The hand aches and does not obey: tunnel syndromes and methods of its treatment. Carpal tunnel syndrome—prevention and treatment

Carpal (or carpal) tunnel syndrome is a condition that develops when the median nerve located in the carpal tunnel is injured or compressed. Sometimes this syndrome is called tunnel syndrome, but this is not quite the correct term, since there are other tunnel syndromes. With the development of this disease, the sensitivity and movements of the first three and part of the fourth finger occur.

In this article we will introduce you to the causes of development, symptoms and methods of treating the syndrome. carpal tunnel. This information will help you make a timely decision about the need for treatment, and you can prevent the development of irreversible damage to the median nerve.

In the world, carpal tunnel syndrome is detected in 1.5-3% of the population, and in half of the cases, patients are active computer users. This disease is considered occupational, because it is much more often encountered by people who, due to their professional activities, are forced to make frequent and monotonous flexion and extension movements of the hand (for example, office workers who work at the computer for a long time, tailors, musicians, etc. ).

This syndrome is most often observed in people 40-60 years old, but can develop at older ages. at a young age. According to statistics, in 10% of cases the disease is detected in people under 30 years of age.

Experts believe that those people who work at a computer for a long time are most susceptible to developing this syndrome. According to one of the numerous studies, it is detected in every sixth active PC user. According to various sources, the syndrome develops 3-10 times more often in women.

Causes

The main cause of carpal tunnel syndrome is compression of the median nerve as it passes through the tunnel formed by the transverse ligament and bones of the wrist. Constriction is caused by inflammation and swelling of the joint, tendons and muscles within the joint or within the carpal tunnel. In most cases, the cause of such damage to the median nerve is work that requires frequent and repetitive movements.

In addition to occupational factors, the development of carpal tunnel syndrome can be provoked by other diseases and conditions:

1. . With bruises or sprains, swelling of the ligaments and muscles of the hand occurs, which causes compression of the nerve. Dislocations or fractures, in addition to swelling of the soft tissues, may be accompanied by displacement of the bones. Such injuries put pressure on the nerve. At proper treatment dislocation or fracture, the compression is eliminated, but with bone deformation or muscle contractures, disorders in the joint can become irreversible.
2. and other joint lesions of a rheumatic nature. The inflammation and swelling that occurs with these diseases causes compression of the nerve soft tissues carpal tunnel. With prolonged progression of the syndrome cartilage tissue The joint ages, loses its elasticity and wears out. Wear and death of cartilage leads to fusion of joint surfaces and their deformation.
3. Tenosynovitis (tendon inflammation). The tendons are affected by pathogenic bacteria and become inflamed. The tissue in the wrist area swells and puts pressure on the nerve. Sources of infection can be: purulent wounds on the hands, panaritium, etc. In addition, inflammation of tendon tissue can be non-bacterial and caused by chronic stress injuries: frequent movements hands and arms, prolonged exercise, exposure to cold.
4. Diseases and conditions accompanied by fluid retention in the body. Swelling of soft tissues (including in the carpal tunnel) can be observed when taking oral contraceptives, pregnancy, kidney pathologies or.
5. Median nerve tumor. Such neoplasms are rarely observed. These can be schwannomas, neurofibromas, perineuromas and malignant tumors nerve sheaths. Their growth causes displacement and compression of the nerve.
6. Diabetes. The course of this disease is accompanied by the accumulation of fructose and sorbitol in the nerve tissues. When they are activated by the enzyme protein kinase C, damage occurs to neurons and their processes. In addition, metabolic disorders lead to insufficient blood flow to the nerves and a decrease in their nutrition. All these consequences cause non-infectious inflammation nerves (including the median nerve). Nerves become swollen and can become compressed in narrow areas such as the carpal tunnel.
7. . This disease develops over a long period of time and is accompanied by growth of the bones of the face and limbs to disproportionate sizes. In addition to bone changes, soft tissue growth is observed. Enlargement of the carpal bones causes a narrowing of the carpal tunnel, and median nerve is infringed.
8. Genetic predisposition. Compression of the median nerve may occur with such anatomical feature hands, like a “square wrist”, congenital deficiency production of lubricant by the tendon sheaths or congenital thick transverse carpal ligament.

Symptoms

The development of carpal tunnel syndrome occurs gradually. In most cases, one hand is affected, i.e., the “working” hand (for right-handers - the right, for left-handers - the left). Sometimes nerve compression occurs in both arms (for example, with endocrine disorders or pregnancy).

Paresthesia

Tingling and numbness in the fingers is the first sign of the syndrome. Paresthesia is felt by the patient immediately after waking up, but is completely eliminated by noon. As the syndrome develops, they begin to appear at night, and then during the day. As a result, the patient cannot long time hold the hand suspended (when putting the phone to your ear, holding the handrail in public transport and etc.). When trying to perform such holds, paresthesia intensifies and the person changes his hand to perform the action (transfers the phone to the other hand, changes its position, etc.).

Pain

Initially, the patient experiences burning or tingling pain. Occurring at night, they disturb sleep, and a person has to wake up in order to lower his arm down or shake his hand. Such actions help normalize blood circulation in the fingers, and pain is eliminated.

Painful sensations do not occur in specific joints, but are widespread. They capture the entire finger - from base to tip. If left untreated, pain begins to appear during the day. Any movement of the hand causes them to intensify, and the patient cannot work fully. At severe course Pain syndromes can involve the entire palm and spread all the way to the elbow, making diagnosis difficult.

Clumsy hand movements and loss of strength

As the syndrome worsens, the patient develops weakness in the arm and is unable to perform precise movements. It is difficult for him to hold small objects (a needle, a button, a pen, etc.), and such actions are accompanied by the feeling that they are falling out of the hand.

In some cases, there is a decrease in the force of opposition of the thumb to the rest. It is difficult for the patient to move it away from the palm and actively grasp objects.

Decreased sensitivity

This symptom appears when there is significant damage to the median nerve. A third of patients complain of a reaction to a sudden change in temperature or cold: a burning sensation or painful numbness is felt in the hand. Depending on the severity of the disease, the patient may not feel a light touch on the hand or a pin prick.

Amyotrophy

This muscle change appears in the absence of treatment for late stages syndrome. The patient experiences a visual decrease in muscle size. In advanced cases, the hand becomes deformed and becomes like a monkey's paw ( thumb leads to a flat palm).

Change in skin color

Violation of the innervation of skin cells leads to disruption of their nutrition. As a result, the skin of the fingers and the area of ​​the hand innervated by the median nerve acquires a lighter shade.

Diagnostics

To diagnose carpal tunnel syndrome, the patient needs to consult a neurologist. The patient's examination plan includes special tests, instrumental and laboratory methods.

Tests for carpal tunnel syndrome:

1. Tinel test. Tapping from the palm of the hand in the area of ​​the narrowest part of the carpal tunnel causes tingling in the fingers.
2. Phalen test. The patient should bend the arm as much as possible at the wrist and hold it there for a minute. With carpal tunnel syndrome, increased paresthesia and pain occur.
3. Cuff test. A blood pressure cuff is placed between the elbow and wrist. It is inflated with air to significant figures and left in this position for one minute. The syndrome causes tingling and numbness in areas innervated by the median nerve.
4. Raised hands test. Hands are raised above the head and held for a minute. With the syndrome, after 30-40 seconds the patient feels paresthesia in the fingers.

Such tests can be used for preliminary self-diagnosis at home. If, during even one of them, discomfort, then you need to see a doctor.

To clarify the diagnosis, the patient is prescribed the following instrumental examination methods:

• electroneuromyography;
• radiography;

To identify the causes of carpal tunnel syndrome (eg, rheumatoid arthritis, diabetes mellitus, autoimmune diseases, hypothyroidism, etc.), the following laboratory diagnostic methods may be recommended to the patient:

• blood biochemistry;
• blood and urine test for sugar;
• analysis for thyroid-stimulating hormones;
• clinical analysis of urine and blood;
• blood test for rheumatoid tests (rheumatoid factor, C-reactive protein, antistreptolysin-O);
• blood test for CIC (circulating immune complexes);
• blood test for antistreptokinase.

Treatment

Treatment for carpal tunnel syndrome always begins with a protective regimen that removes stress from the wrist. In the absence of such measures, therapy is ineffective.

Security mode for carpal tunnel syndrome:

1. When the first signs of the syndrome appear, the hand should be fixed using a special clamp. Such an orthopedic product can be purchased at a pharmacy. It allows you to reduce the range of motion and prevent further tissue trauma.
2. For two weeks, completely avoid activities that cause or worsen symptoms. To do this, it is necessary to temporarily change jobs and eliminate movements that cause increased pain or paresthesia.
3. Apply cold for 2-3 minutes 2-3 times a day.

The further treatment plan for carpal tunnel syndrome depends on the severity of its symptoms. If necessary, it is supplemented by therapy for the underlying disease causing compression of the median nerve (for example, rheumatoid arthritis, trauma, hypothyroidism, renal pathologies, diabetes mellitus, etc.).

Local treatment

This type of therapy allows you to quickly eliminate acute symptoms and unpleasant sensations that bother the patient.

Compresses

To perform compresses, various multicomponent compositions can be used to eliminate inflammation and swelling of the tissues of the carpal tunnel.

One of the composition options for compresses:

• Dimexide – 60 ml;
• Water – 6 ml;
• Hydrocortisone – 2 ampoules;
• Lidocaine 10% - 4 ml (or Novocaine 2% - 60 ml).

Such compresses are performed daily. The duration of the procedure is about an hour. The resulting solution from the preparations can be stored in the refrigerator for several days.

Injecting drugs into the carpal tunnel

Using a special long needle, the doctor injects a mixture of solutions of a local anesthetic (Lidocaine or Novocaine) and a glucocorticosteroid hormone (Hydrocortisone or Diprospan) into the carpal tunnel. After the administration of this composition, pain and other unpleasant sensations are eliminated. Sometimes they can get worse in the first 24-48 hours, but after that they begin to gradually regress and disappear.

After the first administration of such a composition, the patient's condition improves significantly. If the signs of the syndrome return again after some time, then two more such procedures are performed. The interval between them should be at least 2 weeks.

Drug therapy

The choice of medications, dosage and duration of their use depend on the severity of the disease and accompanying pathologies. The drug treatment plan for carpal tunnel syndrome may include the following:

• B vitamins (B1, B2, B5, B6, B7, B9 and B 12): Milgamma, Neurobion, Neurobex, Doppelhertz active, Benevron, etc.;
• non-steroidal anti-inflammatory drugs: Xefocam, Dicloberl, Airtal, Movalis, etc.;
• vasodilators: Pentilin, A nicotinic acid, Trental, Angioflux;
• : Hypothiazide, Furosemide, Diacarb, etc.;
• anticonvulsants: Gabapentin, Pregabalin;
• muscle relaxants (drugs for muscle relaxation): Sirdalud, Mydocalm;
• glucocorticosteroids: Metipred, Hydrocortisone, Prednisolone;
• antidepressants: Duloxetine, Venlafaxine.

Physiotherapy

Physiotherapeutic treatment methods can be used against the background of drug therapy or for the rehabilitation of patients after surgery.

Treatments for carpal tunnel syndrome include:

• acupuncture;
• techniques manual therapy;
• ultraphonophoresis;
• shock wave therapy.

Prescribing physiotherapeutic procedures is possible only if there are no contraindications to them.

Surgery

Surgery for carpal tunnel syndrome is recommended if other methods of therapy are ineffective and symptoms of the disease persist for six months. The purpose of such surgical interventions is aimed at expanding the lumen of the canal and eliminating pressure on the median nerve.

Carpal tunnel syndrome(CTS, carpal tunnel syndrome) is a disease that is characterized by pain, tingling, numbness and weakness of the fingers.

Carpal tunnel syndrome occurs as a result of compression of the median nerve, which supplies the thumb, index, middle and ring fingers.

The carpal tunnel is a clearly defined space whose walls are formed by the two bones that support the wrist. The floor of the carpal tunnel is formed by thick palmar ligaments. The median nerve passes through this canal. As the surrounding tissues swell and thicken, pressure inside the carpal tunnel increases, cutting off the normal blood supply to the median nerve.

This pressure is especially noticeable when the arm is fully bent.

Syndrome prognosis

Daily Activities

Prevalence of the disease

Occurrence of disease

Symptoms of Carpal Tunnel Syndrome

Pain and numbness in the arms, especially at night.
. Pain, tingling, numbness of the thumb, index and middle fingers.
. Periodic feeling tingling throughout the arm.
. The pain spreads upward, sometimes all the way to the shoulder.
. Numbness in the morning, which goes away when shaking the arm.
. Episodes of arm weakness and lack of coordination, especially in the morning.
. A feeling of swelling in the fingers, and sometimes the swelling is visually noticeable.

Disease progression

Many diseases and conditions can produce symptoms that resemble carpal tunnel syndrome, some of which are very serious and require immediate medical attention.

Among the possible options:
Diabetes. . Diseases.
thyroid gland
. Inflammation of the joints.
. Pregnancy.
. Use of COCs.
. Amyloidosis.

. Aging.

Numbness, tingling, and muscle weakness in carpal tunnel syndrome are caused by compression of the median nerve. This nerve transmits signals between the arm muscles and the brain. The most common cause of carpal tunnel syndrome is inflammation and swelling of the tissue around the median nerve. Sadly, in most cases the exact cause remains unknown.

1. The following are some diseases and injuries that can cause carpal tunnel syndrome: Inflammatory diseases joints, including rheumatoid arthritis. These diseases cause pain and swelling of the joints in different parts
bodies. Swelling leads to carpal tunnel syndrome. 2. Injuries such as swipe
by the wrist. Not only can injuries cause tissue swelling, but they can also cause fractures in the wrist bones, leading to damage to the median nerve.

3. A variety of activities and hobbies that involve constant, repetitive finger movements, especially when combined with strong grasping movements or vibration (power tools).

It can be:
Cutting fish or meat.
. Construction and carpentry work.
. Working with electronic circuits.
. Work in auto repair shops.
. Forestry work.
. Scanning and counting money.
. The work of hairdressers.
. Manual agricultural labor.
. Embroidery and knitting.

. Computer set.

To confirm carpal tunnel syndrome, the doctor must know about the patient's work and lifestyle, as well as examine the hand and, in some cases, perform tests. During the examination, your doctor will evaluate the strength, sensitivity, and mobility of your arm.

Tinel test. The doctor should gently tap the arm where the median nerve passes. Tingling or pain when percussing may indicate carpal tunnel syndrome.
. Phalen test. The doctor will ask you to bend your arm as much as possible and hold it in this position for 15 seconds to 3 minutes. Tingling, numbness, or pain during the test may indicate damage to the median nerve.
. Nerve conduction study (NVC). During this procedure, the doctor sends impulses to the muscles and uses a special device to record the speed of their conduction. With carpal tunnel syndrome, the speed slows down.
. A test that combines nerve conduction testing and electromyography (EMG/NCV) is used to study nerve function, confirm diagnosis, and assess disease severity. This test is also prescribed to identify diseases that masquerade as carpal tunnel syndrome.
. X-ray, CT scan hands and blood tests will help the doctor exclude numerous diseases and injuries that we discussed above.

Treatment of carpal tunnel syndrome

1. Home measures.

Regulating your daily activities is an important step in preventing and relieving symptoms of the disease.

Here are some simple ways:

Rest your hands and fingers periodically.
. Change your activity to relieve pressure on your hands.
. Delegate some household responsibilities to your family.
. Review your hobbies, including those related to the computer.

If you think the syndrome is related to your professional activity, and you don’t want to change it, then talk to your doctor and your boss. Together, you can develop a plan that will help you relieve your symptoms by eliminating certain activities. In many Western clinics, such issues are dealt with by occupational therapists who adapt the patient to certain working conditions so that they do not affect his illness.

2. Diet.

Carpal tunnel syndrome is associated with vitamin B6 deficiency, although this is not necessarily the case—many patients with CTS do not have a significant vitamin deficiency. Try it multivitamin complexes to exclude this option.

3. Medicines.

Oral nonsteroidal anti-inflammatory drugs (NSAIDs for short), including aspirin, ibuprofen, and naproxen, can reduce the inflammation, swelling, and pain of carpal tunnel syndrome. The listed drugs can be taken without a doctor's prescription, but only for a short time.

4. Surgical treatment.

For moderate to severe cases of illness American doctors surgical treatment is recommended. If splints and medications do not alleviate the condition, then more radical treatment. IN otherwise After months, the nerve damage may become irreversible.

In traditional surgery, a transverse incision is made into the ligament, which increases the space inside the carpal tunnel. This operation can be performed using a limited incision in the palm or endoscopically using two miniature (1 cm) incisions in the palm and wrist into which flexible instruments are inserted. The procedure takes place under local anesthesia.

IN the latter case The scars are smaller and the recovery period is shorter. Both are simple surgical procedures that are performed on an outpatient basis. After the procedure, you will have to limit use of your affected arm for a couple of weeks. Typically, full restoration of hand functionality takes from 6 to 10 weeks, and for people who engage in heavy physical labor - from 3 to 4 months.

Your restrictions after the procedure may be as follows:

Driving: Most surgical patients can drive within 1-2 days after the procedure.
. Writing: You will, of course, be able to hold a pen after the procedure, but you should rest for 4-6 weeks before serious writing work.
. Grasping, shaking: minor activity is possible after 6-8 weeks, but such actions can be performed at full strength after 3 months. American observations indicate that full strength is achieved within the first year.

Possible side effects surgical treatment carpal tunnel syndrome:

Pain and inflammation at the incision site.
. Possible return of symptoms of the disease.
. Accidental damage nerves (extremely rare).

5. Intra-articular injections.

Injections of corticosteroids (anti-inflammatory hormones) into the joint can relieve inflammation and swelling by reducing pressure on the median nerve. These injections provide significant relief for most people with carpal tunnel syndrome.

6. Immobilizing splints and bracelets.

These wrist devices can be used to help keep your wrist in proper position while you sleep. They prevent too much sudden movements brushes, so your doctor may ask you to wear them during the day. An occupational therapist can order immobilization devices specifically for your needs based on the job you are performing. They should be worn for weeks or months.

Konstantin Mokanov

Carpal tunnel syndrome(tunnel neuropathy) is a complex of symptoms that arise as a result of compression peripheral nerves in narrow anatomical spaces - tunnels. IN medical literature More than thirty variants of tunnel neuropathy have been described. There are tunnel syndromes affecting the upper, lower limbs, neck, torso. The most common is carpal tunnel syndrome, which is why this disease is often called carpal tunnel syndrome. In the structure of tunnel neuropathies, carpal tunnel syndrome accounts for 50% of all cases.

The carpal (carpal) tunnel is located at the base of the hand. It is formed by the carpal bones and the transverse ligament. Inside the canal pass the median nerve, the flexor tendons of the fingers and hand, as well as their synovial membranes.

The median nerve contains sensory and nerve fibers. Sensory fibers are responsible for the sensitive innervation of the skin of the palmar surface of the first three and half of the fourth fingers, as well as the dorsal surface of the nail phalanges of the same fingers. Motor fibers provide movement of the fingers.

Normally, the median nerve runs freely in the canal. But with microtrauma to the ligaments that occurs in people of certain professions, thickening and swelling of the transverse ligament develop, which leads to compression of the nerve. As a result chronic inflammation connective tissue, which is caused by a constant load of the same type, the ligament thickens and swells, which leads to an increase in pressure inside the canal. Increased pressure leads to venous stagnation and, as a consequence, disruption of the blood supply to the nerve.

Sensitive nerve fibers are affected first, followed by motor fibers. In addition, fibers of the autonomic nervous system may be damaged.

Reasons leading to the development of carpal tunnel syndrome:

The peak incidence occurs between 40 and 60 years of age. It is noteworthy that women get sick more often than men. This is probably due to the fact that women have a narrower carpal tunnel.

In approximately half of all cases, both hands are affected. But it is worth noting that signs of the disease primarily appear on the “working” hand (right-handers on the right, left-handers on the left).

Carpal tunnel syndrome develops gradually. The first sign of the disease is the appearance of pain and numbness in the first three fingers of the hand, which occurs at night. These unpleasant symptoms prevent a person from sleeping normally. When a person wakes up, he is forced to lower his hand down and shake off his hand. Then the pain goes away, but returns in the morning. Pain is felt throughout the finger from its base to the terminal phalanx.

When the disease begins to progress, pain begins to bother a person even during the day, which greatly affects his activity. It is noteworthy that any movement in the wrist increases pain.

Another characteristic symptom- numbness of the first three fingers in the morning. But then the person begins to feel numbness at night and daytime. Unpleasant symptoms in the fingers intensify when holding the hand suspended for a long time, for example, while talking on the phone or while driving a car.

As the disease progresses, muscle weakness in the hand area. Thus, it is difficult for a person to hold small objects in his hand; they slip out of his hands. In the later stages, atrophy of the hand muscles and contractures in the form of the so-called “monkey’s paw” develop.

With strong or long-term compression the median nerve develops decreased sensitivity. The patient may not feel touch or even pain in the area of ​​the first three fingers.

When the vessels inside the canal are compressed, the skin of the hand may become pale, the local temperature may decrease, and swelling may occur.

Sometimes tunnel syndrome can be accompanied by pain not only in the hand, but also in the forearm and elbow. This confuses the doctor and may lead to thoughts about another pathology, for example, osteochondrosis. Therefore, special methods are used to carry out differential diagnosis.

For example, there is a simple raised hands test. The patient raises his straightened arms above his head and holds for a minute. If you have carpal tunnel syndrome, the first three fingers experience numbness and tingling, and sometimes even pain.

To perform the Phalen test, the patient is asked to bend the hand and hold it there for a minute. If you have carpal tunnel syndrome, the first three fingers experience increased tingling and pain.

A cuff test is also sometimes performed. The doctor places a measurement cuff on the patient's arm. blood pressure. Then the pressure in the cuff is inflated to over 120 mmHg, which is held for a minute. In carpal tunnel syndrome, a tingling sensation occurs in the fingers innervated by the median nerve.

But the most reliable diagnostic method after all, it is Tinel's test. The doctor taps a finger or hammer over the median nerve. If you have carpal tunnel syndrome, you may experience tingling in your fingers.

A useful diagnostic test is the injection of corticosteroids with lidocaine into the carpal tunnel. If after this the pain and tingling in the fingers decrease, it means pathological process located in the carpal tunnel.

Leading instrumental method Determination of carpal tunnel syndrome is electroneuromyography. Using this study, it is possible to measure the electrical activity of skeletal muscles, as well as the speed of nerve impulses. At rest, the electrical activity of the muscles is minimal, but increases with muscle contraction. But in the presence of carpal tunnel syndrome, electrical activity is low during muscle contraction because the conduction of nerve impulses along the damaged median nerve is slowed down.

Treatment of carpal tunnel syndrome

Treatment of carpal tunnel syndrome is aimed primarily at eliminating the cause of the disease, as well as eliminating pain, improving local blood circulation, nutrition and innervation of tissues, and restoring hand function.

Conservative treatment will be most effective in patients with symptoms lasting no more than a year. It includes wearing a support splint, as well as the appointment of such medicines:

An effective treatment is to inject corticosteroids into the carpal tunnel. Already after the first such procedure, the patient feels significant relief.

Criteria for predicting low effectiveness of conservative treatment:

1. The patient's age is over fifty years;
2. Symptoms of the disease are observed for ten or more months;
3. Constant tingling in the fingers;
4. Presence of stenosing tendon tenosynovitis;
5. Positive Feleng test in less than thirty seconds.

Thus, in 66% of patients without a single criterion for conservative treatment manages to achieve good result, 40% had one criterion, 16.7% had two, and 6.8% had three or more criteria.

As the disease progresses and there is no result from conservative therapy resort to surgical treatment. Surgery should be performed before irreversible damage to the median nerve occurs. If the operation is performed in a timely manner, it is possible to achieve a good result in 90% of patients. The goal of surgery is to reduce pressure on the median nerve by expanding the intracanal lumen. Operations can be performed endoscopically or open method.

After surgery, a plaster cast is applied to the hand for several days. During the recovery period, the patient is advised to undergo therapeutic exercises with a fixed wrist and physiotherapeutic procedures. If the disease is caused by the characteristics of the profession, you should change your occupation during the recovery period. After three months, hand function is restored by approximately 70-80%, and after six months it is completely restored.

After complete recovery, the person can return to his or her occupation. But if at the same time unfavourable conditions labor will not be eliminated - relapse cannot be avoided.

Incidence of carpal tunnel syndrome in last years has increased significantly. Doctors attribute this fact to the fact that computers have appeared in human life. People work and spend their leisure time at the computer. If the workplace is not organized correctly and the hand is in an awkward position when using equipment, the prerequisites are created for the development of carpal tunnel syndrome.

To prevent the occurrence of the disease, you should adhere to the following recommendations:

1. Arrange yours correctly workplace. The table should not be too high. While working at the computer, your hand should not sag, but lie comfortably on the table or armrest of a chair. The brush should be straight.
2. Choose the right keyboard and mouse. The mouse should fit comfortably in your palm. This way the brush will be more relaxed. There is even a special joystick mouse created for people with carpal tunnel syndrome. No less useful can be special mouse pads equipped with a bolster at wrist level. This will ensure correct position brushes Also, pay attention to the angled keyboard.
3. Take breaks every thirty to forty minutes.
4. Do hand exercises: shaking your hands, rotating your wrists, clenching and unclenching your fingers.

Grigorova Valeria, medical observer

Carpal tunnel syndrome is a disease that is accompanied by the appearance nagging pain, tingling and numbness in the wrist and hand. Reason this state is pinching of the median nerve, which passes to the palm and fingers through the median canal, or “carpal tunnel,” which is a space in which, in addition to the nerve, nine tendons responsible for the operation of the fingers pass. This channel protects the nerve from compression, and if its integrity is disrupted, the symptoms described above occur.

This is the most expensive Occupational Illness. The annual cost of its treatment in the United States amounts to several billion dollars.

Statistics

Symptoms

Carpal tunnel syndrome is characterized by a gradual onset with increasing tingling and numbness in the fingers (usually the thumb, index and middle fingers). In the initial stages of the disease, symptoms may periodically subside, but subsequently reappear with greater intensity. In this case, patients are concerned about discomfort when moving the hand and forearm.

Symptoms of carpal tunnel syndrome include:

If the symptoms described appear, especially if they occur in everyday life or affect your sleep patterns, you should immediately consult a doctor. If not treated promptly, it can cause permanent damage to the nerve and muscles of the arm.

Causes

Carpal tunnel syndrome occurs as a result of compression of the median nerve. This nerve passes to the hand through the carpal tunnel. It is responsible for tactile sensitivity in the palm and in all fingers except the little finger. The median nerve is also responsible for the functioning of the muscles of the thumb.

• The cause of the disease can be any change in a person's health that leads to compression, irritation, or swelling of the tissue around the nerve in the carpal tunnel. For example, common causes are forearm fractures or swelling due to an exacerbation of rheumatoid arthritis.
• The disease often develops as a complication of diabetes, rheumatoid arthritis, obesity or pregnancy.

Risk factors

The average patient with carpal tunnel syndrome is a woman over 50 years of age who works with equipment that requires frequent repetitive movements, for example, a secretary, an assembly line worker, etc.

Risk factors for developing the syndrome include:

• Anatomical factors. A fracture of the wrist bones, including an incorrectly fused one, leads to deformation of the canal and increased pressure on the nerve. People who have congenital anomalies the structure of the carpal tunnel is more susceptible to the development of such diseases;
• Floor . The disease is much more often diagnosed in women. This may be due to the smaller volume of the carpal tunnel compared to men. Because of this, any hand injury in women is more likely to be accompanied by compression of the median nerve.

According to research, women with carpal tunnel syndrome have less carpal tunnel volume than healthy women.

• Some chronic diseases associated with nerve damage (diabetes mellitus, multiple sclerosis and etc.);
• Inflammatory diseases(eg, rheumatoid arthritis) may affect the tendons in the wrist, thereby increasing tension in the carpal tunnel;
• Violation water balance . Fluid retention, a common condition during pregnancy or menopause, can lead to increased pressure inside the carpal tunnel and irritation of the median nerve.

If a woman develops carpal tunnel syndrome during pregnancy, it usually goes away on its own after childbirth.

• Other diseases. The likelihood of developing median nerve compression syndrome increases in people suffering from obesity, diseases of the thyroid gland, and kidneys;
• Factors related to workplace characteristics. Working with equipment that has vibrating parts or, for example, on a conveyor, requiring frequent repeated bending of the wrist. Such movements increase pressure on the median nerve, worsening damage that has already begun. Although it has been scientifically proven that work characteristics are not a direct cause of compression of the median nerve.

If you type 40 at 40 words per minute, you'll make 12,000 keystrokes in an hour. In an 8-hour workday, you will complete 96,000 clicks.

A person presses a key with a force of 225 grams. That is, per day the load on your fingers will be 16 tons. For people typing at a speed of 60 words per minute, this figure is already 25 tons.

Constant work on a computer associated with typing often leads to the development of symptoms of carpal tunnel syndrome. At the same time, the risk of developing carpal tunnel syndrome in this group is significantly lower than in severe cases. physical labor. Was held a little research, which showed that the incidence rate among computer users was 3.5% (no different from the average for the general population).

To reduce the risk, use an ergonomic keyboard. Although it costs a little more than usual, it allows you to maintain a physiological position of your hands when working. Many doctors cite an ergonomic keyboard as a long-term investment in their health.

Diagnostics

The following methods are used for diagnosis:

• Anamnesis is the history of the development of the disease (the appearance and increase in the severity of symptoms).
• Examination - During the examination, the doctor will assess the sensitivity of the fingers and the strength of the muscles of the hand. To determine sensitivity, the use of any special devices is not required, and a hand dynamometer is used to assess muscle strength.
• Symptoms of the disease upon examination are checked by pressing on the area of ​​the median nerve. When pressed, the described symptoms intensify, pain appears in the fingers. This test can detect signs of the disease in most patients.
• X-ray - the usefulness of X-ray examination remains controversial, since it cannot detect the presence of a pathological condition. This method is used only to exclude other diseases with similar symptoms (arthritis, fracture).
• Electromyography- this is a study in which the formation is recorded nerve impulses to muscles during their contraction. To do this, before the start of the study, thin electrodes are inserted into the muscles being studied. During the study, an assessment is made electrical activity muscles at rest and contraction. Electromyography can detect tunnel syndrome, accompanied by muscle damage.
• Nerve conduction analysis. A weak electrical discharge is applied to the area of ​​the median nerve, after which the speed of the impulse through the median channel is determined. A slower rate of impulse conduction indicates compression of the median nerve.

Treatment

Treatment for carpal tunnel syndrome should begin as early as possible. Therefore, you need to seek help immediately when the first symptoms appear.

In some cases, treatment comes down to normalization labor activity and physical activity. It is recommended to take regular breaks during long monotonous work, avoid excessive loads on the joints of the hands.

If such methods do not help, then treatment is carried out, depending on the severity, wearing a splint, medication or surgical treatment. Splinting and others non-drug methods will be effective only for mild forms of the disease. Typically, the positive effect of such treatment is observed in patients who have been ill for less than 10 months.

Medication methods

With early diagnosis of the disease, the condition of a patient with carpal tunnel syndrome can be improved without surgery. This treatment is carried out at home.

TO medicines, used in the treatment of carpal tunnel syndrome include:

• Non-steroidal anti-inflammatory drugs. Ibuprofen, Nimesulide (Nise. Nimez), Analgin and other drugs in this group help to quickly relieve the symptoms of the disease (pain, swelling). Although there is no evidence that such treatment will not lead to recovery.
• Corticosteroids (hormonal drugs). To relieve pressure on the median nerve, corticosteroids are administered directly into the median canal. It's more effective method relieving swelling and inflammation.

Oral corticosteroids do not have a significant therapeutic effect.

Some patients experienced improvement in their condition after taking vitamin B6. This vitamin has anti-inflammatory properties and can relieve swelling that is causing symptoms.

You need to understand that eliminating symptoms with the help of medications does not lead to recovery, but only alleviates the patient’s condition. Therefore, it is recommended to continue wearing the splint while taking anti-inflammatory drugs. The use of the splint at night is especially effective. Wearing a wrist splint while you sleep can help relieve tingling and numbness in your hand.

Plus this method is that it can be used without restrictions in pregnant women and nursing mothers.

Operation

If the patient's condition worsens even after drug treatment, then surgery is the most appropriate treatment option. The goal of surgical treatment is to excise the ligament compressing the median nerve.

There are two types of operations:

• Endoscopic - in this case, a special device with a video camera is used to cut the ligament, which is inserted into the median canal through a small incision. This is a low-traumatic operation that leaves almost no scars. The advantage of this method is less pain during the healing period;
• Direct open intervention - this operation involves a larger incision in the palm along the median canal. However, the result remains the same - cutting the ligament to relieve pressure on the median nerve. Although in this case the surgeon will also try to make the incision as small as possible to reduce the risk of complications, healing still takes longer than with endoscopic intervention. The advantage of the method is Great chance dissection of the ligament throughout the damaged area.

Be sure to discuss with your doctor how carpal tunnel syndrome should be treated and any possible risks surgical intervention. These include wound infection, the size of the scar after healing, and injury to a nerve or vessel. The likelihood of complications is much lower with endoscopic intervention, although the result in both cases is almost the same.

Surgery to excise the carpal tunnel ligament is considered common and quite successful. However, approximately 57% of patients experienced a recurrence of one or more pre-treatment symptoms 2 years after surgery. Moreover, after endoscopic operations the frequency re-development symptoms are significantly higher.

Recovery

IN recovery period the tissues of the ligamentous apparatus gradually grow together, again forming a ligament, but at the same time the volume of space inside the median canal increases, preventing compression of the nerve.

A day after the operation, the patient can begin to move his fingers, but holding or lifting any heavy objects is prohibited for one and a half months, so as not to disrupt the formation of scar tissue that should connect the two parts of the cut ligament.

Although weakness and pain may persist for several weeks or even months after surgery, after this period, patients begin to notice improved control of movement in the wrist and the hand returns to normal working condition.

After 6 weeks, the rehabilitation program includes appointments with a physiotherapist and an occupational therapist. To restore muscle tone and normalize the range of motion of the cyst, massage, gymnastics and stretching are used.

How to relieve symptoms yourself

There are several ways to temporarily alleviate the patient's condition. You can carry out this treatment yourself at home:

• By doing long work accompanied by identical hand movements, it is necessary to take regular breaks and give your hands a rest.
• Do some exercises, make rotational movements with your hands, stretch your palms and fingers;
• Take a pain reliever (aspirin, ibuprofen, naproxen, etc.);
• Wear a splint on your wrist at night. Choose a comfortable splint so that it fits snugly around your hand, but is not too tight;
• When sleeping, do not put your hands under your head. This can put more pressure on the nerve.
• If symptoms persist, contact your doctor immediately.

Alternative Treatments

Alternative therapies can be used to manage the symptoms of carpal tunnel syndrome. They are easily included in the treatment plan, and most importantly, they are accessible and the degree of impact can be easily selected depending on the severity of the disease.

• Yoga – Yoga poses are used specifically to strengthen and stretch every joint in the body. Yoga classes significantly reduce the severity of symptoms and improve the strength of the hand muscles.
• Manual therapy- V this moment Research into the use of this method is ongoing, but preliminary data indicate a positive effect of some manual therapy techniques in such patients.
• Ultrasound treatment- high-frequency ultrasound exposure leads to an increase in tissue temperature in the treated area. This reduces pain and stimulates the healing process. In patients with carpal tunnel syndrome, a two-week course ultrasound therapy led to a significant reduction in the severity of symptoms of the disease.

Prevention

There are currently no prevention guidelines that have been experimentally proven to be effective, but you can take the following measures to prevent hand injuries:

• Control the force of muscle contraction and relax during periods of rest.When performing various actions most people use more force than is required. If your job requires, for example, long periods of working on a computer, try to press the keys more softly, when writing, use a pen with a soft finger adapter, etc.
• Take frequent breaks from work. Give your arms a rest, schedule breaks in advance, and do arm exercises or stretches while you rest. If you work with a tool that requires a lot of force or with vibrating equipment, rest breaks are very important and become a necessity.
• Watch your movements. Avoid strong flexion and extension of the hand with maximum amplitude. remember, that better position- one in which the hand is in a relaxed state. Organize your workspace so that the tool you need self made, was at or just below the elbow.
• Watch your posture. With incorrect posture, the spine bends too much and the shoulders protrude forward. In this position, the muscles of the neck and shoulders remain tense, resulting in compression of the nerves in the neck. Due to compression of large nerves, the conduction of impulses throughout the arm, including the wrists and fingers, is disrupted.
• Avoid overcooling your hands. Stiffness and pain in the hands are more common when working in a cold environment. If the temperature in the workplace is not controlled, wear gloves to help keep your hands warm.

Clinical researches

A lot of research is currently being prepared or has begun, aimed at finding ways to prevent and treat carpal tunnel syndrome. Here are some of them.

• One study is evaluating which patients benefit from surgical treatment compared with non-surgical treatment. In this case, a new method of magnetic resonance exposure is used. Patients with mild to moderate forms of the disease are selected for inclusion in the study. (Responsible institution: University of Washington, [email protected]).
• Another promising study is to determine the benefit of wearing a wrist guard to prevent median canal injury in people working with vibration equipment. The bracelet is designed to absorb vibrations without restricting hand movements. The study is being conducted at the University of California, Los Angeles, [email protected].

Some patient stories

Peter Taylor, 58, sales consultant

I first noticed tingling in my fingers several years ago. Since then, he has undergone two operations to cut the ligaments of the median canal. Currently there are no symptoms of the disease.

“I realized that something was wrong when I started waking up at night due to stabbing pain in the fingers. Then my hand went numb. It became difficult for me to play golf with friends, I could not hold the club. I turned to a therapist, who suspected the development of carpal tunnel syndrome and gave me a referral for tests. After nerve conduction testing, the diagnosis was confirmed, with lesions developing in both arms. I was prescribed surgical treatment, but separately for each arm. My first operation was performed on right hand under local anesthesia. The operation was carried out on the same day when I was admitted to the hospital, and in the evening I was discharged. For several days after the operation, I felt pain in my arm, then it became dull, and after a week it went away completely. During the recovery period, I performed a certain set of exercises, and soon I could use my fingers again in full. Surgery on the left hand was performed 4 months later. She also passed without complications. By then I was having difficulty moving my left arm, but now my condition is back to normal. I am very grateful to my doctors for their professionalism.”

Kevin Peterson, 50

I am a jazz keyboardist with 35 years of experience. Now, after 35 years the beginning of my musical career I developed carpal tunnel syndrome. The pain in my hands was so severe that I would wake up at night and could not play a single tune without pain or numbness in my fingers. In the end, I agreed to surgical treatment. Within a few weeks after the operation, I could play the piano again as if I were 20 years old again. Thanks to the doctors for giving me a second wind to study music.

Rachel Beaudoin, 34

The surgery to treat carpal tunnel syndrome was performed when I was 8 months pregnant. It was pregnancy that caused the condition to worsen, but after treatment all the symptoms went away and I feel great.

Gamer story

For as long as I can remember, I have always played computer games. But I did not expect the development of such a disease. Even now, as I type this text, I feel pain in my hands, although I am taking a new medicine.

Computer games have always been my hobby, and about a week ago, after playing CS again, I felt pain in my hand. At first I didn't think much of it. Over the next few days, the pain in my arm continued to worsen, but I ignored it and continued to play and do everyday activities. And then, right during the next game, the pain became unbearable.

After being examined by a doctor, it turned out that I have severe tunnel syndrome. I was told that “severe” meant that the pain would be very severe and that it would probably bother me constantly. It also turned out that computer games were the cause of the disease.

And now I take painkillers and still can’t even lift a juice box without pain. I don’t think I’ll want to play any game again anytime soon.”

The widespread use of computers and the creation of flat keyboards with sensitive keys that increase typing speed have led to the fact that the incidence of injuries to the hands, forearms and shoulders began to grow at epidemic rates. The cause of the development of carpal tunnel syndrome is also high probability prolonged use of a mouse or trackball may result. Constant use of joysticks when playing on consoles has the same effect.

Today, doctors no longer have any doubt that frequent, long-term computer games significantly increase the risk of disease. The problem in this case is always insufficient rest while playing games or working at the computer. It is necessary to take regular breaks to allow your hands to rest.

Repeated sprains and fractures, unusual wrist anatomy, arthritis, and certain other conditions can reduce the space in the carpal tunnel, thereby increasing the risk of CTS. From accompanying symptoms you can often get rid of it at home, but sometimes for complete cure medical attention is required.

Steps

Part 1

Try not to pinch the median nerve. The carpal tunnel is a narrow tunnel made up of small bones in the wrist, connected by ligaments. This channel protects the nerves blood vessels and tendons. Main nerve, responsible for the movements of the palm and its sensitivity is called the median. Therefore, you should avoid activities that lead to pinching and irritation of the median nerve, such as frequent bending of the hand at the wrist, lifting heavy objects, sleeping with bent wrists, and punching hard surfaces.

• Make sure that wrist watch and the bracelets sat quite loosely on the wrist - if they are too tight on the wrist, this can lead to irritation of the median nerve.
• In most cases of CTS, it is difficult to identify a single cause. Typically, CTS is caused by a combination various factors, such as frequent wrist strain combined with arthritis or diabetes.
• The anatomy of the wrist can also contribute - in some people the bones of the carpal tunnel at or do not have the correct shape.

1. Stretch your wrists regularly. Daily wrist stretching can help reduce the symptoms of CTS or get rid of them altogether. In particular, wrist stretches help expand the space available for the median nerve within the carpal tunnel because it stretches the ligaments surrounding the tunnel. The best way to stretch both wrists at the same time is to assume a “praying pose.” Place your palms together about 6 inches from your chest and lift your elbows until you feel a stretch in both wrists. Hold this position for 30 seconds, then lower your elbows again. Repeat the exercise 3-5 times a day.

   Shake your palms. Feeling numb or aching pain in one or both palms (or wrists), shake them thoroughly for 10-15 seconds, as if shaking off water from them. By doing this, you will achieve quick, albeit temporary, improvement. This shaking will stimulate circulation and improve blood flow to the median nerve, causing symptoms to temporarily disappear. You can do this type of exercise, which helps combat the symptoms of CTS, many times a day, just taking a few seconds off from your work.

   • Symptoms of CTS most often appear (and first appear) in the thumb, index and middle fingers, as well as part of the ring finger. This is why people with CTS seem clumsy and often drop things.
   • Only the little finger is not affected by CTS symptoms because it is not connected to the median nerve.

2. Wear a special wrist support bandage. This semi-rigid brace or splint will help you avoid the symptoms of CTS throughout the day by keeping your wrist in a natural position and preventing it from bending too much. A wrist splint or brace should also be worn during activities that may aggravate symptoms of CTS, such as computer work, carrying heavy bags, driving, or bowling. Wearing a support bandage while you sleep can help prevent nighttime symptoms, especially if you have a habit of tucking your hands under your body while you sleep.

   • You may need a support bandage for several weeks (day and night) to noticeably reduce the symptoms of CTS. However, in some cases, the support bandage has a negative effect.
   • Wearing wrist splints is also helpful if you have CTS and are pregnant, since your palms (and feet) are more likely to swell during pregnancy.
   • Wrist supports and splints can be purchased at a pharmacy or medical supply store.

3. Consider changing the position in which you sleep. Some postures can significantly worsen the symptoms of CTS, which reduces sleep duration and quality. Worst pose is one in which your fists are tightly clenched and/or your palms (with curved wrists) are tucked under your body; The posture in which the arms are above the head is also unfavorable. Instead, try sleeping on your back or side with your arms close to your body, wrists straight, and palms open. This position will ensure normal blood circulation in the wrists and blood supply to the median nerve.

   • As noted above, using support slings during sleep helps prevent incorrect position palms and wrists, but it will take some getting used to.
   • Avoid sleeping on your stomach with your arms under the pillow, as this will cause your wrists to become pinched. People sleeping in this position often experience numbness and tingling in their palms upon awakening.
   • Most wrist supports are made of nylon and have Velcro fastening, which can irritate your skin. In this case, place a sock or piece of thin cloth under the bandage to reduce skin irritation.

4. Take a closer look at your workplace. In addition to poor sleep posture, symptoms of CTS can be caused or exacerbated by poor workplace design. If your computer keyboard, mouse, desk, or chair is positioned poorly and without consideration for your height and body type, it can cause tension in your wrists, shoulders, and mid-back. Make sure the keyboard is positioned in such a way that you don't have to bend your wrists all the time when typing. Buy an ergonomic keyboard and mouse designed to reduce stress on your hands and wrists. Your employer may cover the costs.

   Take over-the-counter medications. Symptoms of CTS are often associated with inflammation and swelling in the wrist, which further irritates the median nerve and adjacent blood vessels. Therefore, reduce the symptoms of CTS by at least in the short term, nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Aleve) often help. You can also take painkillers such as paracetamol (Tylenol, Panadol) to relieve pain caused by CTS, but they do not reduce inflammation and swelling.

   Part 2

   Medical care for CTS

   1. Make an appointment with your doctor. If you experience the symptoms listed above in your wrist/hand for several weeks or more, you should see a doctor. The doctor will examine you and probably prescribe X-ray examination and a blood test to rule out possible diseases and lesions whose symptoms resemble CTS, such as rheumatoid arthritis, osteoarthritis, diabetes mellitus, stress fracture in the wrist or problems with blood vessels.

      Visit a physical therapist or massage therapist.

      Try corticosteroid injections. To relieve pain, inflammation, and other symptoms of CTS, your doctor may recommend injections of a corticosteroid drug (such as cortisone) into your wrist or heel of your hand. Corticosteroids are powerful and fast-acting drug, which can relieve swelling in the wrist and relieve pressure on the median nerve. They can also be taken orally, but this is considered much less effective than injections and also causes more severe side effects.

      • Others are also used in the treatment of CTS. steroid drugs, such as prednisolone, dexamethasone and triamcinolone.
      • Corticosteroid injections can lead to complications such as local infection, profuse bleeding, weakening of tendons, muscle atrophy and nerve damage. Therefore, they are usually done no more than twice a year.
      • If steroid injections do not significantly improve the condition, surgery should be considered.

   2. Carpal tunnel surgery should be considered as a last resort. If other treatments have failed to relieve your CTS symptoms, your doctor may recommend surgical intervention. The operation is resorted to extreme cases, as there is a risk of making the situation even worse, although for many patients, surgery helps completely relieve the symptoms of CTS. The purpose of this surgery is to relieve pressure on the median nerve by cutting the main ligament that is pressing on it. In case of CTS, the operation is performed in two various methods: endoscopic and open.

      • At endoscopic surgery uses a thin, telescope-like device with a camera on the end (called an endoscope) that is inserted into the carpal tunnel through an incision in the wrist or palm. Using an endoscope, the surgeon sees the canal and can cut the ligament pressing on the nerve.
      • Typically, endoscopic surgery results in less pain and less side effects, and also promotes faster healing.
      • Unlike endoscopic surgery, open surgery involves making a larger incision in the palm and wrist to reach the problematic ligament and release the median nerve.
      • The risks of surgery include nerve damage, infection, and scar tissue formation. All this can lead to a worsening of the situation with the SZK.

   3. Please remain patient during the post-operative recovery period. During this period, you will be advised to frequently hold your operated arm above heart level and move your fingers, which will help reduce swelling and prevent stiffness. Mild pain, inflammation and stiffness may be present in the hand and wrist for up to six months after surgery, and full recovery may take up to a year. You will be asked to wear a wrist support for the first 2-4 weeks after surgery, although you will be advised to develop your palm.