Tunnel neuropathy is quite common. It is associated with impaired microcirculation and compression of peripheral nerves, in the so-called tunnels, that is, narrow fibrous-osseous canals of the upper and lower extremities.
Such a pathology may be due to genetic predisposition, endocrine disorders (such as hypothyroidism and diabetes mellitus), as well as joint diseases: from rheumatoid arthritis to deforming osteoarthritis.
Currently, there are several theories explaining the mechanism of development of tunnel neuropathy (for example, hormonal), but none of them has received final scientific confirmation, so the disease is considered multifactorial. Depending on which nerve is affected, there are several types of this pathology.
Compression-ischemic: basic information
Sometimes you can find such a term as "tunnel compression-ischemic neuropathy". And this is by no means a tautology.
The term "compression-ischemic" means thatthere is a sufficiently long compression of the nerve, accompanied by circulatory disorders, which lead to ischemia of the nerve fibers.
There are many varieties of this pathology, for example, tourniquet, tunnel, iatrogenic (postoperative) neuropathy. Tunnel diseases are distinguished into a separate group, since they have a common feature: local compression of the nerve occurs inside the natural canals and tunnels.
If you look at the ICD 10 code for tunnel neuropathy, you can see that there is a clear division into mononeuropathies of the upper and lower extremities. They are assigned codes G56 and G57, respectively. The latter group includes, for example, tunnel neuropathy of the peroneal nerve.
The diagnosis of such diseases is carried out using various methods. For example, ultrasound of the nerve and radiography of the articular tissues are considered the most informative, although in some cases the doctor may prescribe an additional study - electromyography.
Tunnel neuropathy of the ulnar nerve: causes and symptoms
The disease is one of the most common pathologies of the nerves of the brachial plexus. The cause is considered to be compression, that is, compression of the nerve in the indicated area.
This is often associated with the peculiarities of professional activity, for example, if a person has to work for a long time with the elbows resting on a desk or machine. Although in some cases this form of the disease can develop in athletes withprolonged squeezing of the base of the palm, as happens with cyclists. A similar picture is typical for those who work a lot with hand tools.
The reason why the disease so often affects the ulnar nerve is its superficial location, which makes this area especially vulnerable.
Despite the name "ulnar tunnel neuropathy", signs of the disease can appear at the level of the wrist, and in the area of the ring finger, and little finger.
It all starts with numbness and paresthesia. The function of the radial and median nerve is preserved. But as the disease progresses, the hand begins to resemble a clawed paw, since the main phalanges of the fingers are sharply extended, the little finger is set aside. There is atrophy of the small muscles of the hand.
Pathology of the radial nerve: causes and symptoms
Tunnel neuropathy of the radial nerve is considered no less common disease. For the occurrence of its symptoms, sometimes it is enough just to put your hand unsuccessfully during sleep. Interestingly, this usually happens in people who fall asleep soundly after hard physical work, or due to prolonged sleep deprivation, but this situation also occurs in patients who fall asleep after alcohol intoxication.
But most often it occurs due to muscle overload and injury, and in general is a secondary pathology. This phenomenon is experienced by those who run, conduct, as well as patients who have to use crutches.
Other factors contributing to the development of this disease are:
- humeral injury;
- incorrect tourniquet application;
- bursitis, synovitis, other inflammatory diseases including rheumatoid arthritis;
- infections (including influenza);
- intoxication;
- degenerative joint disease - arthrosis.
Tunnel neuropathy of the radial joint is characterized by the so-called hanging hand. This means that if the arm is extended forward, the hand on the affected side will not be able to take a horizontal position, it will hang down. At the same time, the index and thumb are pressed against each other.
Patient feels numbness and paresthesia on the back of the hand, as well as around the index, thumb and middle fingers.
Neuropathy of this type includes two main syndromes. This is radial tunnel syndrome, which is characterized by compression of the superficial branch of the nerve in the area of the anatomical snuffbox, as well as Turner's syndrome (it is more often observed with a fracture).
Pathology of the median nerve: causes and symptoms
Tunnel neuropathy of the median nerve can be due to a variety of reasons. These are, for example, injuries of the upper limb or nerve damage associated with professional activities (typical for people who have a large load on the hands, resulting in constant overstrain). Also, a similar situation can be caused by improper injection intocubital vein.
Tunnel neuropathy symptoms are pain in the thumb, index and middle fingers. In addition, discomfort or pain of varying intensity is also felt on the inner surface of the forearm.
It becomes more and more difficult to bend the hand in the palms (during the examination, the doctor specifically asks to clench the palm into a fist to check this feature). Muscles can atrophy quite a lot over time, especially around the thumb. If nothing is done about it, the hand will look more and more like a monkey's paw.
Tunnel neuropathy of the peroneal nerve and its features
This is a special kind of mononeuropathy. It manifests itself in the so-called drop foot syndrome, in which the patient cannot bend the foot or straighten its toes. In addition, the skin of the anterolateral region of the lower leg is affected, its sensitivity decreases.
The peculiarity of this pathology compared to what was described above is as follows: it affects the peroneal nerve, which consists of relatively thick nerve fibers. They are distinguished by a solid layer of myelin sheath, but it is this structure that is most susceptible to damage when metabolic processes are disturbed.
According to statistics, only in 30% of patients it is associated with primary damage to the nerve itself, and in most cases it develops during treatment after injuries and surgery.
Of course, don't underestimate othersreasons that can lead to such a pathology. This, for example, can be various injuries (from a knee bruise to a fracture of the lower leg), vascular disorders leading to ischemia, curvature of the spine, gout, diabetes mellitus, wearing excessively tight shoes.
When a joint is injured, nerve damage is acute, pain immediately appears. In other cases, neuropathy develops gradually, as a chronic disease in which there is a violation of the extension of the foot, as a result, when walking, the patient is first almost imperceptibly, and then forced to bend the affected limb at the knee joint strongly enough so that the toe does not catch on the floor.
The process is accompanied by pain both in the foot itself and in the lower leg. Over time, muscles can atrophy. The patient cannot stand on their heels or walk on their toes, and this is one of the easiest ways to check which nerve is affected.
Treatment: basic principles
Treatment of tunnel neuropathies can be effective only if the cause is established and the mechanism of compression is determined. As for the methods, in this case an integrated approach to therapy is used.
Fortunately, in most cases, treatment is conservative. However, in some situations (usually severely neglected), a more radical surgical intervention may be required, in which the tissue that is compressing the nerve is cut. Typically, such an operation is prescribed in cases where conservative treatment has not yielded results. Absolute indications for its implementationalmost never happens.
As for conservative therapy, its methods partly depend on which nerve is affected. For example, if we are talking about tunnel neuropathy of the lower extremities, then treatment begins with the fact that the leg is fixed in such a position that the nerve is not compressed. For this, special shoes, orthoses, and other devices are used.
Etiotropic therapy
Considering such a disease as tunnel neuropathy, it is necessary to note the important role of etiotropic therapy, which is aimed at eliminating the cause of the pathology. For example, if we are talking about arthrosis or other degenerative joint disease, then drugs containing chondroitin sulfate and glucosamine are prescribed.
In a sense, they have both anti-inflammatory and analgesic effects, but they work very slowly. Their effect will be noticeable only after 2-3 months of use.
The main thing that these drugs do is they help restore joint tissues, and they are prescribed for this very reason. In addition, they can be taken for a long time, unlike analgesics and non-steroidal anti-inflammatory drugs. The latter relieve acute pain, but they cannot be used for a long time, this is where chondroitin sulfate with glucosamine comes in handy.
Additional treatment
Another area of etiotropic therapy is the restoration of metabolic processes, normal motor activity, and the removal of inflammation and swelling.
For this, the fastest option is to injectglucocorticosteroids in the form of injections directly into those tissues that surround the nerve. In this case, "Diprospan" is most often used - it is a two-component glucocorticosteroid containing betamethasone dipropionate. It gives a long-lasting anti-inflammatory effect. In extreme cases, novocaine nerve blocks are prescribed.
An alternative option is compresses with anesthetics, dimexide and glucocorticosteroids, which are applied to problem areas for 20-30 minutes. Non-steroidal anti-inflammatory drugs such as Ibuprofen may also be used, but are considered less effective.
To improve blood circulation, drugs such as nicotinic acid or Pentoxifylline are prescribed. Antioxidants are prescribed - for example, thioctic acid.
In almost all cases, to improve the functioning of the nervous system, vitamins of group B are prescribed. A large role in the treatment is played by massage (it can only be performed by a specialist) and a specially designed set of exercise therapy exercises. Physiotherapy methods are widely used. These are magnetotherapy, electrophoresis, electrostimulation procedures.
Symptomatic therapy
If tunnel neuropathy is diagnosed, how to treat it is the most important question. And at the same time, a special role is played by the choice of a drug for symptomatic therapy, which will help relieve pain.
For this, the following types of funds are used:
- Anticonvulsants. Their action is based on the fact that they calm certain structures of the spinal cord and brain, whichare responsible for the appearance of a pain reaction when the nerve is compressed.
- Anesthetics (it would be more correct to call them transdermal systems with an anesthetic, which is lidocaine). They work in the same way as anticonvulsants.
- Tricyclic antidepressants. They reuptake serotonin and dopamine, which helps relieve pain.
However, tricyclic antidepressants are prescribed only when the potential benefit far outweighs the possible side effects: drowsiness, increased blood pressure, impaired coordination of movements. Relatively safe are drugs such as Escitalopram, which are also among the antidepressants, but in a different group.
If we are talking about the treatment of pathologies such as compression-ischemic tunnel neuropathies (the carpal nerve is damaged or some other), and it is known for sure that mechanical compression of the vascular and nerve trunks by spasmodic muscles has occurred, then muscle relaxants are prescribed. They relax the muscles and have an analgesic effect.
According to doctors, in this group one of the most effective means is Tizanidin, Baclosan and Tolperisone are also used.
Conclusion
Tunnel neuropathy is a common disease and requires complex therapy. A mandatory requirement is the timely diagnosis of pathology, since it is much more difficult to treat a disease in an advanced state.
It is also not recommended to ignore unpleasantsymptoms, and even more so to self-medicate, as this can lead to unpleasant consequences. And the use of dubious drugs or folk remedies on the advice of friends is strictly prohibited. It is not recommended to do anything without prior consultation with a specialist.
