That we treat carpal tunnel syndrome. Carpal Syndrome of the Wrist: Treatment from a Practitioner Alternative Treatment for Carpal Tunnel Syndrome

1. Vitamin B12. Useful for increasing the body's defenses, reducing paresthesia and chilliness.
2. Vitamin B6. Restores nerve fibers, reducing swelling in the joint area and pain symptoms.
3. Vitamin FROM. It has an anti-inflammatory and firming effect, enhances the effectiveness of B vitamins.
4. Vitamin D3.
5. Vitamin E.

The most popular complexes:

• "Dihydroquercetin Plus" - contains a valuable natural antioxidant - dihydroquercetin , obtained from the bark of Siberian larch. As part of the drug, the action of dihydroquercetin is enhanced by vitamin C and vitamin E, the combined action of which helps to restore blood microcirculation in the affected area of ​​the hand and wrist.

• "Osteovit" - contains vitamin D3 And drone brood. D3, when combined with B6, is involved in the mineral metabolism of the body.

3. Local treatment- injection of drugs into the joint

Direct drug injection into the carpal tunnel- most effective method treatment of carpal syndrome. To do this, a mixture of painkillers Lidocaine and Novocaine with the addition of corticosteroids is injected into the carpal tunnel with a special long needle. Most often, after the introduction of the drug into the cavity, the pain will disappear.

In some cases, it may intensify, but after a day or two pass completely. The course of treatment is up to three weeks and consists of two injections.

If the pain syndrome does not go away completely, then the procedure is repeated with a two-week interval.

4. Non-drug treatment

Apart from medical method effects, doctors use other techniques to achieve good results. As the most common, we can note such options for exposure as: acupuncture, manual therapy and yoga.

5. Treatment of the disease that led to the syndrome

In order for the treatment to be really effective, you should first take care of ridding the patient of the diseases that caused the carpal syndrome (if any). Otherwise, the applied methods will not give any results, and a relapse may occur. Each type of pathology will require individual treatment:

• Treatment of rheumatoid diseases associated with lesions of the hand joint;
• Hypothyroidism involves hormone replacement therapy;
• With menopause is assigned hormone therapy, but provided that the woman is not yet 60 years old and the last menstruation was no later than 10 years ago;
• In diabetes mellitus, treatment is used that is aimed at preventing sugar spikes in the patient;
• Chronic kidney failure involves helping the patient to improve the process of removing fluid from the body or the end products of protein metabolism;
• At high blood pressure HMF inhibitors are used.

6. Physiotherapy

IMPORTANT: This technique cannot be used for people with contraindications (oncology, heart failure, pregnancy and other problems).

Various procedures are prescribed as physiotherapeutic treatment, for example, electrophoresis or local cryotherapy.

7. Ultraphonophoresis

The procedure is carried out in conjunction with drugs and is a technique in which special ultrasonic vibrations affect the body. This leads to better penetration of drugs into cells, and also allows you to accelerate the flow of blood in the capillaries. With this treatment of the carpal canal, the vessels expand, pain disappears and swelling subsides. As medicinal product dimexide is used.

The procedure is aimed at reducing pain and inflammation in the treatment of carpal tunnel syndrome. One session takes up to 30 minutes, and the treatment course is 8-12 sessions.

8. Shock wave therapy

This method of treating carpal tunnel syndrome has established itself as a fairly effective and proven technique.

UVT has a complex effect on the whole body and promotes breaking down deposits of calcium and uric acid, which narrow the canal in rheumatic diseases. The therapy has a positive effect on the blood supply to the affected area, allowing you to remove swelling and save the patient from pain.

Surgery

Surgery is recommended only when all other methods have failed. Surgery required in case when the form of carpal syndrome is advanced, and the patient has persistent relapses or muscle atrophy.

The operation is a dissection of the carpal ligament, and in some cases, excision of scar tissue. Surgery may be open or endoscopic. The second option is more sparing a technique after which the scar is practically absent.

With an open intervention, the surgeon gets full access to the damaged area, which gives more opportunities to eliminate pressure on the carpal canal.

Such an operation is not considered difficult, so the likelihood of complications is minimal.

As a result of numerous operations, experts came to the conclusion that it is worth giving preference to the endoscopic technique under local anesthesia. This approach requires less time for the rehabilitation of the patient.

Diet

Proper nutrition in carpal tunnel syndrome is very important for the patient, because it will make up for the lack of vitamins, minerals and essential trace elements. It is best to supplement the menu with products rich in calcium And vitamin B. This will strengthen the bone and nerve tissue. Fast food should be excluded from the menu, all fatty, fried, spicy and overly salty.

Treatment at home

If you diagnose the problem in a timely manner and start treatment at home, then it is quite possible to exclude the development of irreversible complications. In addition to the methods described, doctors recommend that patients engage in special therapeutic exercises to train their hands. Excellent results gives a trip to the pool. It is important that the water is warm and covers the entire limb up to the shoulder. Also, experts recommend do yoga, or other types of therapeutic techniques aimed at developing the joint.

Even if there are mild symptoms of carpal syndrome, it is important to stop doing the work that caused the disease.

This alone will give you much more than all the pills, believe me. If you work at home (for example, at a computer) and you have problems with the carpal tunnel, break off. Do something that relaxes the tension in the channel:

• Wash the dishes. Warm water is wonderfully relaxing.
• Do a wet cleaning of the floor. Be sure to use your hands and warm water.
• Wash windows.

And be sure to do regular physical exercise which strengthen the joint and muscles of the wrist.

Folk remedies

Before turning to traditional medicine, you should first visit an experienced doctor. Only he will be able to advise on this or that folk recipe. Folk remedies may not give the desired result or even cause complications. If folk recipe can really help, it's worth a try. The most famous are:

1. Tincture from a string. A composition of string, burdock leaves, hop cones, birch leaves, verbena and elder flowers should be brewed in a thermos and infused for 2-3 hours, and then taken 150 ml four times a day.
2. White clay. Dilute white clay with water, transfer the gruel to gauze and apply to the affected area of ​​\u200b\u200bthe wrist.
3. Make a compress from fresh goat's milk.
4. Tincture of cucumber and wild rosemary. Grind 2-3 red peppers and 3 cucumbers in a blender, add half a liter of water and let it brew for about a week. Rub her wrist: the tincture will improve blood circulation and relieve the feeling of numbness in the fingers.
5. pumpkin compress. Turn the pumpkin into a mushy state and apply on the wrist, wrapped in cellophane.
6. Sea buckthorn. Grind the berry, pour water and heat. Soak your hands in the broth, then be sure to wipe them so that they do not cool down.
7. Pepper rub. Pour 150 grams of pepper vegetable oil and simmer over low heat for half an hour. Once cool, rub into wrist.

The carpal canal is bounded in depth by the volar surface of the radius, on the ulnar side by the hook of the hamate, on the radial side by the scaphoid, and superficially by the junction of a sufficiently dense transverse carpal ligament, palmar aponeurosis, and fascia of the forearm.

IN carpal canal pass nine tendons (deep and superficial flexors of the four fingers and a long flexor of the first finger) and the median nerve.

Carpal tunnel syndrome refers to compression neuropathy of the median nerve at the level of the wrist. Thus, the syndrome can develop against the background of any pathological conditions leading to increased pressure in the carpal tunnel, which include: mechanical irritation and swelling of any of the nine flexor tendons, the development of their tenosynovitis, swelling of the median nerve itself, anatomical changes and scarring in the tissues surrounding carpal canal, anomalies in the development of the worm-like muscles, pathological formations of the carpal tunnel (deep ganglion cysts), compaction and contraction of the transverse carpal ligament.

Sir James Paget first described compression of the median nerve against the background of a fracture of the distal radius in 1854. Later, in 1880, James Putman, a Boston neurologist, described similar symptoms in a group of patients.

Patient complaints

Patients with this pathology often have characteristic symptoms as, night pains and paresthesias, numbness in the zone of innervation of the median nerve distal to the wrist and weakness of the muscles of the elevation of the first finger.

The doctor should have information about the patient's family history and general somatic condition. Consideration should be given to the presence of congenital diseases or anomalies, diseases connective tissue, systemic and metabolic disorders and previous injuries distal forearm And wrist joint.

Diagnostics

Clinical examination is critical for an accurate diagnosis. In acute cases, pain is determined along the carpal canal. Light percussion in the projection of the median nerve in the wrist area causes "electric shootings" that spread to the zone of innervation of the median nerve, known as Tinel's symptom(Tinnel).

Phalen test(Phalen) is performed by maximum bending of the hands and their full contact with the back surfaces in the so-called position “reverse to the position of the praying hands”. carpal channel at the same time, it narrows and the test is considered positive if paresthesias appear in the fingers within 60 seconds. As the pathology progresses, the time of induction of this symptom decreases.

Other studies include monofilament test, two-point discrimination test, reverse phalen test And turnstile test. IN late stages you can observe atrophy of the muscles of the elevation of the first finger. Muscle strength is determined subjectively by adducting the abducted first finger, overcoming the resistance provided by the second finger of the examiner and comparing the result with the opposite side.

A careful history and physical examination help the clinician differentiate between isolated wrist compression neuropathy and double crush syndrome. The clinical correlation of the double-crash phenomenon is confirmed by the high incidence of carpal syndrome in patients with cervical radiculopathy. A high incidence of carpal tunnel syndrome has also been described in association with more proximal median nerve entrapment. Therefore, upper aperture syndromes must be ruled out. chest, round pronator and pathology of the central nervous system.

Electromyography and electroneurography (ENG) help diagnose carpal tunnel syndrome. Indications for surgical treatment should not be set or changed based on the results of ENG, especially if its indicators are normal, but there are Clinical signs syndrome. Deceleration of the distal latency of the median nerve to 7.0 milliseconds or more indicates severe nerve compression. In this case, it is necessary to resolve the issue of surgical intervention without delay.

The most important diagnostic aspects carpal tunnel syndrome are a thorough history taking and clinical examination. Electrophysiological examination of the median nerve is an additional diagnostic method that allows you to confirm the presence of pathology and has a prognostic value for the results. surgical treatment.

Radiography of the wrist joint allows to exclude possible congenital or acquired bone anomalies. Postponed fractures of the distal bones should be taken into account forearms and bones wrists. Misunited fractures of the distal radius, previous radiocarpal interventions, and a hypo- or aplastic hook of the hamate can complicate the surgeon's work when using a slit cannula. It is recommended to perform a standard X-ray wrist joint in anteroposterior, lateral and carpal projections.

When indications for an extended examination, it may be necessary to perform MRI, CT, ultrasound, scintigraphy or arthrography.

Treatment

Conservative treatment consists of day or night splinting of the wrist joint, changing the mode of daily physical activity, physiotherapy and oral intake non-steroidal anti-inflammatory drugs. The efficacy of intercarpal steroid injections varies according to the literature.

Surgical decompression as a treatment was first introduced in 1933, followed by a classic article published by Phalen in 1950. Since then, open carpal tunnel release has established itself as the "gold standard" for surgical treatment of carpal tunnel syndrome.

The indications for surgical release of the transverse carpal ligament are well established, and the intervention in most cases is limited to endoscopic.

Advantages of endoscopic carpal tunnel release over open surgery include:

• Absence of massive scars and pain during support
• Less pronounced inhibition of the grip function
• Less recovery time

Rehabilitation

Active movements begin immediately after the end of the action of local anesthesia. The patient is advised to avoid heavy lifting or pressure on the hand until the discomfort disappears, usually within 2-3 weeks.

Active finger movements reduce the formation of scar tissue in the wrist area, and thus prevent adhesions affecting the nerve and tendons in the area of ​​intervention. The stitches are removed after a week. If the patient begins heavy physical activity too early, such as lifting weights, this can lead to swelling and prolonged pain in the palmar surface of the hand. In such cases, myofascial release and infusion therapy help to cope with the problem.

Compression nerve fiber anywhere in the human body entails pain and dysfunction of muscle tissue. Carpal tunnel syndrome currently competes in prevalence with osteochondrosis. This is due to an increase in static loads on the wrist and hand when performing professional duties. If 20 years ago, such pathologies were mainly suffered by persons of low intellectual and hard physical labor, such as cooks, drivers, hairdressers, painters and plasterers, today the carpal tunnel syndrome is rapidly expanding its sphere of influence. Sufficiently at risk most of able-bodied population aged 25-45, employed in office work. Once the diagnosis has been established, treatment may consist of watchful waiting (pain medications are prescribed), or it may be suggested surgery. Our manual therapy clinic offers a completely different approach to the treatment of carpal tunnel syndrome, which allows you to fully restore your ability to work and get rid of discomfort without surgical and pharmacological influence.

About what this disease is and how it can be treated - we will tell in this article.

What is carpal tunnel syndrome

Carpal tunnel syndrome is a pathology in which there is constant or intermittent compression of the median nerve. It departs from the elbow and is responsible for the innervation of the thumb, index and middle fingers. The ring finger is inverted by it about half. Therefore, the main symptoms appear in relation to these fingers. These may be the following manifestations:

• drawing and burning pains;
• feeling of numbness and crawling;
• decreased muscle strength;
• decrease in the volume of muscle tissue;
• convulsions and a feeling of electric shock during certain movements;
• inability to touch the thumb to the pads of all the others on one hand.

What is tunnel syndrome, people who do not follow hygiene recommendations when working at a computer are at risk, since prolonged static stress of the ligamentous apparatus responsible for the movement of the fingers leads to its thickening. The carpal canal is a passage between bone tissues wrists and ligaments. The ligaments located here are responsible for the mobility and innervation of the fingers. With an increase in synovial membranes in volume, compression of the median nerve occurs.

The risk of developing pathology increases significantly if the patient has the following factors:

• wrist injuries (sprains, fracture of the beam in a typical place, bruises, dislocations) in history;
• inflammatory processes in articular tissues (arthritis);
• degenerative changes in the joints (osteoarthritis);
• excess body weight against the background of metabolic disorders;
• diabetes and disruption thyroid gland;
• negative inheritance.

The clinical picture develops gradually. Pain on initial stages short-term, quickly subsides when resting the diseased limb. As the degree of compression increases, the pain syndrome becomes more and more prolonged and is difficult to correct with non-steroidal anti-inflammatory drugs.

Carpal tunnel syndrome: treatment and rehabilitation

An initial examination by a neurologist already allows us to identify this pathology with the help of simple tests. However, to clarify the diagnosis, the specialist prescribes an x-ray, computed tomography, EMG and a number of other examinations. Once a diagnosis of carpal tunnel syndrome is made, treatment should begin immediately. To do this, official medicine recommends temporarily abandoning professional duties and ensuring complete rest for the injured hand. Fixation is carried out with the help of orthoses. Non-steroidal anti-inflammatory drugs are prescribed to relieve pain and eliminate soft tissue swelling in the carpal tunnel area. Vitamins of group B are used to improve the trophism of the nerve fiber. As additional measures, methods of physiotherapy, massage and therapeutic exercises can be used. In severe cases, corticosteroid injections are used.

All of the above measures are not therapeutic effect, their action is aimed at eliminating symptoms and temporarily returning the patient to work. Meanwhile, the disease progresses over time. Sooner or later, surgery will be required.

In order to prevent such a situation from becoming a reality, it is important to start effective treatment immediately. Our manual therapy clinic offers a set of effective techniques to completely eliminate carpal valve syndrome. Reflexology is used physiotherapy, massage and osteopathy. We invite you to free consultation an experienced specialist of our clinic at any time convenient for you.

It includes:

• median nerve
• The motor branch of the median nerve, with options for branching from the median nerve:
• Out of bond 50%
• Under the bundle 30%
• Through a bundle 20%

pressure in the carpal tunnel

Lowest at rest with the wrist in a neutral position (2.5 mmHg). 11 rises up to 30 mm Hg. Art. with full flexion of the wrist. With carpal tunnel syndrome, the pressure rises to 30 mm Hg. Art. and 90 mm Hg. Art. respectively (Phalen's test provokes a rise in pressure).

anomalies

They may confuse clinical picture when inappropriate signs appear (for example, numbness of the fifth finger with carpal tunnel syndrome).

• Martin Gruber: motor connecting branch from the median nerve to the ulnar nerve on the forearm
• Riche-Cannieu: motor and sensory connecting branches from the median to the ulnar nerve on the hand.

Causes

• Idiopathic - most common, typically in women between 35 and 55 years of age.
• Traumatic - 5% wrist fractures, 60% lunate dislocations
• Metabolic - pregnancy (most common), renal failure and hemodialysis, hypothyroidism (rare).
• Vibration
• Repetitive monotonous movements (vague picture, overload, monotonous repetitive movements and position are considered predisposing, but objectionable).
• There is no clear evidence to correlate with carpal tunnel syndrome
• Synovitis - exacerbation of rheumatism. Osteoarthritis of the wrist joint.
• Very rarely - mucopolysaccharidosis, mucolipidosis, amyloidosis, diseases leading to space filling (ganglion, nerve tumor, abnormal short flexor of the fingers).

Diagnostics

Symptoms

• Nocturnal dysesthesia, including reflex shaking or hanging of the hand.
• Decreased sensation or tingling in the zone of innervation of the median nerve:
• Goosebumps appear when holding the steering wheel of a car
• Holding the handset causes a tingling sensation
• Decreased dexterity of movements when grasping with the first and three-phalangeal fingers:
• Difficulty or inability to fasten shirt buttons
• Inability to grasp small objects (such as coins)
• Inability to hold the needle while sewing.

signs

• Positive Tinel percussion test:
• Sensitivity 60%, specificity 67%
• Positive Phalen flexion test for 60 seconds:
• Sensitivity 75%, specificity 47%
• Test for direct compression of the nerve: with pressure on the nerve by a doctor for 30 seconds. tingling appears:
• Sensitivity 87%, specificity 90%
• Threshold tests (monofilaments and vibration) for diagnosis are not indicative, but reflect the severity
• Density tests (discriminatory sensitivity) have no sensitivity or specificity. They show a decrease in sensitivity.

Electrophysiology

• NB: NOT REQUIRED for typical clinical presentation
• They can be misleading because in 10% of cases with a typical picture after surgical intervention indicators are normal, especially in young women.
• Diagnostic parameters: latent period of terminal sensitivity >3.5 ms or conduction velocity of sensitivity > 0.5 ms compared to the other side; motor latency >4.5 ms or motor impulse conduction velocity > 1.0 ms compared to the other side.
• Electromyography reveals fibrillation and positive sharp teeth with severe compression with muscle atrophy.
• Values ​​do not return to normal even after successful decompression and are therefore of little value in diagnosing chronic or recurrent carpal tunnel syndrome.

Differential Diagnosis

• Radiculopathy C6
• pronator syndrome
• Proximal compression of the median nerve at the level of the brachial plexus.

Conservative treatment

Observation: spontaneous resolution is possible, for example, during pregnancy, untreated exacerbation of rheumatism.

Splinting: Effective when only nocturnal symptoms are present. When muscles are affected, an opposing splint or C-shaped insert is used in the first interdigital space (adductor contracture)

Steroid injections: temporary relief, but cure is rare except early symptoms or overt tenosynovitis. Risk of iatrogenic nerve injury. The temporary effect confirms the diagnosis.

Dissection of the carpal ligament

open intervention

A longitudinal incision along the 4th ray (along the line from the radial edge of the fourth finger to the middle of the distal carpal fold) above the carpal canal prevents damage to the cutaneous nerves. Dissect the palmar fascia, dissect the transverse carpal ligament closer to the ulnar edge to avoid damage to the motor branch of the median nerve and provide shelter for the nerve after surgery. It is necessary to ensure that the ligament and fascia are dissected at the level of the distal margin and proximally under visual control, as well as to inspect and verify the integrity of the thenar branch. Endoneurolysis does not provide additional benefits.

Endoscopic Ligament Dissection

One or two portal endoscopy. Some acceleration in recovery of function and return to work, but greater risk of iatrogenic nerve/tendon/superficial arterial arch injury and incomplete decompression, especially in the early recovery curve.

results

In 95% of cases, it is recommended to treat nocturnal dysesthesia, regardless of age, severity of symptoms before surgery, duration of the disease. Numbness and muscle weakness may persist, especially in old age and long-term illness. It takes 4 to 6 weeks to heal and regain grip strength.

Complications

• Complex regional pain syndrome.
• Painful scar (usually within a few weeks, therapy helps resolve).
• Pain on support (cause unclear, pain over bony margin, refractive effect possible, persisting for several months, usually with subsequent resolution).
• Infection
• Relapse: less than 1% of cases. Re-intervention is effective only in 70% of cases. Nerve conduction does not play a role in diagnosis due to persistence of changes even after successful decompression.

Reconstructive interventions

Transposition to restore opposition is possible in the absence of opposition due to weakness of the abductor digiti brevis muscle and is done at the time of surgery (for age > 70 years or prolonged decompression) or if function is not restored within six months of decompression (age<70 лет и кратковременная декомпрессия).

Donor muscles:

• Superficial flexor of the fourth finger
• Own extensor of the second finger
• Long palmar muscle with fascia (Camitz):
• Can be performed simultaneously with decompression of the carpal tunnel through the same access, although the muscle is not as strong as the superficial flexor of the fourth finger or its own extensor of the second finger.
• Abductor Fifth Finger Muscle (Huber):
• Good for children
• Provides muscle mass in the area of ​​​​the eminence of the thumb.
• Immobilization is possible in the postoperative period without adverse consequences, the method is designed for muscle contraction, and not for tendon sliding.

Programmer, pianist, seamstress and sign language interpreter - what unites people of such different professions? They have the same working tool - their own hands, and therefore the risk of the same occupational disease, called carpal tunnel syndrome (synonyms: carpal tunnel syndrome or carpal tunnel syndrome). We will tell further about the causes, symptoms and treatment of this disease.

In the wrist, each person has a common channel or anatomical tunnel, the intended purpose of which is to conduct peripheral nerves, tendons and blood vessels to the palm and fingers. The walls of this tunnel are the bones of the wrist - on three sides, and on the side of the palm - the transverse (carpal) ligament.

Normally, this tunnel is quite narrow, especially its section under the ligament. It is this anatomical narrowness that is fertile ground for the formation of carpal tunnel pathology.

Since the median nerve passes through the carpal canal, which innervates the fingers from the thumb to the ring finger, any narrowing of the already narrow carpal space leads to disruption of the normal blood supply and compression of the median nerve.

The result is compression-ischemic neuropathy of the median nerve - the primary source of all clinical manifestations of carpal tunnel syndrome.

Causes of carpal tunnel syndrome

The cause of carpal tunnel syndrome is compression of the median nerve in the anatomical tunnel near the wrist joint.
The algorithm for the development of the syndrome is most often as follows:

• A person makes monotonous movements with a brush for a long time (typing on the keyboard, manipulating a computer mouse, doing needlework - sewing or knitting something). In this case, the wrist, as a rule, is half-bent, and the hand is constantly tense - this creates the conditions for the occurrence of the so-called repetitive load injury. In the English-language medical literature, it is also called "chronic injury from repetitive stress."
• As a result of constant tension in the tissues of the wrist, congestion and inflammation occur. The situation is aggravated by emerging microtraumas of ligaments, muscles, tendons.
• Injured tissues become inflamed, swell, which leads to narrowing of the anatomical tunnel in the wrist, compression of the median nerve - clinical signs of carpal syndrome appear.

Compression-ischemic neuropathy of the median nerve can also occur for other reasons:

1. as a result of injuries of the hand and forearm, in which swelling of the tissues of the wrist develops;
2. due to congenital anomalies of the bones and connective tissue of the wrist, which lead to a narrowing of the carpal tunnel;
3. due to an acute or chronic inflammatory disease of the connective tissue, in which the carpal tunnel narrows;
4. due to cysts or tumors in the carpal tunnel.

The likelihood of carpal tunnel syndrome increases if:

Symptoms and signs of carpal tunnel syndrome

Carpal tunnel syndrome is characterized by:

• Much more often only one hand is affected. This will be the leading (working) hand if the trigger for the development of the syndrome was "chronic injury from repetitive stress."

If the syndrome is due to a systemic connective tissue disease or endocrine disorders, both hands may be affected at the same time.

• The syndrome is formed gradually - at first there are sensory disturbances, then motor and trophic dysfunctions.
• In the early stages, all the characteristic symptoms disturb the patient at night or in the early morning. They pass after shaking or kneading the affected limb.
• Sensory and motor disorders apply only to the part of the hand innervated by the median nerve - the inner surface of the fingers from the thumb to the ring finger, the back surface of the middle and index fingers.

The range of symptoms of carpal tunnel syndrome includes:

1. Domestic awkwardness due to impaired fine motor skills. The patient has difficulty in performing precise movements with his fingers - fastening buttons, peeling vegetables.
2. Sensory disturbances - pain, numbness, "goosebumps", a tingling sensation in the fingertips. The pain symptom can be either minor, not causing severe discomfort, or acute, spreading throughout the arm. Periodically occurring numbness of the fingers over time is replaced by chronic.
3. Movement disorders, when episodes of muscle weakness and discoordination of finger movements are replaced by paresis of the hand, muscle atrophy.
4. Obvious symptoms of trophic disorders in the limbs are a change in the temperature of the affected areas of the hand, hair loss, yellowness and brittle nails, blue skin.

Diagnostic studies

The diagnosis is made by a neurologist based on the following diagnostic signs and symptoms:

• Numbness of fingers, decrease in their tactile sensitivity.
• Positive Tinel test.
  Tapping with a hammer on the wrist in the projection of the carpal tunnel leads to the appearance of shooting or tingling pain in the fingers.
• Positive Durkan test.
  Squeezing the wrist in the area of ​​the anatomical tunnel causes numbness in the first four fingers.
• Positive Phalen test.
  The hand bent at a right angle at the wrist loses sensation in less than 1 minute.
• Positive opposition test.
  With severe carpal syndrome, the patient cannot connect the pads of the thumb and little finger.

Used instrumental research methods:

1. , with which you can accurately determine the degree of conduction of the median nerve;
2. radiography, ultrasound, tomography are necessary to exclude others.

Treatment of carpal tunnel syndrome

The goal of treatment for carpal tunnel disease is to eliminate or reduce median nerve compression. The method of treatment depends on the symptoms, the severity of the syndrome.

In the early stages, conservative methods of treatment are indicated, including:

In severe cases and if conservative therapy is ineffective, the help of a surgeon may be required. The following types of operations are practiced to eliminate carpal tunnel syndrome:

1. Endoscopic dissection of the carpal ligament.
   Under local anesthesia, the transverse palmar ligament is cut through two small incisions in the palm. As a result, the canal space expands, the nerve ceases to be compressed.
2. Open surgery for dissection of the carpal ligament and reconstruction of the carpal tunnel.

Surgical treatment, usually carried out on an outpatient basis, is very effective: in the vast majority of cases, the motor functions of the wrist joint, the sensitivity of the hand are completely restored.

The rehabilitation period after surgery can last from several months to a year - it all depends on the degree of pathological changes in the carpal tunnel and median nerve before surgery.

Despite the fact that carpal tunnel syndrome is not a deadly disease, its symptoms cannot be ignored. Indeed, over time, without treatment, this seemingly harmless pathology can lead to a complete loss of limb performance and even disability.

Timely and targeted therapy almost always guarantees a complete recovery and restoration of the working capacity of the hand.