Transverse ligament of the wrist. Conservative treatments for carpal tunnel syndrome

carpal tunnel and median nerve

The carpal tunnel is a tunnel that is formed by the carpal bones on one side and the transverse carpal ligament on the other. The tendons of the flexor muscles of the hand and the median nerve pass through this tunnel.

The median nerve is the thickest nerve in the upper limb. Passing in the area of ​​the carpal canal to the hand, it gives branches to the thumb, index, middle and half of the ring finger. In addition, it innervates the muscles of the thumb. The median nerve, passing through the carpal canal, is located above the tendons of the muscles. The tendons of the flexor muscles are covered with a special sheath - synovial sheaths. In these sheaths, the tendons glide during movement.

Carpal syndrome (carpal tunnel syndrome) is one of the most common diseases of the wrist area. It consists in compression of the median nerve in the area of ​​the carpal tunnel. In a broad sense, the syndrome of the carpal tunnel occurs under the condition of a decrease in its size or an increase in the volume of tissues inside it.

Carpal tunnel syndrome occurs under any conditions leading to a decrease in its size or an increase in the tissues inside it, which leads to compression of the median nerve.

Causes of carpal tunnel syndrome include:

Injury to the wrist area, which leads to swelling of the tissues in it, the occurrence of hematomas.

A fracture of the bones in the wrist area is most often a fracture of the radius.

Arthritis of the wrist joint.

Tumors in the carpal canal.

Inflammation in the area of ​​the synovial sheaths of the tendons of the flexor muscles.

Pregnancy, while there is a tendency to swelling of soft tissues.

Diabetes mellitus, which is manifested by pathology of peripheral nerves - neuropathy.

Decreased thyroid function.

With compression of the median nerve, there is a violation of the blood supply to its outer shell and even a complete cessation of blood circulation in it. There is ischemia. In the beginning, only the superficial parts of the nerve are affected. But with prolonged ischemia, the lesion also affects the deep layers of the nervous tissue. As a result, scar tissue forms in the nerve. This causes pain and numbness in the fingers.

Manifestations of carpal syndrome

The manifestations of carpal tunnel syndrome are usually bright. This is accompanied by intermittent or constant numbness in the fingers (and palms), tingling and pain, which are noticeably worse at night. Patients repeatedly wake up at night due to pain, are forced to move and knead their stiff and “stiff” fingers, and put their hands down.

In the morning, there is an increase in these symptoms. During the day, patients experience gradual relief, but even after short overloads, deterioration occurs again. Over time, the discomfort gets worse. Sometimes the pain can radiate up to the shoulder. Numbness first captures one or two fingers, then spreads to all the others, sometimes including the little finger. When raising the arm up, the pain intensifies, which is associated with a deterioration in blood flow.

On examination, you can notice some cyanosis and pasty swelling. When feeling in the palm area, pain is determined.

Diagnosis of carpal syndrome

Diagnosis of carpal tunnel syndrome is mainly based on diagnostic tests. They consist in the artificial induction of ischemia of the median nerve and further evaluation of the manifestations. A certain role in the diagnosis of this pathology can be played by radiography, in the case when this syndrome is a consequence of a fracture of the bones of the forearm. In addition, magnetic resonance imaging is performed.

Treatment of carpal syndrome can be either conservative or surgical.

Conservative therapy

The most popular method of conservative treatment of carpal tunnel syndrome is the use of anti-inflammatory drugs. In mild cases, they are taken in the form of tablets. In severe cases of manifestation of this disease, the so-called steroidal anti-inflammatory drugs (hydrocortisone, kenalog, etc.) are used. Steroid medications are given by injection into the carpal tunnel itself. Usually, two injections are given with an interval of about 2 to 3 weeks. In rare cases, a third injection may be required.

Surgery

In the absence of the effect of conservative treatment, surgical treatment is indicated. The operation for carpal tunnel syndrome consists in decompression, that is, reducing pressure in the area of ​​the carpal tunnel, and, accordingly, reducing compression of the median nerve.

Usually, general anesthesia is used for this operation, but under certain conditions, conduction anesthesia can also be used. Several methods have been proposed for performing an incision during this operation. An incision is made on the inner surface of the wrist, about 3-4 cm long. The flexor retinaculum ligament, which is one of the walls of the canal, is necessarily dissected. Next, the contents of the canal are examined, abnormal muscles, tumors, hypertrophied synovial membranes, unusual bone protrusions, fibrous bands constricting the nerve, etc.) are detected and eliminated.

Endoscopic surgery

There is also an endoscopic method of surgical treatment of this syndrome. It requires a minimal skin incision. A special cannula is used, which is inserted into the carpal canal. The doctor examines the canal and makes sure that there are no nearby blood vessels. then a special scalpel in the form of a hook is inserted through the cannula. With its help, the ligament of the carpal tunnel is dissected and compression of the median nerve is eliminated.

Operational risks and possible complications

As with any surgical intervention, complications can occur in the surgical treatment of carpal tunnel syndrome.

• Complications associated with anesthesia (for example, allergies and more serious complications).
• Infectious complications - are manifested by pain in the area of ​​​​the surgical wound, redness and swelling. To prevent this complication in the postoperative period, antibiotics are prescribed.
• Technical errors in the operation - ranging from incomplete dissection of the carpal ligament of the canal to damage to blood vessels and nerves.

• Carpal syndrome - treatment

There are people who, by occupation, are at risk of a disease called "carpal tunnel syndrome." Programmers, system administrators, machinists, drivers, hairdressers, as well as those who are engaged in knitting and embroidery, playing the cello, violin or piano, often complain of pain in the wrist of the “working” hand. However, anyone can get sick, regardless of their occupation. Women are more likely to get sick, as their wrists are thinner.

Carpal tunnel syndrome (carpalis - Latin for carpal tunnel) is a set of symptoms that are caused by compression of the median nerve in the carpal tunnel. After monotonous work with a brush, a person feels numbness, weakness of the hand, pain in it.

The reasons

In order for the wrist to be sufficiently mobile and at the same time stable, its bones are connected by many strong ligaments. Inside the wrist there is a fibrous rim through which the tendons and nerves of the hand pass - the carpal tunnel.

A large number of the same type of movements (including when working with a computer mouse) or an uncomfortable position of the hands, which leads to the fact that the wrist is constantly in tension, can cause swelling of the tendons and ligaments that form this narrow tunnel, and hence the pinched nerves. This is the root cause of the syndrome.

However, factors such as:

• Heredity.
• Age after 50 years.
• Fractures, injuries, bone outgrowths, cysts, tumors in the wrist area.
• Obesity.
• Infections.
• Hormonal changes in pregnant or menopausal women, leading to the retention of excess fluid in the synovial membranes (the inner layer of the joints).
• Smoking and alcohol, which cause a decrease in blood flow to the median nerve.

Clinical manifestations of the disease can occur not only when a person works with a brush, but even in a dream. Helps reduce symptoms by changing the position of the hand or shaking the hand.

Initially, they can come and go, but over time they inevitably turn into constant companions of the disease. It can get to the point that it becomes difficult to perform any movement associated with finger work: buttoning a shirt or tying shoelaces.

What does a person feel?

• Tingling (including at night).
• Numbness and swelling of the fingers.
• Weakness in the muscles of the hand.
• Pain in the fingers or in the entire hand (often resembling a backache or a sharp electric shock).

A neurologist examines such a patient. He can determine:

With the help of effleurage over the area of ​​the carpal tunnel, the patient's reaction in the form of "lumbago" in the fingers (the so-called Tinel's symptom);

With the help of maximum flexion of the wrist in the wrist joint for 1 minute, the patient's reaction in the form of weakness, numbness or tingling (the so-called Phalen test).

The history of the disease, its additional factors (indirect causes) are studied.

As additional diagnostic methods are used:

1. Electroneuromyography (the degree of damage to the muscles of the forearm is established).
2. Nerve conduction velocity (is it normal).
3. X-ray of the wrist joint (its goal is to exclude other diseases of the hands).

Treatment

The main methods of treatment of carpal tunnel syndrome are conservative and surgical.

The first is used when the disease is diagnosed in the early stages. The more pronounced the symptoms and the more often they disturb the patient, the more severe the form of the disease and the less likely it is that conservative treatment will be effective. In such cases, surgical intervention is preferable.

Conservative treatment involves:

• Fixation of the wrist joint (an orthosis is put on at night - a special orthopedic apparatus; it fixes the hand in a physiological (natural) position; during the day, while working, you can wear splints).
• Taking medication to reduce pain and reduce inflammation (for example, treatment with Nimesil or Nurofen).
• Change of professional conditions, if the work is associated with an active load on the hands.
• Steroid injections (such as prednisolone or dexamethasone) that are given into the carpal tunnel to reduce symptoms.

If treatment with conservative methods for six months has not yielded results, then surgical intervention is inevitable.

This operation is usually performed on an outpatient basis under local anesthesia. The carpal ligament (in other words, the transverse carpal ligament) is surgically dissected.

The recovery period lasts a couple of months and suggests the possibility of minor pain, swelling, stiffness in the hand. In order to exclude such consequences, a rehabilitation program is individually developed for the patient with a whole range of measures for the effective restoration of hand function.

The hand will completely return to normal within a year: the more neglected the disease was, the longer it will take.

Eat well during treatment. If the body is provided with all vital biologically active substances, then recovery will be accelerated, and the period of rehabilitation and restoration of working capacity will be reduced.

First of all, you need to make your workplace comfortable. When working with the keyboard, strictly follow the angle of the bend of the arm at the elbow - 90 °. When working with the mouse, keep an eye on the brush - straight and lies on the table away from the edge (the elbow should also be on the surface of the table). Use a special wrist support (the same mouse pad). The chair or work chair must have armrests.

Secondly, during the work, take breaks and do preventive exercises that will improve blood circulation in the muscles of the wrist and help stretch them:

• Shake your hands.
• Clench your fingers into fists (5-10 times).
• Rotate your fists around your axis.
• Press the left hand on the fingers of the right (as if turning the palm and wrist outward) and vice versa.

Finally, improve your diet, stop smoking, play sports, and maintain a normal body weight.

Forecast

As for the prognosis for carpal tunnel syndrome, timely diagnosis and comprehensive, adequate treatment will make it favorable. It is absolutely impossible to start the disease: irreversible damage to the nerve is fraught with loss of working capacity of the hand.

Below is a video - an excerpt from E. Malysheva's program about carpal tunnel syndrome:

Carpal tunnel syndrome is a common condition that causes pain, numbness, and weakness in the hands and wrist. The disease occurs when the median nerve is compressed in the carpal tunnel. This nerve supplies the thumb, index and middle fingers, as well as half of the ring finger. The little finger ("little finger") is usually not affected. The median nerve also provides strength to some muscles at the base of the thumb.

What is a carpal canal?

The carpal tunnel is a narrow tunnel in the wrist. The bottom and sides of the tunnel are formed by a semicircle of carpal bones. The transverse ligament forms the upper part of the tunnel.

The median nerve and tendons pass through this narrow space. (Tendons are "rope" structures that connect the muscles of the forearm to the bones of the hand.) Tendons allow the fingers to bend and straighten. Conditions that cause narrowing of the carpal tunnel or swelling and inflammation of the tendons that go away

through this tunnel, cause carpal tunnel syndrome by compressing the median nerve.

Causes of the disease

The causes of the carpal tunnel syndrome are all conditions in which the tunnel narrows and the nerve is compressed in it. Among them are:

• injuries in the wrist area (fractures and dislocations of bones).
• cysts or tumors in the wrist area that cause compression of the median nerve.
• frequent repetitive movements of the same type in the area of ​​the wrist joint (flexion-extension as well as the impact of vibration on the hand). People of certain professions are subject to this: painters, violinists, cashiers,
  milkmaids, equipment assemblers, artists, dentists, tattoo artists.
  An additional effect is exerted by hypothermia of the brush.
• prolonged incorrect position of the hand in the position of excessive flexion or extension, most often the result of an incorrect position of the hand and computer mouse in office workers - with excessive extension, the median nerve is squashed in the canal.
• risk factors are diseases and conditions of the body in which there is a tendency to tissue edema, as a result of which the carpal canal narrows - these are pregnancy, thyroid diseases, diabetes mellitus, obesity, amyloidosis, taking hormonal contraceptives, rheumatism, kidney failure, etc.

Symptoms.

Among the main complaints of patients with carpal tunnel syndrome are tingling, numbness, burning, crawling, pain or shooting in the fingers (all, including the thumb, but excluding the little finger). Sometimes the pain radiates to the forearm or shoulder.

As a rule, symptoms appear at night or in the morning after waking up. The pain is so pronounced that it can wake the patient. Symptoms decrease after a few minutes after shaking the hand, this forces the person to lower the hand down from the bed, shake the hand. May appear

weakness in the hands, which is manifested by the awkwardness of the hand and the difficulty of holding objects.

In severe cases, there is a disappearance of sensitivity, muscle atrophy, dry skin of the fingers, weakness of the muscles of the thumb. Habitual gestures such as grasping objects, sewing, buttoning shirts become difficult to perform.

Diagnostics

In most cases, a physical examination of the patient, conducting special tests, can diagnose carpal tunnel syndrome.

Phalene's maneuver

This maneuver can be performed as follows:

• Place the backs of your hands on top of each other with your fingers pointing down
• Drop both elbows down.
• Hold this position for 20 seconds.

If you feel pain and the sensation in your arm increases, the test is positive, which could mean narrowing of the carpal tunnel.
Second carpal tunnel syndrome Tinnel test. The test is performed as follows:

• The wrist joint is in the middle position, that is, the arm lies straight
• Now press with two fingers on the carpal tunnel.
• Keep pressing for 20 seconds. If you feel a tingle in your hand, the test is considered positive.

However, studies such as an electroneuromyogram, radiography of the wrist joint, computed tomography, and blood tests are prescribed. They confirm the diagnosis and, to a greater extent, serve to assess the severity of nerve damage and determine the tactics of therapy.

How is carpal tunnel syndrome treated?

Non-surgical treatment

Treatment begins with wearing an orthosis on the wrist at night to give it a neutral position and, accordingly, to reduce nerve compression. Also, non-steroidal anti-inflammatory drugs, such as ibuprofen, nimesil, ketonal, etc., are prescribed to alleviate the pain syndrome. Diuretics are indicated to reduce tissue swelling. In order to improve microcirculation, angioprotectors are used - pentoxifylline or nicotinic acid. To improve the nutrition of the nerve - vitamins of the B-milgamma group, combilipen, etc.

Topical application of NSAIDs is shown, as well as compresses on the wrist joint (with dimexide, artrafik). In some cases, medical blockades with glucocorticoids are used, which allow you to remove local swelling and compression of the nerve, in addition to alleviating

symptoms, they are a diagnostic measure to confirm the diagnosis. As physiotherapy, ultraphonophoresis with hydrocortisone, laser therapy, magnetotherapy, manual therapy, shock wave therapy are indicated. As an auxiliary method, acupuncture can be used.

• pain and tingling in the area of ​​\u200b\u200bthe brush, which are especially pronounced at night;
• feeling like the hand and wrist are swollen;
• numbness of the second and third fingers.

Carpal tunnel syndrome: diagnosis and treatment at the highest European level

Carpal tunnel syndrome: operation

Carpal Tunnel Syndrome: Treatment at Home

It is interesting:

CARPAL CANAL SYNDROME: CAUSES OF DISEASE DEVELOPMENT

• Diabetes.
• Various inflammations (rheumatoid arthritis, rheumatism) in the wrist and hand area.
• Peripheral neuropathy.
• Inflammatory processes in the tendons.
• Problems with ligaments, degenerative-dystrophic.
• benign tumors.

Carpal Tunnel Syndrome: Symptoms

Center for Hand Surgery at KhGKB No. 31

Carpal tunnel syndrome is a condition in which the median nerve is compressed at the wrist. It can be said that tunnel syndrome is a disease of the century, which is currently widespread, especially among IT people who work at a computer for a long time. The disease belongs to neurological diseases and is included in the group of tunnel neuropathies.

The syndrome is manifested by very unpleasant symptoms: prolonged numbness of the fingers and acute pain in the wrist. Long pastime at the computer, constant monotonous loads on the hand when working with a mouse lead to a narrowing of the anatomical canal, which infringes and compresses the peripheral nerve in the carpal tunnel.

What is carpal tunnel syndrome

Tunnel syndromes are not an independent disease, but a complex of clinical symptoms caused by pinching and compression of the nerve in narrow spaces, the so-called anatomical tunnels. The walls of such tunnels are natural channels that normally allow peripheral vessels and nerves to pass freely. With various pathologies, their narrowing occurs, which leads to compression of the vessels and nerves passing through it.

Pathology at all times occurred in women much more often than in men. This is due to the fact that women are more likely to perform monotonous monotonous work, which puts a strain on the muscles of the hand. Among men, the disease affects programmers working at a computer. Compression of the carpal nerve can be caused by thickening of the tendons that are close to the median nerve, as well as damage to the nerve itself: its thickening and swelling.

Carpal tunnel syndrome develops as a result of repetitive movements that involve the same wrist muscles. The first symptoms appear when using a computer mouse, when the hand is in a permanent wrong position. This puts a lot of pressure on the wrist and can be complicated by cubital tunnel syndrome. It is the computer mouse that is responsible for the spread of the disease around the world. And since computers are in every home and young people sit online for many hours, the disease takes on the character of a pandemic.

Causes of the syndrome

Above we have already written about the causes of the development of the pathological process. Any pathological processes that reduce the size of the anatomical canals and contribute to the compaction of the tissues inside it can cause the development of carpal tunnel syndrome. There are many additional factors that can provoke the development of the syndrome. These include:

1. Wrist injuries (sprains, fractures, bruises);
2. Pregnancy. During this period, the female body is subject to many phenomena, such as edema. When a significant amount of fluid accumulates in the body, problems with the nerve fibers arise, as the swelling puts increased pressure on the wrist, which leads to a pinched nerve.
3. Metabolic disorders (diabetes mellitus).
4. Rheumatoid arthritis.
5. Hormonal disruptions. During the period of hormonal changes, mainly in women, there are problems with the joints, which are often accompanied by tunnel neuropathies.

The above problems can cause unpleasant symptoms when you do the following:

• monotonous monotonous actions with hands;
• with an uncomfortable position of the hands;
• while talking on a mobile phone;
• when performing physical exercises with emphasis on the wrist;
• with prolonged vibration (working with the keyboard);
• with prolonged use of the mouse (the brush is in a suspended state).

In addition, bad habits can complicate the situation: smoking, alcohol, obesity.

Symptoms

The primary symptoms that appear at an early stage of the disease are characterized by tingling in the fingers, severe but short-lived pain at the site of the median nerve. As the disease progresses, the symptoms get worse and worse. Most clearly, the symptoms make themselves felt at night, which prevents a person from having a good rest. At the same time, a person cannot fall asleep until the morning due to extremely unpleasant numbness of the hand and severe pain, he develops insomnia and chronic fatigue.

The syndrome has its own characteristics. For example, not the entire hand becomes numb, but only three of its fingers: the thumb, index, middle and half of the ring finger, the little finger is never affected in this pathology. In very advanced cases, the functionality of the hand is impaired, it cannot be clenched into a fist, pain occurs when trying to connect the thumb and little finger, a person is not able to take an object in his hand and then hold it. In other words, fine motor skills are disturbed and the hands stop obeying, which can lead to muscle atrophy and disability.

A person becomes helpless and vulnerable, he cannot drive a car, talk on the phone, work at a computer, perform household activities, and take care of himself.

All symptoms at the initial stage of the disease are reversible and safely eliminated. In advanced cases, surgical treatment may be required, in which the canal is widened and excess tendons are removed.

Timeline of symptoms:

1. During monotonous and monotonous movements (for example, at the computer, or when knitting), there is a strong dull pain in the area where the nerve passes, which radiates to the thumb, index and middle fingers. To eliminate the pain, it is enough to stop and shake your hands several times, and also take a half-hour break. The problem occurs due to poor patency of the nerve and circulatory disorders. At this stage, all symptoms are reversible.
2. If the problem was ignored for a long time, then after a certain time, the tingling and burning sensation in the hand no longer goes away on its own, but haunts a person even after hours for several hours, turning into a constant dull pain. The cause of constant pain is the compaction of the tendon located around the nerve. It begins to put pressure on the nerve and there are pains on the inside of the hand, radiating to the fingers.
3. The body tries to compensate for unfavorable factors, therefore, an accumulation of lymphatic fluid is observed between the cartilages, which carries away fragments of the affected tissue and cells with the lymph flow. In its natural state, this process is great at troubleshooting, and the fluid is self-absorbing. With constant loads, the inflammatory process is not able to regress and its self-healing is impossible. Therefore, prolonged swelling and stagnation of lymph are irreversible without additional treatment. Edema and numbness are significant at night, and if they are accompanied by severe pain, then the disease has reached its climax. And soon the only way out will be surgery.

Diagnostics

Diagnosis is carried out by an experienced neurologist or neurosurgeon, since a doctor of another specialization will not be able to distinguish short-term nighttime numbness of the hand from a pathological process. The main diagnostic method is to determine the speed of nerve conduction of impulses. For this purpose, electromyography (EMG) or electroneuromyography (ENG) is performed. The latter allows you to differentiate carpal tunnel syndrome from spinal hernia and osteochondrosis.

How is electromyography performed? The patient, who is sitting in a comfortable chair, is placed on the hand with electrodes, having previously treated them with an antiseptic. The electrodes are connected to a special electromyograph apparatus. Electrical impulses are passed through the electrodes, and nerve conduction is recorded. The result is displayed on a computer monitor and simultaneously recorded on paper in the form of waves. The result of electromyography is very similar to an electrocardiogram and is performed on the basis of the same principles. The specialist studies and evaluates the result to reach a verdict.

It is also possible to diagnose the disease on the basis of some tests.

Testa Fallen. To perform the test, it is necessary to bend and unbend the brushes by 90 degrees (see figure). A feeling of numbness or tingling occurs immediately within 20 seconds. A healthy person may also experience numbness and pain, but not earlier than after 1 minute.

Tinel test. When tapping with a neurological hammer, tingling and irradiation of pain in three fingers are felt. Sometimes tapping causes acute pain.

Durkan test. Mechanical compression of the wrist in the area of ​​the nerve causes numbness of the thumb, index, middle and sometimes half of the ring finger.

An oppositional test is also carried out, which consists in the impossibility of connecting the thumb and little finger. This phenomenon develops as a result of thenar weakness (elevation at the base of the thumb).

Treatment of carpal tunnel syndrome

Treatment of the disease is carried out in three directions:

• drug treatment;
• physiotherapy;
• gymnastic exercises;
• surgery.

Medical treatment

At an early stage of the disease, the patient's condition can be improved with the help of medicines. Such treatment is carried out on an outpatient basis. Prescribe drugs of the NSAID group (non-steroidal anti-inflammatory drugs), which quickly relieve inflammation, pain and swelling:

• diclofenac;
• ibuprofen;
• nimesulide;
• analgin.

Corticosteroids are injected directly into the carpal tunnel to reduce pressure in the area of ​​the compressed nerve. Injections are very effective in dealing with pain, swelling and inflammation.

Vitamin B has a good therapeutic effect, since the vitamin itself has an anti-inflammatory effect.

It should be noted that symptomatic treatment with medication does not lead to complete healing, but only alleviates the patient's condition. Therefore, along with medicines, it is recommended to wear an orthosis. Wearing an orthosis allows you to remove nighttime symptoms, which are especially exhausting for the patient.

Physiotherapy

As a physiotherapy treatment use:

1. Paraffin baths. A sick hand is lowered into a bath with molten paraffin. Then the procedure is repeated 3-4 more times until the so-called paraffin glove is formed on the hand. Then a special glove is put on the hand with paraffin or the hand is wrapped in a warm towel. Joints and tendons under the influence of hot paraffin warm up, which relieves inflammation, swelling and pain.
2. Ultraviolet therapy. In this treatment, tendons and joints are heated by short-wave electromagnetic waves in the range of several gigahertz.
3. Ultrasonic treatment. Exposure to high frequency sound waves leads to an increase in temperature in the treated area, which improves the conductivity of the channel, relieves swelling and pain. A two-week course of ultrasound treatment can significantly reduce the manifestation of symptoms.
4. Manual therapy. During the treatment with this method, improvements in the blood circulation of the hand were noticed.

Gymnastic exercises

Exercises can be performed independently at home, so their advantage is obvious.

Exercise number 1. Dip your hand in a bath of hot water, clench it into a fist and rotate it in the water. Hot water should be the right temperature to keep your hand warm. The duration of the procedure is no more than 15 minutes. After finishing, put on a winter glove or wrap your hand in a warm cloth or scarf.

Exercise number 2. Night warming compress, which is made on the basis of diluted alcohol or vodka. Do not take pure medical alcohol, it can burn the skin on your hand.

Exercise number 3. Massage. It is necessary to massage the entire arm, and not just the hand, starting from the outside of the palm, rising up to the outside of the forearm. Massage should be performed by a professional massage therapist.

Exercise No. 4 Hydromassage. You can do it yourself twice a day. Cool and warm water is used in the morning, and warm in the evening. Massage should affect the collar part, shoulder blades, shoulders, forearms, hands.

Surgery

Carried out in severe neglected cases, when all other methods are ineffective. The goal of surgery is to cut the ligament that puts pressure on the median nerve.

There are two types of operations:

• endoscopic;
• classic open intervention.

An endoscopic procedure involves the use of an endoscope that is inserted into the carpal tunnel through a pinpoint incision. This is a minimally invasive operation that leaves a small dot on the patient's skin. The recovery period after such a procedure is short and almost painless.

The classic open procedure involves a larger incision on the inside of the palm. After this type of intervention, the scar remains larger and the recovery period is longer.

radial tunnel syndrome

It is an increase in pressure on the radial nerve, which is located in the muscles and bones of the elbow, as well as the forearm. The causes of this disease can be:

• injury;
• lipomas (benign tumors);
• inflammation of surrounding tissues;
• osteochondrosis;
• spinal hernia.

Symptoms of the disease are sharp pains that have a burning character on the back of the hand and in the upper part of the forearm, which appear when you try to straighten your fingers and wrist. Unlike carpal syndrome, radial tunnel syndrome does not cause numbness or tingling because the radial nerve is responsible for muscle contraction.