Neurologist
Chudinskaya
Galina Nikolaevna
Experience 29 years
Neurologist, member of the Association of Interdisciplinary Medicine
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If a person does the same job for a long time, for example, sits at a computer for a long time, pain may appear in his hands. This will be tunnel syndrome. This problem can occur not only to those people who work at the computer, but also to drivers, since their hands are in one position for a long time.
Tunnel syndrome occurs when the tissue around the tendon swells, putting pressure on the nerve. This leads to the patient beginning to feel tingling in the hands and numbness in the fingers. The muscles become weak and swelling may appear on the fingers.
Carpal tunnel syndrome is associated with the tunnel that runs between the transverse ligament and the bones of the wrist. In the middle of the carpal tunnel there is the median nerve. Any diseases, injuries, or pathologies lead to a narrowing of the canal, and this affects the nerve, which causes the syndrome.
Causes
Tunnel nerve syndrome is both a congenital anomaly and a disease associated with a person’s activity and lifestyle.
Among the main causes of carpal tunnel syndrome are:
- maintaining an uncomfortable hand position for a long time (this may be associated with professional activities, for example, working at a machine);
- genetic predisposition;
- hormonal imbalances caused by pregnancy, menopause;
- inflammatory processes;
- benign, malignant tumor in the canal area.
The causes of tunnel syndrome include diseases such as arthrosis, diabetes, arthritis, and thyroid diseases. Patients may encounter this problem due to metabolic disorders, after fractures, frequent injuries, or bruises.
Why are the nerves compressed?
Nature has provided a muscular-osseous or muscular-fibrous bed for the nerve. The causes of compression are different:
- congenital narrowness of the bone canal;
- swelling due to constant overload;
- abnormal bone growth or acromegaly;
- inflammation of nearby joints;
- tendon inflammation;
- degenerative changes in bones – arthrosis and arthritis;
- too large callus after a fracture;
- endocrine and metabolic diseases in which tissue nutrition is disrupted - diabetes mellitus, myxedema.
Each peripheral nerve along its length passes through narrow places in which it can be compressed. This primarily concerns the median nerve of the arm, which has to overcome three tunnels - at the wrist, forearm and in the lower third of the shoulder. The ulnar nerve may become compressed at the elbow joint and under the palmar ligament. The obturator, lateral cutaneous, sciatic, tibial, and plantar digital nerves may be compressed in the leg.
Kinds
There are more than 30 types of carpal tunnel syndrome, among the main and most common ones we should highlight:
- carpal tunnel syndrome;
- cubital tunnel syndrome;
- elbow;
- peroneal tunnel syndrome;
- tarsal.
Most often, patients experience carpal tunnel syndrome (1.5% of the world's population). The arms suffer more from neuropathy than the lower extremities. Even less often, doctors are consulted with tunnel neuropathy of the trunk.
Symptoms and signs
The working arm often suffers from the disease; pain is especially disturbing in the morning and at night. The main symptoms of carpal tunnel syndrome include:
- colic, stabbing pain;
- weakness in the arms;
- decreased sensitivity;
- limbs become less active and mobile.
Patients experience a sensation as if goosebumps are running over their palms, a feeling of shooting pain, and numbness. It will become difficult for a person to control and control his hand; when clenching his palm into a fist, unpleasant sensations will arise, and in the later stages, pain.
Take into account! The disease affects all fingers except the little fingers.
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Ulnar (cubital) and radial tunnel syndromes
- if you regularly rest your joint on any hard objects (for example, using a phone, tablet, laptop, lying on your stomach, or incorrect body position while sleeping).
- if you hold your hand in an unnaturally bent position for a long time (again, an example is your mobile companion during long-term communication).
- playing certain sports (for example, basketball, in which the elbow area is under constant tension), in which the nerve can be damaged, which will cause ulnar neuropathy (one of the names of the syndrome).
If you see a doctor on time, you may avoid many unpleasant sensations. The initial symptoms of this disease are acute pain and loss of sensation in the limb, as well as tingling in the hand, especially in the little finger and ring finger. If you missed this point, then no less unpleasant symptoms may develop later:
- change in the shape of the hand and general weakness of the hand (in particular the two fingers above)
- loss of ability to fully move fingers
- death of muscle tissue
The final diagnosis can be made only after a detailed examination, or using various methods that check the presence of an impulse in certain areas of the nerve fiber.
Symptoms of Radial Tunnel Syndrome (RTS)
The cause of RTS is the same pinched nerve. But this nerve runs much deeper - in the bones and muscles of the forearm. The beginning of the problem can be any of the following situations:
- bone tumors
- inflammation of external tissues
- all kinds of fractures and dislocations
The main symptom of RTS is muscle pain in the forearm and part of the hand, mainly from the palm. The pain is especially aggravated when trying to straighten the arm. Tingling sensations are not as common as ulnar neuropathy.
As in the case of the previous example, it is possible to draw a correct conclusion only with a comprehensive examination of the limb that has disturbed you.
Treatment
The difficulty of treating LTS is determined by the pressure on the nerve. If it is not strong enough, then the use of surgical interventions is not required; it is quite possible to get by with preventive measures and a little effort. Such measures may include avoiding situations in which the elbow joint experiences stress when placed on hard surfaces under the slightest pressure, as well as wearing various orthopedic devices, such as cuts during activity and splints during sleep to prevent excessive flexion of the arm. You should try to avoid sitting for a long time at a personal computer, preferably sleep in a supine position, and do not rest your elbows on the table while eating. Sports and active recreation will also have to be excluded for a while.
If these measures do not help, then an unpleasant but reliable surgical intervention comes to the rescue, in which most patients are satisfied with the result. The main method in this case is to shift the nerve to another area that is freer from compression. But in rare cases, the complexity of the operation is an order of magnitude higher and boils down to the fact that space is freed up near the nerve without moving it by cutting off part of the tissue. The postoperative period is several months. At this time, as after almost any operation, any physical activity on the operated limb is not recommended, otherwise the entire treatment may be useless and will have to be repeated.
In the case of RTS, various intramuscular drugs are often used to reduce inflammation and swelling. Splints and other orthopedic devices may also be used. As a preventative measure, special exercises are prescribed to improve the supply of tissue cells with necessary microelements. In addition, physical therapy procedures such as ultrasound and other types of electromagnetic waves may be prescribed.
But here, too, if the ineffectiveness of the treatment is realized (as a rule, it comes after 2-3 months), they resort to surgical intervention.
In this case, again, various methods are used to reduce pressure on the nerve (both changing its position and changing its environment). But, in any case, operating on a limb is a last resort, and it is used when the doctor and patient realize the hopelessness of the situation. This is usually caused by severe weakness in the hand and elbow, as a result of pain and ailments, as well as sagging of the wrist and the inability to bend the limb. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
When to see a doctor
Do not expect that everything will go away on its own; if you do not consult a doctor in a timely manner, atrophy of the limbs may begin to develop. If your profession involves working at a computer, you stand at a machine for a long time, or you work as a driver, you are at increased risk. When the first symptoms appear (nighttime, vegetative, pain), you need to consult a specialist.
Neurologists at JSC Meditsina (clinic of Academician Roitberg) have extensive experience in treating such problems. Our clinic is located in the center of Moscow, within walking distance are the Mayakovskaya, Belorusskaya, Novoslobodskaya, Tverskaya, and Chekhovskaya metro stations.
How does compression of the median nerve manifest?
Through the carpal tunnel (the same as the carpal tunnel), the median nerve passes to the hand at two levels: through the wrist joint and above it. The sensitive part of the median nerve passes over the joint, which on the hand itself is divided into small branches, and these branches are different for each person - concentrated or scattered. Inside the wrist joint there is a muscle branch that goes to the thumb and allows you to clench your hand into a fist.
The first sign of the syndrome is bursting night pain in the hand. “Goosebumps” run all over the fingers of the hand, except the little finger. The pain is exhausting and excruciating and can radiate to the forearm or shoulder. A person wakes up in the middle of the night in pain and has to get up to rub his hand, put it down and shake it. When the hand goes down, the pain subsides, but when you try to lift it, it resumes. Sometimes you have to spend several hours like this. The hand swells, women cannot wear their usual rings. If you tap your wrist, the pain intensifies. It becomes difficult to retract the thumb. Simple housework - wringing out clothes, knitting, sewing - causes pain even during the daytime.
If the median nerve is compressed in the upper part of the forearm, the forearm will become very painful. This happens to those who, due to the nature of their work, often have to turn their hand up and down while holding an object with their fingers. These are drivers, carvers, hand milkers, painters, and artists. The pain first appears after carrying heavy loads, when the main load falls on the forearm, usually after lifting a heavy box or crate. If you clench your hand into a fist and sharply turn it down, the pain will instantly intensify. Difficulties are caused by writing and raising your hand up. The muscles at the base of the thumb may undergo atrophy.
Compression of the median nerve in the lower third of the shoulder is called “lover's palsy.” This condition occurs in those on whose shoulder a person sleeps for a long time and serenely. Of course, this is not real paralysis, but the same pain, numbness and impaired movement.
Diagnostics
To correctly diagnose the disease, the doctor communicates with the patient and takes into account his complaints. Afterwards, the limbs are examined, tests and instrumental examination are prescribed.
The main tests include:
- Tinnel;
- Vest;
- Fallena.
The patient is also prescribed an ultrasound, computed tomography, and MRI, which makes it possible to determine (or refute) the presence of tumors. Before prescribing treatment, the specialist is faced with the task of determining how affected the nerve is. For this purpose, electroneuromyography is prescribed.
Treatment
Your doctor will tell you how to treat carpal tunnel syndrome. Do not self-medicate; painkillers will temporarily eliminate the pain, but the cause will remain, which gives rise to new symptoms.
Treatment depends on symptoms and causes. In case of a mild form of the disease, a massage is prescribed; a specialist may also prescribe wearing an orthosis - it will reduce pain at night and simplify the work process during the day. The massage can be performed either by a clinic specialist or by the patient at home; the doctor will introduce you to the technique and movements. Medications may also be prescribed to help restore blood circulation. For severe pain, painkillers are prescribed. At the initial stage, conservative treatment, for example, physical therapy, will help. In the later stages, it is necessary to cut the retaining ligament and eliminate the pinched nerve.
Carpal tunnel syndrome
This is the most common tunnel syndrome, where the median nerve is compressed at the wrist. Women suffer from it 3 times more often than men due to the fact that they have a much smaller bone canal for the nerve than men. This syndrome can develop not only from injuries and injuries, but also after removal of the mammary glands for cancer. In women who have undergone surgery, lymph circulation is poor, and the carpal tunnel is very swollen. Severe swelling can also appear in this place during pregnancy, menopause or menopause.
Diseases and hormonal changes are predisposing factors that “set the stage” for nerve compression. The immediate impetus is monotonous movements repeated day after day for several years. Movements of the hand are most often uncomfortable, unphysiological, and cause the muscles to become too tense. As a rule, these are movements necessary in a certain profession. Seamstresses, polishers, and musicians suffer. In recent years, the carpal tunnel has become increasingly affected by programmers who regularly press buttons on a computer keyboard.