Carpal tunnel syndrome occurs due to compression of the median nerve between the bones and tendons of the wrist muscles.
Its main symptoms are pain, numbness and tingling in the thumb, index, middle and ring fingers.
After long period compression of the nerve may result in weakening of the strength of the fingers and muscles at the base thumb hands may atrophy. In more than half of cases, both hands are affected by the disease.
About 5% of people in the world suffer from this disease. It usually occurs in adulthood. Women are more susceptible to the disease than men. In 30% of people, symptoms of the syndrome decrease within a year without special treatment.
Risk factors for developing the syndrome include:
- obesity;
- hypothyroidism;
- pregnancy;
- repetitive, monotonous work.
The causes of the disease are often types of work, which include:
- working on a computer;
- work that requires a strong hand grip;
- working with vibrating tools.
Anatomical features of the canal structure
The carpal tunnel (tunnel) is an anatomical compartment located at the base of the palm. The nine flexor tendons and the median nerve pass through this tunnel, which is surrounded on three sides by the bones of the wrist, forming an arch or arc.
The median nerve provides sensory and motor function to the thumb, index, middle and half ring finger. At the level of the wrist, the nerve innervates the muscles at the base of the thumb, which allow it to abduct from the other four fingers and also extend out of the plane of the palm.
Carpal and curbital tunnel syndrome
Simply bending the wrist to 90 degrees reduces the size of the canal. The median nerve can be compressed by a decrease in the size of the canal, an increase in the size of its internal tissues (eg, swelling of the lubricant tissue around the flexor tendons), or both.
Compression of the median nerve causes atrophy, weakness, and loss of sensation in the fingers it innervates.
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Symptoms of the disease
Symptoms of carpal tunnel syndrome usually begin gradually. People with carpal tunnel syndrome experience numbness, tingling, or burning in the fingers, particularly the thumb, index, middle, and radial half of the ring finger. The discomfort usually increases at night and in the morning.
Hands of the patient
Pain and discomfort may radiate up the arm and be felt in the forearm or even the shoulder. Less specific symptoms may include pain in the wrists or hands, loss of grip strength and manual dexterity.
If the syndrome remains untreated, weakness and atrophy of the muscles of the thumb may occur, because these muscles do not receive sufficient nerve stimulation.
Diagnosis of carpal tunnel syndrome
The diagnosis is made based on a thorough examination of the patient's medical history, signs, symptoms, clinical examinations and can be confirmed using electrodiagnostic tests - electromyography and nerve conduction velocity.
If there is nerve dysfunction and muscle atrophy at the base of the thumb, the diagnosis is usually confirmed.
Physical tests
The Phalen test is performed by gently flexing the wrist, then holding it in that position for 60 seconds and waiting for symptoms.
A positive result results in pain and/or numbness in the median nerve distribution.
The faster the numbness begins, the stronger the resulting syndrome.
The Tinel test is a way to detect irritated nerves. It is performed by lightly tapping the skin on the flexor dorsi muscle to induce a tingling sensation in the distribution of nerves. The Tinel test is less sensitive but more specific than the Phalen test.
A Durkan test may also be performed, performed by squeezing the wrist or applying strong pressure on the palm over the nerve for 30 seconds to identify symptoms.
The arm elevation test is performed by raising both arms above the head. If symptoms are reproduced in the nerve distribution within 2 minutes, the diagnosis is positive. The hand raise test has high sensitivity and specificity.
The purpose of electrodiagnostic testing is to compare the conduction velocity of the median nerve with that of other nerves supplying the arm.
The most sensitive, specific and reliable test is the combined sensory index (Robinson index). Electrodiagnosis is based on demonstrating decreased nerve conduction through the carpal tunnel in the context of normal nerve conduction elsewhere.
The role of MRI or ultrasound imaging in the diagnosis of carpal tunnel syndrome has not been established and their use is not recommended.
Syndrome according to ICD-10
Disorders associated with carpal tunnel syndrome cover a spectrum of problems physical health, recognized in international system classification of diseases ICD-10.
The disease belongs to mononeuropathies upper limb except for the current one traumatic disorder nerve.
In ICD-10, this syndrome is coded G56.0 and is defined as carpal tunnel syndrome.
Treatment at home
Home treatment can relieve pain and prevent further or permanent damage to the median nerve if treatment is started when symptoms first appear.
If you have mild symptoms, such as occasional tingling, numbness, weakness, or pain in your fingers or hands, you should next steps to reduce inflammation:
- It is necessary to rest your fingers, hands and wrists. It is important to stop doing activities that may be causing numbness and pain. Once symptoms subside, these activities can be resumed gradually.
- You can apply ice to your wrist for 10 to 15 minutes, once or twice an hour.
- You can wear a wrist splint at night to keep your wrist in a neutral position and relieve pressure on the median nerve.
- Once the pain is gone, you can begin exercises to improve the flexibility and strength of your hand and wrist. You can learn the best hand and wrist positions during the movements.
- You may consider taking nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections to relieve pain and reduce swelling. Research has not shown these remedies to be highly effective, but they may help relieve symptoms.
Conservative treatment
Treatment for carpal syndrome should begin as soon as possible after the onset of symptoms.
Conservative treatment options are useful if you have mild or moderate symptoms that started less than 10 months ago.
Physical activity may reduce the risk of developing the syndrome.
At the same time, it is necessary to take more frequent breaks to rest the hands and avoid activities that increase the symptoms of the syndrome.
Additional treatment options include wrist splinting. You may need to experiment to find a treatment that works for your particular case.
Before using additional or alternative treatment, you should consult your doctor.
- Yoga. Yoga poses designed to strengthen, stretch, and balance the upper body and joints can help reduce pain and increase hand strength.
- Hand therapy. Research has shown that certain physical and occupational hand therapies can reduce the symptoms of carpal tunnel syndrome.
- Ultrasound therapy. High intensity ultrasound can be used to raise the temperature of the affected area of body tissue to reduce pain and promote healing.
Current research shows conflicting results from ultrasound therapy, but it may help reduce symptoms within a few weeks.
Surgery
Surgical treatments involving incision of the transverse carpal ligament have better results compared to non-surgical treatments therapeutic methods. Tire after surgery not required.
Surgery may be appropriate if symptoms are severe or do not respond to other treatments.
Carpal tunnel surgery aims to relieve the contraction pressure on the median nerve.
The operation can be performed by two different methods:
- Endoscopic surgery. The surgeon uses an endoscope to cut into the ligaments by making one or two small incisions in the arm or wrist. Endoscopic surgery is less painful than open surgery surgical intervention in the first few days or weeks after surgery.
- Open surgery. The surgeon makes an incision in the palm of the hand above the carpal tunnel and cuts the ligaments to free the nerve.
During the healing process, the ligament tissue gradually fuses, making more room for the nerve. This internal process healing usually takes several months, but the skin heals within a few weeks.
Surgical risks may include incomplete release of the ligament, wound infection, scarring, and nerve or vascular injury.
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Conclusion
In most cases, relief of symptoms through medical or surgical treatment will reveal minimal residual symptoms of nerve damage.
Long-term chronic course syndrome (usually in older people) can lead to permanent nerve damage, i.e. irreversible numbness, muscle atrophy and weakness. Recurrence of carpal tunnel syndrome after successful surgery is very rare.
Video on the topic
Definition of carpal tunnel syndrome
Orthopedic doctors talk about carpal tunnel syndrome when the median nerve (Nervus Medianus) in the wrist is damaged. When tissue edema increases pressure on the median nerve (Nervus Medianus), which results in pinching.
Carpal tunnel syndrome is one of the most common diseases diagnosed by orthopedists. Approximately every tenth resident of Germany will experience this disease during their lifetime.
The carpal tunnel is located on the inside of the wrist, at the base of the hand and is surrounded by a ligament connective tissue– wrist ligament. The tendons and median nerve (Nervus Medianus) pass through the carpal canal, which controls certain muscles of the hand and fingers, and is also responsible for sensitivity in the thumb, index, middle and partially ring fingers.
Damage to the median nerve is accompanied by the following symptoms:
- decreased hand sensitivity
- a feeling of tingling and numbness in the hands - primarily in the area of the thumb and middle fingers
- pain with grasping movements
- pain in the fingers, radiating to the arm
Symptoms usually appear at night, in the morning and intensify with additional stress on the hands.
Orthopedists diagnose carpal tunnel syndrome primarily in people over 40 years of age. The disease occurs three times more often in women than in men. In particularly severe cases, numbness can become permanent and lead to atrophy of the muscles of the palmar cavity (at the base of the thumb).
Synonyms: carpal tunnel syndrome (CTS), carpal tunnel syndrome (CTS), median nerve compression syndrome, nerve compression syndrome.
Term in English language: carpal tunnel syndrome
Description
Carpal tunnel syndrome occurs primarily in people aged 40-70 years. Orthopedists rarely diagnose this disease in children. Patients wake up in the morning because their arm feels numb or tingling. If you shake your hand, then, as a rule, the complaints go away. In the future, motor disorders are added to sensory disorders, for example, a decrease in strength in the thumb.
Carpal tunnel syndrome often develops not in one, but in both hands. At first, complaints appear only periodically. However, prolonged pressure on the median nerve (Nervus Medianus) inevitably leads to its damage. If carpal tunnel syndrome is not monitored by an orthopedic physician, the muscles at the base of the big toe will atrophy. Damage to the median nerve and severe muscle atrophy cannot be restored. Therefore, it is important to promptly seek help from an orthopedist.
Causes of carpal tunnel syndrome
Quite often it is impossible to identify any specific cause. of this disease. In this case, orthopedic doctors talk about idiopathic carpal tunnel syndrome, which mainly occurs in women during menopause due to excessive accumulation of fluid and tissue swelling in the carpal tunnel. Pregnancy can also trigger the development of carpal tunnel syndrome.
In addition to the above, orthopedists call following reasons appearance of the disease:
- hypofunction thyroid gland(hypothyroidism)
- deformations and displacements in the wrist area after previous injuries
- rheumatic diseases
- scar tissue putting pressure on a nerve
- chronic inflammation of the tendon sheaths (tenosynovitis)
- swelling and inflammatory edema of tissues
- diabetes
- dialysis therapy for renal failure
It is still not clear whether carpal tunnel syndrome is inherited. However, orthopedic doctors often diagnose the disease in several family members on the maternal side.
People in certain professions whose wrists are exposed to excessive stress over a long period of time have a significantly increased risk of developing carpal tunnel syndrome.
What can you do about carpal tunnel syndrome?
Orthopedic doctors advise avoiding stress and refusing to do heavy physical work. Shaking and cooling the hand can provide short-term relief from pain. Applying an ice pack wrapped in a towel to the wrist area has a good effect.
Applying a wrist splint at night and during the day helps keep the wrist in extension, thereby preventing pressure on the median nerve. For those who work a lot behind a computer screen, it is highly recommended that you use an ergonomic keyboard.
Help from specialists
Depending on the symptoms, in addition to consulting your attending physician, a detailed diagnosis may follow from various specialists. These include:
- orthopedist
- neurologist
What to expect at your appointment with an orthopedic surgeon?
Before the orthopedic surgeon begins the examination, he will begin with a conversation (history) regarding your current complaints. In addition, he will also question you about past complaints, as well as the presence possible diseases.
The following questions may await you:
- How long ago did the symptoms appear?
- Could you describe the symptoms more precisely and localize them?
- Have you noticed any changes in the progression of symptoms?
- Are you experiencing additional symptoms How is shortness of breath, chest pain, dizziness?
- Have you already experienced this and have similar symptoms occurred in your family?
- Are there any this moment any diseases or hereditary predisposition to the disease and are you on treatment for this?
- Are you currently taking medications?
- Do you suffer from allergies?
- Do you often find yourself in a state of stress at home?
What medications do you take regularly?
Orthopedic surgeon needs review medicines that you take regularly. Please prepare a chart of the medications you are taking before your first appointment with your podiatrist. You will find a sample of such a table at the link: .
Examinations (diagnostics) performed by an orthopedist
Based on the characteristics of the symptoms identified during the anamnesis and your current state An orthopedic surgeon may perform the following examinations:
- measurement of the speed of excitation propagation along the fibers of the median nerve (Nervus Medianus) of the wrist
- lab tests
- x-ray examination
- Ultrasound (ultrasound examination of the nerve)
- electrophysiological study (EPS)
Treatment (therapy)
For mild to moderate cases, your orthopedist may prescribe a splint to be worn at night to relieve pain and stabilize the wrist. If any other disease is the cause of the development of carpal tunnel syndrome, for example, hypofunction of the thyroid gland (hypothyroidism), the efforts of doctors will be aimed primarily at treating the primary disease.
To reduce pain, the orthopedic doctor prescribes painkillers such as paracetamol, diclofenac or ibuprofen. In addition, injections of glucocorticoids (cortisone) may be prescribed. However, in most cases, after some time, complaints arise again.
If the patient already has sensory impairment (numbness) or paralysis, surgery is necessary. In this case, the wrist ligament is excised, reducing the load on the median nerve. Most often, the orthopedist performs the operation under local anesthesia and, as a rule, it leads to good results. After surgery, it is necessary to ensure complete immobilization of the wrist for the next two weeks. However, doctors advise patients to immediately begin active movements of the fingers to avoid stiffness.
Prophylactic
Because the causes of carpal tunnel syndrome are not clear in most cases, the disease cannot be prevented. It is important to seek help from an orthopedic doctor in a timely manner to avoid further damage.
Forecast
Surgical intervention will help eliminate the patient's complaints about long time. After two to three weeks, the functions of the fingers and hand are restored almost completely. However, surgery is not always necessary.
There are people who, due to their occupation, are at risk for a disease called “carpal tunnel syndrome.” Programmers, system administrators, machinists, drivers, hairdressers, as well as those who knit and embroider, play the cello, violin or piano, often complain of pain in the wrist of the “working” hand. However, anyone can get sick, regardless of their occupation. Women are more likely to get sick because their wrists are thinner.
Carpal tunnel syndrome (carpalis - Latin for carpal tunnel) is a set of symptoms that are caused by compression of the median nerve in the carpal tunnel. After monotonous work with a brush, a person feels numbness, weakness of the hand, and pain in it.
Causes
In order for the wrist to be sufficiently mobile and at the same time stable, its bones are connected by many strong ligaments. Inside the wrist there is a fibrous rim through which the tendons and nerves of the hand pass, called the carpal tunnel.
A large number of similar movements (including when working with a computer mouse) or an awkward position of the hands, which leads to the fact that the wrist is constantly under tension, can cause swelling of the tendons and ligaments that form this narrow tunnel, and hence pinched nerves. This is the root cause of the syndrome.
However, it can also be triggered by factors such as:
- Heredity.
- Age after 50 years.
- Fractures, injuries, bone spurs, cysts, tumors in the wrist area.
- Obesity.
- Infections.
- Hormonal changes in pregnant or menopausal women, leading to retention of excess fluid in the synovial membranes (inner layer joints).
- Smoking and alcohol cause a decrease in blood flow to the median nerve.
Clinical manifestations of the disease can occur not only when a person works with a brush, but even during sleep. Changing the position of the hand or shaking the hand helps reduce symptoms.
Initially, they may come and go, but over time they inevitably turn into constant companions of the disease. It can get to the point where it becomes difficult to perform any movements that involve working with your fingers, such as buttoning a shirt or tying shoelaces.
What does a person feel:
- Tingling (including at night).
- Numbness and swelling of the fingers.
- Weakness in the muscles of the hand.
- Pain in the fingers or throughout the hand (often reminiscent of a shooting or a sharp electric shock).
Such a patient is examined by a neurologist. It can determine:
With the help of tapping over the carpal tunnel area, the patient’s reaction is in the form of “shots” in the fingers (the so-called Tinel’s symptom);
Using maximum flexion of the wrist at the wrist joint for 1 minute, the patient reacts in the form of weakness, numbness or tingling (the so-called Phalen test).
The history of the disease and its additional factors (indirect causes) are studied.
As additional methods diagnostics are used:
- Electroneuromyography (the degree of damage to the muscles of the forearm is determined).
- Nerve conduction velocity (is it normal).
- X-ray of the wrist joint (its purpose is to exclude other hand diseases).
Treatment
The main methods of treating carpal tunnel syndrome are conservative and surgical.
The first is used when the disease is diagnosed early stages. The more pronounced the symptoms and the more often they bother the patient, the more severe the form of the disease and the less likely it is that conservative treatment will be effective. In such cases, surgical intervention is preferable.
Conservative treatment involves:
- Fixation of the wrist joint (at night, an orthosis is put on - a special orthopedic device; it fixes the hand in a physiological (natural) position; during the day, while working, you can wear splints).
- Taking medications to relieve pain and reduce inflammation (for example, treatment with Nimesil or Nurofen).
- A change in professional conditions if the work involves active load on the hands.
- Steroid injections (such as prednisone or dexamethasone) given into the carpal tunnel to relieve symptoms.
If treatment with conservative methods for six months does not produce results, then surgical intervention is inevitable.
This operation is usually performed on an outpatient basis under local anesthesia. Surgically The carpal ligament (in other words, the transverse carpal ligament) is cut.
The recovery period lasts a couple of months and involves the possibility of minor pain, swelling, and stiffness in the hand. To eliminate such consequences, a rehabilitation program is individually developed for the patient with a whole range of measures for effective recovery brush functions.
The arm will completely return to normal within a year: the more advanced the disease, the longer it will take.
Eat well during treatment. If you provide the body with all the biologically vital active substances, then recovery will speed up, and the period of rehabilitation and restoration of working capacity will be reduced.
First of all, you need to make your workplace comfortable. When working with the keyboard, strictly follow the bend angle of your elbow – 90°. When working with the mouse, make sure your hand is straight and lies on the table away from the edge (your elbow should also be on the table surface). Use a special wrist rest (same mouse pad). A chair or work chair must have armrests.
Secondly, while working, take breaks and perform preventative exercises that will improve blood circulation in the wrist muscles and help them stretch:
- Shake your hands.
- Clench your fingers into fists (5-10 times).
- Rotate your fists around your axis.
- Press your left hand onto the fingers of your right (as if turning your palm and wrist outward) and vice versa.
And finally, improve your diet, eliminate smoking, exercise and maintain a normal body weight.
Forecast
As for the prognosis for carpal tunnel syndrome, then timely diagnosis and complex, adequate treatment will make it favorable. It is strictly forbidden to neglect the disease: irreversible damage to the nerve is fraught with loss of hand function.
Below is a video - an excerpt from E. Malysheva’s program about carpal tunnel syndrome:
Content
One of the types of neuritis is carpal tunnel syndrome, which leads to decreased sensitivity of the fingers and disrupts their normal functioning. Absence timely treatment can lead to muscle atrophy and motor ability of the hand. Knowing the causes of this disease, characteristic symptoms and possible consequences, it will not be difficult for a person to understand that he needs to seek help from a doctor as quickly as possible. You should study information on how to protect yourself from a disease that can leave the patient incapacitated for a long time.
What is carpal tunnel syndrome
A complex of interrelated signs of compression-ischemic compression of the median nerve in the carpal tunnel is called carpal tunnel syndrome. This disease is neuropathic in nature and blocks normal flexion at the junction of the forearm and hand. There are several synonymous names for this syndrome:
- carpal tunnel;
- wrist;
- carpal tunnel.
The carpal tunnel (tunnel) is located at the base of the hand, formed by the carpal bones and the transverse ligament. In addition to the median nerve, the tendons of the finger flexor muscles pass through it. As a result of the disease, the innervation of the muscles that are responsible for abduction and opposition of the thumb (the ability to touch the pulps of other fingers), flexion, and extension of the phalanges is affected. The patient feels pain with the slightest movements of the hand.
Causes of Carpal Tunnel Syndrome
Statistics show that women are more often affected by the syndrome. He often blocks normal function hands of people whose professional activity associated with systematic flexion-extension movements of the wrist joint: office workers who often use labor activity computer mouse, keyboard, pianists, drummers, etc. Workers whose hand is extended more than 20° relative to the radius and ulna bones for a long time are at risk.
Carpal tunnel syndrome can be caused by:
- Injuries. Any traumatic injury to the hand (bruise, sprain, fracture), as a result of which the median nerve of the wrist is compressed, causes symptoms characteristic of carpal tunnel syndrome.
- Rheumatoid arthritis. Inflammation of the wrist caused by this disease leads to the growth of the soft tissue of the tunnel in which the median nerve of the wrist is located, and compression of it.
- Tenosynovitis is an inflammation of the connective tissue of the tendons. This disease can have both an infectious origin (pulmonary tuberculosis, felon of the fingers) and a mechanical one: tendon overstrain as a result of prolonged stress on the hand. The disease is sometimes provoked lasting influence cold on the human body.
- Fluid accumulated in the human body as a result of painful conditions. Swelling during menopause, pregnancy, renal failure, etc., affecting the soft tissues of the canal, leads to compression of the nerve.
- A tumor caused by neoplasms on the membranes of nerve tissue. Rarely seen. Diagnosed as schwannoma, neurofibroma, etc.
- Diabetes. Damage to neuronal processes and processes characteristic of this disease may be caused by the accumulation of fructose and sorbitol in nerve tissue. As a result, the median nerve of the carpal tunnel can also suffer from pressure from the carpal tunnel walls.
- Acromegaly is a dysfunction of the pituitary gland. This disease is accompanied by unnatural growth of the bones of the limbs, soft fabric channels in which the nerves are located, which provokes pinching of the carpal tunnel nerve.
- Genetics. "Square wrist" - congenital anomaly, in which there is insufficient production of lubrication in the tendons of the hand. The transverse carpal ligament is thicker than in normal people and puts pressure on the nerve endings.
Symptoms of the syndrome
Carpal tunnel syndrome develops gradually. It can affect one or both hands, depending on the reasons: systemic disorders of the body sometimes provoke compression of the median nerve of two limbs, professional activity more often leads to disease in the hand of the active hand. Tissue paresthesia (numbness, loss of sensation) first appears in the morning, but disappears by midday. Later, the duration of the lack of sensitivity increases - it can be felt both during the day and at night. The disease is accompanied by pain in the form of burning and tingling.
Symptoms appear over time in all fingers except the little finger, which is characteristic feature carpal tunnel syndrome. In the absence of necessary therapy, the pain spreads to the inside of the forearm. Systemic diseases can simultaneously affect the nerve elbow joint. The patient feels weakness in his hand, it is difficult for him to hold small objects. There is awkwardness in movements. Trophic disorders occur (impaired nutrition of tissue cells), which can lead to atrophy of the muscles of the limb.
Diagnostics
Carpal tunnel syndrome requires a neurological examination to determine accurate diagnosis and appointments effective treatment diseases. A person who experiences the symptoms described above should seek help from a neurologist. First, the doctor carefully collects an anamnesis (a set of information obtained from interviewing the patient). If wrist syndrome is suspected, he uses a number of tests to diagnose:
- Tinelya. When tapping with inside palms in the canal area, the patient feels tingling in the fingers with carpal tunnel syndrome.
- Falena. Provides maximum bending of the arm by the patient at the wrist joint and maintaining this position for exactly a minute. Gain pain and paresthesia will indicate compression of the median nerve of the wrist.
- Cuff. A measuring device cuff is placed on the patient's forearm. blood pressure, pump it with air, leave it in this position for a minute. Pain and numbness in areas innervated by the median nerve confirms the presence of carpal tunnel syndrome.
- Raised hands. The patient is asked to raise his arms above his head for 40 seconds. Increased paresthesia indicates compression of the median nerve of the hand.
Diagnosis of carpal tunnel syndrome involves A complex approach. Main diagnostic measures to identify the disease are the following instrumental methods examinations:
- Electroneuromyography. Using a special device, nerve endings are artificially stimulated with electric current. The speed of impulse movement along the nerve is calculated and the presence or absence of a muscle response to stimulation is recorded. Based on certain signs, the specialist determines: the function of which nerve is impaired, the level and nature of the lesion.
- Radiography is an auxiliary method. An x-ray of the wrist joint will show the presence of a fracture, dislocation, inflammatory processes (with arthritis), etc. By eliminating the influencing factors that provoked the disease, the neurologist determines the true cause of the disease and makes a final diagnosis.
- Magnetic resonance imaging (MRI) is a modern technique that allows you to obtain a three-dimensional image of any tissue human body. This method shows the presence of diffuse edema and widening of the median nerve segments. It can be used to determine the presence of tumors localized on the nerve sheath, lipomas (overgrowth of connective tissue) of the periosteum. This helps to accurately determine the cause of the patient’s symptoms.
- Ultrasound (US) is a widely used method in diagnosing carpal tunnel syndrome. With its help, you can identify the reasons that contribute to the inhibition of nerve function in the canal:
- damage to muscles, tendons and ligaments;
- bursitis;
- pathology blood vessels;
- lipomas;
- hematomas;
- abscess, swelling of adjacent tissues;
- bone pathologies, etc.
If the doctor suspects a systemic origin of the cause of carpal tunnel syndrome, the patient is prescribed a series of tests to determine laboratory research general condition body:
- blood:
- to determine sugar levels;
- on thyroid-stimulating hormones to detect thyroid dysfunction and metabolic processes in organism.
- for detailed analysis (content of red blood cells, leukocytes, hemoglobin, etc.);
- for rheumatic tests (biochemical study of blood to determine the presence of inflammatory processes in the body, their exact location, what caused them);
- to determine circulating immune complexes (CIC) in plasma, indicating inflammation of bones and soft tissues;
- antistreptokinase - an analysis that determines the presence of infection in the human body.
- urine for:
- determining the level of glucose in urine;
- clinical analysis to identify kidney pathology, genitourinary system and dysfunction assessments.
Treatment of carpal tunnel syndrome
The first step in treatment is compliance with the protective regime. It involves fixing the wrist joint with a special orthopedic product, which can be purchased at a pharmacy. The clamp eliminates stress on the wrist area. You will have to keep the joint connecting the forearm and hand completely still for two weeks. Without this regimen, it is impossible to avoid further tissue injury. The attending physician will recommend applying cold 3 times a day for 2-3 minutes to the inner surface of the wrist.
Drug therapy
Neurologist prescribes for treatment medications, capable of removing the compressive factor, inflammatory processes and restore sensitivity to areas of the hand innervated by the median nerve. The medications prescribed by the doctor, their dosage and duration of treatment will depend on the severity and reasons that caused it. Drug therapy often includes the use of:
|
Group of drugs |
Examples of drugs |
|
B vitamins |
Milgamma, Neurobion, Neurobex, Doppelhertz active, Benevron |
|
Anti-inflammatory (non-steroidal) |
Ksefokam, Dikloberl, Aertal, Movalis, Xefokam |
| Vasodilators |
Pentilin, A nicotinic acid, Trental, Angioflux |
| Diuretics |
Hypothiazide, Furosemide, Diacarb |
| Anticonvulsants |
Gabapentin, Pregabalin |
|
Muscle relaxants (promoting muscle relaxation) |
Sirdalud, Mydocalm |
|
Glucocorticosteroids (hormonal drugs) |
Metypred, Hydrocortisone, Prednisolone |
| Antidepressants |
Duloxetine, Venlafaxine |
Means for topical treatment
Local treatment is used as part of a set of measures to restore the functions of the median nerve of the carpal tunnel. Compresses applied to the wrist joint, in which active substance is made up of several medications, aimed at eliminating swelling and inflammation. Often Dimexide, Hydrocortisone, Lidocaine are used for this, the proportions of which in the compress are recommended by the doctor.
Towards effective local treatment involves the introduction into the carpal canal of a solution of drugs: anesthetics (novocaine or lidocaine) and synthetic glucocorticosteroids (Hydrocortisone or Diprospan). Steroids are capable of local application with minimal threat side effects significantly slow down inflammatory processes in the body.
Physiotherapy
Together with drug treatment The doctor prescribes physiotherapeutic procedures to treat:
- Acupuncture. Impact on acupuncture points leads to the activation of the body's reserve forces to fight the disease. The procedure improves blood circulation and relieves pain.
- Manual therapy is aimed at desensitizing the central nervous system, which helps reduce pain in the carpal tunnel area.
- Shock wave therapy can restore vital important functions tissue cells (muscle, nervous), due to the rapid contraction-expansion of adjacent blood vessels under the shock wave of the apparatus.
- Ultraphonophoresis. Under the influence of ultrasound, anti-inflammatory medications are administered, which helps eliminate pathologies of the median nerve of the wrist joint.
Surgical intervention
If complex drug therapy does not give positive result within six months, the patient is offered surgical intervention. The purpose of the operation is to expand the lumen of the carpal tunnel and eliminate the factors of compression of the median nerve through surgery.
Two methods are used surgical correction under local anesthesia:
- Open. An incision about 5 cm long is made on the inside of the wrist with a scalpel and the carpal ligament is cut.
- Endoscopic. There are single-portal and double-portal surgical methods, which are used depending on the complexity of the task. The first differs from the second in the number of skin incisions. In this case, an endoscope is used to visually control the passes of the knife unit.
Both methods are difficult to implement. After endoscopic surgery, the patient returns to work sooner than in the case of open surgery, but postoperative complications are observed more often. Rehabilitation period for a patient who underwent open surgery – 1.5 months. After a successful uniportal dissection of the ligament, all hand functions are restored in approximately 25 days without complications.
Treatment of carpal tunnel syndrome with folk remedies
Traditional medicine offers recipes for preparing remedies that can cope with the feeling of numbness and painful sensations. Medicines prepared from natural ingredients according to recipes:
- Cucumber tincture. Cut three medium pickled cucumbers and two red hot peppers into small cubes. Pour the ingredients into 0.5 liters of vodka and leave for 7 days in a dark place. Strain. Rub into the wrist several times a day until the condition improves.
- Oil rubbing. 50 g ground black pepper pour 0.5 l vegetable oil. Stir the mixture well and simmer on low heat for half an hour without bringing it to a boil. The medicine is rubbed into sore spot warm as often as possible.
- Pumpkin wrap. Peel a quarter of a small pumpkin, cut into small cubes and boil in a small amount of water. Crush until a homogeneous paste is obtained and apply warm to the wrist area. Wrap it in polyethylene and cover it with a scarf on top. Keep for 2 hours. Course – 5-7 days.
Video
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Carpal tunnel syndrome is a condition characterized by compression and poor circulation of the median nerve, which occurs when the volume of the carpal tunnel in which it is located decreases. Refers to .
This disease occurs with any pathological processes, which are characterized by narrowing of the channel. Tendency to frequent relapses may be due to congenital narrowness or structural features, and this disease is most often characteristic of women.
Other reasons include:
- Injury.
- Fracture.
- Dislocation.
- Acromegaly.
- Tenosynovitis.
- Deforming osteoarthritis.
- Arthritis, both acute and chronic.
- Pregnancy.
- Kidney failure.
- Hypothyroidism.
- Climax.
- Diabetes.
- Taking contraceptives.
All this happens in the area of the wrist joint. Moreover, the narrowing can be caused not only by a fracture, but also by the swelling that occurs after it.
The causes of carpal tunnel syndrome can include the most different tumors that grow on the palm.
The disease can be acute or chronic. The second option is possible with constant trauma, which is mainly associated with the person’s profession, when one has to constantly bend and straighten the hand.
Compression leads to the development of ischemia - a disruption of blood supply, when over time the deep layers of the nerve fiber are affected. And if at first the main symptom is a violation of sensitivity, then movement disorders occur.
How it manifests itself
Symptoms of carpal tunnel syndrome begin with pain and sensory disturbances. Tingling, numbness and lumbago are noted in the palm of the hand and in the fingers. The pain can spread upward, and sometimes reaches the elbow, and sometimes the shoulder.
The attack begins at night, which prevents the person from sleeping normally. If you start rubbing your hands, lower them down or shake them, and also do self-massage, the pain can noticeably decrease.
Both hands can be affected, but more often the right hand is affected in right-handed people, and the left in left-handed people. Over time, difficulties may arise in moving the hand, especially when trying to grab an object, or if you have to do some actions with the participation of the first finger.
When moving, there is inaccuracy, it seems that everything is literally falling out of your hands. Sometimes it seems that the brush has become swollen, cold, pale, or, conversely, reddened. A person with this diagnosis has difficulty holding a pen, a book, or performing certain actions.
Diagnostics
Carpal tunnel syndrome is detected through a neurological examination. There may also be additional diagnostic tests which will confirm or refute the diagnosis. Accurate data on the condition of the nerve can be obtained using electromyography and electroneurography.
Before treatment, methods for diagnosing carpal tunnel syndrome are used, such as radiography, ultrasound, CT or MRI, and puncture if indicated. Consultations with a neurologist, oncologist, traumatologist or endocrinologist may be required.
Differential diagnosis is made with neuropathy radial nerve, ulnar nerve, polyneuropathy, as well as diseases caused by spondyloarthrosis and osteochondrosis.
How to get rid
Treatment begins with conservative methods. And only if they are ineffective, surgery is performed.
For carpal tunnel syndrome, symptomatic therapy is prescribed. The first thing to do is eliminate the cause. This can be the reduction of a dislocation, the correction of endocrine and other disorders, the relief of inflammation and swelling.
The hand is fixed in a correct position and completely immobilize for up to 2 weeks. Treatment is based on taking drugs that belong to the group of NSAIDs, namely ibuprofen, indomethacin, ortofen and some others. Moreover, they are prescribed only by a doctor.
In the most severe cases, glucocorticosteroids are prescribed. At severe pain It is necessary to carry out therapeutic blockades. Taking B vitamins, as well as mud therapy, electrophoresis, ultraphonophoresis, and compresses have a positive effect. Pentoxifylline and nicotinic acid help reduce the manifestations of ischemia.
After complete removal of inflammation, physiotherapy, massage.
Carpal tunnel syndrome due to fracture radius can also be treated with surgery. It is also carried out when conservative methods are ineffective.
Most often, the prognosis with timely detection and diagnosis is favorable.
