In the human body - a large number of nerves, they are responsible for the movement of the legs, arms and other functions. So, for example, in a person’s hand there are three main ones: radial, median, ulnar nerves. Compression or injury to the median nerve, or any other, can lead to serious problems with hand movements. It is about him that we will talk today, learn about his functions, location, main pathologies.
Anatomy
The median nerve is one of the largest nerves in the brachial plexus. It originates from the bundles of the brachial plexus, or rather, from the lateral and medial. In the shoulder region, it is conveniently located in the groove of the biceps muscle among all the other nerves. Then it descends along the front of the arm through the hole in the elbow to the forearm, where it is very conveniently located between the flexors of the fingers - deep and superficial. Further, it passes into the lower section along the median sulcus and already through the carpal tunnel enters the palm. In the area of the palmar aponeurosis, it divides into three terminal branches, which further create seven separate digital nerves.
The median nerve in the forearm innervates not onlytwo of the pronators, but all of the flexors. The exceptions are the ulnar flexor of the wrist and half of the deep flexor, which is responsible for the motor function of the fingers. As for the hand, here it is responsible for the muscles of the thumb and both worms, the middle of the palm and palmar side of I-III and half of the IV fingers.
Nerve function
Each of the nerves in the human body is responsible for certain functions. So, the median nerve provides flexion and extension of three fingers on the hand: thumb, index and middle. In addition, it is responsible for opposition of the thumb and pronation of the forearm.
Muscle atrophy in case of injury is most often expressed in the tenor area. As a result of this, a flattening of the palm occurs, and the adduction of the thumb makes the hand very similar to a monkey's paw. To independently identify damage to this nerve, it will be enough to detect anesthesia of the terminal phalanges of two of the fingers - the index and middle.
Very often, patients turn to the doctor with complaints that several fingers on their hand do not obey. They feel discomfort in the hand and have median nerve neuropathy or neuritis and nerve damage. But what are these pathologies, what causes and symptoms do they have?
Media nerve injury
Nerve damage is a fairly common pathology, which is caused by a complete or partial interruption of the nerve trunk. Closed injuries can occur due to compression of soft tissues by a foreignan object, for example, if a person was under a blockage, when struck with a blunt object. Tumors, bone fragments during a fracture can also injure the nerve. Open injuries can happen if a person cuts himself or receives a gunshot wound to the arm.
Nerve tissue regenerates very poorly, and with this kind of damage in the distal part of the nerve, Wallerian degeneration can develop very quickly - this is a process during which the nervous tissue is resorbed, and it is replaced by scar connective tissue. That is why no one can guarantee that the outcome of treatment will be favorable, in the end the patient gets a disability.
Nerve damage: classes
The median nerve of the hand, depending on how damaged it is, can provoke several pathologies:
- Concussion. In this case, morphological and anatomical disorders were not observed. Sensitivity and movement functions return as early as 15 minutes after injury.
- Bruised. This condition is due to the fact that the anatomical continuity of the nerve trunk is preserved, but the epineural membranes are torn, and blood enters the nerve. With such damage, motor function is restored only after a month.
- Compression. With this pathology, the severity of disorders is observed, and it depends on the severity and duration of compression, minor violations can be observed, but there are also serious cases that require only the intervention of a surgeon.
- Partial damage manifests itself in the form of loss of individual functions. In this case, the functions are not restored on their own, only an operation is needed.
- Complete break - in this condition, the nerve is stratified into two separate ends - peripheral and central. If serious measures are not taken, then in this case the middle fragment is replaced by a small part of the scar tissue. Functions will not recover on their own, muscle atrophy will increase every day, further trophic disorders are observed. In this case, only surgery can help, but it also does not always give the desired results.
Neuropathy or neuritis of the median nerve can be diagnosed at an early stage, and if appropriate measures are taken, this pathology can be cured without any consequences.
Causes of neuropathy
Many people in the world face such a problem as hand neuropathy. Very often it is associated with fatigue, lack of sleep, and if you have a good rest, sleep, then everything will pass, but in reality everything is not at all like that.
Usually mononeuropathy - damage to one of the nerve fibers, most often develops due to the fact that the nerve is compressed in the place where it passes superficially under the skin itself or in the narrow channels of the bone. There can be several causes of neuropathy:
- surgical intervention, in the place where the operation was performed, over time, the blood ceases to circulate correctly, which ultimately leads to swelling and muscle atrophy, andalso to the fact that the nerves are squeezed;
- injury to the hand, during which swelling developed, leading to compression of the nerve;
- frequent hypothermia;
- irradiation;
- strong load on the muscles of the hands;
- endocrine pathology, this also applies to diabetics;
- intoxication of the body;
- lack of B vitamins;
- tumors;
- past infections: herpes, malaria, diphtheria, tuberculosis and even HIV;
- long-term use of drugs containing phenytoin and chloroquine.
Neuropathy symptoms
Few patients go to the hospital at the first symptoms of pathology, most often they try to use folk remedies. Ointments are used, compresses are made, but it is not always possible to cure the median nerve in this way, the symptoms may reappear and be even more acute. Pathology manifests itself in the form of burning pain sensations that accompany the patient throughout the day, numbness of the fingers, hands and even the entire hand also appears. In addition, other symptoms may appear:
- edema;
- spasms and convulsions;
- goosebumps;
- decrease in temperature sensitivity;
- discoordination;
- difficulty moving arms.
When visiting a doctor or on your own at home, it is possible to determine by movement disorders whether a patient has neuritis, median nerve neuropathy, orno.
Definition of median nerve movement disorder
To determine movement disorders due to compression or any other damage to the median nerve, the doctor may recommend performing these tests:
- if you make a fist, then at this moment the index, as well as partially the thumb and middle fingers remain extended, and the other two fingers on the hand are pressed so hard that it can be difficult even to unclench them later;
- if the median nerve is affected, then the patient, when crossing his fingers, is not able to quickly rotate the thumb of the affected hand around the thumb of the he althy one, this test is called the "mill";
- the patient will not be able to scratch the table with the index finger, he can only rub with the distal phalanx of the finger, or he just knocks with it, at this moment the brush lies on the table;
- if two palms are put together, then the index finger of the injured hand will not be able to scratch the he althy one;
- Patient cannot abduct thumb enough to form a right angle with index finger.
If after a visual inspection there are such failures in the movement of the fingers, then it is recommended to undergo a comprehensive examination.
Diagnosis of disease
Before choosing the right method of treatment, you need to undergo a complete examination by a neurologist who will evaluate reflexes, muscle strength, conduct special tests and tests.
Of the instrumental diagnostic methods, the best ones are:
- electroneuromyography;
- radiographicstudy;
- magnetic tomography.
These studies will reveal where the nerve was damaged, find out what is the cause of the pathology, and determine the degree of disruption in conduction. If necessary, the patient will be advised to undergo laboratory tests, only after that it is possible to accurately diagnose and select the most effective therapy.
Treatment of disease
Treatment of the median nerve is selected individually for each patient, because the causes of the disease can be different and the degree of damage is different for everyone. During treatment, the doctor may resort to etiotropic therapy. This treatment includes antibiotics, antiviral and vascular agents.
In addition, the doctor prescribes anti-inflammatory and decongestant drugs, and physiotherapy, massage and exercise therapy also give good results.
In cases where it has been found that the nerve is compressed, the cause must be eliminated. In this case, the most powerful resolving therapy is needed, but in order to carry it out, you need to start with various enzymes, as well as take resolving and softening scar tissue agents. There are cases where manual therapy and massage help to quickly recover from all symptoms.
For the treatment to be effective, it is necessary to carry out restorative procedures, which ones are suitable in a particular case, the resuscitator decides.
If the median nerve is injured, then in this case it is necessary to determine exactly which of the methods of treatment will be effective - conservative or surgical. For thisrecommend needle myography, it is with its help that you can accurately determine the degree of damage.
Prevention
Injury to the median nerve is a serious condition, if no action is taken, it will be impossible to restore the motor function of the fingers. As preventive measures, methods are used to help normalize metabolic processes, it is also very important to treat infectious pathologies in time. In addition, you need to regularly do gymnastics for the hands, especially if the patient's activity is associated with constant work with his hands (seamstresses, programmers, and others).
Conclusion
Summing up the above, we can say for sure that any even the most minor damage to the median nerve can lead to irreparable consequences. Therefore, if you suddenly notice that the fingers do not bend well, they often cramp or fail to clench a fist, then it is better to consult a doctor. In case of a hand injury, the advice of a doctor and examination is very important. It is better to cure minor changes than to undergo surgery later, which also does not give the desired results in severe cases.
