9 and B 12): Milgamma, Neurobion, Neurobex, Doppelhertz active, Benevron, etc.;
non-steroidal anti-inflammatory drugs: Xefocam, Dicloberl, Airtal, Movalis, etc.;
vasodilators: Pentilin, A nicotinic acid, Trental, Angioflux;
: Hypothiazide, Furosemide, Diacarb, etc.;
anticonvulsants: Gabapentin, Pregabalin;
muscle relaxants (drugs for muscle relaxation): Sirdalud, Mydocalm;
glucocorticosteroids: Metipred, Hydrocortisone, Prednisolone;
antidepressants: Duloxetine, Venlafaxine.

Physiotherapy

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

Treatments for carpal tunnel syndrome include:

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

Prescribing physiotherapeutic 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 symptoms of the disease persist for six months. The purpose of such surgical interventions is aimed at expanding the lumen of the canal and eliminating pressure on the median nerve.

The carpal tunnel is located on the palmar side of the hand at the junction of the forearm and the hand and is formed by the carpal bones on one side and the transverse carpal ligament on the other.

The tendons of the finger flexor muscles and the median nerve pass through the carpal tunnel.

When the contents of the carpal tunnel are compressed, the median nerve, which is least resistant to damage compared to tendons, is the first to suffer. Therefore, neurological symptoms come to the fore.

Carpal tunnel syndrome- one of the types of tunnel neuropathies (nerve diseases), in which peripheral nerves are damaged as a result prolonged compression and their constant traumatization in the musculoskeletal canals by chronically inflamed surrounding tissues.

Carpal tunnel syndrome is also known as carpal tunnel syndrome or carpal tunnel syndrome.

Causes of the disease

There are various reasons that can cause the development of carpal tunnel syndrome:

Tissue swelling as a result of injury to the forearm and hand (fractures, dislocations, bruises);
Tissue swelling in pregnant women, especially during pregnancy later pregnancy, and in women taking oral contraceptives;
Chronic inflammation and swelling of the carpal tunnel structures due to constant occupational trauma (the same type of repetitive flexion-extension movements with constant tension of the hands, work associated with constant vibration);
Tissue swelling as a consequence of a number of diseases internal organs (renal failure), endocrine diseases(decreased function thyroid gland, early period menopause, condition after removal of ovaries, diabetes);
Narrowing of the synovial sheaths (sheaths) of tendons and thickening of their walls as a result of acute or chronic inflammation for systemic diseases connective tissue(rheumatism,), metabolic disorders (), with tuberculosis;
Discrepancy between the size of the canal and the size of its contents as a result of genetically inherited characteristics (square wrist, thick transverse ligament, narrower canal in women, etc.), or pathological growth bones of the hand and wrist (acromegaly);
Tumor of the median nerve;
There is an observation that the diagnosis of carpal tunnel syndrome is more often made in the cold season, which proves the role of cold and hypothermia in the development of this disease.

Symptoms

At the beginning of the disease, tingling, burning sensations and pain appear in the thumb, index, middle, and less often ring fingers. The pain is most often dull, aching, can spread to the hand and forearm, and is felt in the deep tissues of the arm. There is often numbness in the skin of the hand and fingers in the morning immediately after waking up, which is accompanied by a decrease or loss of pain sensitivity.

First, sensitivity is lost on the palmar surface of the index and middle fingers; over time, numbness affects both the palmar surfaces of the thumb and ring finger. The feeling of numbness usually goes away within a few hours of waking up.

Pain, numbness and tingling usually go away if you lower your hand down and move your fingers lightly. But after some time the symptoms appear again.

As the disease progresses, movement disorders: it becomes difficult for the patient to hold small objects in his fingers, inaccuracy of movements appears, objects may periodically fall out of the hands against the will of the person, the strength of gripping objects with the hand with the participation of the thumb decreases.

Often there are symptoms of impaired microcirculation of the diseased hand in the form of pale skin or the appearance of a bluish tint due to vasospasm, coldness of the skin of the fingers to the touch, impaired sweating (increased or, conversely, decreased sweating). As a result of constant vascular spasm, the nutrition of the skin and nails is disrupted with a significant deterioration in their appearance.

Diagnostics

Diagnostic tests and electromyography are used to confirm the diagnosis of carpal tunnel syndrome.

Diagnostic tests

Flexion and extension test. The arm is held in the position of maximum flexion or extension for 1 minute. With carpal tunnel syndrome, tingling sensations appear in the skin of the thumb, index and middle fingers during this time.
Tinnel test. Lightly tapping the carpal tunnel area causes tingling and pain in the fingers. The Tinnel test is positive, as a rule, in severe cases of the disease.

Electromyography studies the ability of muscles to contract under the influence of electrical impulses. Allows you to confirm the diagnosis of carpal tunnel syndrome or suspect another cause of median nerve disease other than compression in the carpal tunnel.

Treatment of carpal tunnel syndrome

The stage of the disease and the prevailing symptoms determine how to treat carpal tunnel syndrome, which techniques are preferable for a particular patient, and whether surgery can be avoided.

Conservative (without surgery) treatment:

Restriction of movements in the sore hand for a long period of time, up to the application of a splint on the wrist or a plaster splint;
Medications:
- non-steroidal anti-inflammatory drugs to reduce pain;
- dehydrating action (removing water from the body), namely diuretics to relieve swelling;
- injection of glucocorticoids into the carpal tunnel area to locally reduce tissue swelling and relieve inflammation;
- drugs that improve blood circulation through the vessels to restore blood supply to the tissues of the diseased hand and restore the function of the median nerve.
Physiotherapeutic treatment: constant magnetic field, acupuncture to improve metabolic processes in damaged tissues.

Surgical treatment is used if conservative treatment is ineffective and consists of cutting the transverse carpal ligament. The operation is performed under local anesthesia. Crossing the transverse carpal ligament allows you to relieve pressure on the finger flexor tendons and median nerve and restore normal blood supply to the tissues of the hand.

After the operation, the affected arm is immobilized with a plaster splint for 10-12 days. IN postoperative period the patient is prescribed physiotherapy, massage, thermal procedures, B vitamins. The function of the hand and the patient’s ability to work are completely restored 4-5 weeks after the operation.