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 rapid movements of the fingers. This is an occupational disease of people who work a lot at the computer. Such a pathology often affects secretaries and PC operators. This is a rather serious disease in which the patient's working capacity and sleep are impaired. Another name for this ailment is carpal tunnel syndrome or carpal tunnel syndrome .
Pathogenesis of the disease
The median nerve provides movement in the upper limbs. It begins in the shoulder area, passes through the entire arm, and branches out in the carpal canal. This section of the peripheral nervous system is responsible for flexion and extension of the muscles, movement of the fingers and rotation of the hand. If the carpal tunnel is narrowed, the median nerve is compressed between the bones and muscles. Because of this, pain and numbness arise.
Causes of pathology
What causes the narrowing of the carpal tunnel, in which there is a pinched nerve? The most common causes of carpal tunnel syndrome are activities that are associated with fast, frequent and uniform movements of the hand and fingers. This disease is very susceptible to people who work a lot at the computer, as well as seamstresses and musicians. As a result of the increased load on the hand and fingers, tendon inflammation occurs. Due to tissue edema, the carpal tunnel becomes narrower, and the nerve is compressed.
However, prolonged work at the computer does not always lead to carpal tunnel syndrome. For the occurrence of the disease, additional factors are necessary. This pathology often affects women and overweight people. In these categories of patients, the carpal tunnel is narrower.
There are other reasons for narrowing the wrist channel and pinching the nerve:
- Arthritis With inflammation of the joints, the tissues of the wrists swell and squeeze the nerve.
- Hand injuries. Bruises and sprains are also accompanied by an inflammatory reaction and swelling. In fractures, pinching of the nerve with bone fragments can occur. Carpal tunnel syndrome often appears after a poorly made reduction of dislocation.
- Water retention in the body. This phenomenon is noted during pregnancy, kidney and thyroid diseases, as well as menopause. The appearance of edema due to excess fluid helps to compress the nerve in the wrist channel.
- Tenovaginitis. This is an inflammation of the wrist tendons . 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, a severe metabolic disorder occurs. As a result, the nutrition of the median nerve deteriorates. 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 dysfunction of the pituitary gland in which excess growth hormone is produced in adults. In patients, the hands grow, which leads to compression of the nerve with bones.
In addition, there is a genetic predisposition to the occurrence of carpal tunnel syndrome. In some people, the carpal canal is square in cross section. This is a congenital anatomical feature. Reduced secretion of tendon lubrication may also be noted. In the presence of additional adverse factors, for example, during long work at the computer, such people have an increased risk of illness.
Symptomatology
The leading symptom of carpal tunnel syndrome is finger pain. It occurs at night and disrupts the patient’s sleep. To reduce discomfort, a person shakes a brush. Such movements stimulate blood circulation and for some time the condition improves. However, pain soon returns.
The pains are stitching or burning in nature. 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 make movements with his fingers.
In advanced cases, pain occurs not only in the fingers, but also in the entire 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 onto the handrail. Numbness occurs after 2-3 minutes, even with little effort. This symptom is associated with a violation of the innervation of the fingers and hand due to compression of the vessels.
The patient cannot hold small objects in his hands. Fingers lose muscle strength. Their movements become awkward and inaccurate. In advanced cases, muscle atrophy and deformation of the hand occur.
The skin of the fingers loses sensitivity. Patients do not feel touch or even injections. Numbness increases with temperature changes, in cold or heat. Pale skin color on the affected brush is noted.
Diagnostics
A neurologist or rheumatologist is involved in identifying symptoms and treating carpal tunnel syndrome. Diagnosis of the disease begins with special tests:
- Sample with a cuff for measuring blood pressure. The doctor puts a cuff on the patient’s hand and pumps air into it. If the nerve is compressed, then there are stitching sensations in the fingers.
- Tinel test. The doctor taps his fingers on the narrowest part of the canal of the wrist. In the presence of pathology, the patient feels a tingling sensation in the hand.
- Test with hands up. The patient raises them above his head and holds them for about a minute. In patients with this, numbness and tingling are noted.
- Sample with bending of the brush. The doctor suggests that the patient bend it and hold it in this position for about a minute. At the same time, pain intensifies, numbness and burning appear.
A person can conduct such tests at home. If during their implementation there is numbness and tingling, then this should serve as a reason for seeking medical attention.
In carpal tunnel syndrome, symptoms may resemble manifestations of cervical osteochondrosis or a hernia of the spine. For the purpose of differential diagnosis, the following examinations are prescribed:
- Electroneuromyography. This study determines the speed of passage of an impulse in the nerves and the electrical activity of the muscles. With pathology, weakening of the muscles of the hand and slow passage of the pulse are noted. Electroneuromyography allows you to determine the initial stage of the disease.
- Magnetic nuclear tomography. The method allows you to determine the size of the wrist channel 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. Using this method, you can determine the width of the median nerve.
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. To this end, a blood test is prescribed for sugar and thyroid hormones, which will help to identify diabetes and hypothyroidism, which often provoke the development of nerve compression. If the patient has swelling of the face or limbs, it is necessary to exclude or confirm the pathology of the kidneys. For this purpose, a urinalysis is prescribed. If the tunnel syndrome is accompanied by pain in the joints, then conduct a study for rheumatoid tests.
Drug therapy
How to treat carpal tunnel syndrome? For therapy to be effective, it is necessary to create a gentle regimen for the affected limb. It is necessary to reduce the load on the brush, and also for a period of at least 2 weeks to abandon work associated with the commission of frequent and similar movements. It is useful to wear special orthopedic fixators for a sore hand (orthoses). They reduce the amplitude of movements and prevent exacerbation.
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 decreases, pain and swelling of the tissues are relieved. At the first stage of the pathology, drugs are administered intramuscularly and intravenously. After improving the condition, the medications are taken in tablet form. The following medications are prescribed:
- Diclofenac
- Movalis
- Ksefokam;
- "Naklofen";
- Aertal.
In more severe cases, treatment is supplemented with corticosteroid hormones:
- Metipred;
- "Hydrocortisone";
- Prednisone.
These drugs quickly and effectively relieve pain and swelling. However, corticosteroids negatively affect the digestive tract and the immune system. Therefore, such drugs are prescribed in short courses.
To improve blood circulation and eliminate numbness of the hand, such vasodilator drugs are used:
- Trental;
- "Angioflux";
- "A nicotinic acid".
They are prescribed by injection or in tablets. A major role in the treatment of carpal tunnel syndrome is played by vitamin therapy. This helps to improve the condition of the median nerve. Prescribe B vitamins (the 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, diuretic drugs are indicated:
- Veroshpiron;
- Furosemide;
- Diacarb.
In some cases, antidepressants (Venlafaxine, Duloxetine) and anticonvulsants (Pregabalin) are prescribed to reduce pain and improve night sleep. However, these drugs are not the first choice. They are used at a time when acute pain is already stopped.
Local funds
In the treatment of carpal tunnel syndrome, local drugs are used to relieve pain. These are ointments and gels based on non-steroidal anti-inflammatory components:
- Diclofenac
- Voltaren;
- "Rapten";
- Clodifen.
If the pain syndrome is very pronounced, then blockade treatment is prescribed. This is a quick and effective way to stop burning and pain. Using a syringe with a long thin needle, drugs are injected directly into the carpal tunnel. Usually use a mixture of corticosteroids (Hydrocortisone, Diprospan) with anesthetics (Lidocaine, Novocaine).
This method leads to the rapid disappearance of all manifestations of carpal tunnel syndrome. Reviews of the blockades indicate that the analgesic effect occurs 1-2 days after the injection. If necessary, the injections are repeated 2 more times with an interval 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 the unpleasant sensations disappear.
Other treatments
Physiotherapy is used both during medical treatment of carpal tunnel syndrome and during recovery after surgery. The following types of procedures are prescribed:
- Ultraphonophoresis. With 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, using the apparatus, ultrasound is applied, 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 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.
Surgery
Surgery for carpal tunnel syndrome is indicated in cases where conservative therapy fails. Doctors recommend surgery if the patient does not show improvement within 6 months.
During the operation, the ligament of the carpal tunnel is dissected. Surgical treatment is carried out in two ways:
- Open method. A small incision is made on the patient’s wrist. A ligament is excised through it.
- Endoscopic method. Two small incisions are made: on the palm and on the wrist. An endoscope is placed in one of them, and a ligament is excised through the other.
After surgery, the wrist is fixed with plaster for several days. During the recovery period, physiotherapy sessions are prescribed. It is also necessary to do therapeutic exercises for the fingers. It is recommended that the patient temporarily change work if it is associated with a load on the hand.
Surgical intervention radically eliminates all manifestations of carpal tunnel syndrome. Reviews of the operation indicate that 3 months after it, most of the functions of the brush are restored. And after six months, a person can return to their previous labor activity. However, if a gentle 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 by folk remedies alone. Nevertheless, home remedies can be a good addition to the main treatment.
The following recipes are recommended:
- A 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 product is drunk in small sips 4-5 times a day. A decoction of lingonberry leaves has anti-inflammatory properties, it is able to 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 affected wrist once a day.
- Remedy for ammonia, camphor and salt. You need to take a tablespoon of salt, 50 g of ammonia and 10 g of camphor. The ingredients are dissolved in 1 liter of water. The resulting product is rubbed on the affected area. This helps reduce pain and numbness.
Treatment of carpal tunnel syndrome at home should be coordinated with your doctor. Only a specialist can take into account all possible indications and contraindications. It is important to remember that plant components can cause an allergic reaction.
Prevention
To prevent the disease, you must follow the rules of the computer. It is necessary to organize your work in such a way as to reduce the load on the hand and fingers. To do this, 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’s best to use the touchpad.
- You need to choose a convenient keyboard, this will reduce the load on the fingers.
- It is useful to purchase a special mouse pad with support for the wrist.
- Periodically, it is necessary to arrange breaks in work, during which to do gymnastics for the fingers.
In addition, you need to monitor your health and treat wrist injuries, endocrine pathologies and arthritis in time. These diseases can provoke pinching of the median nerve. Tunnel syndrome can significantly reduce a person’s performance. This pathology is easier to prevent than to treat.