Shin splints. Manifestations and treatment of shin splints syndrome

Shin splints (or anterior tibial syndrome) is a type of injury that is caused by daily grueling workouts. Pain is felt from the central to lower inner part of the leg as the muscles and tendons attached to the shin bone swell. This swelling usually occurs as a result of repetitive motion of the lower leg during weight-bearing activities such as running or dancing. Shin splints do not keep an athlete off the treadmill for long periods of time. Typically, after two weeks of rest, he will be able to run again without feeling any pain. However, there are a couple of things you need to do when resuming physical activity after you have been diagnosed with shin splints. The list of mandatory actions after healing of the lower leg begins below, with Step 1.

Steps

Part 1

Safe Running Techniques

Warm up before running. Don't underestimate the importance of a good warm-up. It prepares muscles and connective tissue (as well as bone tissue) for upcoming stress.

When running, stay on a flat and soft path. Running on hard surfaces every day will overload the shin bone and cause tibial tibial syndrome to occur again. Choose surfaces that are comfortable for runners, such as an indoor oval track or rubber surface.

• Also avoid uneven or rocky surfaces. Running in sand or fields can cause shin splints due to sudden changes in stress on the shin.

1. Start with walking and move on to running. Start by walking to make sure your legs are strong and that it won't cause any flare-ups, then move on to jogging for a few minutes and gradually work your way up to a regular run.

   • Walk for a few days first, then jog for a few days, and eventually progress to short runs until you resume your previous training regimen.
   • Start with half the distance you've run in the past and gradually increase it over three weeks.

2. After running, do some muscle stretching, such as a calf stretch. Stretching after vigorous activity promotes blood flow to the legs and improves the recovery period. The end result will be a pair of well-rested legs that will perform better in your next workout.

   • Stretching your calves is one of the best ways to cool down after a run. Do the following:
     • Stand in front of a wall. Cross your legs and place one foot in front of the other.
     • The back leg should be straight and on the ground at all times. The front leg should be bent and also on the ground.
   • Place your hands on the wall and begin to bend your front leg. You should feel tension in the calf muscles of your back leg. Stay like this for 30 seconds.
   • Switch legs and repeat.

3. Alternate running with other cardiovascular exercises. Let your lower legs rest by alternating between running, swimming and cycling. These exercises will help you stay toned while allowing your lower legs to recover from the excessive strain caused by running.

   • Cross-training is not only good for your calves, but for your overall health. Instead of endlessly training the same muscles, you will train your entire body.

4. Change your running shoes regularly. Runners who train almost daily should replace their shoes every 6 months. Worn-out boots provide your feet with less cushioning and support. As a result, your shins are subject to greater stress while running.

   Get more rest. The secret to preventing another case of shin splints is rest. The body needs it to recover from the stress caused by running. You may think that rest will dull your fitness, but in fact it will get you back into shape several times faster.

   • Sleep alone will not achieve complete recovery. A day or two of rest each week will keep your muscles firm and prevent overuse injuries.

5. Focus on maintaining a lean body. A leaner body reduces the amount of weight that is placed on your shins with each step. These exercises will help you tone your body for running:

   • The plank exercise trains the core muscles to equally distribute forces to the lower body while running. This exercise also helps in reducing unwanted belly fat, which puts more stress on your shins. Read the article on how to do the plank exercise for detailed information.
   • Bent-over barbell rows train your back and core muscles. Both muscle groups play an important role in maintaining proper form while running, which will reduce stress on your shins. See instructions on how to do bent-over barbell rows here.

   Part 2

   Choosing the right shoes

   1. Consider purchasing shock-absorbing running shoes. Choose the right running shoes to support your feet and reduce stress on your shin area. You can buy special shock-absorbing running shoes or use shock-absorbing insoles to minimize the stress on your feet if you experience shin splints.

      Buy shoes that promote stability if you have normal feet and ankles. Unless you have problems with your feet and ankles, you need shoes that provide stability. It’s called “stable shoes.” These running shoes are designed with high quality cushions and support materials to protect you from any foot injuries while running or pronating your feet.

   2. Purchase “motion control” shoes that are designed for people with flat feet. Overpronation of the foot, which is the cause of most cases of shin splints, is when the dorsum of the foot rotates inward and the sole rotates outward, causing the foot to lose its normal arch. In this case, you will need special shoes to control the movement of the foot - shoes with “motion control”.

      • This type of running shoe has been specially designed and manufactured with additional additives to increase the density of the midsole of your shoe (a running shoe design consists of an outsole - the outer layer in contact with the floor; an insole - the inner layer in contact with the foot; a midsole - the layer between the outsole and insole; the midlayer plays an important role in absorbing the impact of your foot while running and providing the necessary support and comfort to your foot).
      • In cases of overpronation of the foot, increasing the density of the midsole in addition to bridges and transverse arch supports can actually reduce overpronation and avoid injury while running.

   3. Look for “cushioning” running shoes if you have problems with supination. Another common condition is called underpronation, which causes the ankles to bow slightly outward. In this case, you need “shock-absorbing shoes.”

      • In this type of shoe, additional materials are added in the heel and top of the foot to be able to dissipate the shock absorbed between the midsole and the outsole. It also offers more support for your feet and ankles.

   4. When purchasing shoes, think about the surface you will be running on. Remember that your choice of running shoes will depend on the surface:

      • For running on the street or asphalt, shoes should have lightweight but high-quality shock-absorbing qualities to minimize the impact transmitted to the leg through the foot.
      • For trail running, you will need shoes that are resistant to dirt and rocks, and they should also be waterproof.

   5. Shoes should not be too tight. After choosing your running shoes, make sure they are not too tight. The shoe should fit the foot so that there is a small space inside along the width and length so that the foot and toes can move. If there is not enough room inside, your toes will bend and become compressed as you run, especially if you run on sloping surfaces.

      • Also pay attention to the use of additional shoe insoles, which will take up free space, preventing your feet from fitting into the shoes! Be sure to insert insoles into the shoes you try on before deciding they are right for you.

   Part 3

   Restoring the lower leg after injury

   1. Follow the RICE principle (rest, ice, compression, and leg elevation) to treat shin splints.

      • Rest. The patient should refrain from playing sports and any type of activity that puts additional stress on the leg. This will speed up the recovery process and reduce the risk of inflammation. If an athlete ignores these minor precautions, they may worsen their condition and prolong the healing process.
      • Ice. Ice is used to stop the inflammatory process, which, in turn, will reduce swelling and pain. Ice can cause blood vessels to dilate, which will reduce the amount of blood that flows into the affected area. This will prevent fluid from leaking into the outside of the cells, reducing pressure on the surrounding soft tissue and tendons, thereby reducing pain.
        • Under no circumstances should ice be applied directly to the skin; it should be wrapped in a towel or cloth. If you don't have ice packs at home, you can use frozen beans instead. For the first three days, ice should be applied for fifteen minutes every four hours.
      • Pressure bandage. Applying a small amount of pressure to the shin can help reduce pain and relieve inflammation. This can be done by applying a pressure bandage to the lower leg to support the muscles.
      • Elevated leg position. To reduce inflammation, elevate your foot in a chair with a pillow or something soft under your heel.

Sometimes the cause of such pain is a specific injury, but often it is not possible to identify the true cause of the pain.

Symptoms and signs of shin splints

With shin splints, pain may occur in the front and back of the lower leg when activity begins, but then subsides as activity continues. Pain that persists at rest suggests another cause, such as a stress fracture of the tibia.

Diagnosis of shin splints syndrome

• Usually according to the clinical picture.

The examination usually reveals localized tenderness in the area of ​​the anterior muscle lacunae, sometimes pain on palpation of the bone.

Regardless of the cause of the pain, X-ray results are often unclear. If a stress fracture is suspected, a bone scan may be necessary.

Exercise-induced compartment syndrome is diagnosed by an increase in internal compartment pressure measured during exercise.

Treatment for shin splints

• Changing the type of physical activity.
• Stretching exercises for the piriformis muscle, NSAID medications.

You should stop running until it stops causing pain. Early treatment includes ice, NSAID medications, and exercises to strengthen the anterior and posterior calf muscles. During periods when rest is the primary treatment, fitness can be maintained through cross-training such as swimming, which does not require constant weight bearing on the limbs.

Once symptoms have subsided, return to running should be gradual. Shoes with a rigid back and arch support help support your foot and ankle while running, aid recovery, and help prevent future symptoms. Exercises to strengthen the anterior calf muscle by dorsiflexing the ankle joint under resistance (for example, with a resistance band or on a special machine) increase the strength of the lower leg muscles and help prevent lower leg pain.

Shin splints syndrome is an intermittent, severe pain that occurs during intense physical activity. The condition is named for the similarity of the nature of pain with fractures. The unpleasant syndrome disappears after local treatment I, but it may unexpectedly return on the next run, so it is important to identify and rule out its cause.

Shin splints cause pain after running

Clinical symptoms of shin splints are associated with motor overload or excessive running pace, which causes forced muscle contractions. This is not a typical muscle strain, but the symptoms are very similar. The pain radiates to the anteromedial surface of the distal third.

In this case, such severe pain occurs that the person suspects a fracture.

When the muscles of the posterior group are stretched, the pain is localized at the site of their attachment to the osteoarticular joint.

Over time, if measures are not taken, periostitis forms on the tibia. It causes the same severe pain as a fracture, the pain is so sharp and acute that a person falls from surprise and may lose consciousness.

Types of manifestations of the syndrome

An inflammatory process begins on the periosteum due to the fact that the bone shell is torn away from its base. This most often occurs along the medial edge of the tibia. This is exactly what one of the manifestations of shin splints syndrome looks like.

There is no bone splitting as such, and the name comes from the similarity of symptoms.

X-ray and CT images show the area where the shell has been torn away from its attachment point on the bone. The pain is localized either in front of the tibia, or behind it, behind it. Thus, there are two types of tibial pain syndromes:

• rear;
• front.

They most often occur from high loads while running. Muscles from overload come into a state of excessive tension, the tissues of their tendons are stretched to a critical state, threatening to rupture. But physiologically, the leg is designed in such a way that the tendon is more firmly attached to the muscle tissue, so it pulls the bone along with it, which causes the periosteum to tear off. This, in turn, leads to the formation of periostitis on the posterior side of the tibia.

It must be treated promptly and effectively and not return to training, otherwise the tendon may rupture.

With anterior tibial syndrome, the toes are more affected because many of the anterior muscles have their base in the phalanges of the toes, that is, to the medial part of the foot. With inflammation or swelling of the muscles of the medial group, the pressure and load on other muscles of the leg increases, which is facilitated by the small distance between the fascia. This impairs blood circulation and brings pain or at least discomfort.

At the same time, sports physicians express their own opinions regarding the definition of “shin splints.” The views of classical and sports medicine differ in interpretation; this condition has many other names: inflammation of muscle tissue, minor damage to muscle tissue, separation of tissue from the bone, and even traumatic injury to the tibia.

Causes of pathology

Taping the calf muscle

It’s not without reason that this syndrome is recognized as a runner’s disease. While running, the foot hits the track hard with the heel. In this case, the tibia bears such a load that the naturally straight bone bends slightly from the stress of the impact. A little, it's a completely minor bend.

However, if it is repeated constantly and for a long time, it leads to thinning of the bone tissue in this place. This causes constant bone pain or even leads to microcracks in the bone tissue.

During running, the legs experience high rotational loads.

These same loads have a negative effect on the foot, its small bones and ligaments. As a result, there is an overload of the calf muscles, the attachment of which goes directly into the ankle joint and into the foot. If the foot itself has congenital or acquired defects - pronation, flat feet, then this only aggravates the situation and increases the risk of shin splints syndrome.

After class, do not stop abruptly. You need to smoothly switch first to a slow run, then to a walk, until the muscles cool down. It is important to use only suitable shoes for training.

Treatment for shin splints

Hip replacement

The first thing the traumatologist prescribes is to limit movements and ensure complete rest for the injured leg.

Treatment is symptomatic: local thermal procedures, injections of anti-inflammatory and, if necessary, painkillers.

A few days of warmth and rest - and you can gradually return to your usual mode of physical activity.

In case of relapse of the disease, one must be wary of paresis or paresthesia, which can affect the deep-lying peroneal nerve. Such damage is often irreversible and leads to unpleasant restrictions on movement. The foot sags, the person begins to “drag” the leg.

A more complex form is loss of sensation in the leg, after which ischemic tissue necrosis occurs with the replacement of muscle cells with scar tissue. This is why shin splints syndrome is dangerous: if treatment is aimed only at eliminating symptoms, without a comprehensive examination of all parameters, this can lead to serious consequences.

Trauma practice shows that both physiotherapy methods and anti-inflammatory treatment are effective, but when a person resumes training, the pain immediately returns.

When faced with such a syndrome, you should think carefully about the advisability of walking and running and, together with an experienced trainer, choose more acceptable methods of training. The only way to prevent shin splints is to limit exercise.

These are things connected by inextricable bonds. Nature has created all the conditions for human existence, but often we ourselves reject its gifts and this leads to multiple health problems. It is because of our arrogance and frivolity that a person gets most of the injuries; it is because of the wrong lifestyle that the body malfunctions.

“Shin splints” (“Shin splints” is pain in the anterior region of the lower leg after excessive physical activity. Most often associated with periostitis - inflammation at the site of partial detachment of the periosteum. The fact is that the muscles are not attached to the bone itself, but to its surface covering - periosteum. Under intense load, the periosteum at the site of muscle attachment peels off, which causes pain with subsequent disruption of the muscles and blood vessels. ) is a common name for a whole complex of problems that cause pain and aching in the legs between the knee and ankle, in the lower leg. The most common type of shin splint is medial tibial stress syndrome, or inflammation of the muscle behind the shin bones in the middle or lower part of the shin. Pain usually occurs after prolonged, regular and rhythmic, repetitive exercise (aerobics or long-distance running). Training mistakes, such as rapidly increasing intensity or distance, or changing running surfaces or shoes, often cause pain. How to recover from this scourge?

Give your feet a rest.

A shin splint will not heal without rest. Therefore, do not try to continue exercising if you feel pain. Allow your legs to recover, and then carefully increase the load on the muscles.

Freeze the pain.

Ice massage will help relieve inflammation after exercise. Ice also helps if walking itself causes pain. Freeze water in a plastic cup, then, as soon as the ice has melted slightly, remove it from the cup and massage it up and down your shin. Massage for 20 minutes after exercise or just three to four times a day for 15-20 minutes.

Take your medicine.

If you experience shin splints, you can take anti-inflammatory drugs such as aspirin and ibuprofen for two weeks when the pain is worst. If you take the medicine strictly according to the clock, this will help establish the level of the medicine in the blood and reduce the inflammatory process. But remember - any medications should be taken only as prescribed by a doctor.

Soften the blows.

To prevent recurring shin pain, buy a pair of shoes that provide good impact protection and replace them approximately every six months. Choose impact-protective shoes made from impact-absorbing materials such as air or gel. Place sorbonate insoles in your shoes (available at any sportswear store) - this is the best shock-absorbing material.

Choose the right place to train.

If you have problems with your legs, then the easiest way to prevent pain is to choose the right place for training and the best option for you will be inexpensive treadmill for home, and there are a lot of reasons for this. Firstly, the surface of the treadmill is flat and quite elastic. Secondly, you can precisely regulate the degree of load. And thirdly - at home, eat at home, at the slightest discomfort you can interrupt the workout and you won’t have to walk a whole kilometer, or even more, back.

If purchasing a treadmill is a problem for you, then look for an in-ground treadmill. Running on a soft surface, such as fine gravel, is much easier on the shin than asphalt or concrete, stretch before you start - you should stretch the Achilles tendon (The Achilles tendon is a thick tendon that attaches the calf muscle to the heel bone. The only tendon that provides movement feet. When it is damaged, a person is unable to jump and can even hardly walk. This is one of the most vulnerable places of all jumping and running athletes. Named after the ancient Greek hero Achilles (Achilles), invulnerable in battle. His mother, the goddess Thetis, dipped the baby. into the waters of the underground river Styx entirely, with the exception of the heel, by which she held him. The heel remained unprotected by the waters of the Styx. Hence the name of the tendon and the expression “Achilles heel”, allegorically - a weak side, a vulnerable spot. ) before and after sports activities such as running or aerobics. Lean your hands against the wall, one leg forward, the other back, do not lift your heels off the floor. Stretch each leg, first with the knee straight, then bent. All this should take you 3-5 minutes.

Jump less.

Surprisingly, shin splints tend to affect people who do aerobics more than runners; many aerobic exercises involve jumping. Instead, engage in sports that involve less jumping and heavy lifting if you have problems caused by shin splints.

A few words about rhythm.

Combine intense days with fast days, or cross-train by replacing running or aerobics with cycling, swimming or walking. Establish a rhythm of exercise and rest for yourself to reduce the stress on your lower leg.

Continuous exercise can also cause a stress fracture of the tibia or fibula. (The tibia and fibula are two bones of the lower leg. There are really two of them, although usually only one can be felt. )

A special x-ray (bone scan) is the only way to differentiate shin pain caused by a stress fracture from pain caused by soft tissue inflammation.

If you are actually suffering from a stress fracture, rest first. Take a break from exercise for three to four weeks until your leg heals. (As simple as it sounds: do nothing. However, for exercise enthusiasts, this advice is extremely difficult to follow. However, continuing to exercise with a stress fracture or shin splint will only prolong the agony.)

Tunnel syndrome as compression-ischemic neuropathy

Root causes of tunnel syndromes

In addition, the joints themselves are more often exposed to various types of pathological changes ( inflammatory, traumatic, degenerative), after which narrowing of the channels is possible.

Many systemic diseases contribute to the occurrence of tunnel syndromes ( diabetes mellitus, rheumatoid arthritis), diseases of the corresponding joints, blood diseases ( multiple myeloma), kidney failure, alcoholism.

Muscle bed syndrome

Muscle box syndrome is a type of tunnel syndrome that occurs when a nerve is pinched due to a sharp increase in pressure inside the fascial sheath.

This pathology is rare, but requires emergency medical intervention, since extremely severe complications are possible, including the death of the patient.

Carpal syndrome (wrist syndrome)

Overview of Carpal Tunnel Syndrome

Karpalny ( carpal) the canal is quite narrow, its bottom and walls are formed by the bones of the wrist, covered with a fibrous sheath. The roof of the tunnel is the transverse carpal ligament. Inside the canal are the finger flexor tendons in special sheaths. The median nerve runs between the tendons and the ligament.

Clinic and diagnosis of carpal syndrome

Then there is a decrease in sensitivity and, finally, movement disorders ( decreased opposable force of the thumb) and tenor muscle atrophy.

As with other tunnel syndromes, the diagnosis of carpal tunnel syndrome is clarified by a test with a paraneural injection of novocaine hydrocortisone.

Treatment of carpal syndrome

Several surgical techniques have been developed. Thus, the operation can be performed under general anesthesia and under general anesthesia. Endoscopic methods are used, when a special cannula is inserted through a small incision, with the help of which the canal is inspected, then a scalpel is inserted through the cannula and the transverse ligament is dissected.

Ulnar nerve neuropathy

Elbow carpal syndrome (Guyon's syndrome)

The canal contains the ulnar nerve with its accompanying vessels, as well as fatty lumps that ensure the sliding of the neurovascular bundle during hand movements. Guyon's canal is located at the level of the first row of carpal bones.

The ulnar nerve can be easily felt on the inner surface of the elbow of an extended arm.

The final level of damage to the ulnar nerve can be determined by sharp flexion of the elbow or tapping in the area of ​​the cubital canal. In the case of cubital syndrome, these actions will cause pain and paresthesia in the area of ​​innervation.

Treatment of ulnar nerve neuropathy

For conservative treatment of ulnar nerve neuropathy, anti-inflammatory drugs, therapeutic exercises, and physical therapy are prescribed. If conservative treatment fails, surgical intervention is indicated.

Radial nerve neuropathy

Compression-ischemic neuropathies of the radial nerve on the shoulder

Neuropathies of the radial nerve, resulting from compression in the elbow joint. Radiation syndrome

This tunnel syndrome is not characterized by movement disorders; neuropathy is manifested by pain in the affected joint. Night pain is typical. The appearance or intensification of pain when extending the middle finger of the hand while overcoming resistance is of diagnostic significance. The test is carried out with the arm extended at the elbow and wrist joints.

Roth's disease (Roth-Bernhardt disease)

Roth's disease is the most common leg tunnel syndrome

After emerging from the canal, the nerve is located under the fascia lata of the thigh, innervating a small area of ​​skin ( palm sized) in the upper third of the outer surface of the thigh.

Clinic and diagnosis of Roth's disease

The pain intensifies in an upright position and when walking due to tension in the thigh fascia.

Treatment of Roth's disease

Femoral nerve neuropathy

Clinic and diagnosis of femoral nerve neuropathy

Weakness of the iliopsoas causes impaired hip flexion, and weakness of the quadriceps causes impaired knee flexion.

Treatment of femoral nerve neuropathy

Sciatic nerve neuropathy (piriformis syndrome)

Clinic and diagnosis of piriformis syndrome

Treatment of piriformis syndrome

Peroneal nerve neuropathy

Clinic and diagnosis of peroneal nerve neuropathy

Often, compression-ischemic neuropathy of the peroneal nerve occurs when performing professional work associated with squatting ( one of the names of the pathology “occupational paralysis of tulip bulb diggers”), the habit of sitting with your legs crossed is also of certain importance.

The most striking manifestation of the disease is paralysis of the extensors of the foot and fingers ( foot drop). Characterized by a decrease in sensitivity of the outer surface of the lower half of the leg, the dorsum of the foot and the first four toes. With a sufficiently long course, atrophy of the anterior and external muscles of the lower leg develops.

Treatment of peroneal nerve neuropathy

Palpation and percussion of the tarsal canal causes pain and paresthesia in the plantar part of the foot ( Tinel's sign).

Foot and ankle tunnel syndrome

Treatment in our clinic:

• Quick and effective pain relief;
• Our goal: complete restoration and improvement of impaired functions;
• Visible improvements after 1-2 sessions;
• Safe non-surgical methods.

Constant injuries and increased physical stress on the lower extremities lead to the development of pathological changes. The most dangerous are dislocations, sprains of ligaments and tendons, impacts and bone fractures. Foot tunnel syndrome most often develops in people who are professionally involved in sports or have specific working conditions. The risk group mainly includes sellers, painters, builders, and cooks. In general, all those who are forced to spend a lot of time on their feet during the working day.

Predisposing factors that cause ankle tunnel syndrome include:

• degenerative diseases of the cartilage tissue of the joints of the lower extremities;
• psoriasis and other systemic pathologies;
• metabolic disorders;
• varicose veins of the lower extremities;
• diabetes mellitus in combination with diabetic foot;
• neuropathies of various origins, affecting impulse conduction along the femoral and tibial nerve;
• incorrect placement of the foot (flat feet and club feet);
• excess body weight;
• period of pregnancy occurring with edematous nephrotic syndrome.

Elimination of possible risk factors and a change in professional activity in most cases is a necessary condition for successful treatment of this disease.

Symptoms of Foot and Ankle Tunnel Syndrome

The pathology is based on a violation of the physiological structure of the tendon apparatus of the tibial muscles of the leg. With further flexion of the foot, stretching of the intra-articular cavities occurs. They are filled with synovial fluid. All this creates conditions for compression damage to the nerve passing in the tarsal tunnel.

Symptoms of foot tunnel syndrome may include the following, depending on the stage of the process:

• slight crunching sound when trying to move the foot in different directions;
• presence of swelling on the back of the ankle;
• pain in the ankle joint and throughout the foot;
• convulsions;
• feeling of numbness in the skin of the foot.

You can distinguish ankle tunnel syndrome from a sprain by two typical signs:

• swelling appears after 2-3 hours;
• the pain at the back of the ankle is clearly concentrated and appears after a typical crunch or click.

For the purpose of differential diagnosis, radiography is prescribed to show narrowing of the tarsal tunnel. If it is difficult to make a diagnosis, arthroscopy and computed tomography may be indicated.

There is another type of ankle tunnel syndrome - anterotarsal compression. The tibial nerve is affected, which provokes severe burning pain along the entire leg from the foot to the knee. The toes go numb, and when you try to straighten the foot, the pain intensifies significantly. Compression occurs inside the bone fibrous canal against the background of hematomas, tumors, fluid effusion in various pathologies of the venous bed. A typical symptom is burning pain in the area of ​​the plantar part of the foot. The most acute pain occurs after physical activity. After a short rest everything goes away on its own.

When examined by an experienced doctor, it is enough to perform a Tinel test. To do this, percussion (tapping) of the projection of the passage of the compression nerve is done. If this procedure causes an attack of pain spreading along the nerve, then a preliminary diagnosis is established without doubt. Then, to clarify, a series of diagnostic procedures may be prescribed.

Treatment methods for foot tunnel syndrome

Official medicine currently offers patients only surgical methods of therapy. In some cases, when tunnel syndrome of the foot and ankle is associated with avulsion of bone tissue, only surgery will really help. The sooner it is performed, the more favorable the prognosis for restoring mobility can be given by the surgeon.

If ankle tunnel syndrome is associated with sprained ligaments or pathologies of the venous bed, conservative methods of therapy can also be used. In particular, our manual therapy clinic is ready to offer patients a range of techniques aimed at treatment and rehabilitation. Therapeutic gymnastics and massage, osteopathy and reflexology are used.

Physical activity should be avoided for the entire recovery period. Orthoses are used to fix the foot. Treatment of concomitant and predisposing pathologies is also required.

Tunnel syndrome in the leg

Calf muscle strain- a common phenomenon associated with their chronic overload or forced contraction. Treatment is symptomatic and includes rest, local warmth and a gradual return to activity.

Shin splints syndrome

The term " shin splints» refers to a syndrome of transient pain in the lower leg caused by running or long walking; it must be differentiated from stress fractures and ischemic disorders. This condition usually occurs in the early period of training in athletes when running on a hard surface. The causes of its occurrence may be periostitis of the tibia and stretching of the muscles of the posterior group of the leg at the site of their attachment. The most common location of pain is the anteromedial surface of the distal two thirds of the leg.

When treating the syndrome " shin splints“Many methods were used, but Andrish proved that they are almost the same type and that the pain will not disappear until the patient stops training. The mainstay of treatment is rest, local heat if it relieves pain, and analgesics.

Carpal Tunnel Syndromes

IN human body there are a number of fascial sheaths covering various muscle groups. Most often, compression occurs in those cases where muscle groups are “squeezed” and are subject to compression within their cases, for example on the lower leg and especially among the anterior muscle group. Other similar syndromes described in relation to the calf muscles include deep posterior sheath and fascial sheaths surrounding the peroneal muscle group and soleus muscle.

Has recently been described chronic tunnel syndrome. In a series of observations of 100 patients with chronic tunnel syndrome involving 233 cases, the majority were runners. They noted aching or sharp pains that occurred during exercise and a recurrent feeling of tension. The average duration of clinical manifestations before surgery was 22 months. Bilateral lesions were present in 82 patients. In most patients, the syndrome developed in the anterior or posterior fascial sheath of the leg. All patients underwent fasciotomy with good outcome.

Anterior Shin Tunnel Syndrome

Anterior shin sheath includes the tibialis anterior muscle, the long extensor of the first toe and the long extensor of the toes. These muscles are closely adjacent to one another. The entire group is covered by the anterior fascia of the leg. Most anterior muscle tunnel syndromes result from fractures of the lower leg bones. These fractures are usually simple. Other causes include femoral artery thrombosis, athletic exercise, closed trauma, and ischemia.

Any reason that causes swelling of the muscles of this group can lead to the development of this syndrome. Experimental studies have shown that, regardless of the reasons, the common factor for the development of carpal tunnel syndrome is an increase in intracase pressure, causing impaired blood circulation in the muscles.

Clinical picture of anterior tibial tunnel syndrome

The syndrome is characterized by pain along the anterior surface of the leg, weakness of the dorsal flexors of the foot and fingers, and varying degrees of sensory loss along the innervation of the deep peroneal nerve. The earliest and most reliable sign of carpal tunnel syndrome is the irradiation of pain into the sheath area during passive plantar flexion of the toes or foot. The emergency physician should not wait for paresis or paresthesia to occur along the deep peroneal nerve, as this will undoubtedly lead to catastrophic consequences.

When severe pain appears over the area of ​​the anterior sheath, there is a loss of function to such an extent that muscle contraction quickly becomes almost impossible and paresis of the foot develops. Passive stretching of muscles provokes pain. The skin over the sheath becomes erythematous, shiny, hot and painful on palpation. The patient experiences a peculiar feeling of “numbness”. Then, ischemic muscle necrosis develops, followed by replacement of muscle cells with scar tissue.

The doctor should suspect carpal tunnel syndrome in any patient with cramping pain in the area of ​​the anterior calf sheath, which is usually described as constant, aching pain that increases with walking and is relieved to some extent by rest. The doctor should not rush to diagnose a muscle spasm, shin splints or bruise, because if he has an understanding of this pathology and knows that the above-mentioned conditions can result in the development of carpal tunnel syndrome, he has no right to make a mistake in making a diagnosis.

Method of measuring intracase pressure

Here are four signs of anterior tunnel syndrome:

1) pain with passive plantar flexion of the foot;

2) pain that increases with dorsiflexion of the foot against resistance;

3) paresthesia in the space between the 1st and 2nd fingers;

4) pain on palpation of the anterior sheath.

Axiom: whenever a patient complains of vague pain along the anterior surface of the leg with a partial decrease in the amount of dorsiflexion of the fingers and toes, anterior tunnel syndrome should be suspected.

Treatment of anterior tibial tunnel syndrome

If carpal tunnel syndrome is suspected, the limb is covered with ice packs and placed in an elevated position. Any pressure bandages are contraindicated. If there is no improvement, fasciotomy is indicated. To determine the intracase pressure, a catheter (with a tampon) is inserted under the fascia. If there is no such catheter, you can use a simple, but reliable and accurate method. The figure shows how to measure case pressure using a device available in any emergency department. With the development of muscle necrosis, the resulting fibrous scar is irreversible.

Early fasciotomy (performed within 12 hours of the onset of symptoms) restores normal function in 68% of patients, while in patients who had fasciotomy performed later than 12 hours, complete recovery was observed in only 8% of cases. Complications are also much more common with late fasciotomy, reaching 54%; with early fasciotomy, their incidence is 4.5%. If all four fascial sheaths are involved, double fasciotomy or resection of the fibula is indicated.

Deep posterior tunnel syndrome

The deep posterior sheath contains the flexor digitorum longus, tibialis posterior, flexor hallux longus, and posterior tibial artery and nerve. The transverse gastrocnemius bridge forms the posterior wall of the case, the interosseous membrane forms the anterior wall. The clinical picture of this syndrome, as a rule, is complicated by the involvement of other adjacent cases in the process. The most common cause of the syndrome is a fracture of the lower leg bones, usually in the middle or distal third. Other causes include shin bruises, artery damage, and even fractures of the calcaneus and talus.

In the initial period, the patient often experiences only a few symptoms: increasing pain with passive extension of the fingers, weakness during flexion along with hypertension along the innervation zone of the posterior tibial nerve on the plantar side of the foot, tissue tension and pain on palpation along the medial side of the distal third of the leg. All of the above symptoms can appear within 2 to 6 days from the moment of injury.

Treatment of deep posterior tunnel syndrome

If this condition is suspected, all circular dressings are removed and the limb is carefully examined. When a diagnosis of deep posterior tunnel syndrome is made, fasciotomy is indicated. Its technique is somewhat more complicated than with anterior tunnel syndrome (described by Ragapep).

Surgical orthopedics - Surgery.su - 2008

Tarsal tunnel syndrome– a multifactorial disease that belongs to the group of so-called compression neuropathies, that is, conditions in which compression of the nerve occurs. With tarsal tunnel syndrome, compression of the tibial nerve and its branches occurs in the area where it passes under a special ligament at the level of the ankles of the leg - the flexor retinaculum. This condition is similar to carpal tunnel syndrome in the hand.

The manifestations of tarsal tunnel syndrome can vary from patient to patient. Typically, this disease is clinically manifested by the following symptoms: sensory disturbances in the foot area from acute pain to loss of sensitivity, impaired motor function of the foot, resulting in atrophy of its muscles, as well as gait disturbances.

The reasons for the development of tarsal tunnel syndrome can be different. These can be soft tissue tumors, such as lipomas, ganglia arising from tendons, benign tumors in the tarsal canal area, tumors of the nerve itself and its sheath, as well as varicose veins. In addition, bone growths – exostoses – can compress the nerve.

Diagnosis of tarsal tunnel syndrome based on its clinical manifestations, patient interview data and identification of the causative factor. Symptoms such as Tinel's and Phalen's symptoms are characteristic. The first is that tapping the back of the inner ankle causes pain along the tibial nerve. Phalen's symptom is the appearance of this pain when the nerve is compressed in the area of ​​the tarsal canal for 30 seconds, which worsens the pain.

X-ray examination can help identify changes in the structure of the bones of the foot (loss of bone tissue, thinning of the phalanges), bone growths that can put pressure on the nerve.

Additional diagnostic methods are electromyography and determination of nerve conduction. In addition, it is necessary to conduct a blood sugar test to exclude diabetic neuropathy, which occurs in diabetes mellitus. To identify soft tissue tumors, which, unfortunately, are not detected by radiography, magnetic resonance imaging or ultrasound examination is performed.

Conservative treatment of tarsal tunnel syndrome can be performed by injecting steroid drugs in combination with an anesthetic into the site of nerve compression. For this purpose, drugs such as diprospan, Kenalog or hydrocortisone are used. This method helps relieve pain and reduce other symptoms of neuropathy.

In addition, to improve blood supply and microcirculation in the area of ​​nerve compression, physiotherapy is used: UHF therapy, magnetic therapy, electrophoresis with novocaine. In case of pathology of the neuromuscular system, orthopedic shoes are used to reduce the tension of the tibial nerve.

If conservative measures are ineffective, surgical treatment. tarsal tunnel syndrome. It depends on the reason that caused the compression of the nerve. If a tumor or ganglion is present, excision is performed. If there are adhesions around the nerve, it is freed from them. After surgery, it is recommended to begin early foot movements as well as physical therapy.

After surgery, there may be complications such as bleeding, infectious complications, and suppuration from the wound. During surgery, nerve branches may be damaged.

orthopedicsurgery.surgery.su

Carpal tunnel syndrome It is a fairly common problem among people who work physically, including athletes. The essence of this disease is that a nerve is pinched in an arm or leg between hardened ligaments or enlarged muscles, like in a tunnel. As a result, unpleasant sensations appear in those parts of the limb to which this nerve goes.

The most common manifestations of carpal tunnel syndrome are numbness, crawling, tingling and pain in the arm or leg, always on one side. They may not appear immediately, but gradually and only under load. In the future, if left untreated, the symptoms worsen, it becomes difficult to move the hand and hold objects in it. If a nerve is pinched in the leg, pain appears when walking, numbness in a certain position or during exercise.

The causes of a pinched nerve are usually the growth and hardening of ligaments or muscles under large, similar loads with frequent repetitions. For example, tennis players are often susceptible to ulnar nerve tunnel syndrome, so this disease even got its name - “tennis elbow.”

If the disease is not paid attention to and not treated, then over time the arm or leg may completely stop obeying its owner - muscle and nerve atrophy will develop. Sometimes the process becomes so advanced that neurosurgery may be required to free the pinched nerve.

Traditional treatment tunnel syndrome is based on the use of painkillers and muscle relaxants - substances that relax muscles. However, these drugs affect the entire body at once and do not allow them to act specifically on the muscle that pinched the nerve. Hence the frequent failures in treatment.

In addition to drug treatment, you can try to relax the pinched muscle with massage, physiotherapy or therapeutic exercises. The problem is that massage cannot provide a lasting effect, and after several procedures the spasm returns. And as practice shows, most patients do not like to do therapeutic exercises or do not find the time.

Osteopathy offers a better approach to treating carpal tunnel syndrome and gets to the root of the problem. Why did these particular muscles tense? Why did the problem occur, for example, on the left and not on the right? And so on... The cause of the disease can be anywhere: in a violation of the biomechanics of the pelvis or legs, in a violation of the movements of internal organs, skull bones, in a scar due to a long-ago operation, etc. And only by finding and eliminating the basis of the disease can we talk about the beginning of recovery. Only then will the effectiveness of physiotherapy, massage and medications increase, the pain will decrease and disappear, and the nerves will no longer be injured.

Carpal tunnel syndrome

Manifested by pain, numbness, tingling and weakness in the arm and hand. Pain and numbness extend to the palmar surface of the thumb, index, middle and ring fingers, as well as to the dorsum of the index and middle fingers. Initially, symptoms occur when performing any activities using a brush (working on a computer, drawing, driving), then numbness and pain appear at rest, sometimes occurring at night.

Pronator teres syndrome (Seyfarth syndrome)

With the development of this type tunnel syndrome the patient complains of pain and burning 4-5 cm below the elbow joint, along the anterior surface of the forearm, and pain radiating to the I-III fingers, half of the IV finger and palm. This syndrome usually begins to appear after significant muscle load for many hours with the participation of the pronator and flexor digitorum muscles. Such types of activities are often found among musicians (pianists, violinists, flutists, guitarists), dentists, and athletes. Pronator teres syndrome sometimes occurs in nursing mothers. In them, compression of the nerve in the area of ​​the pronator teres occurs when the baby’s head lies on the forearm, he is breastfed, lulled to sleep, and the sleeping person is left in this position for a long time.

Cubital tunnel syndrome

The main manifestations of the syndrome are pain, numbness, and/or tingling. Pain and tingling is felt in the outer part of the shoulder and extends to the little finger and half of the fourth finger. At the beginning of the disease, discomfort and pain occur only when pressure is applied to the elbow or after prolonged bending. In a more severe stage, pain and numbness are felt constantly. Another sign of the disease may be weakness in the arm. It manifests itself as a loss of “confidence” in the hand: suddenly objects begin to fall out of it during some habitual actions. For example, it becomes difficult for a person to pour water from a kettle. In advanced stages, the hand on the affected arm begins to lose weight, and pits appear between the bones due to muscle atrophy.

Radial nerve compression syndrome

It manifests itself as pain in the extensor muscles of the forearm, their weakness and hypotrophy. Active extension of the third finger while pressing it and simultaneously straightening the arm at the elbow joint causes intense pain in the elbow and upper forearm.

Entrapment of the obturator nerve in the obturator canal

I am concerned about pain in the groin area and on the inner surface of the thigh, which intensifies with movements in the hip joint and with straining. The pain disappears with rest. Sensory disturbances spread along the inner thigh. The causes of the formation may be: hernia of the obturator foramen, inflammatory processes in the area of ​​the symphysis pubis, fractures of the pelvic bones. The syndrome can occur after operations on the genitourinary organs, during childbirth.

Entrapment of the external or lateral cutaneous nerve of the thigh under the inguinal ligament (Bernhardt-Roth disease or meralgia paresthetica)

It manifests itself as burning, sometimes unbearable pain along the anterior outer surface of the thigh, with numbness and symptoms of dermatitis. The pain intensifies with prolonged standing, walking, or stretching the leg. The pain is relieved by lying down with legs bent. There is no atrophy or muscle weakness. The disease is characterized by spontaneous recovery. Infringement of the cutaneous nerve of the thigh occurs in quite a number of situations: misalignment of the pelvis or torso, shortening of the lower limb, obesity of the III-IV degree, ascites, when wearing a corset, a hernia bandage, a bandage for pregnant women.

Pinched sciatic nerve (piriformis syndrome)

Characterized by burning pain and tingling in the lower leg and foot. The pain can be localized in the buttock area (piriformis muscle) and along the sciatic nerve (down the back of the thigh). The pain intensifies when the hip is rotated inward; when the hip is rotated outward, the pain weakens. The pain also intensifies when the hip is adducted, as this tightens the piriformis muscle.

Entrapment of the tibial nerve in the area of ​​the tarsal tunnel (tarsal tunnel syndrome)

Characterized by significant pain on the sole and toes. The pain most often occurs at night during sleep, and decreases when hanging your legs from the bed. Pain can also occur during the day, usually while walking. Often the pain spreads along the sciatic nerve all the way to the buttock.

Entrapment of the plantar digital nerves - Morton's metatarsalgia

Main complaint: acute, burning, paroxysmal pain in the area of ​​the plantar surface of the foot, spreading to the third interdigital space, the third and fourth toes. The pain that worries patients is described very figuratively: “as if I had stepped on glass, on a needle, on a nail. ", "looks like an electric shock", "the sole was pierced with a knife", etc. The pain initially occurs while walking or running, forcing you to stop, sit down and take off your shoes. In the future, they may occur spontaneously during sleep. Foot deformation, flat feet, and wearing narrow high-heeled shoes play a big role in the infringement.

doctorkutuzov.ru

Carpal tunnel syndrome (tunnel syndrome): symptoms and treatment

Tunnel syndrome (tunnel neuropathy) is a complex of symptoms that arise as a result of compression of peripheral nerves in narrow anatomical spaces - tunnels. More than thirty variants of tunnel neuropathy are described in the medical literature. There are tunnel syndromes affecting the upper, lower extremities, neck, and torso. The most common is carpal tunnel syndrome, which is why this disease is often called carpal tunnel syndrome. In the structure of tunnel neuropathies, carpal tunnel syndrome accounts for 50% of all cases.

Causes of Carpal Tunnel Syndrome

The carpal (carpal) tunnel is located at the base of the hand. It is formed by the carpal bones and the transverse ligament. Inside the canal pass the median nerve, the flexor tendons of the fingers and hand, as well as their synovial membranes.

The median nerve includes sensory and nerve fibers. Sensory fibers are responsible for the sensitive innervation of the skin of the palmar surface of the first three and half of the fourth fingers, as well as the dorsal surface of the nail phalanges of the same fingers. Motor fibers provide movement of the fingers.

Normally, the median nerve runs freely in the canal. But with microtrauma to the ligaments that occurs in people of certain professions, thickening and swelling of the transverse ligament develop, which leads to compression of the nerve. As a result of chronic inflammation of the connective tissue, which is caused by constant load of the same type, the ligament thickens and swells, which leads to increased pressure inside the canal. Increased pressure leads to venous stagnation and, as a consequence, disruption of the blood supply to the nerve.

Sensitive nerve fibers are affected first, followed by motor fibers. In addition, fibers of the autonomic nervous system may be damaged.

Reasons leading to the development of carpal tunnel syndrome:

• Genetic predisposition (square wrist, thickened transverse ligament);
• Professional activities associated with constant flexion and extension of the hand (typists, seamstresses, pianists, painters, assemblers, carpenters, carvers, masons);
• Long work at the computer;
• Trauma (for example, a broken wrist);
• Pregnancy, lactation, menopause;
• Endocrine diseases (acromegaly, hypoparathyroidism);
• Taking hormonal contraceptives;
• Kidney failure;
• Joint damage (rheumatoid arthritis, gout);
• Hypothermia.

The peak incidence occurs between 40 and 60 years of age. It is noteworthy that women get sick more often than men. This is probably due to the fact that women have a narrower carpal tunnel.

Symptoms of Carpal Tunnel Syndrome

In approximately half of all cases, both hands are affected. But it is worth noting that signs of the disease primarily appear on the “working” hand (right-handers on the right, left-handers on the left).

Carpal tunnel syndrome develops gradually. The first sign of the disease is the appearance of pain and numbness in the first three fingers of the hand, which occurs at night. These unpleasant symptoms prevent a person from sleeping normally. When a person wakes up, he is forced to lower his hand down and shake off his hand. Then the pain goes away, but returns in the morning. Pain is felt throughout the finger from its base to the terminal phalanx.

When the disease begins to progress, pain begins to bother a person even during the day, which greatly affects his activity. It is noteworthy that any movement in the wrist increases pain.

Another characteristic symptom is numbness of the first three fingers in the morning. But then the person begins to feel numbness at night and during the day. Unpleasant symptoms in the fingers intensify when holding the hand suspended for a long time, for example, while talking on the phone or while driving a car.

As the disease progresses, muscle weakness occurs in the hand area. Thus, it is difficult for a person to hold small objects in his hand; they slip out of his hands. In the later stages, atrophy of the hand muscles and contractures in the form of the so-called “monkey’s paw” develop.

With strong or prolonged compression of the median nerve, a decrease in sensitivity develops. The patient may not feel touch or even pain in the area of ​​the first three fingers.

When the vessels inside the canal are compressed, the skin of the hand may become pale, the local temperature may decrease, and swelling may occur.

Diagnosis of carpal tunnel syndrome

Sometimes tunnel syndrome can be accompanied by pain not only in the hand, but also in the forearm and elbow. This confuses the doctor and may lead to thoughts about another pathology, for example, osteochondrosis. Therefore, special methods are used to carry out differential diagnosis.

For example, there is a simple raised hands test. The patient raises his straightened arms above his head and holds for a minute. If you have carpal tunnel syndrome, the first three fingers experience numbness and tingling, and sometimes even pain.

To perform the Phalen test, the patient is asked to bend the hand and hold it there for a minute. If you have carpal tunnel syndrome, the first three fingers experience increased tingling and pain.

A cuff test is also sometimes performed. The doctor places a blood pressure cuff on the patient's arm. Then the pressure in the cuff is inflated to over 120 mmHg, which is held for a minute. In carpal tunnel syndrome, a tingling sensation occurs in the fingers innervated by the median nerve.

But the most reliable diagnostic method is still the Tinel test. The doctor taps a finger or hammer over the median nerve. If you have carpal tunnel syndrome, you may experience tingling in your fingers.

A useful diagnostic test is the injection of corticosteroids with lidocaine into the carpal tunnel. If after this the pain and tingling in the fingers decrease, it means that the pathological process is located in the carpal tunnel.

The leading instrumental method for determining carpal tunnel syndrome is electroneuromyography. Using this study, it is possible to measure the electrical activity of skeletal muscles, as well as the speed of nerve impulses. At rest, the electrical activity of the muscles is minimal, but increases with muscle contraction. But in the presence of carpal tunnel syndrome, electrical activity is low during muscle contraction because the conduction of nerve impulses along the damaged median nerve is slowed down.

Treatment of carpal tunnel syndrome

Treatment of carpal tunnel syndrome is aimed primarily at eliminating the cause of the disease, as well as eliminating pain, improving local blood circulation, nutrition and innervation of tissues, and restoring hand function.

Conservative treatment

Conservative treatment will be most effective in patients with symptoms lasting no more than a year. It includes wearing a support splint, as well as prescribing the following medications:

• Nonsteroidal anti-inflammatory drugs (diclofenac, movalis);
• Corticosteroids (prednisolone, hydrocortisone);
• Vasodilators (nicotinic acid, trental);
• Diuretics (furosemide, veroshpiron);
• Muscle relaxants (sirdalud, mydocalm);
• B vitamins (neurorubin, milgamma).

An effective treatment is to inject corticosteroids into the carpal tunnel. Already after the first such procedure, the patient feels significant relief.

Criteria for predicting low effectiveness of conservative treatment:

1. The patient's age is over fifty years;
2. Symptoms of the disease are observed for ten or more months;
3. Constant tingling in the fingers;
4. Presence of stenosing tendon tenosynovitis;
5. Positive Feleng test in less than thirty seconds.

Thus, in 66% of patients without a single criterion, a good result can be achieved with conservative treatment, in 40% - in the presence of one criterion, in 16.7% - with two, and in 6.8% - in the presence of three or more criteria.

Surgical treatment

With the progression of the disease and in the absence of results from conservative therapy, surgical treatment is resorted to. Surgery should be performed before irreversible damage to the median nerve occurs. If the operation is performed in a timely manner, it is possible to achieve a good result in 90% of patients. The goal of surgery is to reduce pressure on the median nerve by expanding the intracanal lumen. Operations can be performed endoscopically or openly.

After surgery, a plaster cast is applied to the hand for several days. During the recovery period, the patient is advised to undergo therapeutic exercises with a fixed wrist and physiotherapeutic procedures. If the disease is caused by the characteristics of the profession, you should change your occupation during the recovery period. After three months, hand function is restored by approximately 70-80%, and after six months it is completely restored.

After complete recovery, the person can return to his or her occupation. But if unfavorable working conditions are not eliminated, a relapse cannot be avoided.

Prevention of carpal tunnel syndrome

The incidence of carpal tunnel syndrome has increased significantly in recent years. Doctors attribute this fact to the fact that computers have appeared in human life. People work and spend their leisure time at the computer. If the workplace is not organized correctly and the hand is in an awkward position while using equipment, the prerequisites are created for the development of carpal tunnel syndrome.

To prevent the occurrence of the disease, you should adhere to the following recommendations:

Set up your workspace properly. The table should not be too high. While working at the computer, your hand should not sag, but lie comfortably on the table or armrest of a chair. The brush should be straight.

Choose the right keyboard and mouse. The mouse should fit comfortably in your palm. This way the brush will be more relaxed. There is even a special joystick mouse created for people with carpal tunnel syndrome. No less useful can be special mouse pads equipped with a bolster at wrist level. This will ensure the correct position of the brush. Also, pay attention to the angled keyboard.

Take breaks every thirty to forty minutes.

Do hand exercises: shaking your hands, rotating your wrists, clenching and unclenching your fingers.

Grigorova Valeria, medical observer