Neuropathy of the median nerve. Symptoms and treatment

Defeat n. medianus in any part of it, leading to pain and swelling of the hand, a disorder in the sensitivity of its palmar surface and the first 3.5 fingers, a violation of the flexion of these fingers and opposition of the thumb. Diagnosis is carried out by a neurologist based on the results of a neurological examination and electroneuromyography; additionally, with the help of radiography, ultrasound and tomography, musculoskeletal structures are examined. The treatment includes painkillers, anti-inflammatory, neurometabolic, vascular pharmaceuticals, exercise therapy, physiotherapy, massage. Surgical interventions are performed according to indications.

General information

neuropathy median nerve occurs quite often. The main contingent of patients is young and middle-aged people. The most common sites of damage to the median nerve correspond to the zones of its greatest vulnerability - anatomical tunnels, in which compression (compression) of the nerve trunk is possible with the development of the so-called. tunnel syndrome. The most common tunnel syndrome n. medianus is carpal tunnel syndrome - compression of the nerve when it passes to the hand. The average incidence in the population is 2-3%.

The second most common site of damage to the median nerve is its area in the upper part of the forearm, which runs between the muscle bundles of the round pronator. This neuropathy is called pronator teres syndrome. In the lower third of the shoulder n. medianus may be compressed by an abnormal process humerus or Struser's ligament. Its defeat in this place is called the Struser's tape syndrome, or the syndrome of the supracondylar process of the shoulder. In the literature, you can also find a synonymous name - the Coulomb-Lord-Bedossier syndrome, which includes the names of the co-authors who first described this syndrome in 1963.

Anatomy of the median nerve

N. medianus is formed by joining the bundles of the brachial plexus, which, in turn, start from the spinal roots C5–Th1. After passing axillary zone runs next to the brachial artery along the medial edge of the humerus. In the lower third of the shoulder, it goes deeper than the artery and passes under the ligament of Struzer, when it enters the forearm, it goes in the thickness of the round pronator. Then it passes between the flexor muscles of the fingers. On the shoulder, the median nerve does not give branches; sensory branches depart from it to the elbow joint. On the forearm n. medianus innervates almost all the muscles of the anterior group.

From forearm to hand n. medianus passes through the carpal tunnel. On the hand, it innervates the opposing and abductor muscles. thumb, partly the muscle that flexes the thumb, worm-like muscles. Sensory branches n. medianus innervate the wrist joint, the skin of the palmar surface of the radial half of the hand and the first 3.5 fingers.

Causes of median nerve neuropathy

Neuropathy of the median nerve can develop as a result of nerve injury: its contusion, partial break fibers with cut, torn, stab, gunshot wounds or damage by bone fragments in case of fractures of the shoulder and forearm, intra-articular fractures in the elbow or wrist joints. The reason for the defeat of n. medianus may be dislocations or inflammatory changes (arthrosis, arthritis, bursitis) of these joints. Compression of the median nerve in any of its segments is possible with the development of tumors (lipomas, osteomas, hygromas, hemangiomas) or the formation of post-traumatic hematomas. Neuropathy can develop as a result of endocrine dysfunction (with diabetes mellitus, acromegaly, hypothyroidism), with diseases that entail changes in ligaments, tendons and bone tissue(gout, rheumatism).

The development of tunnel syndrome is due to compression of the median nerve trunk in the anatomical tunnel and a violation of its blood supply due to concomitant compression of the vessels supplying the nerve. Concerning tunnel syndrome also called compression-ischemic. Most often, neuropathy of the median nerve of this genesis develops in connection with professional activities. For example, painters, plasterers, carpenters, packers suffer from carpal tunnel syndrome; round pronator syndrome is observed in guitarists, flutists, pianists, in nursing women who hold a sleeping child on their arm for a long time in a position where his head is on the mother's forearm. The cause of the tunnel syndrome may be a change in the anatomical structures that form the tunnel, which is noted with subluxations, tendon damage, deforming osteoarthritis, rheumatic disease of the periarticular tissues. In rare cases (less than 1% in the general population), compression is due to the presence of an abnormal process of the humerus.

Symptoms of median nerve neuropathy

Neuropathy of the median nerve is characterized by severe pain syndrome. The pain captures the medial surface of the forearm, hand and fingers 1-3. Often it has a burning causalgic character. As a rule, pain is accompanied by intense vegetative-trophic disorders, which is manifested by swelling, heat and redness or coldness and pallor of the wrist, the radial half of the palm and 1-3 fingers.

The most noticeable symptoms of movement disorders are the inability to make a fist, oppose the thumb, bend the 1st and 2nd fingers of the hand. Difficulty bending the 3rd finger. When the hand is bent, its deviation to the ulnar side is observed. Tenor muscle atrophy is a pathognomonic symptom. The thumb is not opposed, but placed on a par with the rest, and the hand becomes similar to a monkey's paw.

Sensory disturbances are manifested by numbness and hypesthesia in the zone of innervation of the median nerve, i.e., the skin of the radial half of the palm, the palmar surface and the rear of the terminal phalanges of 3.5 fingers. If the nerve is affected above the carpal tunnel, then the sensitivity of the palm is usually preserved, since its innervation is carried out by a branch extending from the median nerve to its entrance to the canal.

Diagnosis of neuropathy of the median nerve

AT classic version median nerve neuropathy can be diagnosed by a neurologist during a thorough neurological examination. To identify motor insufficiency, the patient is asked to perform a series of tests: clench all fingers into a fist (1st and 2nd fingers do not bend); scrape on the surface of the table with the nail of the index finger; stretch a sheet of paper, taking it only with the first two fingers of each hand; rotate thumbs; connect the tips of the thumb and little finger.

With tunnel syndromes, Tinel's symptom is determined - soreness along the nerve when tapping at the site of compression. It can be used to diagnose the location of the lesion n. medianus. In pronator teres syndrome, Tinnel's symptom is determined by tapping in the area of the pronator's snuffbox (upper third inner surface forearms), with carpal tunnel syndrome - when tapping on the radial edge of the inner surface of the wrist. In supracondylar process syndrome, pain occurs when the patient simultaneously extends and pronates the forearm while flexing the fingers.

Clarify the topic of the lesion and differentiate neuropathy n. medianus from shoulder plexitis, vertebrogenic syndromes(radiculitis, disc herniation, spondylarthrosis, osteochondrosis, cervical spondylosis), polyneuropathy helps electroneuromyography. In order to assess the condition of bone structures and joints, bone radiography, MRI, ultrasound or CT of the joints are performed. In supracondylar process syndrome, an x-ray of the humerus reveals a “spur”, or bone process. Depending on the etiology of neuropathy, the following are involved in the diagnosis:

The median nerve is one of the major branches of the brachial plexus along with the brachial and radial nerves. It originates from two bundles - lateral and medial. Goes through parts of the biceps (biceps muscle). In front through the elbow region reaches the forearm and is localized between the flexors of the fingers. Through the canal of the wrist enters the palm. Here it is divided into three parts, which are further divided into seven more branches.

The median nerve innervates almost the entire upper limb, as it has a long path and gives great amount branches. Responsible for flexion of the muscles of the forearm, for the movements of the large, middle and index finger, possible abduction and adduction of the brush, its rotation. It is responsible not only for motor activity, but also for the sensitivity of the wrist.

The defeat of this nerve is due to the influence of internal and external factors:

Regular prolonged use of a computer mouse and keyboard. Constant identical movements in the process of working at a computer lead to the development of such a pathology as -. Hands are in a static position of flexion or extension, blood circulation and trophism are disturbed nervous tissue. The risk factors here are the female gender, since the median nerve canal is anatomically narrower than in males, the third or fourth stage of obesity - the load on the upper limb increases.
All types of arthritis. Most of problems with the body begins with inflammation. Soft tissues swell, the lumen of the canal narrows, respectively, the nerve is subjected to pressure from the outside. Due to chronic pathological process many tissues are sclerosed, erased. The articular surfaces gradually fuse together, as the bone surface is exposed. The hand deforms over time due to wrong position anatomical structures, the patient's condition worsens.
Injuries. Frequent problem orthopedics in conjunction with neurology. In case of sprain, dislocation, fracture or bruise of the arm adequate response organism is an extension blood vessels and accumulation of fluid soft tissues. As in the previous case, nerve compression occurs. The bones are displaced, there is a risk of improper union, which sharply aggravates the situation.
Accumulation a large number fluid is associated with concomitant human diseases: nephrosclerosis, acute or chronic kidney failure, pregnancy, menopause, hormone deficiency thyroid gland, violation of the genital organs and so on.
Edema is caused by specific and non-specific pathogens (tenosynovitis). Pathology can proceed as catarrhal form, and with the formation of pus. Microorganisms reach the site of the lesion in several ways: from neighboring anatomical structures, through the blood, and directly through the wound.
Diabetes. The causative factor is a violation of glucose metabolism and energy starvation of cells that gradually die. is destroyed.
genetic predisposition. If close relatives (brothers, sisters, parents) suffered similar diseases, there is a high risk of its development in the person himself.

Classification

They are classified from the point of view of surgery into open and closed. Open wounds include all types of wounds: stab, lacerated, cut, chopped, and so on. They can affect, in addition to the nerve, tendons, and muscles, and blood vessels.

To closed injuries include contusion, sprain, concussion and compression.

Diseases according to orthopedic classification are divided into three groups:

Neuropraxia - reversible damage to nerve fibers;
Axonotmesis - pathology is characterized by the degeneration of individual sections of the nervous tissue;
Neurotmesis - deep damage to the nerve trunk, including violations of the connective tissue membrane.

neuropathy

Neuropathy of the median nerve - damage due to constant compression of the anatomical formation. Otherwise known as carpal tunnel syndrome. The highest prevalence among middle-aged people is from thirty to sixty years.

In most cases, this disease develops on one side. The main complaint of the patient is pain and numbness. upper limb, since its innervation is disturbed, and pain receptors on the contrary, they get irritated. Discomfort at first worries only at night, which prevents a person from sleeping. As the disease progresses, the symptoms increase and daytime days, which reduces the ability to work and the quality of life. Unpleasant sensations localized not only in the region large joints, but also throughout the course of the median nerve up to the fingertips.

There is a loss of strength muscle tone. Median nerve disease is due to impaired blood supply to tissues, metabolism and oxygen delivery. The patient sometimes cannot hold even the lightest and smallest things. For the same reason, the color of the skin of the hands changes.

Since the nerve is also responsible for tactile sensitivity, accordingly, the reaction to external stimuli is reduced or absent. The patient does not feel touch, temperature fluctuations.

Movement disorders, muscle atrophy are gradually noted.

Median nerve neuropathy is diagnosed by tests for pain and tactile sensitivity, an increase in symptoms with increased pressure on the forearm or raising the limb for a while.

For clarification, directions to the laboratory and instrumental diagnostics. Blood and urine tests give an expanded picture of the patient's health status, his concomitant pathologies (hypothyroidism, diabetes mellitus, nephrosclerosis). This is important for the attending physician, since the disease could develop precisely because of them.

A direct study of the carpal tunnel is engaged in electroneuromyography. It determines the location of the lesion, its size, depth. It is based on connecting electrodes installed on the arm to a computer that reads electrical impulses from the nerve fiber at rest and during movement.

Treatment begins with fixing the wrist in the correct position with an orthopedic bandage. Medical therapy includes the use of preparations with B vitamins, non-steroidal anti-inflammatory medicines("Diclofenac"), glucocorticosteroids ("Prednisolone"), vasodilators("Pentilin"), diuretics according to indications ("Veroshpiron"). Anticonvulsants (Pregabalin) and antidepressants (Duloxetine) are used to relieve pain and have a general calming effect. Treatment is complemented by massage, physiotherapy exercises.

Neuropathy sometimes requires surgical intervention aimed at restoring or expanding the lumen of the carpal tunnel.

neuropathy

Neuropathy of the median nerve is a pathology associated with traumatization of the upper limb, namely its bruise, injury, fracture.

In connection with the deformation of the bones of the limb, the nervous system almost fails to adequately innervate the hand and fingers. This is where almost all clinical picture. The patient complains of pain in the thumb, index and middle fingers, discomfort on inside forearm. The hand is not able to perform flexion, extension and rotational movements. Outwardly, muscle atrophy is observed in the region of the tubercle near the thumb. Tactile and temperature sensitivity is lost.

Neuralgia is diagnosed by examining the movements of the fingers and the hand as a whole. Nerve damage can be studied in detail using ultrasound diagnostics, ultrasonography and electroneuromyography.

Treatment involves the use of anticholinesterase agents (Galantamine), muscle relaxants (Norcuron), antioxidants (vitamin E). The therapy is complemented by acupuncture, physiotherapy, massage.

It is necessary to treat by surgical intervention only in case of a strong proliferation of connective tissue at the site of injury, as this negatively affects the functioning of the nerve. Neurolysis of the median nerve is performed using microsurgical devices and a microscope.

Neuritis

Neuritis of the median nerve is a disease associated with inflammation of the anatomical formation. This group includes pathologies of both infectious and non-infectious etiology.

The patient notes weakness in the hand, difficulty in bending the upper phalanges of the fingers. There may be a tingling sensation or "goosebumps". Outwardly, there is a change in shade skin, their cyanosis, excessive sweating palms, swelling of the limb, violation of the structure of the skin and nails. As a person's condition deteriorates, they develop trophic ulcers, cracks in the epidermis, muscles atrophy and are replaced connective tissue, in this case recovery motor activity almost impossible.

The neurologist is obliged to study the mobility of the hands, starting with a healthy one. He asks the patient to clench his palm into a fist, to bend the limb as much as possible in the wrist area. In the results laboratory research the presence of inflammation is visible (an increase in the number of leukocytes, an erythrocyte sedimentation rate, a decrease in blood protein).

Additionally, it is diagnosed by radiography, computed and magnetic resonance imaging in order to visually study the forearm area and the course of the median nerve.

Treatment with the development of microorganisms begins with the use of antibiotic therapy. a wide range actions of a group of penicillins, cephalosporins. To raise immunity, it is necessary to use vitamin complexes, as well as immunomodulatory drugs. Treatment should include non-steroidal anti-inflammatory and decongestants, analgesics. From physiotherapy, electrophoresis with painkillers gives the greatest effect, impulse currents and UHF.

Neuritis of the median nerve is inflammatory disease peripheral nerve, which can cause different kind pain all over the nerve. In humans, sensitivity can be disturbed and manifested muscle weakness in the area that the nerve innervates.

Affecting several nerves at once, the disease is called polyneuritis. This disease is diagnosed by a neurologist. In order for neuritis to be correctly and accurately diagnosed, the specialist must conduct a general examination and make all kinds of specific functional tests. In addition to general inspection the doctor should conduct electromyography, electroneurography and a specially designed study of the EAP.

A disease such as neuritis can be caused by many reasons. This can be ordinary hypothermia, and various infections that have entered the human body in the process of various injuries, as well as with some vascular disorders, with hypovitaminosis.

Moreover, such intoxications as exogenous and endogenous can lead to the development of neuritis. Most often, peripheral nerves can affect the musculoskeletal canals. It should be noted that the anatomical narrowness of this canal can lead to such unpleasant disease, like neuritis, and develop the so-called tunnel syndrome.

Often, such a disease can appear as a result of compression of the peripheral nerve trunk itself. This can happen at any time, during surgery and even in your sleep. Take, for example, a person who long time walks exclusively with the help of crutches. During this time, he may develop neuritis of the axillary nerve.

If a person squats for a very long time, then he may develop. If a person's profession is associated with constant flexion and extension of the hand, then he can develop neuritis of the median nerve (this most often applies to people who play the piano and cello).

Causes of neuritis of the median nerve

There are many reasons for the occurrence of such a disease. All kinds of injuries of the upper limbs, nerve damage in the process of violating the necessary technique during internal injection into the cubital vein, various wounds that are on the surface of the forearm, and overstrain of the hand, which are of a professional nature, can provoke the appearance of this disease.

The functionality of the median nerve allows you to define it as mixed. Due to the fact that it is able to innervate a large number of muscle groups, as a result of their contraction, such types of movement are produced as extension and flexion of two wrist fingers, namely the second and third. There are also such types of movements that are produced by some muscles of the median nerve along with the ulnar ones. Its general composition includes all kinds of sensory fibers that are capable of innervating the skin on the radial carpal surface, palmar surface, starting from the first and ending with the fourth finger of the hand, as well as dorsal surface all available distal phalanges of the above fingers.

Symptoms and diagnosis of neuritis of the median nerve

If the patient has median nerve neuritis, symptoms such as weakness in flexion of the hand, weakness in flexion of the first and second fingers, especially the terminal phalanges, appear. The sensitivity of the palmar surface of the first and second fingers is significantly reduced.

the most successful and successful treatment neuritis of the median nerve lies in the fact that all kinds of therapeutic effects occurred precisely at the point of damage to the nerve itself. In order to simplify and improve treatment somewhat, the attending physician should know the following:

in order to carry out targeted treatment, the specialist will take an interest in which specific point is affected;
what reasons led to such an ailment (it can be all kinds of injuries, scars and compression in the area of a particular nerve);
it is important to determine the degree and level of damage to a particular nerve.

About all kinds of diagnostic methods have already been mentioned above. Now in more detail about some of them.

Electroneuromyography. Thanks to this survey you can easily determine the speed and volume of impulses along the existing nerve. Moreover, thanks to this examination, you can easily detect the damaged area and determine the time for the restoration of the existing nerve. In addition, electroneuromyography allows you to accurately assess the effect of any type of treatment, so you can choose the most appropriate and effective method.

During radiography and computed tomography it is possible to obtain complete necessary information about the deformation of a particular joint and all available bone canals of a given nerve. Moreover, it is possible to determine the causes and points of defeat with greater certainty.

Treatment of the disease

After the specialist managed to find out the reason for which the compression of this nerve occurs, all kinds of treatments become more effective and correct. In the process of treatment, the specialist should resort to etiotropic therapy.

This therapy includes treatment with antibiotics, various antiviral and vascular drugs.

Moreover, the treatment of this difficult disease should include various anti-edematous and anti-inflammatory drugs. It is necessary to carry out various physiotherapy, specially designed massage and exercise therapy.

If the nerve is compressed, the main objectives of treatment are:

Elimination of compression of the median nerve. To do this, it is necessary to carry out a sufficiently powerful resolving therapy. In order to this therapy was produced, you need to start with the use of various enzymes, as well as take various agents and preparations that absorb and soften scar tissue, and much more. There are also such cases that for a complete cure it is enough only manual therapy and massage at the site of injury.
Acceleration of healing and, of course, restoration of the nerve itself. To do this, it is necessary to resort to the use of some modern medicines who are able to restore the liberated from all harmful factors nerve.
Restoration of muscle function and muscle volume. In order for the treatment to positive result, it is necessary to perform all kinds of restorative procedures. In this matter, each patient can be helped by a rehabilitation doctor.

When injuring the median nerve, first of all, it is necessary to decide on a conservative or surgical treatment. Each doctor will be able to solve this issue only when a needle myography is performed, thanks to which it will be possible to determine the degree of damage.

After the doctor makes a diagnosis and finds out all the questions that interest him, only then will he choose the most suitable method of treatment for each patient.

The disease of neuropathy of the median nerve is often found in the practice of a neurologist. Proper movement of the arms and hands depends on the health of the radial, median, and ulnar nerves. The slightest damage to them leads to problems and discomfort. Violation of the work of the nerves accompanies the disease, called neuropathy of the upper extremities in neurology.

According to human anatomy, the median nerve (from the Latin nervus medianus) is the largest in brachial plexus. It innervates almost the entire upper limb.

The median nerve responds:

for flexion of the muscles of the forearm;
for the motor activity of the thumb, middle and index fingers;
wrist sensitivity;
abduction and adduction of the left and right hand.

Reasons for the defeat

Neuropathy of the median nerve is considered damage to its site. The cause of the disease is often soft tissue swelling due to any mechanical damage or illness.

Damage to the median nerve is due to the following factors:

Injuries. Sprains, dislocations, fractures, bruises provoke the expansion of blood vessels, fluid accumulates in soft tissues. Nerve compression occurs. The situation can be aggravated by damage to the bone, its improper fusion.
Arthritis. With this disease, the soft tissues of the body swell, and there is pressure on the nerve. Chronic illness often leads to a disastrous result, deformation of the hand. This is due to the fact that the tissues begin to wear out, and the surfaces of the joints undergo fusion, the bone is exposed.
Fluid in soft tissues also accumulates due to other diseases, such as: nephrosclerosis, kidney problems, thyroid hormones, pregnancy, menopause, ischemia, and some other pathologies.
genetic predisposition. If parents, grandparents suffered from joint problems, sometimes it is inherited.
The risk group includes people suffering from diabetes. Due to impaired glucose metabolism and oxygen starvation cells are destroyed nerve fibers.
. This disease belongs to the diseases of the peripheral nervous system. Blood circulation is disturbed when the hands do not change their position while in a static state. This provokes compression of the nerve. Often the syndrome develops with prolonged use of the mouse and keyboard.
Due to certain activities, compression-ischemic neuropathy of the median nerve occurs. It is associated with prolonged macrotraumatization of the nerve. Contributes to this, for example, heavy physical work with overload of the forearm and hand.

To external reasons neuropathy of the median nerve of the hand also includes:

intoxication of the body;
alcohol abuse;
past infections (eg, HIV, diphtheria, herpes).

Classification

Neuropathy (neuropathy) is a disease characterized by damage to nerve fibers. When only one nerve becomes inflamed during an illness, this is called mononeuropathy, two or more is called polyneuropathy.

Neuropathy is divided into 3 forms:

(when nerve fibers and blood vessels are affected due to high sugar in blood);
toxic ( infectious diseases, chemical substances- all this affects the state of nerve fibers);
post-traumatic (this type of disease develops after damage to the myelin sheath of the nerve. Most often, the sciatic, ulnar and radial nerves are injured);

Neuritis develops under similar conditions as median neuropathy, but inflammation is characteristic of this disease.

According to the type and location of the pathology development zone, neuropathy has the following classification:

damage to the lower extremities;
neuropathy of the sciatic nerve;
median nerve;
peroneal nerve;
facial nerve;
tunnel neuropathy;
sensorimotor neuropathy.

N medianus approaches the hand through the carpal canal. Here it innervates the muscles responsible for the opposition and abduction of the thumb, the worm-like muscles, the muscles that flex the finger. Also, its branches supply nerve fibers wrist joint.

Median nerve neuropathy is associated with carpal tunnel syndrome, as the disease develops starting with constant compression in the wrist.

From the point of view of surgery, lesions of the median nerve are divided into open and closed. Open, in addition to the nerve, affect the tendons, blood vessels and muscles of the patient. Closed include bruising, squeezing or stretching. Damage to the median nerve can form along with plexopathy - a lesion of the cervical or brachial nerve plexuses.

Defeats that have complex character(eg, trauma) often extend to the ulnar nerve. There is a cubital syndrome (with compression of the nerve of the cubital canal).

Symptoms of the disease

Neuropathy of the median nerve of the hand (or neuritis) refers to diseases of the nervous system. At the beginning of the development of the disease, the patient has difficulty squeezing the first, second and third fingers of the hand into a fist. It is also difficult and easy for him to move the second and third fingers of his hand. Other symptoms:

The impossibility of opposing the thumb to the rest.
Poor sensation in the palm and fingers.
The appearance of the "monkey's paw". This is due to the fact that atrophy of the muscles of the hand occurs. As a result, the first finger of the hand is installed with the second in the same plane.
The main symptom is sharp pain, manifested in the segment from the forearm to the fingers of the diseased hand.
Numbness of the hand, muscle weakness, tingling in the forearm.

Diagnostics

To diagnose neuralgia of the median nerve, the doctor performs a series of procedures. With the development of the disease, the patient cannot perform some actions. For example, an attempt to scratch the surface of the table with the index finger (while the palm is pressed against the table) fails. The patient is unable to clench his hand into a fist, as well as oppose the thumb to the others.

Another way to diagnose is to ask the patient to show the "mill". To do this, with crossed arms, you need to rotate the sore finger of a healthy hand around the thumb of the injured one. If the nerve is affected, the person will not be able to do it.

With neuropathy of the median nerve, the patient's thumb cannot be moved to the side so that a right angle with the index finger is obtained. Also forefinger one hand cannot scratch a healthy hand if you put 2 palms together.

The doctor also diagnoses in the following ways:

computed tomography of the hand;
electroneuromyography;
hand x-ray.

The examination will show what treatment is best to carry out. Diagnostic data will give the doctor the opportunity to study information about damage to the joint and bone canals of the nerve. The doctor will evaluate the reflexes, the state of the muscles, and answer the question of whether the disease is caused by the narrowness of the canal or the patient's lifestyle. The doctor will determine whether it is possible to prescribe neurolysis for the treatment of the disease - surgical intervention during which the sensitivity of the nerves is restored.

Treatment

People with median nerve neuropathy rarely see a doctor in the first stage of the disease. Conversion occurs when there are more anxiety symptoms neurological problems:

spasms, convulsions;
goosebumps;
problems with coordination;
lack of sensitivity to temperatures.

For the treatment of the median nerve of the hand to be successful, it is important to find the exact location of the lesion. It is equally important to establish the cause, which is done at the diagnostic stage.

For effective therapy, the doctor also needs:

determine the degree of nerve damage;
to identify the factors leading to this symptom;
find a specific hit point.

Treatment happens:

operational (with the help of surgical intervention);
conservative (drugs). Often, doctors turn to etiotropic therapy. This antibiotic treatment antiviral agents, vascular drugs.

The degree of damage is determined using special survey- needle myography. If the nerve is compressed, treatment may include the following steps:

Absorption therapy has good effect to relieve nerve compression. It involves taking various medicines and enzymes, agents that absorb and soften scar tissue. If the compression is not strong, manual therapy and special massage are often enough.
Nerve recovery. Special medicines prescribed by a doctor contribute to the "revitalization" of the nerve.
Muscle rehabilitation. The goal of therapy is to restore their muscle volume. Healing procedures prescribed by a rehabilitation physician.
Conservative treatment of the radial and ulnar nerves may include wearing splints.

What other means are used?

Demixidol in the area of the carpal tunnel.
Acupuncture.
Interstitial electrical stimulation.
Therapeutic blockade in the carpal tunnel (diprospan plus lidocaine), intramuscular injections(movalis plus novocaine)
Non-steroidal anti-inflammatory drugs, in addition to blockades (arthrosilene).

During the diagnosis, a disease can also be detected - plexitis of the median nerve. It is caused by injury or infection.

Initially, medications are always used, conservative methods therapy. With a low efficiency of physiotherapy treatment, an operation is performed in the clinic. The decision in favor of surgical intervention is made in violation of the integrity of the nerve trunk, great weakness in the fingers.

It is not recommended to treat the disease folk remedies. During therapy, the patient should not overwork and expose himself to severe physical activity. AT acute period disease, you need to lie more, rest.

exercise therapy and special exercises usually assigned to postoperative period. Physiotherapy is carried out with conservative treatment or also after surgery.

Patients with an ailment may be shown Spa treatment. A contraindication to it is the acute period of the disease.

Forecast and prevention

If there is no threat to health in the form of infections or injuries, sufficient attention should be paid to the prevention of neuropathy of the upper extremities, namely:

Physical exercises for the hands. They include a simple warm-up for the brushes.
When working at a computer, it is important to take breaks. When using a computer mouse, you need to hold it in different hands alternately.
Vitamin intake is useful, as well as strengthening general condition human health. This reduces the risk of neurological diseases of the extremities.

It should be remembered that timely treatment started guarantees a good prognosis for future hand performance. Restoration of motor activity should begin as soon as possible. Ignoring therapy or improper self-medication often causes disastrous consequences.

Successful treatment depends on both the type and age of the injury.

Treatment of post-traumatic neuropathies

Post-traumatic neuropathies associated with damage to any nerve trunk on the forearm (ulnar, radial and median nerves) are treated in a fresh time by restoring the anatomical integrity.

In this case, execution is shown neurolysis- a surgical operation aimed at releasing the nerve from squeezing by scar tissue. Thus, the sooner you turn to a specialist with post-traumatic neuropathy, the better the treatment process will be and the less postoperative complications will occur.

If, after the onset of the development of the lesion, a sufficiently long time has already passed (from 2-3 months), then the surgical intervention will be much more voluminous. In this case, you will either have to sew in the nerves in an uncomfortable position of the upper limb (to reduce the tension, the arm is specially bent and unbent in certain joints), or plastic surgery (transplant) should be performed.

The more time passes after an injury, the more more likely development of neurogenic contracture of the hand - the affected nerve ceases to innervate certain muscles and arise irreversible changes in the form of muscle contracture. These contractures can only be eliminated with the help of various orthopedic operations, during which the transposition of the tendons and muscles is performed.

Also one of the relatively new, but very popular methods surgical correction or prevention of neurogenic contractures of the limb in high level damage is neuroticism- restoration of lost muscle innervation.

Treatment of compression neuropathies

With early treatment of a patient with initial manifestations of compressive neuropathy, treatment with conservative therapy methods is possible:

produced splinting(fixation with a splint or orthosis) limbs in a physiological position
appointed NSAIDs(non-steroidal anti-inflammatory drugs), drugs that improve trophism and regeneration of nervous tissue (such as Trental, Neuromidin, B vitamins, Prozerin)
physiotherapy.

A separate problem in the treatment is the introduction of hormonal drugs into the intended area of nerve compression. These injections are only suitable for idiopathic cause diseases, because in this way they are not eliminated volumetric formations that are the cause of the disease.

In addition, at the injection site hormonal drug a site of dystrophy and degeneration of surrounding tissues with altered vascularization is always found, and the drug can get into the region of the nerve or nearby tendons. All this can lead to the development of persistent contractures of the hand, neurological disorders, expressed pain syndrome. In our practice, we try to avoid the use of methods that can lead to such complications.

Treatment of carpal tunnel syndrome

The most common type of lesion is ischemic tunnel neuropathy (tunnel syndrome). This is a carpal tunnel syndrome, in which the median nerve, located in the carpal tunnel, is compressed either by a thickened wall of this channel, or by some volumetric formations (tumor). It can also be compressed due to the modified sheaths of the flexor tendons.

If compression occurs at the level of the carpal tunnel, the most common treatment for ischemic neuropathy ulnar nerve- This dissection of the wall of the carpal tunnel.

The incision is performed either in an open way (open release) or with the help of endoscopic techniques. The difference between these surgical methods treatment is only in the amount online access. The use of endoscopy allows operations to be performed through small incisions, but with an open release, it is possible to visualize the entire canal, which gives best review and allows you to make sure that there are no volumetric formations.

Treatment of cubital tunnel syndrome

The second most common ischemic neuropathy syndrome is cubital duct syndrome. This is an ischemic neuropathy of the ulnar nerve, which runs at the level elbow joint in the cubital channel formed ulna and connective tissue "bridge".

Depending on the alteration of the canal walls, it is possible various options treatment - from simple dissection of the canal wall connective tissue bridge to nerve transposition into intact tissues. For example, if there is a deformity in the area of the bone walls of this canal, there is a need to move the ulnar nerve to the palmar side relative to the elbow joint.

Another type of compression neuropathy is ischemic neuropathy of the ulnar nerve at the level of Guyon's canal. This canal is located on the hand (as well as the carpal one) and is formed by the bones of the wrist and the connective tissue bridge. This pathology occurs quite rarely and is treated by decompressing the canal (dissecting one of its walls).

The choice of anesthetic aid depends on the type and volume of the operation - if this is a simple option for dissecting the canal wall, then conduction anesthesia is sufficient. For longer and more serious operations, general anesthesia is preferred.

Additional Treatment

In the postoperative period, it is obligatory to immobilize the operated limb in a physiological position (with compression neuropathies or with nerve plastics). When stitching with a slight tension, it is advisable to fix in a forced position, in which the tension of the nerve will be the least.

In the process of treating neuropathy, regardless of the cause of the lesion, drug therapy should also be used:

be sure to prescribe vitamins of group B, drugs "Trental", "Prozerin", which improves neuromuscular transmission, "Neuromidin", "Dibazol" in minimal doses
treatment should be accompanied by immobilization of the operated limb (up to 3 weeks) to minimize scarring in the surgical area. In addition, immobilization is necessary to reduce the risk of suture rupture in the postoperative period.
it is also necessary to carry out adequate physiotherapy exercises, the purpose of which is to prevent the development of contractures in the operated limb and the use of physiotherapy, which will be aimed at reducing the formation of scar tissue in the area of operation

To assess the dynamics of recovery of the damaged nerve after surgery, it is necessary to periodically perform electroneuromyography.