Carpal tunnel syndrome is a set of symptoms that occur when the median nerve is compressed as it passes through the wrist. The median nerve originates from the brachial nerve, which divides closer to the forearm into the radial, ulnar and median.
The median nerve passes along the palmar surface of the wrist to the hand through the carpal tunnel. This canal is formed by the carpal bones and the transverse carpal ligament. The flexor tendons pass through it along with the median nerve.
Carpal tunnel syndrome refers to the so-called. tunnel syndromes - infringement of various anatomical structures in the bone-fibrous canals.
Causes
Carpal tunnel syndrome is a fairly common pathology. Its occurrence is caused by both the narrowness of the canal itself (congenital, acquired - scarring, etc.) and overload of the flexor tendons. Main reasons:
- Overuse (repetitive monotonous movements of the wrist)
- Trauma (after bruises and fractures, there may be deformation of the canal or compression of structures in it due to swelling)
- Some diseases (rheumatoid arthritis, Paget's syndrome, acromegaly, hormonal disorders, alcoholism, etc.)
- Professions associated with the impact of vibration on the hand (bulldozer operator, working with a jackhammer, etc.)
Causes of the disease
The cause of the disease can be a narrowing of the carpal tunnel of the wrist or an increase in tissue inside. When a wrist is fractured, the carpal tunnel may be affected by the bone.
The risk group also includes people performing professional duties related to:
- By applying effort;
- Uncomfortable wrist position;
- Vibrating instruments;
- Monotonous repetition of monotonous movements.
With a combination of risks, the likelihood of developing the disease increases.
The cause of the disease can be inflammation of the synovial membrane. As pressure increases, the nerve stops functioning normally.
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.
Carpal tunnel syndrome - how to reduce pain?
Class Clinic
Who is more susceptible to carpal tunnel syndrome - women or men, young or elderly? What professions are at risk? Which modern treatment methods are most effective? Tatyana Borisovna Avdeeva, a practicing neurologist at the Kaliningrad medical center Class Clinic, spoke about tunnel syndromes and the peculiarities of using local injections in their treatment.
What is carpal tunnel syndrome and how does it manifest?
Tunnel syndromes are a group of diseases that occur when nerves are compressed by bones, muscles and tendons. The most common symptoms are numbness in the area innervated by the compressed nerve and prolonged, intermittent pain. Often, tunnel syndrome is understood only as carpal tunnel syndrome (carpal syndrome), when compression of the median nerve occurs between the bones, tendons of the wrist and the transverse carpal ligament. This is not entirely true, since this is only a special case of the disease.
Is carpal tunnel syndrome really a disease of programmers and office workers, or is this opinion wrong?
Almost everyone is at risk, since there are a huge number of carpal tunnel syndromes, but carpal syndrome, which is talked about in this case, more often actually occurs from working at a computer. Meanwhile, it occurs no less often in athletes, drivers, milkmaids and representatives of any other professions where chronic injury in the wrist joint is possible.
In my practice, there was a case when carpal tunnel syndrome developed in a patient who, due to his occupation, constantly carried water in twenty-liter bottles and practically did not work at the keyboard. We can say that representatives of any profession where it is necessary to regularly repeat the same type of actions are at risk.
Is local injection therapy (blockades) used for this disease?
The main manifestations of carpal tunnel syndrome are pain and numbness, and in severe, advanced cases - paralysis and muscle atrophy. In this disease, the nerve is compressed in the canal, as a rule, this is caused by local tissue swelling due to chronic injury. With such mechanisms and symptoms, it is really effective to use local injection blockades as one of the methods of complex therapy.
In what cases is local injection therapy indicated for tunnel syndromes and what drugs are used?
Almost all, if there are no contraindications - concomitant infectious or oncological processes. In case of tunnel syndromes, blockades can be used not only as a symptomatic method of relieving intense pain, but also as a pathogenetic treatment, since by relieving swelling, we relieve nerves from compression. Thus, with the help of local injection therapy, we can influence the mechanism of disease development, while obtaining a long-term and fairly stable result.
Glucocorticosteroid hormonal drugs are also used, which, in combination with or without local anesthetics, lead to a reduction in edema and stop compression of the nerve. Nonsteroidal anti-inflammatory drugs may also be used. In such cases, we quickly get results; the effects of local injection therapy appear the very next day: pain disappears, sensitivity and normal mobility are later restored.
Is it possible to treat carpal tunnel syndrome solely with blockades?
It is difficult to guarantee complete recovery using only blockades. It is always necessary for the patient to participate in treatment, adherence to a certain work schedule, position of the affected limb, reduction of stress and other recommendations of the neurologist. Sometimes local injection therapy is used as an emergency method to restore performance. It can also be used as a method of minimally invasive pathogenetic treatment, but only in cases where the degree of pain of the process allows this. There are cases when it is impossible to cope with carpal tunnel syndrome other than surgery.
It should be remembered that the result (especially in the early stages of the development of this disease) largely depends on the implementation of the neurologist’s recommendations. Injection blockades will certainly bring relief. But without proper occupational hygiene, improvements will be temporary and the process of re-traumatization will again lead to deterioration. That is why you should not consider local injection therapy as a guaranteed method of getting rid of carpal tunnel syndrome. This disease must be treated comprehensively.
Make an appointment with Tatyana Borisovna Avdeeva on the website or by phone (4012) 33-44-55.
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.
Treatment Methods for Carpal Tunnel Syndrome
This disease should be treated comprehensively. The doctor decides which methods are suitable for a particular patient:
- Medication method. Anti-inflammatory drugs, such as Nurofen or Nimesil, can reduce pain. In more severe cases, local injections (directly into the wrist area) with corticosteroid drugs are possible. Vasoactive drugs may be prescribed to improve blood circulation.
- Fixation of the wrist joint. To do this, the patient should wear an orthosis on his arm during night sleep to fix the hand in a natural position, which avoids compression of the median nerve.
- Change of activity. As practice shows, if the patient stops loading the same arm muscles every day, the disease recedes. However, this is not always possible to do - changing your profession overnight is not easy.
- Shock wave therapy (SWT) . The essence of the therapy is the impact on the palm and wrist area with acoustic waves using a special device. This allows you to stimulate local blood circulation, eliminate pain and swelling, improve tissue metabolism, and start recovery processes. UVT is prescribed in courses, their number is determined by the doctor. To achieve the effect, at least five procedures are required. This method is successfully used in Health Plus clinics.
- Surgical intervention. If the methods described above do not produce results within six months, surgical intervention is resorted to. As a rule, this method is also used in case of detection of an already advanced form of the disease. During the operation, the carpal ligament (transverse carpal ligament) is cut, thereby decompressing the median nerve.
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.
What happens when a nerve is compressed?
The blood supply to the outer sheath of the nerve slows down and blood stops flowing. This condition is called ischemia. At first, the outer shell of the nerve is affected, but as pressure increases, its inner part becomes thicker, as new cells - fibroblasts and scar tissue - are formed.
As a result, the patient feels pain and the hand becomes numb. When the pressure normalizes, the symptoms quickly subside. In the absence of timely treatment, the chances of recovery are reduced or lost.
Diagnostics
The diagnosis can be made by interviewing and examining the patient based on characteristic areas of numbness and pain symptoms. A characteristic indicator is night pain and numbness of the hand.
Important information for diagnosis is the absence of damage to the little finger. To check, the patient is recommended to pinch his little finger.
The next group of complaints is numbness during certain activities - driving a car or sweeping.
If symptoms occur after injury, an x-ray is taken to rule out a fracture.
To obtain additional data, ultrasound and electrical stimulation are prescribed, with the help of which the performance of the nerves of the hand and the speed of passage of impulses through the nerve are checked.
It is important to exclude other types of problems that provoke an increase in symptoms - pain in the shoulder, elbow or neck, hernia of the cervical spine.