Carpal tunnel syndrome is a disease that is accompanied by severe pain in the fingers and a feeling of numbness. This is a very common pathology. The risk group includes people whose work is associated with monotonous and fast finger movements. This is an occupational disease of people who work a lot at the computer. This pathology often affects secretaries and PC operators. This is a rather serious disease in which the patient's performance and sleep are disturbed. Another name for this disease is carpal tunnel syndrome or carpal tunnel syndrome.
Pathogenesis of disease
The median nerve provides movement in the upper limbs. It starts in the shoulder area, runs through the entire arm, and branches in the carpal tunnel. This section of the peripheral nervous system is responsible for muscle flexion and extension, finger movement, and hand rotation. If the carpal tunnel is narrowed, then the median nerve is compressed between the bones and muscles. This causes pain and a feeling of numbness.
Causes of pathology
What causes a narrowing of the carpal tunnel that causes a pinched nerve? The most common causes of carpal tunnel syndrome are activities that involve fast, frequent, and repetitive hand and finger movements. This disease is very susceptible to people who work a lot at the computer, as well as seamstresses and musicians. As a result of increased stress on the hand and fingers, inflammation of the tendons occurs. Swelling causes the carpal tunnel to narrow and compress the nerve.
However, prolonged work at the computer does not always lead to carpal tunnel syndrome. For the occurrence of the disease, additional factors are needed. Women and overweight people are more likely to suffer from this pathology. In these categories of patients, the carpal tunnel is narrower.
There are other reasons for narrowing the carpal tunnel and pinching a nerve:
- Arthritis. When the joints become inflamed, the tissues of the wrist swell and compress the nerve.
- Hand injuries. Bruises and sprains are also accompanied by an inflammatory reaction and swelling. In fractures, the nerve can be pinched by bone fragments. Carpal tunnel syndrome often appears after poor-quality reduction of the dislocation.
- Water retention in the body. This phenomenon is observed during pregnancy, diseases of the kidneys and thyroid gland, as well as menopause. The appearance of edema due to excess fluid contributes to squeezing the nerve in the carpal tunnel.
- Tendovaginitis. itinflammation of the tendons of the wrist. Pathology can be caused by bacteria or muscle tension in the hands. With inflammation, the lumen of the canal narrows due to swelling of the tendons.
- Diabetes. With this disease, there is a severe metabolic disorder. As a result, the nutrition of the median nerve worsens. There is inflammation of a non-infectious nature. This leads to swelling of the nerve and its compression in the lumen of the wrist.
- Acromegaly is a disorder of the pituitary gland in which adults produce an excess amount of growth hormone. In patients, the hands grow, which leads to compression of the nerve by the bones.
In addition, there is a genetic predisposition to developing carpal tunnel syndrome. In some people, the carpal tunnel is square in cross section. This is a congenital anatomical feature. There may also be decreased secretion of tendon lubrication. If there are additional adverse factors, for example, when working at a computer for a long time, such people have an increased risk of the disease.
Symptomatics
The leading symptom of carpal tunnel syndrome is pain in the fingers. It occurs at night and disturbs the patient's sleep. To reduce discomfort, a person shakes the brush. Such movements stimulate blood circulation and for some time the condition improves. However, soon the pain syndrome returns.
Pain is stabbing or burning. They are not localized in the joints, but are distributed throughout the finger. As the disease progresses, discomfort occurs not only at night,but also during the day. Due to the sharp pain, it becomes difficult for a person to move his fingers.
In advanced cases, pain occurs not only in the fingers, but throughout the hand, radiating to the elbow.
Another important clinical sign of the disease is numbness and tingling. At the beginning of the pathology, such a symptom occurs only in the morning, immediately after waking up. In the future, this symptom appears during the day with any load on the fingers and hand. It becomes difficult for a person to hold a book or a telephone receiver in his hands. When traveling in transport, the patient cannot hold on to the handrail. Numbness occurs after 2-3 minutes, even with little effort. Such a symptom is associated with a violation of the innervation of the fingers and hands due to squeezing of the vessels.
The patient cannot handle small objects. Fingers lose muscle strength. Their movements become awkward and inaccurate. In advanced cases, muscle atrophy and hand deformity occur.
The skin of the fingers loses its sensitivity. Patients do not feel touch and even injections. Numbness is aggravated by temperature changes, in conditions of cold or heat. There is a pale skin color on the affected hand.
Diagnosis
A neuropathologist or rheumatologist is involved in identifying the symptoms and treating carpal tunnel syndrome. Diagnosis of the disease begins with special tests:
- Test with blood pressure cuff. The doctor puts a cuff on the patient's arm and pumps air into it. If the nerve is compressed, then appeartingling sensation in the fingers.
- Tinel test. The doctor taps his fingers on the narrowest part of the carpal tunnel. In the presence of pathology, the patient feels a tingling sensation in the hand.
- Test with raised hands. The patient raises them above his head and holds for about a minute. Patients experience numbness and tingling.
- Test with the bending of the brush. The doctor offers the patient to bend it and hold it in this position for about a minute. This intensifies the pain, numbness and burning sensation.
Such tests a person can conduct at home. If numbness and tingling appear during their implementation, then this should be a reason to see a doctor.
With carpal tunnel syndrome, symptoms may resemble manifestations of cervical osteochondrosis or spinal hernia. For the purpose of differential diagnosis, the following examinations are prescribed:
- Electroneuromyography. This study determines the speed of the impulse in the nerves and the electrical activity of the muscles. With pathology, there is a weakening of the muscles of the hand and a slow passage of the impulse. Electroneuromyography allows you to determine the initial stage of the disease.
- Magnetic-nuclear tomography. The method allows you to determine the size of the carpal tunnel and its relationship with the median nerve.
- X-ray. This study is prescribed if carpal tunnel syndrome occurs after a fracture. X-rays can also show congenital deformities of the wrist.
- Ultrasound diagnostics. With this method, you can determinemedian nerve width.
Based on the tests and instrumental methods of research, the doctor makes a diagnosis. However, it is necessary to identify the cause of the pathology. For this purpose, a blood test for sugar and thyroid hormones is prescribed, which will help identify diabetes and hypothyroidism, which often provoke the development of nerve compression. If the patient has swelling of the face or limbs, then it is necessary to exclude or confirm the pathology of the kidneys. For this purpose, a urine test is prescribed. If carpal tunnel syndrome is accompanied by joint pain, then a rheumatoid test is done.
Drug therapy
How to treat carpal tunnel syndrome? For therapy to be effective, it is necessary to create a sparing regimen for the affected limb. It is necessary to reduce the load on the hand, and also for a period of at least 2 weeks to abandon work associated with making frequent and similar movements. It is useful to wear special orthopedic fixators for a sick hand (orthoses). They reduce range of motion and prevent flare-ups.
Treatment of carpal tunnel syndrome begins with the appointment of non-steroidal anti-inflammatory drugs. They reduce the synthesis of prostaglandins. As a result, inflammation is reduced, pain and swelling of tissues are relieved. At the first stage of the pathology, drugs are administered intramuscularly and intravenously. After the condition improves, the drugs are taken in tablet form. The following medications are prescribed:
- "Diclofenac";
- "Movalis";
- "Xefocam";
- "Naklofen";
- "Aertal".
In more severe cases, treatment is supplemented with corticosteroid hormones:
- "Metipred";
- "Hydrocortisone";
- "Prednisolone".
These drugs quickly and effectively relieve pain and swelling. However, corticosteroids negatively affect the gastrointestinal tract and the immune system. Therefore, such drugs are prescribed in short courses.
To improve blood circulation and eliminate numbness of the hand, the following vasodilators are used:
- "Trental";
- "Angioflux";
- "Nicotinic acid".
They are prescribed in injections or tablets. Vitamin therapy plays an important role in the treatment of carpal tunnel syndrome. This helps to improve the condition of the median nerve. Assign vitamins of group B (drug "Neurobion" and "Milgamma"). In the acute period of the disease, drugs are administered intramuscularly. After reducing pain, burning and numbness, vitamins are consumed in tablets.
If carpal tunnel syndrome is caused by fluid retention in the body, then diuretic drugs are indicated:
- "Veroshpiron";
- "Furosemide";
- "Diacarb".
In some cases, antidepressants (Venlafaxine, Duloxetine) and anticonvulsants (Pregabalin) are prescribed to reduce pain and improve nighttime sleep. However, thesedrugs are not first choice drugs. They are used during the period when acute pain has already been stopped.
Local funds
In the treatment of carpal tunnel syndrome, local preparations are applied to the skin to relieve pain. These are ointments and gels based on nonsteroidal anti-inflammatory components:
- "Diclofenac";
- "Voltaren";
- "Rapten";
- "Clodifen".
If the pain syndrome is very pronounced, then treatment is prescribed by the blockade method. This is a quick and effective way to relieve burning sensation and pain. Using a syringe with a long, thin needle, drugs are injected directly into the carpal tunnel. Usually a mixture of corticosteroids (Hydrocortisone, Diprospan) with anesthetics (Lidocaine, Novocaine) is used.
This method leads to the rapid disappearance of all manifestations of carpal tunnel syndrome. Reviews of blockades indicate that the analgesic effect occurs 1-2 days after the injection. If necessary, the injections are repeated 2 more times with a break of 14 days. It should be noted that in the first hours after the blockade, a slight increase in pain is possible. However, very soon, all discomfort disappears.
Other procedures
Physiotherapy is used both during the period of drug treatment of carpal tunnel syndrome, and during recovery after surgery. Assign the following types of procedures:
- Ultraphonophoresis. AtWith the help of ultrasonic waves, painkillers and anti-inflammatory drugs are introduced into the body. These funds are applied to the skin in the affected area. Then, with the help of the apparatus, ultrasound is supplied, which contributes to the deep penetration of drugs. Usually, about 8-12 procedures are required to improve the condition. If necessary, the treatment is repeated after a few months.
- Shock wave therapy. This is one of the most effective treatments for carpal tunnel syndrome. The affected area is affected by infrasound. It improves blood circulation, reduces pain and relieves numbness. After 5-7 sessions, most patients experience significant relief. The use of shock wave therapy has helped many patients avoid surgery.
Surgical treatment
Surgery for carpal tunnel syndrome is indicated in cases where conservative therapy fails. Doctors recommend surgery if the patient does not improve within 6 months.
During the operation, the carpal tunnel ligament is cut. Surgical treatment is carried out in two ways:
- Open method. A small incision is made on the patient's wrist. The ligament is cut through it.
- Endoscopic method. Two small incisions are made: on the palm and on the wrist. An observation device, an endoscope, is placed in one of them, and the ligament is excised through the other.
After the operation, the wrist is fixed for several days with a cast. During the recovery periodprescribe physiotherapy sessions. It is also necessary to do therapeutic exercises for the fingers. The patient is recommended to temporarily change jobs if it is associated with a load on the hand.
Surgery radically eliminates all manifestations of carpal tunnel syndrome. Reviews of the operation indicate that 3 months after it, most of the functions of the hand are restored. And after six months, a person can return to his previous work activity. However, if a sparing regimen is not observed during the recovery period, then a relapse of the disease is possible.
Folk remedies
Treatment of carpal tunnel syndrome at home cannot replace drug therapy. It is impossible to get rid of this disease with folk remedies alone. However, home remedies can be a good addition to the main treatment.
The following recipes are recommended:
- Decoction of lingonberry leaves. 1 tablespoon of dry raw materials is placed in 250 ml of water. The composition is put on fire and boiled on a low flame for 15 minutes. Then the broth is filtered. The resulting remedy is drunk in small sips 4-5 times a day. A decoction of lingonberry leaves has anti-inflammatory properties, it can reduce pain and swelling.
- Composition of chili peppers and sunflower oil. Take 50 g of pepper and 0.5 l of oil. The ingredients are mixed and boiled over low heat for 30 minutes. Then the composition is cooled. It is rubbed into the area of the affected wrist 1 time per day.
- Ammonia, camphor and s alt remedy. You need to take a tablespoon of s alt, 50 gammonia and 10 g of camphor alcohol. The ingredients are dissolved in 1 liter of water. The resulting tool wipe the affected areas. It helps reduce pain and numbness.
Treatment of carpal tunnel syndrome at home must be agreed with your doctor. Only a specialist can take into account all possible indications and contraindications. It is important to remember that herbal ingredients can cause an allergic reaction.
Prevention
To prevent disease, you must follow the rules of working at the computer. Your work must be organized in such a way as to reduce the load on the hand and fingers. To do this, you must adhere to the following recommendations:
- When using a computer mouse, you should try to keep the brush not in a bent, but in a straight position. If possible, it is better to use the touchpad.
- You need to choose a comfortable keyboard, this will reduce the strain on your fingers.
- It is useful to purchase a special mouse pad with wrist support.
- Periodically it is necessary to take breaks in work, during which to do gymnastics for the fingers.
In addition, you need to monitor your he alth and treat wrist injuries, endocrine pathologies and arthritis in time. These diseases can cause pinching of the median nerve. Tunnel syndrome can significantly reduce a person's performance. This pathology is easier to prevent than to treat.
