Carpal tunnel syndrome

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

The defeat of the median nerve is often associated with features professional activity often develops on 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 area of the hand is formed by the transverse ligament on the upper side, the bones of the wrist from below and from the sides. The defeat of 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 that are responsible for the innervation of the fingers.

Why do women suffer from carpal tunnel syndrome more often than men? The carpal canal for the fair sex already, during their life female body going through many phenomena associated with hormonal changes: menopause, pregnancy, taking hormonal contraceptives.

The reasons for the development of the disease

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

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

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

Many doctors consider carpal tunnel syndrome to be an occupational disease for 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 is often found in young people under the age of 35.

First signs and symptoms

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

It is worth paying attention to the following signs:

numbness of the fingers. Negative symptoms appear only at night, fingers from the first to the fourth suffer;
there is soreness in the area of the hand, tingling;
often it seems to patients that goosebumps are running inside;
hands get weak.

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

muscles atrophy;
the usual movements with the hands are harder to perform than before;
it is impossible to make small, precise movements with your fingers;
with the severity of the case, discomfort extends to the forearm, elbow area, shoulder.

Diagnostics

Tests help to confirm or deny the diagnosis of carpal tunnel syndrome:

Durkana.
Phalena.
Tinel.

Also carried out:

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

It is important to differentiate the tunnel syndrome in the wrist area with pathologies that have similar symptoms:

cervical radiculopathy;

Effective treatments

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

Not only drug therapy is required, but also physiotherapeutic effects, therapeutic exercises, and limiting the load on the problem area. At the time of treatment, you cannot engage in professional activities involving monotonous movements of the hand and hand.

Medications

Effective medicines reduce soreness, remove swelling. The action of the formulations allows the squeezed canal to take on its usual dimensions, eliminates the reason for the development of negative symptoms.

drugs that relieve inflammation -. Strong tablets, ointments, gels prevent spread inflammatory process to new areas, reduce swelling, numb the problem area. Effective formulations: 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, intestines, negatively affect the liver;
hormonal drugs to eliminate pain syndrome, break the chain of the inflammatory process. A short course of active action with the use of Hydrocortisone and Prednisolone is recommended. Intra-articular injections - effective method elimination of inflammation, reduction of pain. Hormonal drugs have more side effects than NSAIDs, prolonged use often leads to irreversible disorders in various parts of the body.

Other methods of treatment complement the drug intake:

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 puffiness, reduce inflammation. Application of thin honey on the surface of a cut cabbage leaf increases the efficiency of the procedure. A combination of a beekeeping product and cabbage juice renders positive effect not only with carpal tunnel syndrome, but also with arthritis, rheumatism, gout, periarthritis of the shoulder joint;
contrasting baths with chamomile broth, sea salt, infusion of sage. Each remedy has a positive effect on the condition of the hands, reduces swelling and inflammation. To prepare a decoction of medicinal herbs, pour a tablespoon of raw materials with a liter of boiling water, let it brew for an hour, 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 easy way to reduce soreness in a problem hand. Before use, put the washed leaves in boiling water for a minute, shake off the water, cool, wrap the affected area, leave for 45 minutes. After the procedure, apply nutritious cream... If the skin of the hands is tender, flaky, it is advisable to lubricate the brushes with vegetable oil before the treatment session;
diuretic tea against tissue swelling. To stop excessive pressure on the anatomical tunnel is the main task of therapy. There are many recipes for teas and herbal decoctions accelerating the removal of excess fluid from the body. Do a good job medicinal herbs, fruits and berries: dill, lingonberry, parsley, cornflower, bearberry. Useful action have corn stigmas, wild strawberries, field horsetail, knotweed. Diuretic berries and herbs are used with caution. There are limitations: in particular, the active excretion of fluid with the help of traditional medicine and drugs are prohibited during pregnancy.

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

Possible complications

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

In advanced cases, the nerve fibers atrophy, 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.

Learn 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 uses of the decoction bay leaf for joints.

Prevention measures

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

How to proceed:

quit smoking: lack of nutrition worsens the condition of blood vessels and nerve fibers;
take breaks from working at the computer, remember about a five-minute rest every hour, do not forget about gymnastics for the hands and fingers;
more often to relax hands, brushes when painting, plastering work. Builders, repairmen should massage the brushes, after the change apply ointments and gels with a cooling, anti-edema effect;
properly equip workplace to minimize stress on the brushes. For long-term work at the computer, armrests are required to support the elbows;
be sure to use a mouse pad, put 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 the joints, cartilage tissue;

Video. Elena Malysheva on carpal tunnel syndrome:

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

What is Tunnel Syndrome

People do not attach importance when they feel discomfort in the joints, numbness of the fingers at night, the wrist begins to hurt, but we can talk about a serious ailment. 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 is associated with prolonged tension of certain muscle groups, so it is worth learning in more detail about the problem in order to avoid it or stop the development of pathology.

Tunnel Syndrome - Causes

The disease manifests itself more often in older women in women. The cause of the tunnel syndrome is explained by the peculiarities of the female anatomy, age-related changes... V menopause, as well as during pregnancy occur hormonal changes, tissue edema, provoking compression in the canals peripheral nerves... There are other causes of diseases in people of different sex and age.

Factors causing the development of tunnel neuropathy:

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

Pain in the fingers, numbness of the hands may indicate the development of a disease such as carpal tunnel syndrome. This is due to the 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, with professional work).

Carpal syndrome develops more often in women. They have thinner wrists, and with age, hormonal changes and tissue swelling occur. Carpal tunnel syndrome threatens people whose profession is associated with a constant load of certain muscles:

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

Ulnar nerve tunnel syndrome

Due to excessive pinching of the nerve, ulnar tunnel syndrome occurs. What other nuances are there? Elbow injuries can cause pathologies such as neuropathy. ulnar nerve... Inflammation occurs, the affected tendon arch becomes thicker, narrowing of the channels, pressure on the nerve causes pain and numbness. Cubital syndrome develops with constant compression, injury of the ulnar nerve, which occurs in athletes, people performing constant flexion-extension of the elbow joint while performing work.

Tunnel Syndrome - Symptoms

How can you tell if the symptoms of tunnel syndrome have started? A feeling of muscle stiffness in the limbs, numbness of the fingers, the desire to take a more comfortable posture may indicate the development of neuropathy. More often similar symptoms appear in the hands, but can develop in both the upper and lower limbs... Problems first appear in the morning after prolonged immobility or severe compression.

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

Tunnel Syndrome - Treatment

Start as soon as possible earlier treatment tunnel syndrome - early prevention help to avoid the development of the disease. The first symptoms urge you to pay attention to your health - if possible, change your profession or work in a safer posture, do therapeutic exercises. If the disease begins to progress, then anti-inflammatory drugs are prescribed, with hypothyroidism - substitution therapy... Vasoactive and diuretic drugs are effective, physiotherapy is recommended, water treatments, in difficult cases - operation.

Tunnel Syndrome - Home Treatment

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

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

Treatment of tunnel syndrome with folk remedies

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

Mash the berries well and pour water until they become a thick gruel.
Heat the mixture to a temperature of 37 degrees.
Dip your hands (wrists or elbows) into the bath, hold for half an hour.
Wipe your hands with paper napkins, wrap with a warm natural cloth.
The procedure is repeated daily or every other day for a month. After a two-week break, the course of treatment can be repeated if necessary.

Take off unpleasant symptoms and compresses, which are used before bedtime, with exacerbation of the disease. To prepare such a product, mix:

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

Treatment is complemented by taking lingonberry broth. How to prepare it:

2-3 teaspoons of lingonberry leaves pour 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 complex of treatment suggested by the doctor along with home remedies, medical gymnastics, massage will stop the development of compression-ischemic neuropathy and get rid of excruciating symptoms... People who spend a lot of time at a computer doing monotonous manual work should think about disease prevention, because preventing a disease is much easier than curing it.

Video: tunnel neuropathy

Health ecology: 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 a brush

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

It belongs to the category of tunnel neuropathies, in a nutshell, about which we can say that they arise due to compression of the nerve in the fibrous bone and 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 a brush or prolonged forced flexion of the hand occurs. So which professions are at risk? These are pianists, cellists, drummers, bowlers, experienced artists, motorcycle racers, sign language interpreters, those who work with a jackhammer, hairdresser, embroidery and typing. V recent times, when the computer is no longer a rarity and more and more professions are associated 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 ailment. According to the results of one study, every 6th computer worker was diagnosed with this carpal tunnel syndrome. Users whose hand is bent 20 ° or more in relation to the forearm are at greater risk.

Other studies contradict this and say that there is no significant difference in the occurrence of this ailment in people working at a computer and not working at it.

Causes of wrist syndrome

There is a nerve in the carpal tunnel, and when it is pinched, pain in the wrist occurs. Swelling of the tendons located next to the nerve and edema of the carpal tunnel are considered natural causes of pinching of this nerve.

The reason for the pinching of this nerve lies in the prolonged static load on the same muscles. The load is caused by a large number of monotonous movements and often uncomfortable hand position. For example, working on the same computer keyboard, a person's hand is in constant tension.

Carpal tunnel syndrome symptoms

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

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

At further, later stages, numbness, pain and heaviness in the hands begin to appear, tingling in the palms, fingers, wrist, sensitivity in the wrist region is disturbed, tissue irritation and edema may form. Fingers may feel stiff in the morning. In people with carpal tunnel syndrome, indirect manifestations may also appear: insomnia due to pain and wrist cramps.

The advanced stage of wrist syndrome often leads to atrophy of the muscles of the thumb. The possibility of firmly clenching the hand into a fist disappears, thumb does not bend. The hands and fingers of the palm may become unruly.

When a person with tunnel syndrome tries to lift a rather heavy object, this can provoke pain or disconnection of the hands - the object will simply fall out of the 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, and hold the steering wheel of a car for more than 10 minutes.

Diagnosis of carpal tunnel syndrome

A neurologist, sometimes examining a patient, determines the degree of damage to the muscles of the wrist, arising from working at a computer or other professional activity.

However, a person is able to independently determine this disease. Tinel's test and Falen's test are used to diagnose carpal tunnel syndrome.

In the first test, there is a percussion (tapping) in the area of the wrist over 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 get something like the letter "T". If during this time this test causes paresthesia and soreness on the palmar surface 1,2,3 and partially 4 fingers.

Prevention

Since a person does not always manage to refuse or significantly reduce the time of working at a computer and not only, it means that it is worth thinking about preventive measures. Prevention of tunnel syndrome is the correct and comfortable organization of the workplace. Thanks to this approach, you can avoid almost any problems that a person with hands, working at a computer, can have.

One of the main preventive measures should be ergonomics and correct sitting at the computer. It is desirable to have a chair for work in a back position, and the height of which is adjustable (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 at an angle of 90 degrees in relation to the hips. The shoulder with the 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:

The chair and computer chair must be equipped with armrests.
Ergonomic keyboard. It should be positioned so that, bending the arms at the elbow, they form a right angle. A properly positioned keyboard gives the hands a rest when they are resting on it.
Working with the mouse, the elbow should lie on the table, and the straight hand should be placed as far as possible from the edge of the table.
The mode of work on the computer is also fundamentally important. It only takes a few minutes for the tendons to rest and restore the required amount of synovial fluid. But a person suffering from diabetes mellitus 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 of fatigue from movements, but from what is working at the keyboard. In this case, doing hand exercises would be ideal.

Carpal Tunnel Syndrome Treatment

Needed on early stages start treatment of carpal tunnel syndrome caused by prolonged work at the computer keyboard. First things first, you need to tackle the root cause, such as 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 (to minimize the work at the computer), or to immobilize it with a fixed splint. When symptoms subside, exercise is initiated to stretch and strengthen the muscles in the wrist. Physiotherapy should preferably be carried out under the supervision of a physician.

With severe tunnel syndrome, accompanied by acute pain and severe inflammation, medication is required.

At proper nutrition able to fully saturate the body with important bioactive substances, the treatment of carpal tunnel syndrome can become very effective and the healing process will become significantly 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 has proven to be one of the most effective treatments. It helps to reduce pain and also improves grip strength.

A set of exercises

Complex 1

Slowly clench your hands into fists and so 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 the brushes, then with each finger.
Rotate your brushes, then wiggle your fingers. With hands clenched into fists, rotate around the axis.
Shake your hands.
Squeeze your hands together and press with the fingers of one hand on the fingers of the other hand.

Complex 2

You need to raise your hands 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 the brushes (10-12 times) in each direction.
Stretch your arms in front of you and actively wiggle your fingers for one minute.
Place your palms together and turn your fingers towards you, i.e. wrists away from you. Try to slowly push from the palm of your hand with the fingers of one hand to the fingers of the other.

Complex 3

Rub the inner and outer surfaces of your palms until you feel warm.
On the right hand, bend each finger with the thumb on the right. Press each finger four times. For right hand repeat the same.
Turn your palms towards each other internal parties and connect them between the baking soda, palms slightly unfolded. Press your fingers into each other, then shake your hands, relaxing them.
Make your fist slowly. Shake your brushes to loosen them up.
Slowly clench your fist, then quickly and sharply unclench, throwing your fingers out. Lower your hands and shake your brushes.

When working at a computer, if you still do not always manage to fully perform a set of exercises, still take breaks, raise your hands up and rotate with your brushes. If you notice the symptoms of carpal tunnel syndrome of the wrist, you need to make such rotations very carefully and slowly. Relax your muscles periodically by shaking your hands. published

Carpal tunnel (or carpal tunnel) syndrome is a condition that occurs when the median nerve in the carpal tunnel is traumatized or compressed. Sometimes this syndrome is called tunnel syndrome, but this is not an entirely correct term, since there are others tunnel syndromes... With the development of this ailment, a violation of the sensitivity and movements of the first three and part of the fourth finger occurs.

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

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

This syndrome is more often observed in people 40-60 years old, but it can develop into more 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 the development of this syndrome. According to one of the 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 the compression of the median nerve where it passes through the tunnel, which is formed by the transverse ligament and the bones of the wrist. Compression is caused by inflammation and swelling of the joint, tendons, and muscles in the joint or within the carpal tunnel. In most cases, the cause of this median nerve damage is work that requires frequent and repetitive movements.

In addition to professional 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 soft tissues, may be accompanied by bone displacement. Such damage compresses the nerve. At correct treatment dislocation or fracture, the compression is eliminated, but with deformation of the bones or muscle contractures, the disorders in the joint can become irreversible.
and other joint lesions of a rheumatic nature... The inflammation and swelling that occurs with these conditions causes nerve compression. soft tissues carpal tunnel. With prolonged progression of the syndrome cartilage tissue the joint grows old, loses its elasticity and wears out. The wear and tear of cartilage leads to fusion of the surfaces of the joints and their deformation.
Tenosynovitis (inflammation of the tendons)... Tendons are affected pathogenic bacteria and become inflamed. The tissues around the wrist swell and compress the nerve. Sources of infection can be: purulent wounds on the hands, panaritium, etc. In addition, inflammation of the tendon tissues can be non-bacterial and caused by chronic stress injuries: frequent hand and arm movements, 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 rare. These can be schwannomas, neurofibromas, perineuromas, and malignant tumors sheaths of the nerve. 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 activated by the enzyme protein kinase C, neurons and their processes are damaged. 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). The nerves become swollen and can be compressed in tight areas such as the carpal tunnel.
... This disease develops for a long time and is accompanied by the growth of the bones of the face and limbs to disproportionate sizes. In addition to bone changes, there is an overgrowth of soft tissues. The enlargement of the bones in the wrist causes the lumen of the carpal tunnel to narrow and the median nerve is pinched.
Genetic predisposition... Compression of the median nerve can be observed with such anatomical features brushes like a "square wrist", congenital failure tendon sheath production of lubricant or congenital thick transverse ligament of the wrist.

Symptoms

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

Carpal tunnel syndrome develops gradually. In most cases, one hand is affected, that is, the "working" (right-handed - right, left-handed - left). Sometimes nerve compression occurs in both hands (for example, when endocrine disorders or pregnancy).

Paresthesias

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

Pain

Initially, the patient develops pains of a burning or tingling nature. Arising at night, they disrupt 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 pain is eliminated.

Painful sensations do not occur in certain joints, but are common. They cover the entire finger - from base to tip. If untreated, pains begin to appear during the day. Any movement of the hand causes them to intensify, and the patient cannot fully work. At severe course pain syndrome can affect the entire palm and extend to the elbow, making diagnosis difficult.

Clumsy hand movements and loss of strength

With the aggravation of the syndrome, the patient develops weakness in his hand, 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 the 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 and actively grasp objects.

Decreased sensitivity

This symptom appears with significant damage to the median nerve. A third of patients complain of a reaction to abrupt change temperature or cold: the hand feels a burning sensation or painful numbness. Depending on the severity of the disease, the patient may not feel a light touch to 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 has a visual decrease in the size of the muscles. In advanced cases, the hand is deformed, and it becomes like a monkey's paw (the thumb is brought to a flat palm).

Discoloration of the skin

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

Diagnostics

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

Tests for carpal tunnel syndrome:

Tinel's test. Tapping with the palm of the hand in the narrowest part of the wrist canal causes tingling sensations in the fingers.
Phalen's test. The patient should bend his arm as much as possible in the wrist area and hold it that way for a minute. With carpal tunnel syndrome, there is an increase in paresthesias and pain.
Cuff test. The cuff of a pressure monitor is placed between the elbow and wrist. It is pumped with air to significant numbers and left in this position for one minute. In the syndrome, tingling and numbness occurs in the 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, when holding even one of them, discomfort, then you need to see a doctor.

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

electroneuromyography;
radiography;

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

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

Treatment

Treatment of carpal tunnel syndrome always begins with a watchdog regimen that relieves stress on the wrist. In the absence of such measures, therapy is ineffective.

Guard mode for carpal tunnel syndrome:

When the first signs of the syndrome appear, the brush should be fixed with a special retainer. 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 stop activities that lead 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 paresthesias.
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 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 discomfort that bothers the patient.

Compresses

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

One of the options for the composition for compresses:

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

These 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.

Injection of drugs into the wrist canal

The doctor uses a special long needle to inject a mixture of solutions into the carpal canal 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 the first administration of such a composition, the patient's condition improves significantly. If the symptoms of the syndrome return after some time, then two more such procedures are performed. The interval between them should be at least 2 weeks.

Drug therapy

Choice drugs, the dosage and duration of their administration depend on the severity of the disease and concomitant pathologies. In the plan drug therapy carpal tunnel syndrome may include such funds:

vitamins of group B (B1, B2, B5, B6, B7, B9 and B12): Milgamma, Neurobion, Neurobeks, Doppelgerts active, Benevron, etc .;
non-steroidal anti-inflammatory drugs: Ksefokam, Dikloberl, Aertal, Movalis, etc.;
vasodilators: Pentylin, A nicotinic acid, Trental, Angioflux;
: Hypothiazide, Furosemide, Diacarb, etc .;
anticonvulsants: Gabapentin, Pregabalin;
muscle relaxants (drugs for muscle relaxation): Sirdalud, Midocalm;
glucocorticosteroids: metipred, hydrocortisone, prednisolone;
antidepressants: Duloxetine, Venlafaxine.

Physiotherapy

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

The following can be used to treat carpal tunnel syndrome:

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

Appointment of physiotherapy procedures is possible only in the absence of contraindications to them.

Surgery

An operation 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 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 into the hand and is formed by the bones of the wrist on one side and the transverse ligament of the wrist on the other.

Pass in the carpal tunnel of the tendons of the flexor muscles of the fingers and the median nerve.

When the contents of the carpal tunnel are compressed, the median nerve, which is the least resistant to damage compared to the 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 squeezing and their constant trauma 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

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

Swelling of tissues as a result of injury to the forearm and hand (fractures, dislocations, bruises);
Swelling of tissues in pregnant women, especially on later dates pregnancy, and in women taking oral contraceptives;
Chronic inflammation and edema of the structures of the carpal tunnel with constant occupational trauma (the same type of repetitive flexion and extension movements with constant tension of the hands, work associated with constant vibration);
Swelling of tissues 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 the ovaries, diabetes mellitus);
Narrowing of the synovial sheaths (sheaths) of the tendons and thickening of their walls as a result of acute or chronic inflammation with 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 proliferation 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 onset of the disease, there are sensations of tingling, burning and pain 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 hand. Often there is numbness of 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.

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

The pain, numbness, and tingling sensation usually go away when the hand is lowered down and the fingers are moved easily. But after a while, the symptoms reappear.

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

Symptoms of microcirculation disturbance in a diseased hand are often found in the form of skin blanching or the appearance of a bluish tint due to vasospasm, a coldness of the skin of the fingers to the touch, a violation of sweating (increased or vice versa, decreased sweating). As a result of constant vasospasm, 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. In carpal tunnel syndrome, tingling occurs in the skin of the thumb, index, and middle fingers during this time.
Tinnel's test... Tapping lightly on the carpal tunnel area causes tingling and pain in the fingers. Tinnel's test is positive, as a rule, when the disease is severe.

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

Treatment for carpal tunnel syndrome

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

Conservative (without surgery) treatment:

Restriction of movement in a sore hand for a long time up to the application of a splint on the wrist or a plaster cast;
Medications:
- non-steroidal anti-inflammatory drugs for pain relief;
- dehydrating action (removing water from the body), namely diuretics to relieve swelling;
- the introduction of glucocorticoids into the carpal tunnel region to reduce tissue edema and inflammation locally;
- 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.
Physiotherapy treatment: constant magnetic field, acupuncture to improve metabolic processes in damaged tissues.

Surgical treatment is used in case of ineffectiveness of the conservative and consists in dissection of the transverse wrist ligament. An operation is performed under local anesthesia... The transection of the transverse wrist ligament relieves pressure on the flexor tendons of the fingers and the median nerve, and restores normal blood supply to the tissues of the hand.

After the operation, the diseased arm is immobilized with a plaster cast for 10-12 days. V postoperative period the patient is assigned physiotherapy, massage, thermal procedures, vitamins of group B. The function of the hand and the patient's ability to work are fully restored 4-5 weeks after the operation.