How to treat carpal tunnel syndrome - the No. 1 disease of office workers?

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December 7, 2019
My fingers are numb and tingling, my hand doesn’t obey. It is impossible to hold a pen or use a computer mouse. At night, I have a shooting pain in my wrist that prevents me from sleeping. These are symptoms of carpal tunnel syndrome, also called carpal tunnel syndrome.

Carpal tunnel syndrome is a neurological disease. In a broad sense, the concept unites a dozen diseases. But we will talk about one of them - carpal tunnel syndrome. We will tell you why this is a disease of office workers, what to do to prevent it, and how to treat carpal tunnel syndrome.

Who is sick

Carpal tunnel syndrome is called a disease of office workers due to long hours of working at the computer. But people of different professions are susceptible to the disease: musicians, cybersportsmen, motorcycle racers, artists, stenographers. Those who have monotonous hand actions with constant flexion-extension movements of the hand or whose work involves assembling equipment and vibrating mechanisms.

If you look at the structure of the wrist and hand, you can see that at the base of the palm, bones, muscles and tendons form a kind of tunnel - this is the carpal tunnel. Nerves and blood vessels pass through it.

Carpal tunnel syndrome occurs when the median nerve is pinched. Together with the radial and ulnar nerves, the median nerve of the hand is responsible for the sensitivity of the thumb, index, middle, and ring fingers.

There can be several reasons for pinching the median nerve, not just professional activities. It depends on them how to treat carpal tunnel syndrome.

Prevention of carpal tunnel syndrome

Basic methods of preventing carpal tunnel syndrome come down to unloading the ligaments, tendons and muscles of the hand by giving it the most physiological position.
So that you better understand what you should strive for, we will conduct a practical educational program on anatomy. Stand in front of a mirror, lower your arms to your sides and relax your muscles as much as possible. Pay attention to the position of your hands: your palms will be facing your hips, at a slight angle.

Now bend one arm at the elbow 90°. Your hand is now in a neutral position . From this position, you can turn it with your palm up (that is, supination of the forearm) or down ( pronation of the forearm). To remember these names, you can use a simple mnemonic rule, known to every senior student at a medical university: “ SOUP - ABOUT lila.” When you carry a bowl of SOUP , your SOUP is inned, that is, turned palm up. But if you make PRO nation by turning your hand palm down, then PRO you are pouring the contents of the plate.

When you use a computer mouse, your forearm is constantly in a state of pronation. Pronator teres (musculus pronator teres) and pronator quadratus (musculus pronator quadratus) are responsible for pronation. During their contraction, the ulna and radius bones cross, the carpal tunnel narrows, and the tendons passing through it are stretched and displaced, compressing the median nerve.

The situation is further aggravated by the incorrect position of the hand on the mouse body: excessive palmar flexion or dorsal hyperextension in the wrist joint, as well as ulnar (outward abduction) and radial (internal abduction) deviation of the hand only increase compression of the nerve trunk. This leads to the first, simplest recommendation.

The hand and forearm should lie on the same line both horizontally and vertically.

The most radical (and expensive) method of solving this problem is to purchase ergonomic furniture or make a custom-made table and computer chair in accordance with your anthropometric data. A more affordable and universal way is to purchase a special armrest for working with a mouse.

This device provides effective support for the forearm and hand, and can be attached to a table top or to the armrest of an office chair. There are also special mats with gel pads, but they are not as effective because they do not provide support for the forearm itself. Therefore, it is advisable to use them only if your workplace is already properly equipped and your elbow does not hang below the level of the tabletop.

We sorted out the “straightening of the arms.” However, to achieve maximum effect, one more important rule must be followed.

Hands should be in a neutral position.

This can be achieved using ergonomic input devices that help reduce pronation. These include, first of all, vertical mice.

The modern market offers a huge number of similar devices for every taste and budget. The most widely used models are those resembling a shark fin in shape (variations on the Logitech MX Vertical theme), but there are also much more exotic modifications, more similar to classic joysticks.

Which device to choose depends purely on your personal preferences.
The main thing is that the mouse provides a natural position for the hand, so that the palm is located on the edge, almost vertically. Trackballs also help relieve stress on the wrist, but only the “right” ones. No matter what the manufacturers say, moving the cursor with the ball itself only helps to avoid microtrauma and compression of the median nerve caused by ulnar and radial deviations of the hand in the horizontal plane, which are inevitable when working with a classic mouse. However, most of these devices, like the Logitech Trackman Marble pictured below, do nothing to solve the problem of forearm pronation.

The same company’s portfolio also includes a much more ergonomic MX Ergo model with an inclined body, which already allows you to reduce pronation and protect your wrist.

However, to achieve the maximum therapeutic effect, this device should be used with an additional stand that increases the angle of the trackball.

With ergonomic keyboards, everything is a little more complicated: although there are many such devices, truly ultimate solutions for the prevention of carpal tunnel syndrome can be counted on one hand. And that's why.

When typing code or text on a regular rectangular keyboard, we immediately encounter two serious problems: firstly, both forearms are maximally pronated, and secondly, our hands are in a state of ulnar deviation, that is, they are retracted outward.

Part of the situation can be improved by dividing the alphanumeric keys into two blocks located at an angle to each other. As you can see in the picture below, this topology of buttons ensures a natural position of the hands relative to the forearms, allowing you to forget about ulnar deviation.

Since each person has unique anthropometric data, such a device will not suit everyone. But there is a more radical solution - buying a keyboard consisting of two halves, which can be easily positioned at the desired angle.

But, alas, you won’t be able to completely get rid of pronation, because to do this you will have to place the button blocks almost vertically, and it will be uncomfortable for you to type. However, even an inclination of 20° will help to further relieve the wrists.

Keyboards, represented by a pair of independent modules, have an advantage here as well, since they allow flexible adjustment of the tilt angle. However, such devices, all other things being equal, are noticeably more expensive.

Now that you have upgraded your workplace, the only thing left to upgrade is your hands themselves. Therefore, our third recommendation will be as follows.

Perform exercises to strengthen the muscles and tendons of the hand and forearm.

There are many myths surrounding exercises to prevent carpal tunnel syndrome. Unfortunately, most “Internet experts” offer a vinaigrette of various exercise therapy techniques aimed at rehabilitating patients who have suffered serious injuries to the hand, wrist joint or forearm, as well as frankly harmful advice in the style of “crack your fingers and say goodbye to the cartilage of the phalangeal joints.” In addition, would-be advisers position such exercises not as a means of prevention, but as a method of treating carpal tunnel syndrome, which is outright sabotage.

But what will really help avoid the development of carpal tunnel syndrome?
The correct answer is any exercises aimed at increasing grip strength, because they are the ones that most fully utilize the muscles of the hand and forearm during training. It is almost impossible to develop some general recommendations that will suit everyone: everything will depend on your level of physical fitness. However, there are at least 5 simple and accessible exercises that, when performed regularly, will help strengthen your hand and forearm. 1. Squeezing the expander

The simplest exercise that can be performed even at the workplace. To prevent carpal tunnel syndrome, even the cheapest ring expander made of rubber (in common parlance “donut”) is suitable. As for the load, we recommend purchasing an expander that you can “close” (that is, squeeze all the way) at least 10 times in a row.

2. Finger raises with an elastic band
Another simple exercise that you can do every time you feel that your hand is getting tired and needs to be warmed up. Just put a special fitness band on your fingers (usually they are sold in several pieces of different hardness, so there will be no problems choosing the load) and try to fully open your palm.

3. Bending the wrist with weights
The exercise consists of bending the wrist joint at different angles with additional weights, which can be dumbbells or a barbell. Flexion movements must be performed in full amplitude. Performed with both an overhand and underhand grip.

4. Rotation of the wrist with weights
During this exercise, you need to take a dumbbell in your hand and make rotational movements with your hand in clockwise and counterclockwise directions.

5. Working with a roller
The roller is a handle with a load suspended from it on a flexible cable. The essence of the exercise is to gradually wind the cable around the handle, while keeping your arms extended in front of you and working exclusively with your hands. Performed with both an overhand and underhand grip.

There are also more complex exercises, such as push-ups on the fingers, pull-ups on towels or holding the “silver bullet” (when the trainee holds a torsion expander in his outstretched hand, while holding a sports equipment between its handles, shaped like a bullet, from which a load is suspended) , however, they are all designed for well-trained people. By devoting enough time to training (preferably under the supervision of a professional instructor), you will definitely be able to master them. To prevent carpal tunnel syndrome at first, the five listed above will be sufficient. Cloud servers from MacLeod are fast and secure.

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Symptoms

Pain. Burning with shooting. First, with a load on the arm, and subsequently at rest. The pain often bothers me at night. Stops briefly after shaking the hand. If carpal tunnel syndrome is left untreated for a long time, the pain will spread higher up to the elbow and shoulder. Symptoms also include neck pain and headaches.

Numbness. The median nerve is responsible for sensation in the fingers. When its functionality is impaired, tingling occurs or the hand ceases to be felt at all.

Weakness. Everything literally falls out of hand. It is impossible to hold either heavy or light objects. This occurs due to severe pain and loss of motor function.

We are against amateur activity, so first of all we advise you to consult a doctor: a therapist or a neurologist. Treating carpal tunnel syndrome begins with identifying the cause of the disease.

If it is diabetes mellitus or kidney failure, then therapy will be aimed at treating them. Plus, painkillers to relieve symptoms. Specialized programs for the treatment and prevention of such diseases are available at the Mashuk Aqua-Therm sanatorium and resort complex. Here we will provide you with comprehensive support in the fight against the disease.

If carpal tunnel syndrome appears due to professional activity, then you should stop putting stress on your hand for a while. Also apply a splint or bandage for fixation. It is especially useful to do this at night, since during sleep we do not control our movements and the hand may end up in a position that causes pain.

If the symptoms of the disease do not go away for a long time (from 6 months), then carpal tunnel syndrome is treated surgically. Surgery is performed to open the carpal tunnel.

You can treat carpal tunnel syndrome after eliminating the first symptoms and acute pain with physical exercise. Only under the supervision of specialists who will teach exercises and physical therapy.

Tunnel syndromes of the hand

The following forms of hand tunnel syndromes are distinguished:

1.Median nerve tunnels

Carpal tunnel syndrome (wrist) - carpal tunnel syndrome, carpal tunnel syndrome

Pronator syndrome (pronator teres syndrome (in/3 of the forearm)) - Seyfarth syndrome, newlyweds' palsy, honeymoon palsy, lovers' palsy;

Supracondylar syndrome (n/3 shoulders) - Strother's band syndrome, Coulomb, Lord and Bedossier syndrome.

2. Ulnar nerve tunnels

Guyon's syndrome (palm) - ulnar carpal tunnel syndrome, Guyon's bed syndrome, compression-ischemic neuropathy of the distal part of the ulnar nerve;

Cubital tunnel syndrome (elbow) - compression neuropathy of the ulnar nerve in the cubital tunnel, cubital tunnel syndrome, late ulnar-cubital traumatic palsy.

3. Radial nerve tunnels

Radial nerve compression syndrome (in the armpit area) - “crutch paralysis”

Radial nerve compression syndrome (at the level of the middle third of the shoulder) - spiral canal syndrome, “Saturday night paralysis”, “park bench”, “bench” syndrome

Radial nerve compression syndrome (in the subulnar region) - tennis elbow, supinator syndrome, Froese syndrome, Thomson-Kopell syndrome, tennis elbow syndrome, compression neuropathy of the deep (posterior) branch of the radial nerve in the subulnar region.

Tunnel syndromes account for 1/3 of diseases of the peripheral nervous system. There are descriptions of more than 30 forms of tunnel neuropathies in the literature.

Causes

The anatomical narrowness of the canal is, according to many authors, only a predisposing factor in the development of tunnel syndrome. In recent years, evidence has accumulated indicating that this anatomical feature is genetically determined. Another possible cause of the development of tunnel syndrome may be the presence of congenital developmental anomalies in the form of additional fibrous cords, muscles and tendons, and rudimentary bone spurs.

Some metabolic and endocrine diseases (diabetes mellitus, acromegaly, hypothyroidism), diseases of the joints, bone tissue and tendons (rheumatoid arthritis, rheumatism, gout), conditions accompanied by hormonal changes (pregnancy), space-occupying formations of the nerve itself (schwannoma, neuroma) contribute to the development of tunnel syndrome ) and outside the nerve (hemangioma, lipoma). The development of tunnel syndromes is facilitated by frequently repeated stereotypical movements and injuries. Therefore, the prevalence of carpal tunnel syndrome is significantly higher in representatives of certain professions (for example, stenographers have carpal tunnel syndrome 3 times more often).

Clinical manifestations

The most characteristic feature of carpal tunnel syndrome is pain . Usually pain appears during movement, then occurs at rest. The pain may wake the patient at night. Pain in tunnel syndromes is caused by inflammatory changes occurring in the zone of nerve-canal conflict and nerve damage. Tunnel syndromes are characterized by such manifestations of neuropathic pain as a sensation of electric current passing (electrical shooting), burning pain. In later stages, pain may be due to muscle spasm

Then movement disorders arise, manifesting themselves in the form of decreased strength and rapid fatigue. In some cases, the development of the disease leads to atrophy and the development of contractures (“clawed paw”, “monkey paw”).

When arteries and veins are compressed, paleness occurs, a decrease in local temperature, or the appearance of cyanosis and swelling in the affected area.

Diagnostics

In some cases, it is necessary to conduct electroneuromyography (the speed of impulses along the nerve) to clarify the level of nerve damage. tunnel syndrome. Using ultrasound, thermal imaging, MRI, nerve damage, space-occupying formations or other pathological changes can be determined.

Principles of treatment

Stop exposure to the pathogenic factor. Immobilization with the help of orthoses, bandages, splints, allowing to achieve immobilization specifically in the area of ​​damage.

Change the usual locomotor stereotype and lifestyle. Tunnel syndromes are often the result not only of monotonous activity, but also of ergonomic disorders (improper posture, awkward position of the limb during work). Training in special exercises and physical therapy are an important component of the treatment of tunnel neuropathies at the final stage of therapy.

Pain therapy

Anti-inflammatory therapy

Traditionally, for carpal tunnel syndromes, NSAIDs with a more pronounced analgesic and anti-inflammatory effect (diclofenac, ibuprofen) are used. For moderate or severe pain, it is advisable to use the drug Zaldiar (a combination of low doses of the opioid analgesic tramadol (37.5 mg) and the analgesic/antipyretic paracetamol (325 mg). Thanks to this combination, a multiple increase in the general analgesic effect is achieved with a lower risk of side effects.

Impact on the neuropathic component of pain. When pain is the result of neuropathic changes, it is necessary to prescribe drugs recommended for the treatment of neuropathic pain: anticonvulsants (pregabalin, gabapentin), antidepressants (venlafaxine, duloxetine), plates with 5% lidocaine "Versatis". Injections of anesthetic + hormones. An effective and acceptable treatment method for most types of tunnel neuropathies is a blockade with the introduction of novocaine and a hormone (hydrocortisone) into the pinched area.

Other methods of pain relief. An effective way to reduce pain and inflammation is electrophoresis, phonophoresis with dimexide and other anesthetics. They can be carried out in a clinic setting.

Symptomatic treatment. For tunnel syndromes, decongestants, antioxidants, muscle relaxants, and drugs that improve trophism and nerve functioning (ipidacrine, vitamins) are also used.

Surgical intervention. Surgical treatment is resorted to when other methods of helping the patient are ineffective. Surgical intervention consists of releasing the nerve from compression, “reconstructing the tunnel.”

According to statistics, the effectiveness of surgical and conservative treatment does not differ significantly a year later (after the start of treatment or surgery). Therefore, after a successful surgical operation, it is important to remember about other measures that must be followed to achieve a full recovery: changing locomotor stereotypes, using devices that protect from stress (orthoses, splints, bandages), performing special exercises.

Carpal tunnel syndrome

Carpal tunnel syndrome, or carpal tunnel syndrome, is a common form of compression-ischemic neuropathy. In the population, carpal tunnel syndrome occurs in 3% of women and 2% of men. It is caused by compression of the median nerve where it passes through the carpal tunnel under the transverse carpal ligament. The exact cause of carpal tunnel syndrome is not known. The following factors contribute to compression of the median nerve in the wrist area:

1. Trauma (accompanied by local swelling, tendon sprain).

2. Chronic microtraumatization, often found in construction workers, microtrauma associated with frequent repeated movements (in typists, with constant long-term work with a computer).

3. Diseases and conditions with metabolic disorders, edema, tendon and bone deformities (rheumatoid arthritis, diabetes mellitus, hypothyroidism, acromegaly, amyloidosis, pregnancy).

4. Volumetric formations of the median nerve itself (neurofibroma, schwannoma) or outside it in the wrist area (hemangioma, lipoma).

Clinical manifestations

Carpal tunnel syndrome is manifested by pain, numbness, goosebumps and weakness in the arm and hand. Pain and numbness extend to the palmar surface of the thumb, index, middle and ring fingers, as well as to the dorsum of the index and middle fingers. The following tests are used to clarify the diagnosis of carpal tunnel syndrome.

Tinel test

Tapping the wrist (above the median nerve passage) with a neurological hammer causes a tingling sensation in the fingers or pain radiating (electrical shooting) to the fingers; pain may be felt in the area of ​​the tap. Tinel's sign is found in 26-73% of patients with carpal tunnel syndrome.

Durkan test

Compression of the wrist in the area of ​​the median nerve causes numbness and/or pain in the I-III, half of the IV fingers.

Phalen test

Flexing or extending the wrist 90 degrees causes numbness, tingling or pain in less than 60 seconds. A healthy person may develop similar sensations, but not earlier than after 1 minute.

Opposition test

With severe thenar weakness at a later stage, the patient is unable to connect the thumb and little finger, or the doctor can easily separate the patient's closed thumb and little finger.

Differential diagnosis

Carpal tunnel syndrome must be differentiated from arthritis of the carpo-metacarpal joint of the thumb, cervical radiculopathy, and diabetic polyneuropathy.

Treatment

In mild cases of carpal tunnel syndrome, ice compresses and a decrease in load can help. If these measures do not help, the following is necessary:

1. Wrist immobilization. using a splint or orthosis. Immobilization should be carried out at least overnight, and preferably for 24 hours a day in the acute period.
2. Drugs from the NSAID group are effective if the inflammatory process dominates in the pain mechanism.
3. If the use of NSAIDs is ineffective, it is advisable to inject novocaine with hydrocortisone into the wrist area.
4. Electrophoresis with anesthetics and corticosteroids.
5. Surgery. For mild or moderate carpal tunnel syndrome, conservative treatment is more effective. When all means of conservative care have been exhausted, surgical treatment is resorted to, which consists of partial or complete resection of the transverse ligament and release of the median nerve from compression. Endoscopic surgical methods are used.

Pronator teres syndrome (Seyfarth syndrome)

This is an entrapment of the median nerve in the proximal part of the forearm between the pronator teres bundles. It usually begins to manifest itself after significant muscle load for many hours with the participation of the pronator and flexor digitorum muscles. Similar types of activities are often found among musicians (pianists, violinists, flutists, and especially often among guitarists), dentists, and athletes.

Long-term tissue compression is of great importance in the development of pronator teres syndrome. This can happen, for example, during deep sleep when the newlywed’s head is positioned for a long time on the partner’s forearm or shoulder. In this case, the median nerve in the pronator snuffbox is compressed, or the radial nerve is compressed in the spiral canal when the partner’s head is located on the outer surface of the shoulder (see radial nerve compression syndrome at the level of the middle third of the shoulder). In this regard, to designate this syndrome, the terms honeymoon palsy, newlyweds' paralysis, and lover's palsy have been adopted. Pronator teres syndrome sometimes occurs in nursing mothers. In them, compression of the nerve in the pronator teres region occurs when the child’s head lies on the forearm for a long time.

Clinical manifestations

With the development of pronator teres syndrome, pain and burning occurs 4-5 cm below the elbow joint, along the anterior surface of the forearm, and pain radiates to the I-III, half of the IV fingers and palm.

Tinel syndrome

In case of pronator teres syndrome, Tinel's sign will be positive when tapping with a neurological hammer in the area of ​​the pronator snuff box (on the inside of the forearm).

Pronator-flexor test

Pronating the forearm with a tightly clenched fist while creating resistance to this movement (counteraction) leads to increased pain. Increased pain can also be observed when writing (prototype of this test).

When studying sensitivity, a violation of sensitivity is revealed on the palmar surface of the first three and a half fingers and palm. Thenar atrophy in pronatar teres syndrome is usually not as severe as in progressive carpal tunnel syndromes.

Suprocondylar process syndrome of the shoulder (Strother's band syndrome, Coulomb, Lord and Bedosier syndrome)

In the population, in 0.5-1% of cases, a variant of the development of the humerus is observed, when a “spur” or supracondylar process (apophysis) is found on its distal anteromedial surface, the median nerve is displaced and stretched, which makes it vulnerable to damage.

This tunnel syndrome was described in 1963 by Coulomb, Lord and Bedossier and has almost complete similarities with the clinical manifestations of pronator teres syndrome: pain, paresthesia, and decreased flexion strength of the hand and fingers are detected in the area of ​​innervation of the median nerve. In contrast to pronator teres syndrome, when the median nerve is damaged under Strather's ligament, mechanical compression of the brachial artery with corresponding vascular disorders is possible, as well as severe weakness of the pronator teres and minor pronators.

In the diagnosis of suprocondylar process syndrome, the following test is performed: when extending the forearm and pronation in combination with formed flexion of the fingers, painful sensations are provoked with a localization characteristic of compression of the median nerve. X-ray examination is indicated.

Treatment involves resection of the supracondylar process (“spur”) of the humerus and ligament.

Cubital tunnel syndrome

Cubital tunnel syndrome is compression of the ulnar nerve in the cubital tunnel at the elbow joint between the medial epicondyle of the humerus and the ulna. It ranks second in frequency of occurrence after carpal tunnel syndrome.

Cubital tunnel syndrome can be caused by frequently repeated flexion of the elbow joint, i.e. the disorder may occur with normal, frequently repeated movements in the absence of obvious traumatic injury. Relying on your elbow while sitting may contribute to the development of cubital tunnel syndrome. Patients with diabetes and alcoholism are at greater risk of developing cubital tunnel syndrome.

Clinical manifestations

Manifested by pain, numbness and/or tingling. Pain and paresthesia are felt in the lateral part of the shoulder and radiate to the little finger and half of the fourth finger. Another sign of the disease is weakness in the arm. For example, it becomes difficult for a person to pour water from a kettle. Subsequently, the hand on the sore arm begins to lose weight and muscle atrophy appears.

Diagnostics

In the early stages of the disease, the only manifestation other than weakness of the forearm muscles may be loss of sensation on the ulnar side of the little finger. The following tests can help verify the diagnosis of Cubital Tunnel Syndrome.

Tinel test

The occurrence of pain in the lateral part of the shoulder, radiating to the ring finger and little finger when tapping with a hammer over the area where the nerve passes in the area of ​​the medial epicondyle.

Equivalent of Phalen's sign

Sudden bending of the elbow will cause paresthesia in the ring and little fingers.

Frohman's test

Due to weakness of the abductor policis brevis and flexor policis brevis, there will be excessive flexion at the interphalangeal joint of the thumb on the affected hand in response to a request to hold a paper between the thumb and index finger.

Wartenberg test

When you put your hand in your pocket, the little finger is moved to the side and does not go into the pocket.

Treatment

It is recommended to fix the elbow joint in an extension position at night using orthoses, hold the car steering wheel with your arms straightened at the elbows, and straighten the elbow when using a computer mouse. In the absence of a positive effect from the use of traditional means: NSAIDs, COX-2 inhibitors, splinting did not have a positive effect within 1 week, an injection of an anesthetic with hydrocortisone is recommended.

If the effect of these measures is insufficient, surgery is performed. All techniques for surgical release of the nerve involve moving the nerve anterior to the internal epicondyle. After the operation, treatment is prescribed to quickly restore nerve conduction.

Guyon's tunnel syndrome

It develops due to compression of the deep branch of the ulnar nerve in the canal formed by the pisiform bone, the hook of the hamate bone, the palmar metacarpal ligament and the palmaris brevis muscle. There are burning pains and sensitivity disorders in the IV-V fingers, difficulty in pinching movements, adduction and extension of the fingers.

The syndrome is very often the result of prolonged pressure from working tools (vibrating tools, screwdrivers, pliers), and is more common among gardeners, leather cutters, tailors, violinists, and people who work with jackhammers. May sometimes develop after using a cane or crutch. Enlarged lymph nodes, fractures, arthrosis, arthritis, ulnar artery aneurysm, tumors and anatomical formations around Guyon’s canal can also cause compression.

Differential diagnosis

In the hand, pain occurs in the hypothenar region and the base of the hand, as well as intensification and irradiation in the distal direction during provoking tests. Sensitivity disorders in this case occupy only the palmar surface of the IV-V fingers. On the back of the hand, sensitivity is not impaired.

Differential diagnosis is made with radicular syndrome (C8). Paresthesia and sensitivity disorders can also appear along the ulnar edge of the hand. Paresis and hypotrophy of the hypothenar muscles are possible. But with C8 radicular syndrome, the zone of sensory disorders is much larger than with Guyon’s canal, and there is no wasting or paresis of the interosseous muscles. With bilateral nerve damage, ALS is sometimes misdiagnosed.

Treatment

If diagnosed early, restricting activity may help. It is recommended to use fixators: orthoses, splints at night or during the day to reduce trauma.

If conservative measures fail, surgical treatment is performed to reconstruct the canal in order to release the nerve from compression.

Radial nerve compression syndrome

There are 3 options for compression lesions of the radial nerve:

1. Compression in the armpit area. Occurs due to the use of a crutch, paralysis of the extensors of the forearm, hand, main phalanges of the fingers, abductor pollicis muscle, and supinator occurs. The flexion of the forearm is weakened, the reflex from the triceps muscle fades. Sensitivity disappears on the dorsal surface of the shoulder, forearm, partly the hand and fingers.
2. Compression at the level of the middle third of the shoulder ("Saturday night paralysis", "park bench", "bench" syndrome). Occurs more often. But most often, compression occurs due to compression of the nerve on the outer back surface of the shoulder during deep sleep (often after drinking alcohol). Nerve compression can be caused by the partner's head lying on the outer surface of the shoulder.
3. Compressive neuropathy of the deep (posterior) branch of the radial nerve in the subulnar region (supinator syndrome, Froese syndrome, Thomson-Kopell syndrome, tennis elbow syndrome).

This is a chronic disease caused by a degenerative process in the area of ​​muscle attachment to the lateral epicondyle of the humerus. It manifests itself as pain in the extensor muscles of the forearm, their weakness and hypotrophy.

Treatment includes general etiotropic and local therapy. There is a possible connection between tunnel syndrome and rheumatism, brucellosis, arthrosis of metabolic origin, and hormonal disorders. Anesthetics and glucocorticoids are injected locally into the area of ​​the pinched nerve. Physiotherapy is carried out, the prescription of vasoactive, decongestant and nootropic drugs, antihypoxants and antioxidants, muscle relaxants, ganglion blockers, etc. Surgical decompression with dissection of the tissues compressing the nerve is carried out if conservative treatment is unsuccessful.

Literature

1. Al-Zamil M.H. Carpal syndrome. Clinical neurology, 2008, No. 1, pp. 41-45
2. Berzins Yu.E., Dumbere R.T. Tunnel lesions of the nerves of the upper limb. Riga: Zinatne, 1989, p.212.
3. Zhulev N.M. Neuropathies: a guide for doctors. - St. Petersburg: Publishing house SpBmapo, 2005, p.416
4. Levin O.S. "Polyneuropathy", MIA, 2005
5. Atroshi I., Larsson GU, Ornstein E., Hofer M., Johnsson R., Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomized controlled trial. BMJ., Jun 24 2006; 332(7556):1473.
6. Graham RG, Hudson DA, Solomons M. A prospective study to assess the outcome of steroid injections and wrist splinting for the treatment of carpal tunnel syndrome. Plast Reconstr Surg., Feb 2004; 113(2):550-6.
7. Horch RE, Allmann KH, Laubenberger J., et al. Median nerve compression can be detected by magnetic resonance imaging of the carpal tunnel. Neurosurgery, Jul 1997; 41(1):76-82; discussion 82-3.
8. Golubev V.L., Merkulova D.M., Orlova O.R., Danilov A.B., Department of Nervous Diseases of the I.M. Sechenov Faculty of Physics and Postgraduate Medical Academy

Symptoms, diagnosis

The main manifestations of carpal tunnel syndrome are associated with nerve entrapment. The median nerve innervates 2–3 fingers, half of 4 fingers and most of 1 finger. Accordingly, all symptoms manifest themselves in the innervation zone. Patients complain of a feeling of numbness, pain, and tingling in the indicated fingers. There may be moderate swelling (or the sensation of such). Symptoms are more severe at night or in the morning. Patients have to periodically shake their hands at night, which leads to a reduction in pain. As carpal tunnel syndrome progresses, pain can spread up the arm and, in severe cases, even reach the neck.

There are several diagnostic tests that help in making a diagnosis.

Tinel's symptom - tapping with a hammer or finger on the skin in the projection of the carpal tunnel causes pain and tingling in the fingers. A variation of Tinel's symptom - with moderate pressure from the researcher's finger in the projection of the carpal tunnel for more than 1 minute, pain and paresthesia appear in the fingers innervated by the median nerve.

Characteristic symptoms are pain when touching the tip of the thumb to the pads of other fingers. Difficulty in finger movements (inability to fasten a button, etc.).

The little finger is never affected by carpal tunnel syndrome.

According to indications, additional studies may be prescribed - radiography, test for the speed of impulses along the nerve, etc.

In some cases, bilateral carpal tunnel syndrome occurs.

Treatment

Conservative treatment

Carpal tunnel syndrome should be treated in the early stages of the disease. The earlier treatment is started, the greater the chance of using conservative measures, the less likely it is that carpal tunnel syndrome will progress. Treatment includes oral anti-inflammatory drugs (Voltaren, Movalis), local application of ointments (Indovazin-gel). Medicines that improve nerve nutrition (milgamma, nicotinic acid) are also prescribed.

Blockades with diprospan have a good effect - the drug mixed with an anesthetic is injected directly into the carpal canal, which leads to a decrease in swelling and inflammation - the pressure on the nerve decreases, and improvement occurs.

Physiotherapy and kinesiotaping may be included in complex therapy.

In any case, you need to avoid any load on the hand. Persons engaged in work involving local vibration are recommended to change their profession.

If there are concomitant diseases that contribute to the occurrence of carpal tunnel syndrome (rheumatoid arthritis, diabetes mellitus, etc.), they need to be adequately treated by appropriate specialists. Timely and competent therapy in the treatment of carpal tunnel syndrome can avoid surgical intervention and slow down the progression of the disease for a long time.

Useful exercises

It is important to remember that symptoms of such an unpleasant disease as hand tunnel syndrome occur in every second person who spends a long time at the computer. Therefore, even if you sit at the computer all day long and do not yet notice a single sign of the development of carpal tunnel syndrome, to prevent it, it is worth doing simple exercises from time to time to help restore blood circulation in the hand. Repeat them every two to three hours, ten times.

• Forcefully clench your fingers into a fist, then unclench.
• Clench your fists and rotate your hands, first in one direction, then in the other.
• Press your palms together (“prayer position”), spread your elbows to the sides; slowly and smoothly lower your palms as low as possible, and then return to the starting position.
• Connect the tips of the thumb and index finger ("ok" gesture), then the thumb and middle finger, the thumb and ring finger, the thumb and little finger.
• Shake your hands as if trying to shake off droplets of water.

These exercises work well both as a preventive measure and in cases where carpal tunnel syndrome has already made itself felt.

Carpal tunnel syndrome surgery

If conservative therapy is ineffective, as well as in advanced cases, patients may be advised to undergo surgery. During this intervention, the ligament that compresses the median nerve is dissected.

After the operation, pain is significantly reduced immediately, but complete rehabilitation occurs after a few months.

In our clinic we provide conservative treatment of carpal tunnel syndrome - it is possible to perform blockades and kinesio taping. As a rule, after 1 – 2 blockades, the patient’s condition improves significantly – pain, numbness disappear, and movements are restored.