Tunnel neuropathy is a fairly common occurrence. It is associated with impaired microcirculation and compression of the peripheral nerves in the so-called tunnels, that is, narrow fibro-bone channels of the upper and lower extremities.
Such a pathology may be due to a 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 that explain the mechanism of development of tunnel neuropathy (for example, hormonal), but none of them has received final scientific confirmation, therefore the disease is considered multifactorial. Depending on which nerve is affected, several types of this pathology are distinguished.
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 that there is a fairly long compression of the nerve, accompanied by circulatory disorders, which lead to ischemia of nerve fibers.
There are many varieties of this pathology, for example, tourniquet, tunnel, iatrogenic (postoperative) neuropathies. Tunnel diseases are allocated in a separate group, because they have a common symptom: local compression of the nerve occurs inside the natural channels and tunnels.
If you look at the code for tunnel neuropathy according to ICD 10, then it can be noted that there is a clear division into mononeuropathies of the upper and lower extremities. They are credited with codes G56 and G57, respectively. The last group includes, for example, tunnel neuropathy of the peroneal nerve.
Diagnosis of such diseases is carried out using various methods. For example, ultrasound of the nerve and radiography of the joint 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 brachial plexus nerves. The reason is compression, that is, compression of the nerve in the specified area.
This is often associated with the features of professional activity, for example, if a person has to work for a long time with the support of his elbows on a desk or a machine. Although in some cases this form of the disease can develop in athletes with prolonged 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 reasons that the disease so often affects the ulnar nerve, are its superficial location, which makes this area especially vulnerable.
Despite the name “tunnel neuropathy of the ulnar nerve,” signs of the disease can appear at the level of the wrist, and in 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 laid aside. Atrophy of the small muscles of the hand.
Pathology of the radial nerve: causes and symptoms
Tunnel neuropathy of the radial nerve is considered an equally common disease. For the occurrence of its symptoms, sometimes it is simply unsuccessful to simply put your hand in sleep. It is interesting that this usually happens in people who fall asleep soundly after hard physical work, or because of 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 injuries, and in general is a secondary pathology. Such a phenomenon is encountered by those who are involved in running, conducting, as well as patients who have to use crutches.
Other factors contributing to the development of this disease are:
- humerus injuries;
- improper harness application;
- bursitis, synovitis, other inflammatory diseases, including rheumatoid arthritis;
- infections (including flu);
- intoxication;
- degenerative joint diseases - arthrosis.
For tunnel neuropathy of the radial joint, the so-called hanging brush is characteristic. This means that if the arm is pulled forward, the hand on the affected side cannot take a horizontal position, it will hang down. In this case, the index and thumb are pressed together.
The patient feels numb and paresthesia on the back of the hand, as well as in the region of the index, thumb and middle finger.
Neuropathy of this type includes two main syndromes. This is a radial tunnel syndrome, which is characterized by compression of the surface branch of the nerve in the region of the anatomical snuff box, as well as Turner syndrome (it is more often observed with a fracture).
Pathology of the median nerve: causes and symptoms
Tunnel neuropathy of the median nerve may be due to a wide variety of reasons. This, for example, injuries of the upper limb or nerve damage associated with professional activities (typical for people who have a large load on the hand, resulting in a constant overstrain). Also, a similar situation can be caused by improper injection into the ulnar vein.
Symptoms of tunnel neuropathy of the median nerve are pain in the thumb, index and middle fingers. In addition, discomfort or pain of varying degrees of intensity is also felt on the inner surface of the forearm.
Bending the hand in the palms is becoming increasingly difficult (upon examination, the doctor specifically asks to squeeze the hand into a fist to check this feature). Muscles can atrophy quite a lot over time, especially around the thumb. If you do nothing with this, your hand will more and more resemble a monkey paw.
Tunnel neuropathy of the peroneal nerve and its features
This is a special kind of mononeuropathy. It manifests itself in the so-called hanging foot syndrome, in which the patient cannot bend the foot or straighten her fingers. In addition, the skin of the anterolateral region of the lower leg is affected, its sensitivity decreases.
A feature of this pathology compared to what was described above is the following: it affects the peroneal nerve, consisting of relatively thick nerve fibers. They differ in a solid layer of the myelin sheath, but it is such a structure that is most susceptible to damage in violation of metabolic processes.
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, do not underestimate other reasons that can lead to such a pathology. This, for example, can be various injuries (from a bruised knee to a broken leg), vascular disorders leading to ischemia, curvature of the spine, gout, diabetes mellitus, wearing excessively tight shoes.
When injuring a joint, a nerve lesion is acute, pain immediately manifests itself. In other cases, neuropathy develops gradually, like 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 imperceptible, and then forced enough to bend the affected limb in the knee joint so that the sock does not catch on the floor.
The process is accompanied by pain both in the foot itself and in the lower leg. Muscles can atrophy over time. The patient cannot stand on his heels or walk on toes, and this is one of the simplest ways to check which particular nerve is affected.
Treatment: basic principles
Treatment of tunnel neuropathies can be effective only if the cause is established and the mechanism of the occurrence of compression is determined. As for the methods, in this case, an integrated approach to therapy is used.
Fortunately, in most cases, conservative treatment is prescribed. However, in some situations (usually severely neglected), a more radical surgical intervention may be necessary, in which the tissue that compresses the nerve is dissected. Typically, such an operation is prescribed in cases where conservative treatment has failed. There are practically no absolute indications for its implementation.
As for conservative therapy, its methods partially depend on which particular 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 squeezed. For this, special shoes, orthoses, and other devices are used.
Etiotropic therapy
Considering a disease such 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 it is an arthrosis or other degenerative joint disease, then drugs containing chondroitin sulfate and glucosamine are prescribed.
In a certain 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 administration.
The main thing that these drugs do is that they help restore joint tissues, and prescribe them precisely for this. 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 can not be used for a long time, and here chondroitin sulfate with glucosamine will come in handy.
Additional treatment
Another area of etiotropic therapy is the restoration of metabolic processes, normal motor activity, and also the removal of inflammation and swelling.
For this, the fastest option is the introduction of glucocorticosteroids 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 blockade of the nerve is prescribed.
An alternative is compresses with anesthetics, dimexide and glucocorticosteroids, which are applied to problem areas for 20-30 minutes. Perhaps the use of non-steroidal anti-inflammatory drugs like Ibuprofen, but they 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, the administration of B vitamins is prescribed. Massage plays an important role in the treatment (it can only be performed by a specialist) and a specially developed set of exercise therapy exercises. Physiotherapy methods are widely used. This is magnetotherapy, electrophoresis, electrical stimulation procedures.
Symptomatic therapy
If tunnel neuropathy is diagnosed, how to treat it is a critical issue. And at the same time, the choice of a drug for symptomatic therapy, which will help relieve pain, plays a special role.
For this, the following types of tools are used:
- Anticonvulsants. Their action is based on the fact that they soothe certain structures of the spinal cord and brain, which are responsible for the appearance of a pain reaction during compression of the nerve.
- Anesthetics (it would be more correct to call them transdermal systems with an anesthetic, in the role of lidocaine). They act in the same way as anticonvulsants.
- Tricyclic antidepressants. They reuptake serotonin and dopamine, which helps to relieve pain.
However, tricyclic antidepressants are prescribed only when the potential benefit significantly exceeds the possible side effects: drowsiness, increased blood pressure, impaired coordination of movements. Relatively safe are such drugs as "Escitalopram", which are also among antidepressants, but in another 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 that mechanical compression of the vascular and nerve trunks with spasmodic muscles occurred, then muscle relaxants are prescribed. They relax muscles and have an analgesic effect.
According to doctors, in this group one of the most effective means is Tizanidine, Baklosan and Tolperizon 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 the disease in an advanced state.
It is also not recommended to ignore unpleasant symptoms, 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. Without prior consultation with a specialist, it is not recommended to do anything.