Tunnel syndromes: the carpal canal. Neuropathy of the femoral nerve. Neuropathy of the tibial and peroneal nerves - Causes, symptoms and treatment. MF.

Tunnel Syndromes

• Carpal tunnel syndrome( carpal tunnel syndrome)
• Femoral nerve neuropathy
• Neuropathy of the tibial and peroneal nerves

Nerve compression to the bony protuberances or infringement in narrow canals with hard walls leads to the development of tunneling neuropathy.

Carpal tunnel syndrome.

Among the most common tunneling neuropathies is the syndrome of compression of the median nerve in the carpal tunnel. Carpal tunnel syndrome( carpal tunnel syndrome) is caused by compression of the median nerve in the place where it passes through the wrist canal under the transverse ligament of the wrist. The syndrome often develops in individuals whose activity requires repeated flexion and extensor movements in the hand or prolonged bending it( working with the mouse at the computer, typing, playing the piano or cello, working with a jackhammer, etc.).The tendency to develop the tunnel neuropathy of the median nerve is noted in people suffering from somatic diseases, which are manifested by metabolic neuropathies( diabetes, uremia).This symptom complex can develop with rheumatoid arthritis, hypothyroidism, amyloidosis and other diseases. Women are more often ill due to the natural narrowness of the canal.

Symptoms of tunnel syndrome of the carpal tunnel.

Typical signs of the tunnel syndrome of the carpal canal: pain and tingling in the brush region, which are more pronounced at night, a feeling of swelling of the hand and wrist, numbness of the large, index and middle fingers of the hand. In the beginning, numbness is transient, and later becomes permanent. Often there are night pains that spread from the hand to the forearm, sometimes to the elbow joint. When the arm is raised, the pain and numbness increase. When percussion of the median nerve in the area of ​​the carpal tunnel, there is paresthesia in the hand( a positive symptom of Tinel).Flexion of the brush for 2 minutes( Phalen's sign) intensifies the symptoms. There is a moderate decrease in pain and temperature sensitivity in the first three fingers of the hand, weakness of the muscle that opposes the first finger, sometimes its atrophy. There are electromyographic signs of denervation of various degrees in the muscles innervated by the median nerve, a decrease in the rate of impulse conduction along its branches to the hand.

With a prolonged course of a tunnel carpal tunnel syndrome, the patient may develop osteoporosis in the phalanges of the fingers, combined with spasm of blood vessels and persistent burning pain.

Diagnosis of carpal tunnel tunnel syndrome

The cause of this condition is established by examining the patient, studying the characteristics of his lifestyle. Typical muscular-tonic symptoms are detected at the level of the forearm of the same arm. Often, the diagnosis of tunnel syndrome at the level of the carpal canal by a neurological examination is limited.

Treatment of tunnel syndrome of carpal tunnel.

First of all, it is necessary to treat the disease underlying the development of carpal tunnel syndrome. Thus, hypothyroidism is used for substitution therapy. In these cases there is a rapid restoration of impaired functions.

Vasoactive drugs( trental, xanthinol, nicotinic acid) in combination with anti-inflammatory and diuretics( diacarb, triampur) are prescribed to improve regional circulation. Patients with severe paresthesias at night are shown to prescribe drugs carbamazepine series( tegretol 200 mg 2-3 times a day).

In the early stages, an improvement can be achieved by injecting novocaine and steroid preparations into the canal-blockade area. In drug therapy use NSAIDs, analgesics, hormones.

Elimination of soreness, tingling and restoration of sensitivity in the fingers in the treatment of neuritis of the median nerve in the case of tunnel syndrome of the carpal canal is accelerated by the use of physiotherapy( UHF, CMT, etc.), manual therapy( muscular, articular and radicular technique), acupuncture, exercise therapy.

In the absence of the effect of conservative therapy, there are indications for surgical treatment: dissection of the transverse ligament of the wrist. The operation is usually done by the open method, but can be performed with the help of an endoscope.

Prevention of tunnel syndrome of the carpal tunnel

Tunnel syndromes also include compression of the ulnar nerve in the fascial canal between the head of the ulnar flexor of the wrist.

Neuropathy of the femoral nerve.

May be due to its compression at the exit site in the inguinal ligament area. Patients complain of pain in the groin, which are irradiated along the anterior part of the thigh and lower leg. With the passage of time, there are sensory and motor disturbances, there comes a numbness of the skin in the innervated area and hypotrophy, and then atrophy of the quadriceps muscle of the thigh.

Neuralgia of the external cutaneous nerve of the thigh. Neuralgia manifests itself through excruciating painful sensations along the anterior surface of the thigh( Roth's disease).The reason is the compression of the nerve in the canal formed by the inguinal fold.

Pear-shaped muscle syndrome. The sciatic nerve can be squeezed by a spasmodic pear-shaped muscle. The pains are burning, strong, accompanied by paresthesias, spread along the outer surface of the shin and foot. Characteristic increase in pain during internal rotation of the thigh, with the leg bent at the hip and knee joints. Palpation of the pear-shaped muscle also increases pain.

Neuropathy of the tibial and peroneal nerves.

The common peroneal nerve or its branches, the tibial nerve can be affected at the level of the fibular head. Compression occurs when the limb is in the wrong position, in particular, the streets, which like to sit with their legs crossed. Pathogenetic factors are diabetes mellitus, dysproteinemia, vasculitis, etc.

Clinically, the lesion of the common peroneal nerve is manifested by the weakness of the dorsal flexor of the foot, the turn of the foot outside is weakened. There is a numbness in the outer surface of the lower leg and foot. The patients walk, spanking the foot. Reduced sensitivity in the external surface of the lower leg and foot. The defeat of the anterior branches of the tibial nerve leads to weakness of flexion of the foot and fingers. This nerve can be infringed in the place of its passage behind the inner ankle, and also on the foot in the zone of the tarsal canal. There is pain, tingling along the sole and base of the toes, numbness in this area. The medial or lateral branch of the plantar nerve can be involved in the process. When the first lesion is noted, unpleasant sensations occur in the medial part of the foot, while the second is affected by the lateral surface of the foot. There are also sensitivity disorders in the medial or external surface of the foot.

Surgical treatment of tunnel syndromes.

In the absence of the effect of physiotherapeutic treatment, blockade, local administration of hormones, indications for surgical decompression of the compressed nerve arise.