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Can you get carpal tunnel while pregnant
Carpal tunnel syndrome and pregnancy
Carpal tunnel syndrome and pregnancy | Pregnancy Birth and Baby beginning of content
Carpal tunnel syndrome is a condition that occurs when swelling in your wrist presses on a nerve and causes pain in your hand.
It’s common in pregnancy and usually goes away after your baby is born.
It can cause pain, numbness and tingling in your thumb, index finger and middle finger. It can also cause weakness in your hand and pain going up your arm.
You can modify your daily activities to reduce your pain.
See a physiotherapist or occupational therapist to learn exercises and get a special wrist splint fitted to help relieve pain.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition that occurs as a result of swelling around the nerves of your wrist. It can cause numbness, tingling or pain in one or both of your hands.
If you are pregnant, you’re particularly susceptible to the disorder. Up to 5 out of every 10 people who are pregnant develop carpal tunnel syndrome.
What causes carpal tunnel syndrome?
The carpal tunnel is a passage in your wrist that contains tendons and a nerve, called the median nerve, that run through the base of your hand. The carpal tunnel can swell and press against this sensitive nerve, causing pain.
While pregnancy is one cause, other common causes include arthritis or repetitive hand movements, which may occur in some jobs. Visit this healthdirect page for information about carpal tunnel syndrome unrelated to pregnancy.
How does pregnancy cause carpal tunnel syndrome?
When you are pregnant, your hormones cause fluid to build up in your body, which can cause swelling. This can lead to swelling within the carpal tunnel.
The condition is more common in the third trimester, but it can also happen in the first and second trimesters or after you give birth. In most cases, symptoms will go away after your baby is born.
What are the symptoms of carpal tunnel syndrome?
Common symptoms of carpal tunnel syndrome include:
pain, numbness, tingling, or weakness of your hand
difficulty with hand coordination
pain spreading to your arm or shoulder
You will probably feel the symptoms most in your thumb, index finger and middle finger. Symptoms can get worse at night.
The intensity of symptoms can vary from mild irritation or occasional soreness, to severe pain. Symptoms may stop you from sleeping or make it difficult to perform regular tasks such as working, getting dressed, cooking or caring for your baby.
Things that may make your symptoms worse include:
repeating the same hand movements frequently
keeping your hands in the same position for an extended time
supporting your weight with straightened arms
Swelling may be a sign of high blood pressure in pregnancy. If your hands or feet are more swollen than usual, speak to your doctor or midwife.
What can I do to relieve carpal tunnel syndrome?
You may find that your pain is reduced by the following:
Keep your hands elevated as much as you can.
Keep your wrists in a neutral position (not bent forwards or backwards), as much as you can.
Maintain good posture in your arms and wrists while working at a desk and take breaks every 20 minutes.
Sleep on the side of your less affected hand.
Put an ice pack on your wrist or run cold water over your hand.
Here are some things you should avoid:
Avoid any repeated movements that make your pain worse.
Avoid lifting heavy objects.
Avoid tasks where you do the same movement repeatedly.
Don’t bend your wrist as far as it can go.
Here are some things you can do to relieve general swelling in your body:
Lie down whenever you can, with your feet elevated.
Cut down on salt in foods.
Elevate your legs when you’re sitting down.
Wear compression socks or stockings.
Are there any treatments for carpal tunnel syndrome?
Treatment options include physiotherapy or occupational therapy. This may involve fitting you with a splint to keep your wrist in the best position to reduce strain. The splint must be adjusted to fit your wrist in order to be protective and supportive. You should wear your splint at night to keep your wrist in the right position while you’re asleep.
Your therapist will be able to tell you how best to protect your wrist at home, including exercises and resting positions.
You can try fluid drainage massage to reduce the swelling in your hand. You can do this by lifting your arm up and using your other hand to sweep gently along your skin from your fingers towards your shoulder. Be careful not to sweep the other way.
There are other treatments available for carpal tunnel syndrome, such as a cortisone injection into your wrist or even surgery.
Will I still have pain after my baby is born?
Carpal tunnel syndrome tends to ease, and often disappears, after birth. If you still have pain after your baby is born, you may need to change the way you use your wrist. This might affect how you use your hand to hold and care for your baby, including how you feed your baby.
Speak to your physiotherapist, occupational therapist or lactation consultant for strategies and tips on how to minimise strain on your wrist while holding your newborn. It’s a good idea to continue using your splint, if you have one.
Royal Women’s Hospital (Pregnancy-related carpal tunnel syndrome), Australian Government Department of Health (Carpal tunnel syndrome), Western Australia Department of Health (Carpal tunnel syndrome), Western Sydney local Heath District (Fact Sheet Carpal Tunnel Syndrome)
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Last reviewed: June 2022
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Carpal tunnel syndrome - MyDr.com.au
Carpal tunnel syndrome is a progressive and painful condition where the median nerve is compressed as it passes through the carpal tunnel.
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Carpal tunnel syndrome
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Carpal tunnel syndrome and pregnancy go hand in hand | Your Pregnancy Matters
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Your Pregnancy Matters
October 20, 2020
Your Pregnancy Matters
Robyn Horsager-Boehrer, M. D. Obstetrics and Gynecology
Approximately 31% to 62% of pregnant patients have carpal tunnel syndrome.
Swelling – everywhere – is one of the most common symptoms of pregnancy. Patients often notice extra puffiness in their face, legs, and feet. But for some women, swelling manifests inside the wrist, resulting in carpal tunnel syndrome (CTS).
Approximately 4% of adults in the general population have carpal tunnel syndrome, but 31% to 62% of pregnant patients have it. Many patients notice symptoms after 30 weeks' gestation.
During pregnancy, your blood volume doubles. That extra fluid increases pressure and swelling in the blood vessels throughout your body. In tight spaces such as the carpal tunnel area of the wrist – through which nine tendons and one nerve pass – the swelling can compress the median nerve, which runs to the hand.
The median nerve gives sensation to the palm-side surface of thumb, index, and middle fingers, and half the ring finger. It's also responsible for helping to move the muscles in the hand that bend your fingers.
Nerve compression can cause pain, tingling, and numbness in the wrist and hand, which may increase when you're trying to sleep. Pregnancy may be the first time CTS symptoms arise or the last straw that causes a woman to see her doctor for ongoing symptoms.
The good news is that pregnancy-safe treatment is available, and symptoms typically subside for many patients after the baby arrives.
I've invited my colleague, Rupali Kumar, M.D., from UT Southwestern's Physical Medicine and Rehabilitation (PM&R) team to discuss CTS symptoms and treatment options.
Carpal tunnel symptoms in pregnancy
Dr. Rupali Kumar
When the median nerve is compressed during pregnancy, symptoms present as they would in any patient:
● Numbness and tingling
● Burning sensation
● Pain in the wrist or hand
At the onset of CTS, symptoms may come and go. But when numbness or weakness occurs frequently or constantly, that's a potential sign of nerve damage.
In severe cases, patients may have weakened grip strength or decreased finger dexterity. For example, you might have trouble picking up small objects with your fingers, opening jars, or buttoning clothes.
Related reading: 5 weird pregnancy symptoms you might not know about
Diagnosing carpal tunnel in pregnancy
We often can diagnose CTS by talking with you about your symptoms and medical history. If your symptoms are severe, we may recommend an electrodiagnostic study (EMG) to confirm the diagnosis and measure nerve function in the arm, wrist, and hand. An EMG can tell us whether you have nerve damage, how severe it is, and whether it might be reversible with intervention.
The doctor will attach small electrode stickers to your hand and arm in different places and apply low levels of electrical stimulation to gauge the nerve activity. The doctor may also insert a fine acupuncture-like needle in certain areas of the arm and hand to test muscle electrical activity. The study can be a little uncomfortable, but should not cause lasting pain.
Pregnancy-safe treatment options
With CTS, it's best to start with the most conservative therapies. That's especially true in pregnancy. Here is a list of carpal tunnel treatment options that are safe for pregnancy, from least to most invasive.
The first-line treatment is to immobilize the wrist in a neutral position to limit the range of flexion or extension. We use a neutral wrist splint with a metal bar inside that prevents the wrist from moving up, down, or side-to-side but allows the fingers to move.
Splinting gives the median nerve a break and can help alleviate swelling, which can allow mild to moderate nerve damage to heal. However, it's tough to wear a splint all day and do everyday activities. Your doctor may recommend wearing it while sleeping and as much as you can during the day.
Hand and wrist therapy can sometimes help relieve symptoms and prevent further nerve damage. A PM&R doctor or occupational therapist can create a personalized plan for you.
Therapy may include wrist and finger range of motion and strengthening movements, massage, and nerve gliding techniques. We may also recommend desensitization to decrease nerve pain, including alternating hot and cold water baths.
Topical numbing agents can relieve symptoms, but these ointments won't get to the root of the problem. Some patients may benefit from pain relief injections, which include a combination of steroids and a local anesthetic injected around the median nerve under ultrasound guidance.
However, if there are other therapies to try, we typically avoid prescribing steroids during pregnancy to avoid side effects.
Check with your Ob/Gyn before using any over-the-counter or prescribed topical medications. Our PM&R doctors will consult with your Ob/Gyn prior to recommending medication during pregnancy.
Surgery, in severe cases
Carpal tunnel release surgery is reserved for severe cases. In this procedure, a surgeon will cut the ligament that presses on the carpal tunnel, making more room for the median nerve and tendons. This usually improves function and pain.
Generally, we recommend waiting until after pregnancy to have surgeries that are not urgent. If wrist pain or hand weakness severely limits your daily function, talk with your Ob/Gyn about the risks and benefits of having carpal tunnel surgery prior to delivery.
When will symptoms improve?
After delivery, your fluid levels and the extra pressure in your blood vessels will decrease. As such, your symptoms will likely improve or resolve.
That being said, new mothers use their hands and wrists nearly constantly. Lifting, changing, and feeding the new baby may lead to worsened or new hand and wrist symptoms.
Let your Ob/Gyn know as soon as symptoms begin. If we catch carpal tunnel early enough, we can start conservative treatments to reduce the risk of nerve damage or lingering symptoms.
After pregnancy, keep an eye on your wrist health. You'll be lifting your baby a lot and making repetitive motions, which can lead to tendinopathies related to overuse.
Even if your new aches and pains don't seem overtly pregnancy-related, let your Ob/Gyn know. Pregnancy does strange things to the body, and your provider can help you find relief from painful or annoying symptoms.
To visit with an Ob/Gyn, call 214-645-8300 orrequest an appointment online.
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carpal tunnel syndrome
Carpal tunnel syndrome is a condition where compression occurs in the carpal (carpal) canal of the median nerve. Compression or trauma can provoke it.
The concept of carpal tunnel syndrome is not universal for the wrist area, this condition can also manifest itself in other anatomical areas where the nerves lie quite superficially and close to the bone structures at the same time. The syndrome under consideration manifests itself in the form of a decrease or lack of sensitivity in the thumb, index, middle and half of the ring finger, as well as a violation of motor function in them.
Carpal tunnel syndrome is a common pathology and occurs in 1-3% of the population, and mainly in people whose occupation is associated with fine, monotonous motor skills of the hand. Half of all those suffering from this syndrome are people whose type of employment is associated with the use of a computer. Also, this disease can be considered an occupational pathology in musicians, tailors, office workers, etc. The syndrome occurs in the active working-age population at an already mature age (40-60 years), and in 105 cases even at a younger age. The researchers concluded that active PC users have a 15% higher risk of developing the syndrome, especially women.
Causes of carpal tunnel syndrome
The median nerve in the hand passes through a tunnel formed by the transverse ligament and carpal bones of the hand. To provoke compression of the nerve in the canal can:
Traumatic injuries of the hand. Bruises, sprains, sprains, fractures can cause swelling of the ligaments and muscles, or even displacement of the bones of the wrist. All this can compress the nerve in the canal and cause a violation of its function. With proper treatment, all these processes are reversible, but if timely and correct assistance is not provided, then muscle and ligament contractures, as well as bone deformities, may already be irreversible.
Arthrosis, arthritis and other pathological articular processes of various etiologies and genesis. Edema and inflammatory reactions caused by these pathologies, up to tissue necrosis, can also cause nerve compression. With the permanent course of inflammation and the progression of degenerative-dystrophic processes, the articular surfaces of the wrist lose their properties and wear out, resulting in deformation and compression of the nerve in the canal by already bone structures.
Inflammation of tendons or tendovaginitis. Inflammation can be septic (caused by microorganisms) and aseptic (caused by exercise, hypothermia, etc.). Diseases such as purulent wounds of the hand, including panaritiums, improper technique for taking blood from a finger, etc., can provoke septic inflammation. Non-infectious inflammation can be caused by chronic traumatic stress, for example, frequent monotonous motor skills of the hand, static load on it, temperature injury.
Diseases that lead to water retention in the body can cause swelling of the extremities and, as a result, lead to an increase in soft tissue volume and compression of the median nerve. Violation of the water and electrolyte composition can cause: pregnancy, taking hormonal contraceptives, menopause, kidney disease, etc.
Rare, but tumors of nervous tissue and median nerve in particular. Most of these are benign neoplasms (schwannomas, neurofibromas, perineuromas), but there are also malignant ones arising from the nerve sheaths. With its growth, the tumor compresses the nerve, which leads to its damage.
Diabetes mellitus. Under the influence of the protein kinase C enzyme, sorbitol and fructose accumulated in the course of the disease begin to break down in nerve tissues. Because of this, as well as because of the violation of the trophism of neurons and their processes, aseptic inflammation of the nerves and surrounding tissues occurs. Edema increases, which in turn leads to compression of the nerves, including the median one.
Acromegaly. As a result of prolonged and intensive growth of a person suffering from acromegaly, processes of disproportionate growth of bone and soft tissues occur. The median nerve can be entrapped in a narrowed carpal tunnel due to increased bone volume and narrowing of its lumen.
Congenital malformations . The transverse carpal ligament may be thickened from birth, and there is also poor production of tendon lubrication. One of the factors predisposing to carpal tunnel syndrome can be an anatomical feature of the structure, the so-called "square wrist".
Carpal tunnel symptoms
Finger numbness. The syndrome under consideration, as a rule, develops gradually and, in general, the lesion manifests itself unilaterally. Basically, the pathological process occurs in the limb that is leading, for right-handers, the right hand, and for left-handers, the left hand. Carpal tunnel syndrome develops gradually. However, a bilateral process can also be observed, with diseases of the endocrine system, pregnancy, etc.
Paresthesia . Manifested in the form of tingling sensations and loss of sensation in the fingers. Appear in the morning, after waking up and disappear within a few hours. But over time, these manifestations become more stable and intense and may already become permanent. This can lead to a violation of the normal function of the limb: strength, dexterity, etc., the patient has to change hands when performing actions, give rest to the affected limb. Particular inconvenience is caused by manipulations requiring static tension of the limb.
Pain. When the disease manifests itself, a burning and tingling sensation may appear in the hand, which is rather quickly eliminated by lowering the limb down and shaking it. The blood flow in the arm resumes, and the pain disappears. As a rule, this happens during sleep due to the static position of the hand, or during monotonous work performed by the limb. Pain is not characteristic of any specific joints and is common. With the progression of the disease, pain can cover not only the fingers, but the entire hand and arm up to the elbow joint, which often makes it difficult to make a diagnosis. The patient cannot perform his duties because the pains may occur during the daytime.
Loss of dexterity and strength. Over time, if the disease is not treated, the limb begins to lose strength and dexterity in movements. It is difficult for the patient to hold objects in his hands, especially small ones, as if they fall out spontaneously. The ability to perform fine motor skills is lost (grabbing small things, opposing the thumb, etc.).
Reduced sensitivity. Over time, the patient may begin to notice that he does not distinguish the temperature of objects well, stops feeling touches or even injections. There is a painful burning sensation in the arm, numbness.
Muscle atrophy. In advanced forms of the syndrome, atrophy of the musculoskeletal apparatus of the arm may develop, muscles and ligaments not only lose strength, but also decrease in size. Over time, the brush deforms and takes on a shape resembling a monkey's paw.
Skin discoloration. Due to the fact that when the innervation of the hand is disturbed, there is also a violation of the nutrition of skin cells, a change in the color of the skin occurs, they become lighter and unevenly colored.
Diagnosis of carpal tunnel syndrome
For an accurate diagnosis, a consultation with a neurologist is necessary. In this case, the doctor conducts a number of specific tests, and laboratory and instrumental methods of research can also be used.
Tests for carpal tunnel syndrome:
Tinel test. In the narrowest part of the carpal tunnel, on the side of the palm, when tapping, unpleasant tingling sensations occur.
Phalen test. Wrist flexed to its maximum for a minute or less causes pain and paresthesia.
Cuff test. Place the cuff from the blood pressure monitor on the forearm and inflate as much as possible. Within one minute, with a positive test and the presence of the syndrome, a feeling of numbness and tingling appears.
Raised hands test. The upper limbs are lifted vertically upwards and held in this position for one minute. With a positive result, discomfort appears after 30-40 seconds.
All of the above tests can be done at home, and if you have at least one positive test, be sure to consult a doctor.
Of the instrumental research methods, the following are used:
To identify the causes of the disease, the patient is prescribed a blood and urine test:
blood and urine test for sugar;
thyroid-stimulating hormone test;
clinical analysis of urine and blood;
blood test for rheumatoid factor, C-reactive protein, antistreptolysin-O;
blood test for circulating immune complexes;
blood test for antistreptokinase.
Carpal tunnel treatment
The most important thing in the treatment of carpal tunnel syndrome is the observance of measures to prevent the development of the disease. Even with the best and highest quality treatment, preventive measures are indispensable, because the effect may simply not be achieved.
Preventive measures for carpal tunnel syndrome. When the first signs of the disease occur, it is necessary to firmly fix the hand so that there is no possibility of movement in the joint and, as a result, injury to the nerve. The fixator can be applied by a doctor or, for temporary use, purchase an elastic bandage from a pharmacy. Within two to three weeks, you should avoid activities that aggravate the symptoms of the disease. Also, to reduce swelling, it is recommended to apply cold in the wrist area for 2-3 minutes 2-3 times a day. In the subsequent period, treatment is prescribed depending on the severity of the course of the pathological process and its severity. If necessary, the treatment is based on the treatment of the underlying disease (traumatic injury, hypothyroidism, diseases of the urinary system, diabetes mellitus, etc.) that causes compression of the nerve in the canal.
Topical treatment. Includes the use of compresses, the introduction of medicines into the canal cavity. These procedures allow you to quickly ease the painful manifestations and relieve local inflammation.
Medical therapy. Drug therapy in each case is selected individually depending on the underlying or concomitant disease. In this case, B vitamins, non-steroidal anti-inflammatory drugs, vasodilators, diuretics, anticonvulsants, muscle relaxants, glucocorticosteroids, antidepressants, etc. are often prescribed.
Physiotherapy. Can be used both in drug therapy and in the postoperative period during rehabilitation. In this case, they apply: acupuncture; manual therapy techniques; ultraphonophoresis; shock wave therapy. Before using physiotherapy procedures, it is necessary to consult a specialist for contraindications.
Surgical treatment of carpal tunnel syndrome
If for 6 months or more conservative therapy does not give the desired effect, then it makes sense to think about the surgical resolution of the disease. The main task of surgery is to relieve pressure on the median nerve by widening the carpal tunnel.
Most operations are performed under local anesthesia. The following methods are used:
Open access: through the incision (5mm) in the area of the carpal tunnel dissect the carpal ligament.
Endoscopic surgery. There are two types of endoscopic intervention, through two incisions and through one. In the first case, an endoscope is inserted into one incision, and the ligament is cut into the second instrument. In the second case, both instruments are inserted one hole at a time.
At the end of the surgical intervention, a plaster cast is applied to the arm to immobilize the limb. After removing the plaster, a course of physical therapy and physiotherapy is carried out. As a rule, complete restoration of the function of the hand occurs within six months. After recovery, the patient can return to work, subject to the protective regimen, so as not to provoke a relapse of the disease. In the modern world, where computer technology has already been introduced everywhere, the pathology we are considering is becoming more and more common. Timely and qualified assistance, and prevention in the event of carpal tunnel syndrome, allows you to fully and with sufficient persistence achieve remission.
90,000 tunnel syndromes of the hands
distinguish the following forms of tunnel syndromes of the hand:
1. Mid -nerve tunnels
Capenary channel (wrist) - tunnel syndrome of the carpal canal,
23 round pronator (in / 3 forearm)) - Seyfart's syndrome, paralysis of the newlyweds, honeymoon paralysis, paralysis of lovers;
Supracondylar syndrome (n / 3 shoulders) - Strather's tape syndrome, Coulomb's syndrome, Lord and Bedossier.
2. Tunnels of the ulnar nerve
Guyon's syndrome (palm) - ulnar carpal tunnel syndrome, Guyon's bed syndrome, compression-ischemic neuropathy of the distal part of the ulnar nerve;
Cubital canal syndrome (elbow) — compressive neuropathy of the ulnar nerve in the cubital canal, cubital tunnel syndrome, late ulnar-cubital traumatic paralysis.
3. Tunnels of the radial nerve
compression syndrome of the radial nerve (in the axillary cavalry) - “Commercial paralysis”
of the radial nerve compression (at the level of the middle third of the shoulder) - syndrome of the spiral channel, “Syndrome“ Syndrome “ Saturday night paralysis, park bench, benches
Radial nerve compression syndrome (in the subelbow region) - tennis elbow, supinator syndrome, Froze syndrome, Thomson-Kopell syndrome, tennis elbow syndrome, deep compression neuropathy (posterior) branch of the radial nerve in the subulnar region.
Tunnel syndromes account for 1/3 of diseases of the peripheral nervous system. There are descriptions of more than 30 forms of tunnel neuropathies in the literature.
The anatomical narrowness of the canal is, according to many authors, only a predisposing factor in the development of carpal tunnel syndrome. In recent years, data have been accumulated indicating that this anatomical feature is genetically determined. Another possible reason for the development of carpal tunnel syndrome may be the presence of congenital developmental anomalies in the form of additional fibrous cords, muscles and tendons, and rudimentary bone spurs.
Contribute to the development of tunnel syndrome, some metabolic, endocrine diseases (diabetes mellitus, acromegaly, hypothyroidism), diseases of the joints, bone tissue and tendons (rheumatoid arthritis, rheumatism, gout), a condition accompanied by hormonal changes (pregnancy), volumetric formations of the nerve itself (schwanomma , neuroma) and outside the nerve (hemangioma, lipoma). The development of tunnel syndromes is facilitated by frequently repeated stereotyped movements and injuries. Therefore, the prevalence of carpal tunnel syndromes is significantly higher in representatives of certain professions (for example, stenographers are 3 times more likely to have carpal tunnel syndrome).
The most characteristic of carpal tunnel syndrome is pain . Usually the pain appears during movement, then occurs at rest. The pain may wake the patient at night. Pain in tunnel syndromes is caused by inflammatory changes occurring in the area of the nerve canal conflict and nerve damage. Tunnel syndromes are characterized by such manifestations of neuropathic pain as a sensation of the passage of an electric current (electric lumbago), burning pain. In later stages, pain may be due to muscle spasm
Then there are movement disorders, manifested in the form of a decrease in strength, rapid fatigue. In some cases, the development of the disease leads to atrophy, the development of contractures ("clawed paw", "monkey paw").
When arteries and veins are compressed, blanching, a decrease in local temperature, or the appearance of cyanosis and swelling in the affected area occur.
In some cases, it is necessary to conduct electroneuromyography (the speed of the impulse along the nerve) to clarify the level of nerve damage. tunnel syndrome. With the help of ultrasound, thermal imaging, MRI, nerve damage, mass formations or other pathological changes can be determined.
Principles of treatment
Stop exposure to the pathogen. Immobilization with the help of orthoses, bandages, splints, which allow to achieve immobilization in the damaged area.
Change the habitual locomotor stereotype and lifestyle. Tunnel syndromes are often the result of not only monotonous activities, but also violations of ergonomics (wrong posture, uncomfortable position of the limb during work). Training in special exercises and physiotherapy exercises are an important component of the treatment of tunnel neuropathies at the final stage of therapy.
Traditionally, NSAIDs with a more pronounced analgesic and anti-inflammatory effect (diclofenac, ibuprofenac, ibuprofenac) are used for tunnel syndromes. For moderate or severe pain, it is advisable to use the drug Zaldiar (a combination of low doses of the opioid analgesic tramadol (37.5 mg) and the analgesic / antipyretic paracetamol (325 mg). Thanks to this combination, a multiple increase in the general analgesic effect is achieved with a lower risk of side effects.
Effects on the neuropathic component of pain. When pain is the result of neuropathic changes, it is necessary to prescribe drugs recommended for the treatment of neuropathic pain: anticonvulsants (pregabalin, gabapentin), antidepressants (venlafaxine, duloxetine), plates with 5% lidocaine "Versatis". Injections of anesthetic + hormones. An effective and acceptable treatment for most types of tunnel neuropathies is a blockade with the introduction of novocaine and a hormone (hydrocortisone) into the area of infringement.
Other methods of pain relief. An effective way to reduce pain and inflammation is electrophoresis, phonophoresis with dimexide and other anesthetics. They can be carried out in a polyclinic.
Symptomatic treatment. For tunnel syndromes, decongestants, antioxidants, muscle relaxants, drugs that improve trophism and nerve functioning (ipidacrine, vitamins) are also used.
Surgical intervention. Surgical treatment is resorted to when other methods of helping the patient are ineffective. Surgical intervention consists in releasing the nerve from compression, "reconstruction of the tunnel".
According to statistics, the effectiveness of surgical and conservative treatment does not differ significantly after a year (after the start of treatment or surgery). Therefore, after a successful surgical operation, it is important to remember about other measures that must be taken to achieve complete recovery: changing locomotor stereotypes, using devices that protect against stress (orthoses, splints, bandages), performing special exercises.
Carpal tunnel syndrome
Carpal tunnel syndrome - carpal tunnel syndrome, is a common form of compression-ischemic neuropathy. In the population, carpal tunnel syndrome occurs in 3% of women and 2% of men. It is caused by compression of the median nerve at the point where it passes through the carpal tunnel under the transverse carpal ligament. The exact cause of carpal tunnel syndrome is not known. The following factors contribute to the compression of the median nerve in the region of the wrist:
1. Trauma (accompanied by local edema, tendon sprain).
2. Chronic microtraumatization, often found in construction workers, microtraumatization associated with frequent repetitive movements (for typists, with constant long-term work with a computer).
3. Diseases and conditions with metabolic disorders, edema, deformities of tendons, bones (rheumatoid arthritis, diabetes mellitus, hypothyroidism, acromegaly, amyloidosis, pregnancy).
4. Volumetric formations of the median nerve itself (neurofibroma, schwannoma) or outside it in the area of the wrist (hemangioma, lipoma).
Carpal tunnel syndrome is manifested by pain, numbness, goosebumps and weakness in the arm and hand. Pain and numbness extend to the palmar surface of the thumb, index, middle and ring fingers, as well as to the back of the index and middle fingers. The following tests are used to confirm the diagnosis of carpal tunnel syndrome.
Tapping with a neurological hammer on the wrist (above the passage of the median nerve) causes a tingling sensation in the fingers or irradiation of pain (electric lumbago) to the fingers of the hand, pain may be felt in the area of tapping. Tinel's symptom is found in 26-73% of patients with carpal tunnel syndrome.
Compression of the wrist in the area of the median nerve causes numbness and / or pain in I-III, half of the IV fingers.
Flexion or extension of the hand 90 degrees causes numbness, tingling or pain in less than 60 seconds. A healthy person may develop similar sensations, but not earlier than after 1 minute.
With severe thenar weakness at a later stage, the patient cannot connect the thumb and little finger, or the doctor can easily separate the closed thumb and little finger of the patient.
Carpal tunnel syndrome must be differentiated from arthritis of the carpo-metacarpal joint of the thumb, cervical radiculopathy, diabetic polyneuropathy.
In mild cases of carpal tunnel syndrome, ice compresses help, reducing the load. If these measures do not help, the following is needed:
Immobilization of the wrist. using splint, orthosis. Immobilization should be carried out at least overnight, and preferably 24 hours a day in the acute period.
NSAIDs are effective if the pain mechanism is dominated by inflammation.
If the use of NSAIDs is ineffective, it is advisable to inject novocaine with hydrocortisone into the wrist area.
Electrophoresis with anesthetics and corticosteroids.
Surgical treatment. With mild or moderate carpal tunnel syndrome, conservative treatment is more effective. When all means of conservative care have been exhausted, they resort to surgical treatment, which consists in partial or complete resection of the transverse ligament and release of the median nerve from compression. Endoscopic surgical methods are used.
Pronator teres syndrome (Seyfarth's syndrome)
This is a entrapment of the median nerve in the proximal forearm between the pronator teres bundles. Such activities are often found among musicians (pianists, violinists, flutists, and especially guitarists), dentists, athletes.
Prolonged tissue compression is of great importance in the development of pronator teres syndrome. This can happen, for example, during deep sleep with a long position of the newlywed's head on the partner's forearm or shoulder. In this case, the median nerve is removed in the pronator's snuff box, or the radial nerve is compressed in the spiral canal when the partner's head is located on the outer surface of the shoulder (see radial nerve compression syndrome at the level of the middle third of the shoulder). In this regard, the terms honeymoon paralysis, paralysis of the newlyweds, paralysis of lovers are accepted to refer to this syndrome. Pronator teres syndrome sometimes occurs in nursing mothers. They have compression of the nerve in the area of the round pronator occurs when the child's head lies on the forearm for a long time.
With the development of the pronator teres syndrome, pain and burning occur 4-5 cm below the elbow joint, along the anterior surface of the forearm, and pain radiates to I-III, half of the IV fingers and palm.
In pronator teres syndrome, there will be a positive Tinel's symptom when tapping with a neurological hammer in the area of the pronator's snuffbox (on the inside of the forearm).
Pronator flexor test
Pronation of the forearm with a tightly clenched fist while creating resistance to this movement (resistance) leads to increased pain. Increased pain can also be observed when writing (prototype of this test).
When examining sensitivity, a violation of sensitivity is detected on the palmar surface of the first three and a half fingers and the palm. Thenar atrophy in pronatar round syndrome is usually not as pronounced as in progressive carpal tunnel syndromes.
Shoulder suprocondylar process syndrome (Strather's band syndrome, Coulomb, Lord and Bedossier syndrome) process (apophysis), the median nerve is displaced and stretched, which makes it vulnerable to damage.
This tunnel syndrome was described in 1963 by Coulomb, Lorde and Bedossier and has almost complete resemblance to clinical manifestations of pronator teres syndrome: pain, paresthesia, decreased flexion strength of the hand and fingers are determined in the area of innervation of the median nerve. In contrast to the pronator teres syndrome, if the median nerve is damaged under Strather's ligament, mechanical compression of the brachial artery with corresponding vascular disorders is possible, as well as pronounced weakness of the pronators: round and small.
In the diagnosis of the suprocondylar process syndrome, the following test is performed: when the forearm is extended and pronated, in combination with the formed flexion of the fingers, painful sensations are provoked with localization characteristic of compression of the median nerve. X-ray examination is shown.
Treatment for consists of resection of the supracondylar process (“spur”) of the humerus and ligament.
Cubital tunnel syndrome
Cubital tunnel syndrome is a compression of the ulnar nerve in the cubital tunnel in the area of the elbow joint between the internal epicondyle of the shoulder and the ulna. It ranks second in frequency of occurrence after carpal tunnel syndrome.
Cubital canal syndrome can be caused by repetitive bending of the elbow joint, i.e. the disorder may occur with normal, repetitive movements in the absence of obvious traumatic injury. Relying on the elbow while sitting may contribute to the development of cubital tunnel syndrome. Patients with diabetes and alcoholism are at greater risk of developing cubital tunnel syndrome.
Presents with pain, numbness and/or tingling. Pain and paresthesias are felt in the lateral part of the shoulder and radiate to the little finger and half of the fourth finger. Another symptom of the disease is weakness in the arm. For example, it becomes difficult for a person to pour water from a kettle. In the future, the hand on the affected arm begins to lose weight, muscle atrophy appears.
In the early stages of the disease, the only manifestation, apart from weakness of the muscles of the forearm, may be loss of sensation on the ulnar side of the little finger. The following tests may help verify the diagnosis of Cubital Tunnel Syndrome.
Occurrence of pain in the lateral part of the shoulder, radiating to the ring finger and little finger when tapping with a hammer over the area of nerve passage in the region of the medial epicondyle.
Phalen's sign equivalent
Abrupt flexion of the elbow will cause paresthesias in the ring and little fingers.
Due to weakness abductor policis brevis and flexor policis brevis , excessive flexion in the interphalangeal joint of the thumb on the affected hand will be found in response to a request to hold the paper between the thumb and forefinger.
When putting the hand into the pocket, the little finger moves to the side, does not go into the pocket.
It is recommended to fix the elbow joint in the extensor position for the night with the help of orthoses, keep the steering wheel of the car with arms extended at the elbows, straighten the elbow when using the computer mouse. In the absence of a positive effect from the use of traditional drugs: NSAIDs, COX-2 inhibitors, splinting, for 1 week did not have a positive effect, an injection of an anesthetic with hydrocortisone is recommended.
If the effect of the specified measures is insufficient, an operation is performed. All surgical nerve release techniques involve moving the nerve anteriorly from the internal epicondyle. After the operation, treatment is prescribed to restore nerve conduction as soon as possible.
Guyon's tunnel syndrome
It develops as a result of compression of the deep branch of the ulnar nerve in the canal formed by the pisiform bone, the hook of the hamate, the palmar metacarpal ligament and the short palmar muscle. There are burning pains and sensitivity disorders in the IV-V fingers, difficulty in pinching movements, adduction and spreading of the fingers.
The syndrome is very often the result of prolonged pressure of working tools (vibrating tools, screwdrivers, tongs), occurs more often in gardeners, leather carvers, tailors, violinists, persons working with jackhammers. Can sometimes develop after using a cane or crutch. Enlarged lymph nodes, fractures, arthrosis, arthritis, aneurysm of the ulnar artery, tumors and anatomical formations around Guyon's canal can also cause compression.
In the hand, pain occurs in the hypotenar area and the base of the hand, as well as intensification and irradiation in the distal direction during provocative tests. Sensitivity disorders in this case occupy only the palmar surface of the IV-V fingers. On the back of the hand, the sensitivity is not disturbed.
Differential diagnosis is carried out with radicular syndrome (C8). Paresthesia and sensitivity disorders may also appear along the ulnar edge of the hand. Paresis and hypotrophy of the hypothenar muscles are possible. But with C8 radicular syndrome, the zone of sensory disorders is much larger than with Guyon's canal, and there is no hypotrophy and paresis of the interosseous muscles. With bilateral nerve damage, the diagnosis of ALS is sometimes misdiagnosed.
If diagnosed early, activity restriction may help. It is recommended to use fixators at night or during the day: orthoses, splints to reduce trauma.
In case of failure of conservative measures, surgical treatment is carried out aimed at reconstructing the canal in order to release the nerve from compression.
Radial nerve compression syndrome
There are 3 types of compression damage to the radial nerve:
Compression in the armpit. Occurs as a result of the use of a crutch, there is paralysis of the extensors of the forearm, hand, main phalanges of the fingers, the muscle that removes the thumb, the arch support. The flexion of the forearm is weakened, the reflex from the triceps muscle fades. Sensitivity disappears on the dorsal surface of the shoulder, forearm, partly of the hand and fingers.
Compression at the level of the middle third of the shoulder (syndrome of "Saturday night paralysis", "park bench", "bench"). Occurs more often. But most often, compression occurs due to compression of the nerve on the outer-posterior surface of the shoulder during deep sleep (often after drinking alcohol). Nerve compression can be caused by the partner's head lying on the outer surface of the shoulder.
Compressive neuropathy of the deep (posterior) branch of the radial nerve in the subulnar region (arch support syndrome, Froze syndrome, Thomson-Kopell syndrome, tennis elbow syndrome).
This is a chronic disease caused by a dystrophic process in the area of muscle attachment to the external epicondyle of the humerus. Manifested by pain in the extensor muscles of the forearm, their weakness and hypotrophy.
Treatment of includes general etiotropic and local therapy. It is possible that tunnel syndrome is associated with rheumatism, brucellosis, arthrosis of metabolic origin, and hormonal disorders. Anesthetics and glucocorticoids are injected locally into the area of the pinched nerve. Physiotherapy is carried out, the appointment of vasoactive, decongestant and nootropic drugs, antihypoxants and antioxidants, muscle relaxants, ganglion blockers, etc. Surgical decompression with dissection of tissues compressing the nerve is carried out if conservative treatment fails.
Berzins Yu.E., Dumbere R.T. Tunnel lesions of the nerves of the upper limb. Riga: Zinatne, 1989, p.212.
Zhulev N.M. Neuropathy: a guide for physicians. - St. Petersburg: Publishing House Spbmapo, 2005, p. 416
Levin O.S. "Polineuropathies", MIA, 2005
Atroshi I., Larsson G.U., Ornstein E., Hofer M., Johnsson R., Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomized controlled trial . BMJ., Jun 24 2006; 332(7556):1473.