Carpal tunnel syndrome is an occupational disease of people who perform monotonous, same-type movements with a brush in accordance with the specifics of their work activity.
Most often, pathology is diagnosed in cashiers in stores, artists, computer users, hairdressers, some musicians, miners, and others. Women are more prone to illness than men, due to the relatively small size of the carpal tunnel.
The first symptoms of tunnel syndrome appear, usually at the age of 35 - 40 years. The peak incidence is observed in patients 50 - 60 years. The disease occurs in chronic form with alternating periods of exacerbation and remission. Accompanied by pain, paresthesia, impaired motor function. Symptoms of pathology may have varying degrees of severity.
What it is?
Tunnel syndrome, or carpal tunnel syndrome - a chronic neurological disease, accompanied by a feeling of numbness and pain in the fingers. The disease refers to tunnel neuropathy.
The main cause of the development of pathology is the compression of the median nerve located between the bones, the transverse ligament of the hand and the carpal tendons. Such a syndrome often develops in older women, as well as in people who, by virtue of their professional duties, perform monotonic flexion-extensor movements with a brush.
Causes of development
Carpal tunnel is located at the base of the hand. It is formed by the carpal bones and transverse ligaments. Inside the canal is the median nerve, the flexor tendons and their synovial membranes.
The median nerve consists of sensory and motor nerve fibers. They are responsible for the sensitivity of the skin of the palm of the first three and half of the fourth finger, and the back surface of their nail phalanges. The task of motor fibers is to ensure the movement of the fingers.
In a healthy person, the median nerve runs freely along the canal. But with frequent microtraumas, a thickening occurs, and a puffiness of the transverse ligament forms. It begins to put pressure on the nerve, and in parallel with this there is an inflammation of the connective tissues, characterized by a chronic course. Increased pressure on the median nerve provokes venous congestion with subsequent violation of blood circulation in the nerve.
Sensitive fibers are the first to be destroyed, and only then the motor fibers are affected. In addition, even the fibers of the autonomic nervous system may be involved in such a process.
So what are the causes of the disease? Tunnel syndrome may be caused by:
- long monotonous work at the computer;
- injuries suffered (for example, a fractured wrist);
- period of pregnancy, breastfeeding, menopause;
- endocrine pathologies: acromegaly, hypoparathyroidism, etc .;
- taking hormonal contraceptives;
- renal failure;
- articular pathologies (rheumatoid arthritis, gout);
- prolonged hypothermia;
- genetic predisposition;
- features of work, when a person constantly has to bend and unbend a hand.
For the first time, the disease can manifest itself at a young age, but the peak of its surge falls on 40 - 60 years.
In the early phase of its development, tunnel syndrome is accompanied by tremors, tingling in the limbs and itching. Some symptoms may appear later - after the completion of a certain movement of the wrist.
The late stage of the disease is accompanied by:
- pain syndrome;
- heaviness in the hands;
- reduced brush sensitivity;
- increased severity of paresthesia.
Often, patients with carpal tunnel syndrome suffer from insomnia, the occurrence of which is associated with pain and cramps in the affected hand. If the disease becomes neglected, muscle atrophy develops, due to which it becomes impossible to squeeze the hand into a fist. As a result of this process, a person cannot lift weights, hold the phone for a long time, work at a computer, hold the steering wheel of a car for more than 15 minutes and perform similar manipulations requiring rotational movements with a brush. In parallel, the fine motor skills of the hands are disrupted.
It is noteworthy that these symptoms often occur during a night's sleep. At the very beginning of the development of pathology, such ailments quickly pass - for example, after shaking with a hand or changing its position. But as the disease progresses, these symptoms appear more and more often, and the previously mentioned measures aimed at their elimination lose their effectiveness.
To pass a diagnosis in case of suspected tunnel syndrome, it is necessary to contact a neurologist. At the first visit, the doctor collects a history and conducts a survey to determine the sensitivity of the fingers. Next, dynamometry is performed to assess the muscle strength of the injured arm.
To clarify the diagnosis, the doctor should also conduct:
- Falen test. In tunnel syndrome, pain occurs when lifting the arms up.
- Opposition trial. The diagnosis is confirmed if the patient cannot connect the ring finger and the little finger.
- Test Tinel. When tapping the wrist of the affected hand, the patient feels pain.
- Test Durcan. When compressing fingers into a fist, the patient complains of shooting pains in his hand.
Sometimes, in parallel with the above tests, patients with suspected tunnel syndrome are prescribed:
- Electromyography. The objective of this diagnostic method is to determine the bioelectric muscular and nervous activity in a state of rest and physical tension. With this procedure, you can identify damaged areas of the muscles.
- Analysis of nerve conduction. This test is aimed at determining the speed and strength of the transmission of electrical signals by nerves. If a slow pulse has been detected, it means that the median nerve is pinched.
For differential diagnosis, radiography is performed.
How to treat tunnel syndrome
Treatment of tunnel syndrome is to prevent the median nerve from becoming more pinched. Anti-inflammatory and anti-edematous therapy is required to eliminate pain and discomfort. An important aspect of treatment is the complete elimination of the underlying disease that provoked the development of this syndrome.
If the tunnel syndrome was diagnosed at an early stage of its development, then you can get rid of it without surgical intervention. Modern pharmacology has a wide selection of drugs that will be very effective in this disease.
Drug therapy is carried out on an outpatient basis, that is, at home, but according to a scheme developed by a doctor. Usually assigned for this:
- NSAIDs. Eliminate pain and swelling will help nonsteroidal anti-inflammatory drugs: Ibuprofen, Nimesulide, Analgin, etc. However, it’s not worthwhile to pin hopes on a full recovery by using these medicines.
- Hormonal drugs from the GCS group. Corticosteroids have a pronounced anti-inflammatory and anti-edema effect. They also reduce the pressure on the median nerve. Such drugs are introduced only by injection, and exclusively in the middle canal. Oral corticosteroid hormones do not have the desired effect.
Some patients have significantly improved condition when taking pyridoxine - vitamin B6. Vitamin has anti-inflammatory effects, and also eliminates swelling.
However, pharmacotherapy is only a way to relieve symptoms, therefore, it does not fight the problem itself. That is why, in parallel with the medication, it is necessary to wear a splint on the sore hand. It fixes and immobilizes the brush, which is especially important and necessary during a night's sleep. In addition, such a fixation is the key to the absence of such unpleasant symptoms as "lumbago" and numbness in the sore wrist.
The main advantage of this method is that it is not contraindicated for pregnant women and small children.
For symptomatic therapy, it is possible to include in the main treatment regimen and alternative procedures. But this can be done only after consultation with the doctor, since the auxiliary treatment is selected strictly individually.
The following techniques have a favorable effect on the affected bone:
- Yoga. Yogic postures contribute to the strengthening and stretching of each joint in the human body. Such exercises in tunnel syndrome significantly reduce the intensity of symptoms of the disease, as well as have a beneficial effect on the musculoskeletal system as a whole.
- Manual therapy To date, research on the effects of manual therapy on the affected joints in tunnel syndrome and other similar diseases is still being studied. But recent results show that such an approach really improves the condition of patients with articular pathologies.
- Ultrasound therapy. The use of high-frequency ultrasound increases the tissue temperature in the treatment area. This contributes to the elimination of pain and the start of an active process of healing and regeneration. When using this technique to treat patients with tunnel syndrome, the severity of symptoms is significantly reduced, which helps alleviate their condition and improve their well-being.
If drug therapy fails, surgery is performed. During surgery, the surgeon removes the ligaments that press down on the median nerve. This procedure is carried out in several ways:
- Endoscopic surgery. It is less traumatic, and after it there are no scars or scars. During the procedure, a small incision is made on the skin through which the device is inserted with a camera at the end. Next, the doctor uses a special tool to destroy the ligaments in the canal. After the operation, a plaster splint is applied to the incision site.
- Open operation With this manipulation, a deep incision is made along the middle channel. Next, remove the ligaments, pressing on the nerve, the incision is sutured. After such an intervention, the patient must undergo a long course of rehabilitation.
One day after surgery, the patient should gradually move his fingers. After 1.5 months, the patient is prescribed a course of physiotherapy. In parallel, shows occupational therapy.
During the recovery period, massages are held, a course of exercise therapy is prescribed. To fully restore the work of the brush, the patient must regularly move it. If pain occurs, it is necessary to resort to taking pain medication.
When exacerbating the disease, you can try to slowly bend and unbend the fingers of a sore hand, rotate the brush, squeeze rubber objects, spread your elbows to the sides, clenching the fingers of both hands into fists. The pressure of one palm on the other also helps to eliminate pain.
To prevent the development of tunnel syndrome, you must follow these simple rules:
- While working at the computer, try to operate less with the mouse, preferring the touchpad. If this is not possible, then it is important to monitor the position of the hands while working with a computer mouse. The brush should be straight, and be on the table entirely, not hanging, and not being near the edge of the tabletop.
- If you have to work a lot at the computer, then get a chair with armrests.
- While working at the computer, you must use ergonomic models of mice and keyboards. Also, the hand needs a reliable support, which can be done independently.
- You should not spend a lot of time at the keyboard of laptop computers. If this is a working necessity, then it is better to connect a removable keyboard from a stationary computer to the device.
- Every hour you need to take a break - it is very useful for both brushes and eyes.
- If you feel tired, you need to do a short gymnastics. You can perform simple rotational movements with a brush, squeeze and unclench your fingers, clap your hands. To remember the need for such activities, you can put on the desktop an object that attracts attention - a key chain, a bracelet or something else. But it is important that this is such a product that can be twisted in the hands - beads, rosaries, hand balls, etc.
- If a load is created on the wrist, it is recommended to warm up the arm before this. To do this, you can do some simple exercises, or use a warm bath.
The main task of treatment for tunnel syndrome is to eliminate the alarming symptoms - pain, burning, discomfort, etc. However, it is important not only to get rid of unpleasant sensations, but also to eliminate the cause of the development of this disease.
Therapy for tunnel syndrome should be comprehensive - only this way you can eliminate the disease completely, or permanently put it into the remission phase with minimal risk of recurrence. Despite the fact that the disease significantly reduces the quality of life of patients, it has a favorable prognosis, especially with full compliance with all the recommendations given by the attending physician.