What is carpal tunnel syndrome, treatment of it

The modern world can not exist without new technologies. The computer and the Internet have become everyday satellites of almost every person from small to large. Much of the time we spend with you at the computer: someone on duty, and someone as a leisure. Regardless of the reason, when using this device we use a computer mouse for convenience. It would seem that a very convenient and harmless invention. But it was not there. Regular use of the mouse can cause pain and numbness, as well as weakness in the hand. Fingers become disobedient, can not keep objects and hurt at night. These symptoms are caused by the appearance of carpal tunnel syndrome. This is the so-called pathological result of using a computer mouse.

This condition occurs not only when working at a computer, but also as a result of a number of other reasons. Until the age of computer technology carpal tunnel syndrome has arisen, mainly in people engaged in production with intensive use of brushes (frequent flexion and extension). Similar symptoms can also appear in pregnancy, somatic diseases. From this article you can find out what the carpal tunnel syndrome is, when it develops, than it shows how to deal with it, and also what measures can be taken to prevent its occurrence.

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Content

1The canal is what?
2Causes of compression of the median nerve in the canal
3Clinical manifestations of carpal tunnel syndrome
4Diagnostics
5Treatment
6Prevention

The canal is what?

Carpal tunnel syndrome, or carpal tunnel syndrome, is a pathology of the peripheral nervous system. It is based on the compression of the median nerve in the region of a specific anatomical canal in the wrist (a kind of tunnel), from which the name of the disease originated.

The wrist canal is located in the area of the joint of the forearm and the hand from the palmar side. Its walls are formed by the bones of the forearm (radial and ulnar) on one side, the 8th small bones of the wrists on the other, between which a transverse ligament of the wrist is tossed. Inside this peculiar tunnel are located the median nerve and tendons of the muscles of the hand. The size and shape of the canal, the thickness of the transverse ligament of the wrist are initially different for each person. Those people who have a narrow canal and a ligamentous bunch have an increased risk of carpal tunnel syndrome. There is an interesting regularity: Carpal tunnel syndrome practically does not occur in representatives of the Negroid race. This disease mainly affects Europeans. It is possible that the dark-skinned representatives of mankind have initially a fairly wide channel, so they do not infringe on the median nerve in this area.

That part of the median nerve that passes directly through the canal delivers a sensible innervation of the palmar surface of the first three fingers of the hand and half of the ring finger (side, directed to the thumb), as well as the motor innervation of the muscles that support the movement of the thumb (withdrawal and contrasting it with respect to the palm and other fingers of the hand). The compression of the median nerve in the canal region leads to a change in sensitivity in these regions and a decrease in muscle strength, which is the basis of clinical manifestations of carpal tunnel syndrome.

Causes of compression of the median nerve in the canal

Normally, the median nerve feels relatively free in the carpal tunnel. However, some conditions can cause a change in the lumen of the canal, thereby provoking the compression of the nerve and tendons located in it. The narrowing of the lumen of the canal occurs as a result of the edema of the muscles of the hand and the shells of the tendons, a violation of the blood supply to the muscles. These changes occur when:

a large number of monotonous movements of flexion-extension of the hand in the course of professional activity, including with the impact vibration (typists, milkmaids, dentists, seamstresses, pianists, equipment collectors, carvers, carpenters, masons, miners and so on). Subcooling of the hand plays an additional role;
prolonged stay of the brush in the position of excessive flexion or extension. Most often, this occurs when you work at a computer using a mouse with an incorrect posture. Bending the brush more than 20 ° relative to the forearm, when a person uses a computer mouse, leads to the development of carpal tunnel syndrome. In order to ensure the presence of the brush on one straight line with the forearm, it is necessary to use a special rug-stand on the wheels. The mat provides the correct position of the hand when working with a computer mouse;
traumatic injuries in the wrist (fractures, dislocations);
pregnancy (due to propensity to edema);
taking hormonal contraceptives (which is also the cause of the formation of swelling in the area of the carpal tunnel);
other diseases of the body and pathological conditions that lead to swelling or a decrease in the lumen of the canal. These are diabetes mellitus, rheumatoid arthritis, hypothyroidism (decreased thyroid function), amyloidosis, acromegaly, menopause, gout, kidney failure, overweight.

It can not be said that all these conditions will necessarily provoke the development of carpal tunnel syndrome. They increase the risk of its development, serve as a push, a prerequisite for its occurrence, but no more.

Clinical manifestations of carpal tunnel syndrome

Disease is more susceptible to the female sex. According to statistics, women suffer from this disease 10 times more often than men. Most often carpal tunnel syndrome develops at the age of 40-60 years, when the ability of the tissues to bear the load decreases, hormonal restructuring of the organism develops.

Symptoms appear gradually, gradually gaining momentum. The main signs of carpal tunnel syndrome are:

numbness of the first three fingers of the hand (sometimes half of the ring finger), appearing in the morning and with some brush movements. If the patient often holds on to the top rail in public transport, drives the car from fixing the hands on the handlebar, holds the phone in the hand when talking - all this provokes numbness and makes you change your pose, move the phone to another hand and so on. If the profession requires constant brush movements, it also provokes numbness;
paresthesia - unpleasant sensations in the palm and the first three fingers. It can be a tingling, a feeling of crawling, a burning sensation;
pain in the area of 3-4 fingers of the hand (except the little finger), palms, wrists, giving to the forearm, elbow joint. Fingers hurt entirely, and not only in the area of the joints (as with other diseases). Pain has a burning color. As the disease progresses, pain along with numbness begins to disturb the patient at night, preventing sleep. Patients rub, shake hands, lower them down from the bed, which somewhat facilitates the state (in the course of these actions, the blood flow improves somewhat);
awkwardness of fingers and hands. Initially, this symptom is associated with a violation of the sensory innervation of the fingers of the median nerve. Items fall out of hands, fingers do not obey, become wadded, rigid. It is difficult to hold the pen and write, print on the keyboard (fingers do not fall on the right keys). Later such clumsiness also exists due to weakness in individual muscles of the hand;
objective decrease in sensitivity in the innervation zone of the median nerve (all the same first 3.5 fingers and palm site) - hypesthesia. A feeling of light touch (cotton fleece or feather) is lost, the difference between sharp and blunt touch. With the prolonged existence of compression of the median nerve, gross disturbances of sensitivity develop, sensations do not arise even from injections;
when the vegetative fibers that form part of the median nerve are affected, trophic disorders develop. This manifests itself in a change in the temperature of the affected hand (more often it becomes cold to the touch), a change in color (more often develops blanching), sweating disorder (increase or decrease), thickening of the skin on the palm, clouding of the nails. A decrease in the temperature of the environment is accompanied by a blanching and cooling of the affected hand;
weakness of the muscles that exercise the thumb movements. Suffer is mainly the withdrawal and opposition of the thumb. The patient can not grasp the object with a brush (for example, it is impossible to hold the bottle, the glass in the hand due to their specific shape). If the compression of the median nerve exists for a fairly long time, it is even possible that hypotrophy (thinning) muscles of the elevation of the thumb (part of the palm directly adjacent to the first finger).

Depending on the cause of the carpal tunnel syndrome, the localization of the changes may be one-sided or two-sided. If the prerequisite is working with a computer mouse, then only the working hand will suffer. If the narrowing of the canal is caused by pregnancy or some other disease, then, most likely, the involvement of both extremities in the process. As a rule, the prevailing limb (right-handed in right-handers and left-handed in left-handers) suffers more.

Despite the fact that carpal tunnel syndrome does not pose a threat to human life, its occurrence, however, makes a person incapacitated. And the impossibility to carry out labor activity can last for several months. Of course, timely access to medical care and timely diagnosed with subsequent appropriate therapy lead to recovery. The prolonged existence of the disease without adequate treatment can permanently disrupt the functioning of the hand and fingers.

Diagnostics

Carpal tunnel syndrome is a disease where the diagnosis can be made directly when you first seek medical help. Carefully collected complaints, neurologic examination and a number of some symptom-provoking tests help the doctor not to make a mistake. What tests are conducted during the examination? They are quite simple, and do not require any specific equipment. It:

test, or Tinnel's symptom. Its essence is as follows: effleurage (easy tapping) at the level of the fold of the skin in the area of the wrist joint causes pain and paresthesia in the area the first 3 fingers (, , to be more precise), the palms with the extension to the forearm (that is, in those places where these feelings disturb the patient outside the effleurage);
the Falen test. To perform this test, it is necessary to bend the brush in the radiocarpal joint at a right angle and hold it in this position for 1-2 minutes. This situation provokes the onset of numbness, paresthesias and pain in the area of fingers and hands;
turnstile test. The shoulder of the affected hand is squeezed by the cuff of the tonometer until the pulse disappears and is held in this position for 1 minute. As a result, typical symptoms of carpal tunnel syndrome appear;
postural provocation - lifting of the straightened arms above the head and holding in this position for 1 minute. The result is the same as for other tests.

If any doubts about the correctness of the diagnosis still remain, then the patient is assigned an additional method of investigation - electroneuromyography. This method allows you to confirm the violation of the function of the median nerve and clarify the place of its defeat, as well as distinguish the syndrome carpal canal from other diseases of the peripheral nervous system (including osteochondrosis of the spine).

All of the foregoing is eligible only in relation to carpal tunnel syndrome, that is, to clarify precisely this diagnosis. If the syndrome itself is the result of some other disease (diabetes, arthritis, and so on), then other additional research methods may be needed.

Treatment

Successful treatment of carpal tunnel syndrome requires consideration of the cause of the disease. If this is a professional activity, then it is necessary to stop it for the duration of treatment. If the reason lies in the presence of another disease, then it must be treated along with carpal tunnel syndrome, otherwise recovery will not occur.

Correct treatment of carpal tunnel syndrome is always complex. The use of drug and non-pharmacological methods together with some manipulations in the canal zone almost always gives a positive result, and the disease recedes.

From non-medicamentous measures apply:

acupuncture;
compresses with dimexid and anesthetic, non-steroidal anti-inflammatory drugs (Diclofenac);
putting ice cubes for several minutes 1-2 times a day (contributes to reducing edema in the canal zone).

From medicinal preparations use:

non-steroidal anti-inflammatory drugs (Diclofenac, Nimesulide, Ibuprofen, Meloxicam and their analogs). The drugs relieve pain, reduce inflammation and swelling in the carpal tunnel;
diuretics (Furosemide, Lasix, Diakarb). Their use gives a therapeutic effect due to a reduction in edematous tissue;
funds that improve blood flow, and hence, nutrition of the median nerve (Pentoxifylline, Nicotinic acid, Vinpocetine, Nicergoline and others);
vitamins of group B (Kombilipen, Milgamma, Neurovitan, Neurorubin and others).

If these measures are insufficient, then they resort to injection into the carpal tunnel of glucocorticoids with anesthetics (Hydrocortisone or Diprospan with Novocain or Lidocaine). Manipulation is carried out by a special needle in a certain place. Usually even a single injection is enough to cause carpal tunnel syndrome to decrease dramatically. And two or three manipulations, conducted with an interval of several weeks, allow you to completely get rid of the disease.

If the introduction of a hormone with an anesthetic did not give a positive result, and the diagnosis is established correctly, there is only one way out - surgical treatment.

Surgical treatment of carpal tunnel syndrome consists in dissection of the transverse ligament of the wrist. The operation is performed under local anesthesia. In the wrist area, a skin incision of 5 cm in length is made, and then a ligament is cut and the median nerve is released. Endoscopic surgical treatment is also possible. In this case, two cuts of 1-1.5 cm are made and, using a special tube, a tool is applied to the bundle by means of which the bundle is dissected. The scar in the case of endoscopic surgery is less, and not so painful. However, for a complete disappearance of the symptoms of carpal tunnel syndrome after surgery, some time must pass (sometimes several months). During this entire period the patient is given physiotherapeutic procedures aimed at restoring the median nerve, and also therapeutic exercise is prescribed.

Sometimes carpal tunnel syndrome does not heal completely even after surgical treatment. This occurs in cases where the nerve is irreversibly damaged (the compression was too long and strong). In such cases, part of the symptoms remains with the patient forever.

Prevention

If your professional activity is connected with working at a computer, then there are a number of recommendations, the implementation of which avoids the appearance of carpal tunnel syndrome:

correct working posture (right angle between hips and lower back, between shoulder and forearm. Brush and forearm should be on the same straight line. The brush should lie on the table, and not hang in the air. To support the forearm use a special stand on the wheels.);
periodic breaks in work (every 30-60 minutes for 5-10 minutes). During breaks it is necessary to do gymnastics for brushes: shake them, squeeze-unclench your fingers in a fist, massage the brushes, use an expander. This improves blood flow, reduces venous congestion, which serves as prevention of edema of tissues;
the ability to adjust the height of the table, monitor, armrests, resting on the back of the chair.

In addition, to date, there are computer mice in the form of a joystick, which significantly reduces the load on the carpal tunnel. This is somewhat unusual, but their introduction into office life can significantly reduce the risk of carpal tunnel syndrome.

As for other occupations, employment in which can lead to the development of carpal tunnel syndrome, it is necessary observe sanitary and hygienic and technical working conditions in order to avoid the occurrence of this disease. Breaks in work, absence of excess of indicators of vibration, the corresponding duration of working time without reprocessing, and similar measures serve to prevent the occurrence of carpal tunnel syndrome.

Thus, it becomes clear that carpal tunnel syndrome is not a dangerous but very unpleasant disease. It does not threaten life at all, but it gives a lot of inconvenience both at work and in everyday activities. Do not ignore the symptoms that you now know about. The key to successful treatment of this pathology is the timely application for medical care.

The neurologist M. M. Sperling (St. Novosibirsk) tells about what carpal tunnel syndrome is:

Wrist canal syndrome (pain in the arm, treatment)