Tunnel syndromes (tunnel neuropathies) – a group of lesions of the peripheral nerves due to prolonged compression and trauma in the musculoskeletal canals with chronically inflamed surrounding tissues. There are tunnel syndromes of damage to the nerves of the arms, legs, trunk, neck. Carpal Tunnel Syndrome & Exercises.
Very often, “carpal tunnel syndrome” is called carpal tunnel syndrome, which is not entirely true – this is just one of the many tunnel syndromes that has gained the greatest popularity. Other tunnel syndromes, such as compression syndrome of the deep branch of the ulnar nerve, are isolated even in the wrist region.
Carpal tunnel syndrome
The most common and known tunnel syndrome is carpal tunnel syndrome (CTS), i.e. compression of the median nerve (lat. nervus medianus) under the transverse ligament of the wrist. Nerve compression occurs between the three bone walls and the dense ligament that holds the tendons of the muscles that bend the fingers and hand.
Carpal tunnel syndrome is more often observed in women than in men (3-10 times according to various sources). The peak incidence occurs at the age of 40-60 years (although this disease can occur at any age. Only 10% of those suffering from this disease are younger than 31 years old). The risk of getting carpal tunnel syndrome is about 10% for life, 0.1-0.3% per year in adults. The total prevalence of the syndrome is up to 1.5-3%, and the prevalence among certain risk groups is up to 5%. The syndrome is more common among representatives of the Caucasian race, in some African countries it practically does not occur.
Chronic Repetitive Stress Injury
In English texts, the concept of carpal tunnel syndrome is often identified with the term chronic injury from repetitive stress (English repetitive strain injury, RSI; the term has many synonyms: repetitive stress disorder, cumulative trauma disorder, occupational overuse injury, etc.). In fact, RSI is a much wider group of diseases, and some authors even exclude carpal tunnel syndrome from it.
Diseases of this group are found in many professions, including in industries such as construction, mining, machine-building industry, and agriculture. They are caused by chronic functional overstrain, micro traumatization, and performing fast movements of the same type.
In particular, such diseases of a professional nature, in addition to the “sensational” carpal tunnel syndrome, include:
- Myositis (inflammation of the muscles) and creping tenosynovitis (inflammation of the tendon membranes with a characteristic crunch),
- Stenosing tenosynovitis (de Quercin’s disease),
- Stenosing ligamentitis,
- snap finger
- Styloiditis (inflammation of the styloid process of the radius),
- Bursitis (inflammation of the joint bags),
- Shoulder epicondylitis (inflammation in the condyle of the hummers, often external, the so-called “tennis elbow”),
- Deforming osteoarthrosis of the joints of the hand (gradually increasing deformation of bones and joints),
- Periarthrosis of the shoulder joint (dystrophic changes in the soft tissues of the shoulder near the joint),
- Spinal osteochondrosis (damage to the intervertebral discs and other tissues of the spine),
- Diseases of the nervous system from overvoltage.
For professions in which chronic repetitive movements of the hand are observed, de Kerven’s disease and stenosing ligamentitis are characteristic.
Chronic stenotic tendovaginitis (synonym: de Quervin’s disease, French de Quervain, named after a Swiss surgeon) is a peculiar form of chronic inflammation of the tendon membranes, which is characterized by damage to the tendons of the muscles of the thumb. At the same time, the tendon sheath thickens, and the lumen between the sheath and the tendon filled with fluid to reduce friction (synovial cavity) narrows. This disease is characterized by pain during abduction and extension of the thumb of the hand, which can give off to the forearm and shoulder, swelling along the affected tendons.
Clinical manifestations of de Querven’s disease are close to stenotic finger ligamentitis – reactive inflammation of the ligamentous apparatus of the hand. It can occur with repeated injuries, as well as with some infectious diseases (for example, with flu). The ligaments between the phalanges of the fingers and near the joints connecting the fingers to the metacarpus are usually affected. This disease is characterized by inflammatory changes in the area of the affected ligaments (pain during movement, swelling, swelling, redness and local skin temperature increase). It is even possible the necrosis of the ligaments with a violation of the slip of the tendon and difficulty in flexion and extension of the finger with a characteristic clicking (the so-called “snap finger”). In many cases, carpal tunnel syndrome is also actually ligamentitis, but in the wrist area,
Carpal tunnel anatomy
The carpal canal is located at the base of the hand and is surrounded on three sides by the bones of the wrist, and in front by the transverse ligament of the wrist. In this channel pass the median nerve, tendons of the flexors of the fingers and hands, as well as the synovial membranes of these tendons. 
The synovial membrane of the tendon is the membrane of connective tissue surrounding the part of the tendon. There is a small amount of lubricating fluid in the gap between this membrane and the tendon to reduce friction (synovial fluid), which is produced by the synovial cells (lining the cavity of the membrane from the inside).
Transverse wrist ligament
The transverse ligament of the wrist is a strong strand of dense connective tissue, which is attached on one side to the elbow, and the other to the radial elevation of the wrist. This ligament also has another name: “flexor tendon retainer” (lat. Retinaculum flexorum). It turns the groove of the wrist into the carpal canal, in which the flexor tendons and the median nerve pass.
The median nerve (lat. Nervus medianus) is one of the three main nerves of the hand (the other two are the radial and ulnar nerves). It comes from the brachial plexus. On the hand, this nerve leads sensitive fibers to the skin of the tubercle of the thumb, the palmar surface of the thumb, index, middle and half of the ring finger and fibers of internal sensitivity to some muscles of the hand (responsible for the coordination of movements of these muscles). Motor fibers to these muscles of the hand. Vegetative fibers to local arteries (affects the narrowing and expansion of blood vessels, for example, depending on temperature) and sweat glands.
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Etiology and pathogenesis
The following causes of carpal tunnel syndrome are possible:
- Activities that require repeated flexion / extension of the hand or accompanied by exposure to vibration (for example, assembling equipment).
- Edema or trauma of any kind (for example, with fractures) that compress the median nerve.
- Compression of the median nerve in edema in pregnant women or women taking contraceptives.
- There is a strong correlation between overweight and carpal tunnel syndrome. In addition, people of short stature are more prone to the disease.
- Acromegaly, rheumatoid arthritis, gout, tuberculosis, renal failure, decreased thyroid function, early period after menopause (as well as after removal of the ovaries), amyloidosis, possible association with diabetes mellitus.
- The syndrome is characterized by a genetic predisposition, in particular because of the many inherited characteristics (for example, a square wrist, thickness of the transverse ligament, complexion).
carpal tunnel syndrome caused
The carpal tunnel syndrome is caused mainly by compression of the median nerve in the wrist due to thickening or swelling of the synovial membrane of the flexor muscles. As a result of chronic inflammation of the connective tissue, caused by a constant repetitive load, it becomes rougher, thickens, swells, which increases the pressure inside the wrist channel. Increased pressure causes venous congestion, edema, which leads to ischemia (a violation of the blood supply) of the nerve.
First, damage occurs to the sensitive, and only then, the motor fibers of the nerve. Damage to the fibers of the autonomic nervous system (responsible for sweating, expansion / narrowing of blood vessels, etc.) is also possible.
A certain role in the development of carpal tunnel syndrome is played by exposure to cold. According to Irenio Gomes et al, the frequency of diagnosis of carpal tunnel syndrome was significantly higher in the cold season.
Treatment of carpal tunnel syndrome should be started as early as possible and under the supervision of a physician. Root causes such as diabetes or arthritis should be treated first.  Without treatment, the course of the disease tends to progress. 
In some cases, various drugs can relieve pain and inflammation associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen. Other over-the-counter pain relievers can relieve recent symptoms or caused by intense activity. Diuretics for oral administration help reduce swelling. It is possible to administer corticosteroids (prednisone, hydrocortisone) or lidocaine (local anesthetic) by injection directly into the wrist or (for corticosteroids) by mouth to reduce the compression of the median nerve and provide quick temporary relief in people with mild or intermittent symptoms. (Caution: individuals with diabetes, as well as those who may be predisposed to diabetes, should be aware that prolonged use of corticosteroids makes it difficult to select a dose of insulin. Corticosteroids should not be taken without a doctor’s prescription.) In addition, some studies show that vitamin B6 (pyridoxine) medications can relieve symptoms of carpal tunnel syndrome.
Non-drug conservative therapy
Initial treatment generally consists in limiting the load on the affected arm and wrist for at least 2 weeks. Avoiding activities that may worsen symptoms. Immobilizing the wrist with a splint to prevent further damage due to twisting or bending. If an inflammatory reaction is present, ice blisters can be used to relieve edema.
In those patients whose symptoms have eased, stretching and strengthening exercises may be helpful. Such exercises can be carried out under the supervision of a physiotherapist who has training in the use of exercises to treat physical injuries. As a specialist in occupational diseases who has training in examining patients with physical injuries. Assisting them in acquiring skills to improve their own health and well-being.
Some patients confirm that they were helped by acupuncture. Manual therapy, chiropractic. However, the effectiveness of these techniques remains unproven by scientific methods. An exception is yoga, for which the effect of reducing pain and improving grip among patients with carpal tunnel syndrome has been shown.
Carpal tunnel release surgery is one of the most common surgical procedures performed in the United States of America. Surgery is usually recommended if symptoms last for more than 6 months. The operation involves splitting the bundles of connective tissue surrounding the wrist to reduce pressure on the median nerve. The operation is performed under local anesthesia and does not require a long stay in the hospital (in the USA it is performed on an outpatient basis). Many patients require surgery on both hands. There are two types of carpal tunnel opening surgery:
- Open surgery, a traditional intervention used to treat carpal tunnel syndrome. It consists in making a cut up to 5 cm long on the wrist. After which the wrist ligament is crossed to increase the volume of the carpal canal. As a rule, surgery is performed under local anesthesia on an outpatient basis, unless there are exceptional medical circumstances.
carpal tunnel syndrome surgery
- It is believed that endoscopic intervention allows. You to achieve a faster recovery of function and less postoperative discomfort compared to the traditional open operation of opening the channel. The surgeon performs two incisions (about 1-1.5 cm each) on the wrist and palm. Enters the camera connected to a special tube, and examines the tissue on the screen. After which he dissects the wrist ligament. This endoscopic operation. Performed through two punctures, is usually performed under local anesthesia, is effective and is accompanied by minimal scar formation and little soreness in the scar area. These undesirable effects are absent. There are also methods for endoscopic surgery for carpal tunnel syndrome through one puncture.
Although symptom relief can occur immediately after surgery. A full recovery from an intervention on the carpal tunnel can last for months. Some patients may experience infection, nerve damage, stiffness of movement. Pain in the scar area. Sometimes. Due to dissection of the ligament of the wrist. A loss of strength occurs. To restore strength, patients should undergo physiotherapy in the postoperative period. Some patients require a change in the type of work or even a change of job for the duration of recovery after surgery.
Relapse of carpal tunnel syndrome after treatment is rare. Typically, 80-90% of patients completely get rid of the symptoms of the disease after dissection of the transverse wrist ligament. In some cases, during the operation, neurolysis is performed. Excision of cicatricial and altered tissues around the nerve. As well as partial excision of tendon sheaths.
Sometimes with prolonged and severe compression of the nerve, its irreversible damage occurs. In these cases, the symptoms of the disease can persist and even intensify after surgery. In some cases, annoying pain may be due to the presence of tendovaginitis or arthritis of the joints.