Carpal tunnel syndrome surgical treatment. Conservative Treatments for Carpal Tunnel Syndrome Prevention Clinical Trials

Tunnel syndrome, also known as carpal tunnel syndrome, is a condition caused by excessive pressure on the median nerve where it crosses the carpal tunnel. The main causes of carpal tunnel syndrome are regular long-term repetitive actions with the hand (or with both hands), for example, working with a computer mouse, playing the guitar professionally, plastering, and so on. Carpal tunnel syndrome has the following symptoms:

• painful sensations and tingling sensations in the area of \u200b\u200bthe hand, which are especially pronounced at night;
• feeling like the hand and wrist are swollen;
• numbness of the second and third fingers.

It is important to understand that if you do not stop the development of carpal tunnel syndrome in time through treatment in the company of experienced specialists, then there is a high probability of developing osteoporosis of the phalanges of the fingers in conjunction with spasms blood vessels, which is usually accompanied by severe pain.

Carpal tunnel syndrome: diagnosis and treatment at the highest European level

Today, the highest quality in Kharkiv getting rid of carpal tunnel syndrome through surgery and conservative approaches are carried out by doctors from. The center's employees have tremendous experience and high qualifications in the treatment of acute and chronic diseases hand, as well as professional ailments and post-traumatic syndromes, which is proved by the long-term existence of the department - already since 1985! This is the most impressive guarantee that the carpal tunnel syndrome will be defeated in the shortest possible time, and the high-quality rehabilitation passed in the company of our employees will allow patients to return to their normal daily routine as quickly as possible.
It is also important to note that we are firmly convinced that high-quality treatment of carpal tunnel syndrome entirely depends on a well-constructed diagnosis and examination of a patient with complaints of this nature. In general, the primary definition of the problem is based on the characteristic complaints of the patient and the medical history. Further, the most detection of the disease and its stage are used: radiography, magnetic resonance imaging, cT scan, electromyography and other techniques. Research conducted by our employees helps to accurately determine the presence of inflammatory processes that affect the formation of this disease. And it is on the basis of all of the above that the approach is chosen - conservative or surgical.

Carpal tunnel syndrome: surgery

Surgical intervention in our center is prescribed only if the conservative approach and accompanying procedures do not give a noticeable result. The goal of surgery for carpal tunnel syndrome is to decompress the median nerve by severing the ligament of the tunnel. The same measure allows to improve blood circulation in the area of \u200b\u200bthe nerve trunk, which results in a quick decrease (and then complete disappearance) of painful sensations and the resumption of functions.
After the patient is relieved of the carpal tunnel syndrome, he is provided with qualified rehabilitation after surgery, which noticeably accelerates the person's return to normal life.

Carpal tunnel syndrome: home treatment

As the long-term practice of our employees, as well as the publicly available reviews and articles from leading world experts about the carpal tunnel syndrome, show that due to the specificity of the carpal tunnel and its anatomy, independent getting rid of this problem is strongly discouraged. Because this disease is progressive, which means that any delay in a full and qualified impact on the lesion can aggravate the situation so much that conservative treatment, including therapy and a set of exercises for carpal tunnel syndrome, will not be effective, therefore, to solve such a problem, you will have to resort to operable intervention. This is why we do not approve of treating carpal tunnel syndrome through treatment. folk remedies, but we insist on an extremely quick appeal to qualified specialists as soon as the first symptoms were discovered by the patient.

It is interesting:

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CARPAL CANAL SYNDROME: CAUSES OF THE DISEASE

The carpal tunnel is formed by the bones of the wrist - and this relatively narrow "tunnel" contains the blood vessels, tendons, and the connective nerve that run from the forearm into the hand. The peculiarity of the structure of the carpal tunnel is the main reason for the occurrence of the carpal tunnel syndrome, because the "tunnel" has all the necessary prerequisites for squeezing the nerve trunk. Prolonged pressure on the nerve causes dysfunction, which causes carpal tunnel syndrome symptoms in a person. As a rule, the appearance of this problem is associated with one or another trauma of the upper limbs, as well as with professional activities in people whose work is associated with regular and prolonged tension of the hands. Other reasons also affect the appearance of carpal tunnel syndrome: low temperatures and vibrations.
As the reviews from leading experts from all over the world show about carpal tunnel syndrome, the formation of this problem is often associated with the following diseases:

• Diabetes.
• Various inflammations ( rheumatoid arthritis, rheumatism) in the area of \u200b\u200bthe wrist and hand.
• Peripheral neuropathy.
• Inflammatory processes in the tendons.
• Ligament problems, degenerative-dystrophic in nature.
• Benign tumors.

Carpal tunnel syndrome: symptoms

Pain, numbness, burning, tingling and other unpleasant sensations causing a persistent feeling of discomfort in the patient are the main reasons for patients seeking medical attention. Pain is often worse at night, which can adversely affect sleep duration and cause severe sleep disturbances. If the necessary treatment is not completed in a timely manner to get rid of the disease, which, by the way, on early stages can occur in a conservative way, then an operation is necessary to eliminate the carpal tunnel syndrome, otherwise there is a high probability of impaired sensitivity and motor functions. A person loses the ability to carry out precise actions and correctly coordinate movements, during the performance of which he now has to experience excessive stress. Disability due to this disease is widespread in a number of professions.

Center for Hand Surgery at KGKB No. 31

Don't waste precious time treating carpal tunnel syndrome at home, as it can be fraught with complications that can be difficult to get rid of. We will provide you with exactly the treatment that your problem requires. If the disease is at an early stage, then all possibilities will be used for conservative elimination of the disease, and if the development of the disease is out of control, then the most competent option is highly qualified. Also, after passing all the necessary measures, our specialists provide rehabilitation from the syndrome after the operation, which includes a set of actions, including special exercises after the operation of the carpal canal.
We are waiting for patients at the address: Kharkiv, metro station "Holodnaya Gora", Lyubov Malaya Avenue, 4, Kharkiv City Clinical Hospital No. 31, Hand Surgery Center. It should be added that we also help patients from the Kharkiv region: Izium, Kupyansk, Lozovaya, Lyubotin, Pervomaisky, Chuguev, Balakleya, Barvenkovo, Bohodukhiv, Valki, Volchansk, Dergachi, Zmiev, Krasnograd, Merefa, Pivdennoe and from other settlements of the region ... For all questions, you can always contact by phone: our contact numbers are available on this resource:

Carpal tunnel syndrome or carpal tunnel syndrome - what is it?

If translated into everyday Russian, these are painful inflammatory and cicatricial changes in the carpal tunnel of the wrist joint. Here passes the median nerve, tendons of the muscles of the forearm, flexing the fingers, in the event of a malfunction of which there are pains in the hand, numbness of the fingers of the hands, difficulty in small movements of the hand and fingers. The canal from the side of the palm is covered with a tendon plate - a retainer of the flexor tendons.

Carpal tunnel syndrome is much more common than. Here is the data available on the Internet: 50-150 cases per 1000 population, approximately every tenth person over 30 has signs of carpal syndrome. 10% of patients are under 31 years of age. In women, carpal tunnel syndrome occurs several times more often than in men.

Causes of the carpal syndrome.

Carpal tunnel syndrome is better called the compression neuropathy of the median nerve - a large nerve upper limb, responsible for many movements of the forearm, hand, fingers, and sensitivity. But in the carpal canal, a narrow space is allocated to it. Here he can easily get injured. Constant, monotonous movements of fingers, a brush, such as writing, typing on a computer, doing housework in the house, collecting items from small objects, sewing with a needle, can lead to the development of this disease. People who play sports such as tennis, volleyball often develop this disease. There is an anatomical version of the structure of the canal, the structure of the median nerve, when a person is initially predisposed to traumatizing the latter. Carpal tunnel syndrome is associated with compression of not only the median nerve, but other nerve fibersaccompanying the vessels of the palm.

Carpal tunnel syndrome. Symptoms

What does a person complain about with this disease? On numbness and paresthesia (feeling of "goose bumps", "insect crawling", tingling) in the palm, fingers, pain in the wrist joint, in the fingers, weakness of the fingers. Usually in the large, index, middle, and part of the nameless. It becomes difficult to perform many small movements and actions with the brush and fingers: holding small objects between the thumb and forefinger; difficulty to open a jar, for example. There are patients with complaints of pain and numbness of the entire arm, increased paresthesias at night. When a doctor examines a person with the above complaints, he usually finds a decrease in sensitivity in the first 3 fingers. Flexion or extension of the hand causes increased pain, paresthesia due to an additional effect on the median nerve. With pronounced and prolonged compression of the nerve, not only weakness occurs, but also atrophy of the muscles of the palm, primarily the eminence of the thumb. Right-handed people experience pain and numbness in the fingers of the right hand. Left-handed people have pain and numbness in the fingers of the left hand. Sometimes the disease develops on both hands.

Carpal syndrome must be differentiated (separated) from polyneuritis of diabetic, alcoholic nature, from manifestations of osteochondrosis, manifestations of diseases, manifestations, metabolic disorders in the body. Carpal tunnel syndrome can be combined with other neurological painful manifestations.

Many people do not consider the symptoms described above to be serious, so they should seek medical attention. And in vain - the prognosis of the disease depends on a timely, accurate diagnosis and subsequent treatment.

It is necessary to begin treatment with the creation of functional rest for the hand and fingers. For this purpose, you can use special devices sold in orthopedic salons, gloves. Such a device can be made quite simply by yourself. The doctor who treats this pathology will tell you in detail how to do this, how to place the hand in a physiological position in which the pressure on the median nerve is minimal. Physiotherapy helps well - exposure to ultrasound, diathermy, inductothermy, microwaves. A good effect is given by massage with rubbing in anti-inflammatory, warming ointments. This is a non-specific treatment for inflammation of the tissues surrounding the median nerve. After the removal of acute phenomena, exercises for the hands are advisable - physiotherapy exercises. In a short course for pain, you can use non-steroidal anti-inflammatory drugs - tablets, ointments, injections. Special blockades with anesthetic and anti-inflammatory agent help well. Some doctors prefer to start treating a patient immediately with a blockade. In addition to this, joint fixation is recommended for several days. Usually the effect lasts six months, even more. Conservative treatment helps in 90% of cases. The only question is - for what period of time and is the patient ready to strictly follow and execute all the doctor's recommendations? Most experts believe that conservative treatment with little effect should not be delayed for more than a month. It is more expedient to perform a fairly simple operation to decompress the median nerve.

I think this approach is logical. Surgical treatment with the release of the median nerve under the transverse ligament of the palm eliminates painful sensations, paresthesia.

Who treats carpal tunnel syndrome? Neurologists, orthopedists, traumatologists, surgeons, and sometimes rehabilitation doctors. With correct and timely diagnosis, many people can be helped.

Carpal tunnel syndrome is a condition characterized by compression and impaired 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 in any pathological process, which is characterized by narrowing of the canal. The tendency to frequent relapses can be due to congenital narrowness or structural features, and this disease is most often characteristic of women.

Other reasons include:

1. Injury.
2. Fracture.
3. Dislocation.
4. Acromegaly.
5. Tendovaginitis.
6. Deforming osteoarthritis.
7. Arthritis, both acute and chronic.
8. Pregnancy.
9. Renal failure.
10. Hypothyroidism
11. Climax.
12. Diabetes.
13. Taking contraceptives.

All this happens in the area of \u200b\u200bthe wrist joint. Moreover, narrowing can be caused not only by a fracture, but also by edema that occurs after it.

The causes of the carpal tunnel syndrome of the hand can be a variety of tumors that grow in the palm of your hand.

The disease can be acute or chronic. The second option is possible with constant trauma, which is mainly associated with the profession of a person, when you have to constantly bend and unbend the hand.

Compression leads to the development of ischemia - a violation of the blood supply, when the deep layers of the nerve fiber are affected over time. And if in the beginning the main symptom is a violation of sensitivity, then movement disorders occur further.

How does it manifest

Symptoms of carpal tunnel syndrome begin with pain and sensory disturbances. Tingling, numbness and lumbago are noted in the palm and fingers. The pain can radiate upward and sometimes extend to the elbow and sometimes to the shoulder.

The attack begins at night, which prevents the person from sleeping normally. If you start rubbing your brushes, lowering them down or shaking them, and also doing self-massage, the pain can be noticeably reduced.

Both hands can be affected, but still more often the right-handed person is affected, and the left-handed person is affected. Over time, difficulties may appear in the movement of the brush, especially when trying to grab one or another object, and also if you have to do some actions with the participation of the first finger.

With movements, inaccuracy arises, it seems that everything literally falls out of hand. Sometimes it seems that the brush is swollen, cold, pale or, on the contrary, reddened. It is difficult for a person with such a diagnosis to hold a pen, a book, and also perform some actions.

Diagnostics

Carpal tunnel syndrome is diagnosed by neurological examination. Additional diagnostic tests may also be performed to confirm or deny 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 X-ray, ultrasound, CT or MRI, as well as puncture if indicated. Consultation with a neurologist, oncologist, traumatologist, or endocrinologist may be required.

The differential diagnosis is carried out with neuropathy of the radial nerve, ulnar nerve, polyneuropathy, as well as diseases that are caused by spondyloarthrosis and osteochondrosis.

How to get rid of

Treatment begins with conservative methods. And only if they are ineffective, an operation is performed.

With carpal tunnel syndrome, symptomatic therapy is prescribed. The first thing to do is eliminate the cause. This can be reduction of dislocation, correction of endocrine and other disorders, relief of inflammation and swelling.

For the period of treatment, the hand is fixed in correct position and completely immobilized for up to 2 weeks. The 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. When severe pain be sure to carry out medical blockades. Positive effect provides the intake of B vitamins, as well as mud therapy, electrophoresis, phonophoresis, compresses. Pentoxifylline, nicotinic acid, help to reduce the manifestations of ischemia.

After complete removal of inflammation, physiotherapy exercises, massage are performed.

Carpal tunnel syndrome with a fracture of the radius is also treated with surgery. It is also carried out when conservative methods are ineffective.

Most often, the prognosis with timely detection and diagnosis is favorable.

Carpal tunnel syndrome (otherwise it is called carpal tunnel syndrome) is a fairly common problem in modern mankind. The thing is that this pathology has a direct impact on the work of the hand and the wrist itself. In this article, we will take a closer look at this ailment, its primary symptoms and the main methods of treatment.

Description of pathology

The wrist is known to be surrounded by numerous bundles of fibrous tissue. It plays the role of a supporting function for the joint itself. The space formed between the fibrous areas of tissue and directly the bony parts is called the carpal tunnel.

The median nerve, which runs through the entire wrist, provides sensitivity to the thumb, middle, and index fingers of the hand. Swelling or a change in the position of tissues in this area can lead to squeezing, as well as irritation of this nerve. That is why neurological symptoms often come to the fore.

Thus, carpal tunnel syndrome is one of the types of so-called tunnel neuropathies, characterized by damage to peripheral nerves as a result of their constant compression and trauma.

Main reasons

• Tumor of the median nerve itself.
• Swelling of tissues due mechanical damage and hand injuries (sprains, bruises, fractures).
• Chronic inflammatory processes in this area.
• Discrepancy between channel size and content volume.
• Swelling of tissues in women in position, especially in the later stages.
• There is evidence that carpal tunnel syndrome is diagnosed mainly in the cold season. This, in turn, proves the role of hypothermia in the development of this pathology.

Who is at risk?

1. People with a genetic predisposition.
2. Patients with disorders of the endocrine system.
3. People of short stature, overweight.
4. Women in the period of menopause who use oral contraceptives.
5. People with kidney failure, tuberculosis.

Symptoms

Initially, carpal tunnel syndrome manifests itself as a constant tingling and burning sensation in the area of \u200b\u200bthe large, middle, and even ring fingers. Some patients complain of pain. Most often it is aching in nature, it can spread to the forearm. Immediately after waking up, some feel numbness of the hand, which is accompanied by a loss of pain sensitivity.

If you put your hand down and move your fingers slightly, the discomfort goes away very quickly. However, he should be alert. Experts recommend in such a situation to immediately seek advice in order to exclude carpal tunnel syndrome.

Symptoms in the absence qualified treatment soon make themselves felt again. As the pathology progresses, various movement disorders appear. It becomes difficult for the patient to hold any small objects in his hand, the grip strength decreases, and inaccuracy appears in movements involving the hand.

Very common clinical manifestations microcirculation disorders of the affected area in the form of blanching skin, increasing / decreasing sweating in this area. As a result, there is a deterioration in the nutrition of the skin and nails, which is accompanied by a change in their appearance.

Thus, it becomes clear that carpal tunnel syndrome should not be ignored. The symptoms described above act as alarm bells in this case. If the patient does not seek help from a doctor, the likelihood of complications increases.

Diagnostics

The reason that provoked this condition, as a rule, is established during the examination of the patient and studying the features of his lifestyle (taking anamnesis). Very often, the diagnosis of the syndrome is limited to this.

In some cases, specialists additionally prescribe a flexion and extension test, Tinel test, X-ray, MRI, ultrasound and electromyography. The latter test evaluates the ability of muscles to continuously contract under the influence of electrical impulses. Thanks to him, the doctor can confirm the carpal tunnel syndrome or identify another cause of the lesion.

Treatment

With such a pathology, only two options for therapy are possible: drug treatment or surgery.

How is carpal tunnel syndrome treated? Conservative therapy implies a complete cessation of the activity that provoked the appearance of the problem. In addition, experts recommend avoiding strong grasping movements, doing work with bending or tilting the wrist.

Wearing a special bandage is considered an excellent solution. In the early stages, it relieves symptoms by keeping the wrist at rest. The bandage helps to neutralize pain and numbness.

Concerning drug therapy, then in this case, anti-inflammatory drugs are prescribed ("Aspirin", "Ibuprofen"). Their main goal is to reduce edema. Vitamin B6 helps to neutralize pain.

If such simple remedies do not help to overcome the carpal tunnel syndrome, treatment is supplemented with injections of the drug "Cortisone". They are used to relieve swelling directly in the canal itself.

Physiotherapy (acupuncture, constant magnetic field) is considered an excellent solution. She is assigned to improve metabolic processes in previously damaged tissues.

Alternative treatment options

This pathology requires prompt surgical intervention in the event that conservative therapy is ineffective. The operation is performed using local anesthesia. During the procedure itself, the surgeon dissects the transverse wrist ligament, which reduces pressure on the median nerve and tendons, and restores normal blood supply.

After the operation, the patient is placed with a plaster cast for about 12 days. Rehabilitation measures mean special massage, physiotherapy exercises, thermal procedures. The patient's ability to work fully returns approximately five weeks after the operation was performed.

Carpal tunnel syndrome and complications

It should be noted that this pathology does not apply to those disorders that can pose a danger to life. However, a person who is ill for a long time may, over time, lose the ability to carry out their usual actions with their hand normally. Exceptionally competent therapy can prevent such an unpleasant complication and help to fully restore the work of the hand.

Carpal tunnel syndrome is a condition that develops when the median nerve is pinched or injured within the carpal tunnel of the hand. In this case, the movements and sensitivity of the fingers are disturbed (the first three and part of the fourth fingers are affected).

Carpal tunnel syndrome is considered occupational disease, since it most often develops in people of certain professions, whose activities are associated with monotonous flexion and extension of the hand. For example, musicians, tailors, secretaries (work with a computer mouse and keyboard).

There are two other names for carpal tunnel syndrome: carpal tunnel syndrome and tunnel syndrome... Although the latter name is not entirely correct, since there are other tunnel syndromes (for example, compression syndrome of the deep branch of the ulnar nerve).

Statistics

The global prevalence of carpal tunnel syndrome is between 1.5% and 3%. Moreover, about 50% of all cases are active users of a personal computer.

According to various sources, carpal tunnel syndrome is 3-10 times more common in women than in men.

The peak of the onset of the disease occurs between the ages of 40 and 60 years. However, this does not mean at all that young people are not susceptible to this ailment: according to statistics, 10% of all cases are under 30 years old.

It is believed that people who work daily and many hours on the computer are most likely to develop carpal tunnel syndrome. According to one study, every sixth surveyed has it. The greatest risk is for users who, while working with a keyboard and a computer mouse, have their hand extended by 20 ° or more in relation to the forearm. Carpal tunnel syndrome is a relatively "young" ailment. For the first time, a disease similar to carpal tunnel syndrome was described by the English surgeon Sir James Paget in 1854 in a patient with a fracture of the radius at the level of the wrist.

A little later it became clear that the disease can develop in workers performing monotonous movements.

Well, in our time, when the personal computer has firmly entered life modern man, carpal tunnel syndrome has almost become an epidemic. However, science does not stand still. Therefore, there is great news for active users of a personal computer: a special platform and a flying computer mouse with a magnetic ring, which can withstand the weight of a human hand, have been developed. Stylish novelty can be used for both treatment tunnel syndromeand for the prevention of its development.

The structure and work of nerves

There are about 85 billion nerve cells in our body. They are located in the brain and spinal cord (central nervous system - CNS), as well as in nodes (clusters of nerve cells) that lie outside the CNS (for example, the spinal nodes - near the spine).

The processes extending from the nerve cells gather together and form bundles - nerves.

Together, all nerves form the peripheral nervous system, the task of which is to transmit impulses from the brain and spinal cord to organs and tissues. Moreover, each nerve is responsible for its own area or organ.

The structure of the nerve cell (neuron)

Nerve cell (neuron) - structural highly specialized unit nervous system, which has body (soma) and appendages (axon and dendrites).

Body The nerve cell contains a nucleus, and is bounded outside by a wall that consists of two layers of fat. Due to this, only substances that dissolve in fats (for example, oxygen) enter the cell.

Neuronshave a different shape (spherical, fusiform, stellate and others), as well as the number of processes. Depending on the function performed, neurons are sensitive (perceive impulses from organs and transmit them to the central nervous system), motor (send commands from the central nervous system to organs and tissues), as well as intercalary (communicate between sensory and motor neurons).

Nerve cell body not capable of reproduction (division) and recovery in case of damage. However, when the axon or dendrite is cut, the cell ensures the restoration of the dead part of the process (growth).


Axon and dendrites

Axon- a long process of a nerve cell that transmits excitation and information from a neuron to an executive organ or tissues (for example, muscles).

Most nerve cells have only one axon. However, it can divide into several branches that connect to other cells: muscle, nerve or glandular. This connection of the axon with the target cell is called a synapse. There is a synoptic gap between the axon and the cell.

At the end of each branch of the axon there is a thickening, in which there are bubbles with a special substance - a mediator. Until a certain moment, he is in a "sleeping" state.

Outside, most axons are covered with Schwann cells (supporting and nourishing), which form the myelin (pulp) membrane. Between the Schwann cells there are Ranvier interceptions - the area where the myelin sheath is interrupted. However, some axons lack Schwann cells - myelin-free fibers.

The peripheral nervous system is characterized by myelin fibers.

Dendrites- short branched outgrowths of a neuron, with the help of which it receives information from body cells and other nerve cells.

Nerve structure

A nerve is a structure in which bundles of nerve fibers (mainly axons) intertwined are located, running parallel to each other.

Outside, the nerve is covered with three layers:

1. Endoneurium, in which the capillaries (small vessels) that feed the nerve fibers pass.
2. Perineurium, "dressing" bundles of nerve fibers, because it contains collagen (protein - the basis of connective tissue), which has a supporting function.
3. Epineurium is the outer layer of dense connective tissue that surrounds the nerve.

Nerves transmit impulses from the brain, as well as the spinal cord, to the cells of organs and tissues of the body.

How is the nerve impulse transmitted?

it difficult process, which is carried out using a sodium-potassium pump. What does this mean? The fact is that the wall of the outer layer of the axon is a complex structure (membrane), due to which sodium and potassium ions can enter both inside the axon and leave it. As a result, an impulse is formed, which is transmitted from the axon to other cells.

How does impulse transfer take place?

Normally, the axon is at rest and does not conduct impulses. Therefore, potassium ions move inside the body of the axon, and sodium ions outward (approximately, as if a fresh cell is placed in a saline solution).

However, when an impulse arrives at the axon from the dendrite, the situation changes: sodium moves inside the axon, and potassium comes out. As a result, the internal environment of the axon acquires a positive charge for a short period, leading to the cessation of sodium influx into the cell. But at the same time, potassium continues to leave the axon.

Meanwhile, sodium ions inside the cell spread to other parts of the axon, changing the permeability of its membrane, thus contributing to further propagation of the impulse. When it passes through a certain point in the axon, the body of the nerve cell receives a "command" to relax, so it returns to a state of rest.

This transmission of impulse is rather slow (for example, a signal sent by the brain will reach the hand after a minute). However, thanks to the myelin sheaths, it is accelerated as it "jumps" through the Ranvier intervals.

However, the impulse must hit an adjacent cell. For this, it, having reached a thickening at the end of the neuron, promotes the release of mediators from the vesicles that enter the synoptic cleft. Further, the mediators are connected to special receptors on the target organ cell (muscles, glands, and others). As a result, an action occurs: movement of the hand, fingers, turning the head and so on.

Anatomy of the hand, wrist and forearm

A hand is a part of a human hand that has three sections:

All bones of the hand are connected by joints, ligaments and muscles. Thanks to this, movements in the hand become possible, which are controlled by the nervous system.

Forearm -part of the human hand, which consists of two tubular bones (length prevails over width): the radius and ulna. On the upper side, it is bounded by the elbow joint, and below by the wrist.

The structure and function of the median nerve

Features of the passage

The median nerve begins in the shoulder region from the branches formed by the fibers of the spinal nerves (sixth to eighth cervical and first thoracic). Then it goes to the hand, but does not give any branches at the level of the shoulder and the cubital fossa.

Having reached the area of \u200b\u200bthe forearm (from the elbow to the hand), the median nerve gives off several branches. Then it passes in the carpal canal under the transverse ligament of the wrist and branches into terminal branches.

In its course, the median nerve innervates the following muscles:

• Superficial and deep flexor of the fingers, which are responsible for flexion of the II-V fingers
• The muscle that promotes flexion and rotation of the forearm - pronator circular
• Flexor muscle of the wrist - flexes and abducts the hand
• The flexor muscle of the nail phalanx of the first finger
• The long palmar muscle, which flexes the hand and strains the palmar aponeurosis (a broad tendon plate that covers the muscles of the hand from the palmar surface)
• The square muscle, which is responsible for the rotation of the hand and forearm
• Abductor muscle thumb brushes
• The muscle that opposes the thumb of the hand to everyone else
• Flexor thumb
• Muscles that flex II-III fingers.

Median nerve functions

Based on the areas of innervation, the median nerve is involved in flexion and abduction of the hand to the inner side, flexion of the fingers, bringing the elevation of the first finger to the rest of the fingers of the hand, rotation of the hand and forearm.

Also, the median nerve innervates the skin on the palmar surface of the hand of the first, index and middle, as well as part of the ring fingers, and on the dorsum of the hand the skin of the terminal phalanges of the index and middle fingers.

Thus, the median nerve provides both movement and sensitivity of the hand.

Causes of damage to the median nerve

The lumen of the carpal tunnel is rather narrow. Therefore, any factor leading to its narrowing, or provoking the growth of tissues within it, can cause the development of carpal tunnel syndrome, since this compresses the median nerve between the bones and tendons of the wrist.

Prolonged work at the computer (using a computer mouse and keyboard)

Most often, it leads to the development of carpal tunnel syndrome, since this type of activity causes a small chronic injury to the soft tissues of the hand, as well as the tendons that run in the carpal tunnel. The reason is repetitive, fast and frequent movements of the wrist and arm of the same type. The result is aseptic (non-bacterial) inflammation of the tendons in the carpal tunnel, leading to swelling and entrapment by the retainer.

However, studies have shown that not all frequent personal computer users develop carpal tunnel syndrome. Certain conditions are necessary for its occurrence. For example, the most often at risk are people with III-IV degree of obesity (due to fat, the lumen of the carpal tunnel is narrowed), female gender (anatomically narrower carpal tunnel) and some other factors.

Arthritis: rheumatoid, psoriatic, or gouty arthritis, and other rheumatic diseases with joint involvement

At the onset of the disease, an inflammatory reaction occurs in the joints of the wrist. In addition, systemic diseases (affecting the body as a whole) lead to the development of inflammation and swelling of soft tissues, including muscles and tendons, passing in the carpal tunnel, therefore its lumen is narrowed.

Further, over time, as the course of the underlying disease worsens, the aging of the articular cartilage occurs. Therefore, they lose their elasticity, cracks appear on them. As a result, the cartilage gradually begins to wear off, and in some places so much that the bone is exposed. Such changes lead to cartilage death and fusion of articular surfaces. Therefore, deformations occur, as a result of which the normal anatomical structure hand and carpal tunnel.

Acute wrist injuries

They cause the development of carpal tunnel syndrome in about 10% of all cases of the disease. They quickly suppress the production of inflammatory mediators in tissues (histamine, prostaglandins). Therefore, pain and swelling are reduced and tissue sensitivity is improved.

However, systemic corticosteroids are high in side effects (for example, sleep disturbance, ulcers in the stomach and intestines). Therefore, they are used with caution, especially for certain diseases (for example, diabetes mellitus). In addition, they suppress activity immune systemtherefore they are not prescribed in the presence of infections.
There is one more unpleasant moment: after the withdrawal of corticosteroids, the "rebound" syndrome may develop: all the symptoms quickly return again.

Local treatment

It is considered the most effective for relieving acute symptoms.

Administration of medicinal mixtures

A drug mixture of an anesthetic (Lidocaine or Novocaine) with a corticosteroid hormone (Diprospan or hydrocortisone) is injected into the carpal tunnel using a special long needle. As a rule, after the introduction of drugs into the cavity of the carpal tunnel, pain and other symptoms of the disease disappear after some time. However, in some cases, the pain may worsen, but gradually decreases after 24 to 48 hours.

With this method of treatment, the patient's condition improves after the first injection. If the symptoms do not disappear completely, then two more procedures are performed with a two-week interval between them.

With a relapse of the disease (the appearance of symptoms again), the course of treatment is repeated.

Local compresses with a complex composition

One of the composition options:

• Dimexide - 50 ml
• Lidocaine solution 10% - 2 ml, or Novocaine 2% - 30 ml
• Hydrocortisone solution - 1 ampoule
• Water - 30 ml

The compress is applied for 40-60 minutes.

The prepared composition can be stored in a cool place and used for several days.

Carpal tunnel syndrome: surgery

Surgical treatment is recommended if symptoms persist for 6 months.

The goal of the intervention is to reduce pressure on the median nerve by widening the lumen of the carpal tunnel.

There are two types of surgery that are performed under local anesthesia:

After the operation, a plaster cast is applied to the wrist area for several days. Physiotherapy is used as restorative treatment and physiotherapy (finger movements should be carried out with a fixed wrist).

3 months after the operation, the hand function is restored by 70-80%, and after 6 months - completely.

After recovery, the patient can return to their normal activities. However, if the working conditions are not changed (correct arrangement of the workplace, the use of cuts), there is a high risk of relapse (return of symptoms of the disease)

Drug-free treatment

Many doctors use acupuncture, manual therapy, and other techniques to treat carpal tunnel syndrome.

With hypothyroidism hormone replacement therapy is prescribed: L-thyroxine, Eutirox.

With menopause physiological or artificial (removal of the ovaries) for substitution therapy hormonal preparations containing estrogen (female sex hormone) are prescribed. However, such treatment is possible only if the woman had her last menstrual period no later than 10 years ago, and she was not 60 years old.

If a menstruating woman has taking hormonal contraceptives, has developed carpal tunnel syndrome, then they are canceled or changed to another drug.

Treatment diabetes mellitus aimed at preventing surges in sugar levels throughout the day. Because it is in this case that a large amount of substances are formed that damage neurons. However, treatment has its own characteristics depending on the type of disease.

For type I diabetes, insulin is given (short, long, or medium acting). The dosage and regimen of administration is individual, depending on the severity of the disease and the level of sugar in the blood.

In type II diabetes, hypoglycemic drugs (Glucophage, Metformin) are prescribed, which increase the sensitivity of the cell walls to insulin, improving the intake of glucose. In addition, they reduce the production of glucose in the liver, as well as its absorption in the intestine.

While maintaining the partial function of the pancreas, drugs are used that stimulate the production of insulin by its cells. These are sulfonylurea derivatives: Chlorpropamide, Gliquidone and others.

Regardless of the type of diabetes, thioctic acid preparations (Tiogamma, Berlition) are prescribed to improve tissue nutrition. They improve the uptake of glucose by tissues, bind free radicals (unstable molecules that damage other normal cells of the body), especially cells of the nervous system.

With chronic renal failure the treatment is aimed at improving the function and blood circulation in the kidneys, removing excess fluid from the body and end products of protein metabolism.

For this, drugs are used that thin the blood and improve blood circulation in small vessels (for example, Warfarin, Angioflux).

Sometimes diuretics are prescribed (depending on the degree of preservation of kidney function).

Sorbents (Polysorb, Enterosgel and others) are used to remove the end products of protein metabolism.

With high blood pressure, drugs are used that regulate it: ACE inhibitors (Diroton, Captopril), calcium antagonists (Verapamil) and others.

With severe renal failure (stage III-IV), the patient is connected to an artificial kidney apparatus.

Physiotherapy procedures

They have proven themselves well both in treatment with medicines and during the rehabilitation period after surgery.

However, despite their effectiveness, they are not suitable for everyone.

General contraindications for physiotherapy procedures

• Tumor processes
• Pregnancy
• Heavy III degree heart failure
• Any infectious and viral diseases in the acute period (the presence of an increased body temperature)
• Severe diabetes mellitus (high sugar numbers)
• Increased blood pressure - temporary contraindication. After its normalization, the procedure can be carried out.
• Having a pacemaker
• Epilepsy with frequent seizures, hysteria and psychosis
• Decreased blood clotting and bleeding tendency
• Severe cardiac arrhythmia: severe atrial fibrillation (asynchronous contraction of the ventricles and atria) and severe extrasystole (in this disease, the heart rhythm is disturbed)
• The presence of pustular inflammation on the skin (the place of exposure to the apparatus)

Physiotherapy treatments are prescribed both for treating carpal tunnel syndrome and the diseases that led to its development.

Phonophoresis

It is performed along with medications.

During the procedure, the effect on the body is carried out using ultrasonic vibrations, which promote the penetration of drugs into the cell.

In addition, the effect of ultrasound itself is curative: it dilates blood vessels and accelerates blood flow in the capillaries. Thanks to this, pain decreases or disappears, edema decreases and hematomas resolve.

Dimexide, pain relievers, hormones and other drugs are used as medicines. Exception - some medicationswhich ultrasound destroys: novocaine, B vitamins, vitamin C and other substances.

The goals are to reduce pain and inflammation, and to speed up tissue repair.

Indications

• Diseases of the musculoskeletal system: osteochondrosis, arthrosis, arthritis, (vascular disease)
• Active pulmonary tuberculosis
• Individual intolerance to drugs for phonophoresis

Method of application

First, the medical officer wipes the skin area to be treated with a disinfectant solution. Then it applies to the skin medicine, then applies a device to the site of exposure, which delivers ultrasonic waves.

The duration of one procedure is from 10 to 30 minutes. The course is 8-12 sessions. A few months later, if necessary, the course of treatment is repeated.

Shockwave therapy

The method is based on the action of acoustic shock waves (generated by a special sensor), the frequency of which is lower than that perceived by the human ear - infrasound. These waves have a high amplitude of energy and a short duration, due to which they propagate in soft tissueswithout damaging them. This restores metabolism and promotes cell renewal.

As a result, blood circulation in the affected area improves, pain decreases, and sensitivity is restored. Moreover, after several procedures, bone growths begin to disintegrate, and new vessels grow at the site of the lesion.

The method is so effective that with the timely start of treatment, it is equated to the result that is after the operation.

Objectives

Treatment of acute and chronic pain caused by trauma, diseases of the musculoskeletal system (osteochondrosis, arthritis, etc.) and the nervous system.

Indications

• Arthrosis, arthritis, osteochondrosis, hernias and protrusions of intervertebral discs, heel spur
• Gallstones and kidney stones
• Slow healing of fractures
• Soft tissue injuries: muscles, ligaments, tendons
• Cicatricial contraction of muscles, tendons and ligaments, so free movements (flexion, extension) in the limb are limited
• Pain with bruises, fractures, sprains
• Burns and trophic ulcers
• Chronic muscle painarising from prolonged and frequent overwork

Contraindications

(addition to general)

Age up to 18 years, as waves act on the growth zones of the bones. Whereas when they are damaged, irreversible changes develop, which have a bad effect on the development of the child's skeleton.

Methodology

The medical officer helps the patient to sit more comfortably on the couch, then wipes the skin area, disinfecting and degreasing it. Then he adjusts the device depending on the area of \u200b\u200bapplication and disease (there are several programs). Next, he applies a special gel to the skin, after which he applies a sensor to the site of exposure, which sends healing impulses.

The course of treatment is 5-7 procedures, each of which lasts 20-30 minutes. The procedures are carried out at intervals of 3-7 days. After treatment, about 90% of patients have a significant improvement in their condition. If necessary, the course of treatment is repeated after several months.

On a note

Do not use shock waves on the head, intestines, large blood vessels and lungs.

Prevention of carpal tunnel syndrome

According to statistics, the number of patients with carpal tunnel syndrome in last years has increased since the personal computer has firmly entered the life of modern man. However, the formation of the disease can be prevented.

So, what should be done based on the mechanism of development of the disease?

Equip your workplace
Adjust the height of the computer desk so that the armrests of the chair are at the level of its surface. In this position, while working (typing or moving a computer mouse), the forearms lie calmly on the table or armrests, and are not suspended. Therefore, the hands are relaxed during work, and the hand at the wrist does not bend. In this case, there is no additional load on the canal and the median nerve is not compressed.

In addition, while working, try to ensure that the lower back in relation to the hips is at an angle of 90 °, and the angle between the shoulder and forearm is also 90 °.

Try not to strain or pinch. Make sure that the head does not pull in between the shoulders.

Find a comfortable keyboard and mouse
If during work the position of the hands is correct, then the hands lie quietly above the working surface, so the movements in them are free. However, if the keyboard is located high, then you have to keep your hands above it in a suspended position. In this position, the load on the carpal tunnel is increased. Therefore, it is better to purchase a special hand mat or an inclined keyboard.

Choose a computer mouse so that it "fits" in the palm of your hand while you work. This makes the hand less tired and relaxed. For people who have already developed carpal tunnel syndrome, special computer mice have been developed that are shaped like a joystick. When working with them, the carpal tunnel is practically not loaded.

In addition, there are special mouse pads that have a roller (it is better to choose with a helium filling) at the wrist level. In this position, during operation, the carpal tunnel is in a straightened state and is loaded to a minimum.

The position of the brushes when working

Adjust the angle and height of the monitor

So that during the work the text is at eye level. Since if the monitor is located low, then you have to constantly tilt your head down, if it is high, then raise it up. With such movements, blood circulation worsens in cervical spine spine and hands.