Among the neurological pathology of the peripheral nervous system is about 50%, while taking first place in the degree of disability. One of the most common groups of diseases of the peripheral nerves of limbs are the so-called tunneling, or compression syndrome (compression neuropathy). These diseases are quite common (45%) in individuals whose professional activity is associated with prolonged stress certain muscle groups.
In our bodies there are zones of increased vulnerability of the peripheral nerves passing through special channels or tunnels formed by the bones, muscles, ligaments and fascia. Pathological changes in tissues that form the walls of the tunnel, there is irritation and compression (squeezing) of nerves.
The causes of compression (the tunnel) syndrome include: professional and consumer pressure on the muscles and fascia in the vicinity of the tunnel (chronic mikrotravmatizatsiya), traumatic lesions of bone and soft tissue anomalies and variations of the structure of tissues, as well as systemic disease (endocrinopathy, metabolic disease, polyarthritis rheumatic or other nature), accompanied by morphological changes in the tunnel.
The most common compression neuropathy of common carpal tunnel syndrome. In this case most often compression of the median nerve. Carpal tunnel syndrome is most common in older women. This disease is considered an occupational disease among workers performing monotonous flexor-extensor movements brushes (for example, when building machines). It is widely believed that the disease due to the work at the computer, which, however, is not supported by clinical studies.
Carpal tunnel syndrome
Treatment of carpal tunnel syndrome
Carpal tunnel syndrome occurs when the compression in the carpal canal branches of the median nerve.
Manifestations of carpal tunnel syndrome
The most common complaint in carpal tunnel syndrome is numbness in any of the five fingers, except the little finger. At the same time, patients complain that they can not keep things in hand because the patient numb. Violation of sensitivity is accompanied by pain, which gives to the forearm. These symptoms often occur or are worse at night, because at that time slows down the outflow of fluid from the vessels of the extremities, which can lead to its accumulation in the synovial sheaths. In addition, during sleep may occur involuntary flexion of the wrist, may also enhance the compression of the median nerve. In severe cases, there is atrophy and weakness in the muscles of the elevation of the thumb. 25% of patients have stiffness in the fingers, which appear to be caused, by the presence of associated tenosynovitis (inflammation of the tendon sheath).
In most cases, the diagnosis of carpal tunnel syndrome is established by careful questioning and examination by your doctor. Often the symptoms appear or are enhanced 60 seconds after a strong contraction in the hand or fist hammer when tapped on the wrist in a place of passage of the median nerve. In diagnostically challenging situations, uses a more painful (and expensive) investigation of the electrical impulse along the nerve (stimulus electromyography).
Treatment of carpal tunnel syndrome
In patients with mild carpal tunnel syndrome, whose symptoms have appeared recently or are expressed variably, has been successfully applied conservative therapy, which involves taking anti-inflammatory drugs and fixing overnight langetnoy wrist bandage to prevent it from bending. However, in many cases, the symptoms recur again. In this case, surgical treatment is shown. The operation is the method of choice for classic carpal tunnel syndrome. Typically, 80-90% of patients completely rid of the symptoms after the dissection of the transverse carpal ligament, which is involved in the formation of carpal tunnel. In some cases, during an operation performed neurolysis - excision of scar tissue and changed around the nerve, and partial excision of the tendon sheaths.
As a result of these manipulations stop squeezing the median nerve, symptoms disappear. This surgery is an outpatient basis under local anesthesia. After surgery, full recovery of nerve function takes a while, as a rule, the symptoms of the disease, are within three months. Sometimes, during prolonged and severe nerve compression is an irreversible damage. In this case the symptoms persist and even worse after the operation. In some cases, pain can be annoying due to the presence of tenosynovitis or arthritis (joint inflammation). The operation can be performed as traditional open manner and with the use of endoscopic techniques for the visualization of the nerve and the transverse carpal ligament. The advantages of endoscopic surgery are cosmetic small incisions, faster recovery period, reducing the frequency of complications.
Tunnel syndrome - Compression Neuropathy
In the early period of the disease the correct diagnosis is rarely put to the defeat of the tunnel. This is due to the predominance of symptoms of nerve irritation symptoms of the loss of its function.
Usually the clinical picture of carpal tunnel syndrome consists of the following symptoms: Paresthesia (tingling, "pins and needles") in the area of innervation of the affected nerve. As a rule, paresthesias occur at night, which is associated with the development of venous stasis in the distal limbs during sleep. Venous congestion, in turn, contributes to disruption of local blood flow in the tunnel the nerve lesion.
Spontaneous pain is also typical for the destruction of the nerve tunnel. There is a wide range of character and intensity of spontaneous pain - from mild dull pain expressed in the tunnel to the acute pain, not being able to make even a small amount of motion in joints adjacent to the tunnel. Irradiation is characterized by pain in the area of innervation of the nerve.
The vast majority of patients with disorders identified areas of sensitivity in the form of hypesthesia (decreased sensitivity) and hypalgesia (reduced pain sensitivity) in the zone corresponding to the innervation of the nerve, at least - parts and giperpatii hyperalgesia. The appearance of disorders of sensitivity in the later stages of the disease due to slow the growth of tissue pressure in the tunnel. If the tunnel acute nerve damage caused by compression of the structures that form a tunnel, sensitivity disorders develop relatively quickly.
