Advertising on the portal

Median nerve (n. medianus)

WITH The laryngeal nerve is formed by the fibers of the spinal nerves CV - CVIII and TI and with two roots extends from the lateral (external) and medial (internal) secondary bundles of the brachial plexus, which converge at an acute angle and embrace a. axilaris (axillary artery - see Figure 1) from the anterior side (the trunks from which the n. medianus arises lie one above, the other below the artery).

The nerve, having formed, lies, however, not on the front, but on the outer side of the artery; therefore, it would be more accurate to say that he hugs a from the front. axilaris is only the lower branch forming n. medianus. In this position n. medianus descends together with the brachial artery (in the sulcus bicipitalis medialis) along the inner edge of m. biciptis (biceps muscle [shoulder]); at the same time, it little by little begins to bend around the artery from the outside inward and in the middle of the shoulder crosses it from the front side, so that in the lower half of the shoulder it lies on the inside of the artery, not next to it, but retreats more and more inward from it. All along the shoulder n. medianus does not produce branches (see Figure 2).

In the depth of the elbow fold n. medianus fits under the edge of m. pronator teres (round pronator), then under m. flexor digitorum sublimis (superficial flexor digitorum) and lies along the midline of the forearm between the last muscle and the deep flexor digitorum. In this position it reaches the wrist (see Figure 3).

In the upper third of the forearm, the median nerve gives off numerous branches that supply all the muscles of the flexor group, with the exception of one head of the deep digital flexor (m. flexor digitorum profundum), closest to the ulna, and the ulnar flexor carpi (m. flexor carpi ulnaris). One of these branches, running along the midline of the interosseous ligament and supplying m. prnator quadratum (square pronator), called [anterior] interosseous nerve, n. interosseus. Above the wrist joint (that is, at the level of the lower border of the lower third of the forearm), the median nerve gives off a thin branch (ramus palmaris), which supplies a small area of ​​skin in the area of ​​the eminence of the thumb and palm.

Thus, the median nerve supplies the following muscles of the forearm(see Figure 4):
1 . pronator teres(m. pronator teres) - pronates the forearm and promotes its flexion (innervated by the spinal segment CVI - CVII);
2 . flexor carpi radialis(m. flexor carpi radialis) - flexes and abducts the hand (innervated by the spinal segment CVI - CVII),
3 . palmaris longus muscle(m. palmaris longus) - strains the palmar aponeurosis and flexes the hand (innervated by the spinal segment СVII - СVIII);
4 . flexor digitorum superficialis(m. flexor digitorum superficialis) - bends the middle phalanges of the II - V fingers, and along with them the fingers themselves (innervated by the spinal segments CVII - TI);
5. flexor pollicis longus(m. flexor pollicis longus) - bends the nail phalanx of the first finger (innervated by the spinal segments CVI - CVIII);
6 . flexor digitorum profundus(m. flexor digitorum profundus) - flexes the distal phalanges of the II - V fingers, and with them the fingers themselves (innervated by the spinal segments CVII - TI), note: the median nerve predominantly innervates the muscle bundles of the deep flexor of the digitorum, which flex the distal phalanges II and III fingers, since the distal phalanges of the IV and V fingers receive preferential innervation from the ulnar nerve (n. ulnaris);
7 . quadratus muscle(quadrate pronator - m. pronator quadrates) - pronates the forearm and hand (innervated by spinal segments CVI - CVIII).

Proximal to the wrist joint, the median nerve lies superficially between the tendons of the m. flexr carpi radialis (flexor carpi radialis) and m. palmaris longus (long palmar muscle), then passes through the carpal tunnel onto the palmar surface of the hand and branches into terminal branches (see Figure 5). In the carpal tunnel, the median nerve is located under the flexor retinaculum (lig. carpi transvesum) between the synovial sheaths of the long flexor tendon of the first finger and the sheaths of the superficial and deep flexor digitorum.

Having passed along with the tendons of the muscles that flex the fingers under the lig. carpi transvesum, the median nerve is divided into four branches (nn. digitales palmares communis). One of them, closest to the radial cari of the palm, supplies the eminentiae thenar muscles, with the exception of the deep head of the m. flexor pollicis brevis and m. adductor pollicis, as well as the skin of the radial edge of the thumb. The other three branches are directed towards those first spaces of the fingers; On the way, two worm-shaped muscles supply the skin of the radial half of the palm, and, reaching the base of the fingers, each of them is divided into two branches, supplying the skin of the sides of the I, II, III and IV fingers facing each other, located like a. digitales, along the edges of the fingers.

read also article « INNERVATION OF THE HAND BY THE MEDIA NERVE»

Thus, the median nerve supplies the following muscles of the hand(see Figure 6):
1 . abductor pollicis brevis muscle(m. abductor pollicis brevis) - abducts the first [thumb] finger (innervated by the spinal segment CVI - CVII);
2 . muscle that opposes the thumb(m. opponens pollicis) - opposes the thumb to the little finger and all other fingers (innervated by the spinal segment CVI - CVII);
3 . flexor pollicis brevis(m. flexor pollicis brevis) - flexes the proximal phalanx of the thumb and the finger as a whole, takes part in the approximation of this finger (innervated by the spinal segments CVI - TI); Please note that this muscle has double innervation - its superficial head is innervated by the median nerve, and its deep head is innervated by the ulnar nerve;
4 . first and second lumbrical muscles(m. lumbricales) - bend the proximal phalanges and extend the middle and distal phalanges of the II and III fingers; they are innervated by the spinal segments CV - TI).

Summarizing the data on the innervation of muscles and skin by the median nerve, we can draw the following conclusion: the median nerve is involved in flexion of the hand, abduction of the hand to the radial side, pronation of the hand, flexion of the middle phalanges of the II - V fingers, flexion of the terminal phalanges of the II - III fingers, flexion of the terminal phalanx of the thumb (I) finger, flexion of the main phalanx and adduction elevation of the first finger to the other fingers, in flexion of the proximal phalanges with simultaneous extension of the middle and distal phalanges of the second and third fingers; The median nerve innervates the skin (sensory innervation - see Figure 7) of the outer part of the palm, the palmar surface of the I - III and half of the IV fingers, as well as the skin of the distal phalanges of the II - III fingers on the back side. It should be noted that the median nerve contains a large number of autonomic fibers, and therefore its damage is most often accompanied by severe acrocyanosis, hyperhidrosis, muscle atrophy (especially the elevation of the first finger (thenar), as well as causalgia.

It should also be noted that there is significant variability in the formation and structure of the median nerve. In some people, this nerve is formed high up - in the armpit, in others low - at the level of the lower third of the shoulder. The zones of its branching are also variable, especially the muscle branches at the level of the wrist. Sometimes they branch off from the main trunk in the proximal or middle portion of the carpal tunnel and pierce the digital flexor retinaculum. At the site of perforation of the ligament, the muscular branch of the median nerve lies in an opening - the so-called thenar tunnel. The muscular branch can branch off from the main trunk of the median nerve in the carpal tunnel on its ulnar side, then bends around the nerve trunk in front under the flexor retinaculum and, perforating it, goes to the thenar muscles.

The most common cause of median nerve damage is carpal tunnel syndrome, in which compression of the median nerve occurs under the palmar ligament at the level of the wrist. Patients usually complain of numbness or pain, which often occurs at night and causes them to wake up, but sometimes occurs at rest or with physical activity. When you shake your hands, pain and numbness decrease. Numbness and paresthesia are localized in the area of ​​innervation of the median nerve (I-IV fingers), but often patients claim that the entire hand is numb.

Women are more often affected, especially those engaged in intensive manual labor (typists, seamstresses, cutters, musicians). The cause of the syndrome can also be rheumatoid arthritis, hypothyroidism, and acromegaly. During pregnancy, carpal tunnel syndrome occurs in 20% of women; it usually disappears after childbirth without requiring treatment. In most patients, Phalen's symptom (the appearance of paresthesia during forced flexion of the hand) and Tinnel's symptom (the appearance of paresthesia in the innervation zone of the median nerve during percussion in the canal area) are detected. In almost all patients, at least mild weakness can be detected when abducting and opposing the thumb; atrophy of the muscles of the eminence of the thumb occurs relatively late.

The diagnosis can be confirmed using electroneuromyography.

Treatment primarily includes immobilization of the hand in the wrist joint using splints, non-steroidal anti-inflammatory drugs, diuretics, applications with dimexide, novocaine and corticosteroid to the canal area. It is important to reduce the load on the hand or take breaks during work. If the onset of the disease is relatively recent, the effect can be achieved by injecting corticosteroids into the carpal tunnel area.

If conservative treatment is ineffective and muscle atrophy increases, surgical intervention is indicated.

Symptoms of median nerve neuropathy

Muscles innervated by the median nerve: round muscle pronating the forearm (m. pronator teres); quadratus muscle, pronating the forearm and hand (m. pronator quadratus); radial flexor of the hand (m. flexor carpi radialis), long palmar muscle (m. palmaris longus); superficial flexor of the fingers (m. flexor digitorum sublimus); long flexor of the thumb (m. flexor pollicis longus), deep flexor of the fingers, radial part (m. Flexor digitorum profundus), short muscle, abductor of the first finger (m. abductor pollicis brevis), muscle of the opponens pollicis (m. opponens pollicis ); flexor pollicis brevis (m. flexor pollicis brevis); vermiform muscles I-II (mm. lumbricales).

The motor function of the median nerve includes: pronation of the forearm and hand; palmar flexion of the hand and abduction to the radial side; flexion of the proximal phalanges of the I, II, III fingers and extension of the middle and distal phalanges of the II, III fingers; flexion of the distal phalanx of the first finger; opposition of the first finger.

Sensitive fibers of the median nerve innervate the skin of the radial part of the palmar surface of the hand, the palmar surface of the I, II, III and radial part of the IV fingers, the skin of the rear of the distal phalanges of the I, II, III fingers.

In addition, the median nerve contains a significant number of sympathetic fibers that provide autonomic-vascular-trophic innervation.

Symptoms of damage to the median nerve at different levels. The median nerve does not give off branches in the shoulder. Therefore, with high nerve damage, all functions are impaired: flexion of the hand is weakened, the hand is abducted to the ulnar side, flexion of fingers II–III, flexion of the distal phalanx of the first finger and opposition of the first finger are impossible; Pronation of the forearm and hand is difficult. The muscles of the first finger atrophy, the thenar disappears, the palm flattens, the first finger is located in the same plane as the others, and the hand takes on the shape of a “monkey’s paw.” Superficial sensitivity is impaired on the palmar surface of the hand and 31/2 fingers, joint-muscular sensation is usually impaired in the second finger.

To facilitate remembering the zones of innervation of the skin of the hand and fingers, use the “UMRU” rule (the first letters of the Latin names of the ulnar, median and radial nerves): the ulnar part of the palmar surface is innervated by the ulnar nerve, the radial part of the palmar surface is innervated by the median nerve, the radial part of the dorsal surface is innervated by the radial and ulnar nerves. part of the back surface is the elbow.

Damage to the median nerve is naturally associated with severe pain and severe autonomic-vascular and trophic disorders. The skin acquires a bluish (pale) color, thinning or hyperkeratosis, changes in the nails, anhidrosis (hyperhidrosis) are detected, and ulcerations easily occur. With partial damage to the nerve, the development of complex regional pain syndrome (CRPS) - causalgia - is possible.

A largely similar syndrome develops with compression or chronic trauma in the upper third of the forearm between the heads of the pronator teres (pronator syndrome). The development of this syndrome is possible with frequently repeated tense pronator movements (working with a screwdriver, squeezing clothes); prolonged pressure on the ventral surface of the proximal segments of the forearm (“wedding night palsy” or “honeymoon paralysis”; breastfeeding a child whose head lies on the mother’s forearm; pressing a musician’s forearm to the edge of a guitar); unsuccessful intravenous injections (calcium chloride, etc.).

When the median nerve is damaged in the middle and lower part of the forearm, the function of pronation, flexion of the hand and fingers is usually preserved. The basis of the syndrome is sensory disorders, and the only motor defect may be a violation of the opposition of the first finger.

A common type of median nerve injury is carpal tunnel syndrome. Trauma to the nerve in the carpal tunnel is caused by many reasons: overstrain of the muscles and tendons passing through the canal associated with household and professional activities (washerwomen, milkmaids, typists, gymnasts, etc.); thickening of the nerve (amyloidosis, leprosy); congenital narrowness of the canal; proliferation of connective tissue in the canal, metabolic disorders and other pathological changes (myxedema, gout, diabetes mellitus, acromegaly, menopause, pregnancy and lactation, obesity, taking oral contraceptives, systemic scleroderma, rheumatoid polyarthritis). It is assumed that different types of night dysesthesias are a consequence of compression of the median nerve in the carpal tunnel.

Clinical equivalent of carpal tunnel syndrome: night (morning) pain and paresthesia in fingers I, II, III (less often in other fingers and on the forearm); hypoesthesia in fingers I, II, III; weakness of opposition (“bottle” test - it is difficult to grasp a bottle, fasten buttons, wind a watch); often - vegetative-trophic disorders (Raynaud's syndrome).

Study of the functions of the median nerve

1. The patient is asked to clench his fingers into a fist - fingers I, II (III) remain straightened.

2. The patient is asked to “scratch” the second finger on the table - this action cannot be performed.

3. The patient is asked to hold a sheet of paper with fingers I and II, and the doctor tries to pull out the sheet (Frohman test); the patient holds the paper with the straightened first finger (ulnar nerve function) and does not flex the distal phalanx.

4. The patient is asked to make a “ring” with fingers I and II (I and V) and resist the efforts of the doctor who is trying to break this ring. Opposition has weakened.

5. The patient is asked to flex the hand, but the doctor counteracts the flexion - the strength of the hand flexors is reduced.

6. Similarly, check the strength of the flexors of the II, III fingers, and the distal phalanx of the first finger.

7. With fixed proximal phalanges, the patient is asked to flex the middle and distal phalanges, the researcher prevents this movement and records the weakness of the flexors.

8. The patient is asked to pronate the previously supinated and extended forearm and hand, the doctor resists this movement - weakness of the pronators is detected.

9. Find out the presence of subjective sensitivity disorders (pain, paresthesia, night dysesthesia).

10. Examine sensitivity on the hand and fingers and specify the area of ​​​​disorder.

11. Pay attention to the presence of vasomotor and trophic disorders on the hand and fingers.

12. Assess the appearance of the hand (“monkey’s paw”).

Consultation on treatment using traditional oriental medicine methods (acupressure, manual therapy, acupuncture, herbal medicine, Taoist psychotherapy and other non-drug treatment methods) is carried out in the Central district of St. Petersburg (7-10 minutes walk from the Vladimirskaya/Dostoevskaya metro station), With 9.00 to 21.00, no lunches and weekends.

It has long been known that the best effect in the treatment of diseases is achieved with the combined use of “Western” and “Eastern” approaches. Treatment time is significantly reduced, the likelihood of disease relapse is reduced. Since the “eastern” approach, in addition to techniques aimed at treating the underlying disease, pays great attention to the “cleansing” of blood, lymph, blood vessels, digestive tracts, thoughts, etc. - often this is even a necessary condition.

The consultation is free and does not oblige you to anything. on her All data from your laboratory and instrumental research methods are highly desirable over the last 3-5 years. By spending only 30-40 minutes of your time you will learn about alternative treatment methods, learn How can you increase the effectiveness of already prescribed therapy?, and, most importantly, about how you can fight the disease yourself. You may be surprised how logically everything will be structured, and understanding the essence and reasons - the first step to successfully solving the problem!

The most commonly diagnosed peripheral nerve disease is neuropathy of the median nerve, one of the three main motor-sensory nerves in the arms that provide movement and sensation from the shoulder to the fingertips.

Without taking into account pathogenetic factors, many continue to call it neuritis, and ICD-10, based on the anatomical and topographical features of the disease, classifies it as mononeuropathies of the upper extremities with code G56.0-G56.1.

, , , , ,

ICD-10 code

G56.1 Other lesions of the median nerve

Epidemiology

The exact statistics of this pathology are unknown. Most epidemiological studies have focused on carpal tunnel syndrome, which is the most common peripheral compression syndrome of the median nerve with an incidence of 3.4% of all neuropathies: 5.8% in women and 0.6% in men.

European neurologists note that this syndrome is diagnosed in 14-26% of patients with diabetes; about 2% of cases are recorded during pregnancy, in almost 10% of professional drivers, in a quarter of painters, in 65% of people who constantly work with vibrating tools, and in 72% of workers involved in manual processing of fish or poultry.

But pronator teres syndrome is detected in almost two-thirds of milkmaids.

Causes of median nerve neuropathy

In most cases, the causes of median nerve neuropathy are compression of some part of the nerve trunk, which in neurology is defined as compression neuropathy of the median nerve, neurocompression or tunnel syndrome. Compression can be the result of injuries: fractures in the head of the humerus or clavicle, dislocations and strong impacts of the shoulder, forearm, elbow or wrist joints. If the blood vessels and capillaries of its endoneurium adjacent to the nerve are compressed, then compression-ischemic neuropathy of the median nerve is diagnosed.

In neurology, other types of neuropathy of the medial nerve are distinguished, in particular, degenerative-dystrophic, associated with arthrosis, deforming osteoarthritis or osteitis of the shoulder, elbow or wrist joints.

In the presence of chronic infectious inflammation of the joints of the upper extremities - arthritis, osteoarthritis of the wrist, rheumatoid or gouty arthritis, articular rheumatism - neuropathy of the median nerve can also occur. This, as a trigger for pathology, should include inflammatory processes localized in the synovial bursa of joints, tendons and ligaments (with stenosing tenosynovitis or tenosynovitis).

In addition, neoplasms of the bones of the shoulder and forearm (osteomas, bone exostoses or osteochondromas) can damage the median nerve; tumors of the nerve trunk and/or its branches (in the form of neuroma, schwannoma or neurofibroma), as well as anatomical abnormalities.

So, if a person has a rare anatomical formation in the lower third of the humerus bone (approximately 5-7 cm above the middle epicondyle) - the spinous epicondylar process (apophysis), then together with the Struther ligament and the humerus it can form an additional hole. It can be so narrow that the median nerve and brachial artery passing through it can be compressed, leading to compressive ischemic neuropathy of the median nerve, which in this case is called supracondylar apophysis syndrome or supracondylar syndrome.

, , , , , , , ,

Risk factors

Experts consider constant tension in the wrist or elbow joints and prolonged actions with a bent or straightened wrist, characteristic of some professions, to be absolute risk factors for the development of neuropathy of this nerve. The importance of heredity and a history of diabetes mellitus, severe hypothyroidism - myxedema, amyloidosis, myeloma, vasculitis, and deficiency of B vitamins are also noted.

According to the results of some foreign studies, factors associated with this type of peripheral mononeuropathy include pregnancy, increased body mass index (obesity), and in men, varicose veins in the shoulder and forearm.

The threat of median nerve neuritis occurs with antitumor chemotherapy, long-term use of sulfonamides, insulin, dimethylbiguanide (an antidiabetic agent), drugs with derivatives of glycolyl urea and barbituric acid, the thyroid hormone thyroxine, etc.

Pathogenesis

The long branch of the brachial plexus, which emerges from the brachial ganglion (plexus brachials) in the armpit, forms the median nerve (nervus medianus), running parallel to the humerus down: through the elbow joint along the ulna and radial bones of the forearm, through the carpal tunnel of the wrist joint into hand and fingers.

Neuropathy develops in cases of compression of the middle trunk of the supraclavicular part of the brachial plexus, its external bundle (in the area where the upper peduncle of the nerve exits the brachial ganglion) or at the point where the internal peduncle of the nerve departs from the internal secondary fascicle. And its pathogenesis consists in blocking the conduction of nerve impulses and disruption of muscle innervation, which leads to limitation of movements (paresis) of the radial flexor carpi radialis (musculus flexor carpi radialis) and round pronator (musculus pronator teres) in the forearm - the muscle that provides rotation and rotational movements . The stronger and longer the pressure on the median nerve, the more severe the nerve dysfunction.

The study of the pathophysiology of chronic compression neuropathies showed not only segmental, but often extensive demyelination of the axons of the median nerve in the compression zone, pronounced swelling of the surrounding tissues, an increase in the density of fibroblasts in the tissues of the protective sheaths of the nerve (perineurium, epineurium), vascular hypertrophy in the endoneurium and an increase in the volume of endoneurial fluid , increasing compression.

Increased expression of the smooth muscle relaxant prostaglandin E2 (PgE2) was also detected; vascular endothelial growth factor (VEGF) in synovial tissues; matrix metalloproteinase II (MMP II) in small arteries; transforming growth factor (TGF-β) in fibroblasts of the synovial membranes of articular cavities and ligaments.

, , , , , ,

Symptoms of median nerve neuropathy

The main diagnosis definitions for compression mononeuropathies are: supracondylar apophysis syndrome, pronator teres syndrome, and carpal tunnel syndrome or carpal tunnel syndrome.

In the first case - with supracondylar apophysis syndrome (which was already discussed above) - compression of the median nerve is manifested by symptoms of a motor and sensory nature: pain in the lower third of the shoulder (on the inside), numbness and tingling (paresthesia), decreased sensitivity (hypoesthesia) and weakening of the muscles of the hand and fingers (paresis). The frequency of this syndrome is 0.7-2.5% (according to other sources - 0.5-1%).

In the second case, symptoms of neuropathy of the median nerve appear after its compression while passing through the muscle structures of the forearm (pronator teres and flexor digitorum). The first signs of pronator teres syndrome include pain in the forearm (radiating to the shoulder) and hands; further note hypoesthesia and paresthesia of the palm and the dorsal surface of the terminal phalanges of the 1st, 2nd, 3rd and half of the 4th fingers; limitation of rotation and rotational movements (pronation) of the muscles of the forearm and hand, flexion of the hand and fingers. In advanced disease, the thenar muscle innervated by the median nerve (eminence of the thumb) partially atrophies.

In carpal tunnel syndrome, compression of the trunk of the median nerve occurs in the narrow osteofibrous tunnel of the wrist (carpal tunnel), through which, together with several tendons, the nerve extends into the hand. With this pathology, the same paresthesia is noted (which does not go away at night); pain (even unbearable - causalgic) in the forearm, hand, first three fingers and partly the index finger; decreased muscle motility of the hand and fingers.

In the first stage, the soft tissues in the area of ​​the pinched nerve swell, and the skin turns red and becomes hot to the touch. Then the skin of the hands and fingers turns pale or acquires a bluish tint, becomes dry, and the stratum corneum of the epithelium begins to peel off. Gradually, there is a loss of tactile sensitivity with the development of astereognosia.

Complications and consequences

The most unpleasant consequences and complications of neuropathic syndromes of the medial nerve of the upper extremities are atrophy and paralysis of peripheral muscles due to disruption of their innervation.

In this case, motor restrictions relate to rotational movements of the hand and its flexion (including the little finger, ring and middle fingers) and clenching into a fist. Also, due to atrophy of the muscles of the thumb and little finger, the configuration of the hand changes, interfering with fine motor skills.

Atrophic processes have a particularly negative effect on the condition of the muscles if compression or inflammation of the nervus medianus has led to extensive demyelination of its axons - with the impossibility of restoring the conduction of nerve impulses. Then fibrous degeneration of muscle fibers begins, which after 10-12 months becomes irreversible.

, , , , , , , ,

Diagnosis of median nerve neuropathy

Diagnosis of median nerve neuropathy begins with finding out the patient's medical history, examining the limb and assessing the degree of nerve damage - based on the presence of tendon reflexes, which are checked using special mechanical tests (flexion-extension of the joints of the hand and fingers).

To determine the cause of the disease, blood tests may be needed: general and biochemical, glucose levels, thyroid hormones, CRP content, autoantibodies (IgM, IgG, IgA), etc.

Instrumental diagnostics using electromyography (EMG) and electroneurorrhaphy (ENG) makes it possible to assess the electrical activity of the muscles of the shoulder, forearm and hand and the degree of conduction of nerve impulses by the median nerve and its branches. They also use radiography and myelography with a contrast agent, ultrasound of blood vessels, ultrasound, CT or MRI of bones, joints and muscles of the upper extremities.

Differential diagnosis

Differential diagnosis is designed to distinguish mononeuropathy of the median nerve from neuropathy of the ulnar or radial nerve, lesions of the brachial plexus (plexitis), radicular dysfunctions with radiculopathy, scalenus syndrome, inflammation of the ligament (tenosynovitis) of the thumb, stenosing tenosynovitis of the flexors of the fingers, polyneuritis with systemic lupus erythematosus , Raynaud's syndrome, sensitive Jacksonian epilepsy and other pathologies whose clinical picture has similar symptoms.

Treatment of median nerve neuropathy

Comprehensive treatment of median nerve neuropathy should begin with minimizing the impact of compression and pain relief, for which the arm is given a physiological position and fixed with a splint or orthosis. Relief of intense pain is carried out by perineural or paraneural novocaine blockade. While the limb is immobilized, the patient is given sick leave for median nerve neuropathy.

It should be borne in mind that treatment of emerging neuropathy does not cancel the treatment of the diseases that caused it.

To reduce pain, medications in tablets can be prescribed: Gabapentin(other trade names - Gabagama, Gabalept, Gabantin, Lamitril, Neurontin); Maxigan or Dexalgin(Dexallin), etc.

To relieve inflammation and swelling, paraneural injections of corticosteroids (hydrocortisone) are used.

Ipidacrine (Amiridin, Neuromidin) is used to stimulate the conduction of nerve impulses. Take 10–20 mg orally twice a day (for a month); administered parenterally (s.c. or i.m. – 1 ml of 0.5-1.5% solution once a day). The drug is contraindicated in epilepsy, heart rhythm disturbances, bronchial asthma, exacerbations of stomach ulcers, pregnancy and breastfeeding; not applicable to children. Side effects include headache, allergic skin reactions, hyperhidrosis, nausea, increased heart rate, bronchospasm and seizures.

Pentoxifylline (Vazonit, Trental) helps improve blood circulation in small vessels and blood supply to tissues. The standard dosage is 2-4 tablets up to three times a day. Possible side effects such as dizziness, headache, nausea, diarrhea, increased heart rate, decreased blood pressure. Contraindications include bleeding and retinal hemorrhages, liver and/or kidney failure, gastrointestinal ulcers, pregnancy.

To increase the content of high-energy compounds (macroegs) in muscle tissue, alpha-lipoic acid preparations are used - Alpha-lipon (Espa-lipon): first, intravenous drip - 0.6-0.9 g per day, after two or three take tablets for weeks - 0.2 g three times a day. Side effects can be expressed by the appearance of urticaria, dizziness, increased sweating, pain in the abdominal cavity, and intestinal dysfunction.

For neuropathy associated with diabetes mellitus, Carbamazepine (Carbalex, Finlepsin) is prescribed. And all patients need to take vitamins C, B1, B6, B12.

Physiotherapeutic treatment of neuropathies is very effective, so sessions of physiotherapy using ultraphonophoresis (with novocaine and corticosteroids) and electrophoresis (with Dibazol or Proserin) are necessarily prescribed; UHF, pulsed alternating current (darsonvalization) and low-frequency magnetic field (magnetotherapy); conventional therapeutic massage and acupressure (reflexotherapy); electrical stimulation of muscles with impaired innervation; balneo- and peloidotherapy.

After the acute pain syndrome is relieved, about a week after immobilization of the arm, all patients are prescribed exercise therapy for median nerve neuropathy - to strengthen the muscles of the shoulder, forearm, hand and fingers and increase the range of their flexion and pronation.

Traditional treatment

Among the remedies that are recommended for folk treatment of this pathology, pain-relieving compresses with blue clay, turpentine, a mixture of camphor alcohol and salt, and alcohol tincture of calendula are offered. No one has evaluated the effectiveness of such treatment, as well as herbal treatment (ingesting decoctions of elecampane or burdock roots). But it is known for sure that it is useful to take evening primrose oil, since it contains a lot of fatty alpha-lipoic acid.

Carpal tunnel syndrome (neuropathy of the median nerve due to compression in the carpal tunnel) (G56.0) is a lesion of the median nerve resulting from prolonged pressure and chronic trauma in the carpal tunnel area, characterized by pain, tingling, and numbness in the hand.

This syndrome is more common in women (75%), the peak incidence is observed at 40-60 years of age. Prevalence of the syndrome: 1.5-3% in the population.

Causes of carpal tunnel syndrome: professional activities that require repeated flexion/extension of the hand (for example, when working at a computer); nerve damage due to hand injury; acromegaly, rheumatoid arthritis, gout, renal failure, myxedema. A predisposing factor for carpal tunnel syndrome is the anatomical feature of the hand—a “square wrist.”

Symptoms of median nerve neuropathy

Unilateral lesions of the carpal tunnel are more common (in 70% of cases). The disease develops gradually. First, numbness in the area of ​​the I-III fingers of the hand appears periodically with load on the hand (100%), then it becomes constant, and pain occurs (70%).

After changing the position of the hand, the pain goes away. Raising the hand up leads to increased numbness and pain in the hand (60%). Often bothered by tingling, a feeling of “crawling goose bumps”. In 30% of cases, with a long course of the disease (several years), weakness in the hand may occur. Characteristic numbness and pain in the hand are noted and intensify at night.

An objective examination of the patient reveals moderate hypoesthesia (pain, temperature) in the I-III fingers of the hand, paresthesia, weakness of the muscle opposing the first finger of the hand, and thenar atrophy. When percussion of the median nerve in the carpal tunnel area, paresthesia appears in the hand (Tinel's symptom) (90%). Bending the hand for 2 minutes leads to increased paresthesia (Phalen's sign) (50%).

Cuff test - when air is inflated into a cuff located above the site of compression of the median nerve, paresthesia appears in the hand within a minute in the presence of carpal tunnel syndrome.

Diagnosis of median nerve neuropathy

  • Electroneuromyography (signs of denervation, decreased speed of nerve impulses along the branches of the median nerve to the hand).
  • Computed tomography of the hand (congenital narrowness of the carpal tunnel).

Differential diagnosis:

  • Radicular syndrome in cervical osteochondrosis.
  • Naffziger scalene syndrome.
  • De Quervain's disease.
  • Ligamentitis of the finger flexors.

Treatment of median nerve neuropathy

  • Symptomatic treatment (decongestants, analgesics, vitamins).
  • Physiotherapy.
  • Drug blockades.
  • Surgical treatment of carpal tunnel syndrome.

Treatment is prescribed only after confirmation of the diagnosis by a medical specialist.

Essential drugs

There are contraindications. Specialist consultation is required.

  • (analgesic). Dosage regimen: IV, IM, SC in a single dose of 50-100 mg, possible repeated administration of the drug after 4-6 hours. The maximum daily dose is 400 mg.
  • (non-steroidal anti-inflammatory drug). Dosage regimen: IM: 100 mg 1-2 times a day; after pain relief, it is prescribed orally in a daily dose of 300 mg in 2-3 doses, a maintenance dose of 150-200 mg/day.
  • (a diuretic from the group of carbonic anhydrase inhibitors). Dosage regimen: adults are prescribed 250-500 mg once in the morning for 3 days, on the 4th day - a break.
  • Prozerin (inhibitor of acetylcholinesterase and pseudocholinesterase). Dosage regimen: orally for adults, 10-15 mg 2-3 times a day; subcutaneously - 1-2 mg 1-2 times a day.
  • (muscle relaxant). Dosage regimen: injection of small doses of the drug into areas of synkinesis and contractures. A 2-3-stage administration is used with an interval of 10-12 days. The total therapeutic dose is 1/3-1/2 of the dose contained in 1 bottle of the drug. The duration of the therapeutic effect is 3-4 months.
  • (vitamin B complex). Dosage regimen: therapy begins with 2 ml intramuscularly 1 time per day for 5-10 days. Maintenance therapy - 2 ml IM two or three times a week.

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

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

The median nerve responds:

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

Causes of defeat

Neuropathy of the median nerve is considered to be damage to a section of the median nerve. The cause of the disease is often swelling of soft tissues due to any mechanical damage or disease.

Damage to the median nerve is caused by the following factors:

  1. Injuries. Sprains, dislocations, fractures, bruises provoke dilation of blood vessels, fluid accumulates in the soft tissues. The nerve is compressed. The situation can be aggravated by bone damage and improper fusion.
  2. Arthritis. With this disease, the soft tissues of the body swell and pressure occurs on the nerve. Chronic disease often leads to disastrous results, hand deformation. This occurs due to the fact that the tissues begin to wear away, and the surfaces of the joints undergo fusion, exposing the bone.
  3. Fluid in soft tissues also accumulates due to other diseases, such as: nephrosclerosis, problems with the kidneys, problems with thyroid hormones, pregnancy, menopause, ischemia, as well as some other pathologies.
  4. Genetic predisposition. If parents or grandparents suffered from joint problems, then sometimes this is inherited.
  5. The risk group includes people suffering from diabetes. Due to impaired glucose metabolism and oxygen starvation of cells, nerve fibers are destroyed.
  6. . This disease belongs to diseases of the peripheral nervous system. Blood circulation is disrupted when the hands do not change their position while in a static state. This causes compression of the nerve. The syndrome often develops during prolonged use of the mouse and keyboard.
  7. Due to certain activities, compression-ischemic neuropathy of the median nerve occurs. It is associated with long-term macrotrauma to the nerve. This is facilitated, for example, by heavy physical labor with overload of the forearm and hand.

External causes of neuropathy of the median nerve of the arm also include:

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

Classification

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

Neuropathy is divided into 3 forms:

  • (when nerve fibers and blood vessels are affected due to high blood sugar);
  • toxic (infectious diseases, chemicals - all this affects the condition of nerve fibers);
  • post-traumatic (this type of illness develops after damage to the myelin sheath of the nerve. The sciatic, ulnar and radial nerves are most often injured);

Neuritis develops under similar conditions as median nerve neuropathy, but this disease is characterized by inflammation.

Based on the type and location of the pathology development zone, neuropathy has the following classification:

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

N medianus approaches the hand through the carpal tunnel. Here it innervates the muscles responsible for the opposition and abduction of the thumb, the lumbrical muscles, and the muscles that flex the finger. Its branches also supply nerve fibers to the wrist joint.

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

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

Complex lesions (eg, trauma) often extend to the ulnar nerve. Cubital syndrome occurs (when the nerve of the cubital canal is compressed).

Symptoms of the disease

Neuropathy of the median nerve of the hand (or neuritis) refers to diseases of the nervous system. When the disease begins to develop, the patient experiences difficulty clenching the first, second and third fingers of the hand into a fist. It is also difficult for him to simply move the second and third fingers. Other symptoms:

  1. Inability to oppose the thumb to the rest.
  2. Poor sensitivity in the palm and fingers.
  3. The appearance of the "monkey's paw". This is due to the fact that atrophy of the hand muscles occurs. As a result of this, the first finger of the hand is installed with the second in the same plane.
  4. The main symptom is acute pain, manifested in the area from the forearm to the fingers of the affected hand.
  5. Numbness of the hand, muscle weakness, tingling in the forearm.

Diagnostics

To diagnose median nerve neuralgia, the doctor performs a series of procedures. As the disease develops, the patient cannot perform certain actions. For example, an attempt to scratch the surface of a table with the index finger (with the palm pressed against the table) fails. The patient is unable to clench his hand into a fist, or to place his thumb against the rest.

Another diagnostic method is to ask the patient to show the “mill”. To do this, with your arms crossed, you need to rotate the sore finger of your healthy hand around the thumb of the injured one. If the nerve is affected, the person will not be able to do this.

With median nerve neuropathy, the patient’s thumb cannot be moved to the side enough to form a right angle with the index finger. Also, the index finger of one hand cannot scratch the healthy hand if you put 2 palms together.

The doctor also diagnoses in the following ways:

  • computed tomography of the hand;
  • electroneuromyography;
  • X-ray of the hand.

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

Treatment

People with median nerve neuropathy rarely see a doctor at the first stage of the disease. Referral occurs when more alarming symptoms of neurological problems appear:

  • spasms, convulsions;
  • crawling sensation;
  • problems with coordination;
  • lack of sensitivity to temperatures.

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

For effective therapy, the doctor also needs:

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

Treatment happens:

  • operative (using surgery);
  • conservative (medicines). Often doctors turn to etiotropic therapy. This is treatment with antibiotics, antiviral agents, and vascular drugs.


The degree of damage is determined using a special examination - needle myography. If the nerve is compressed, treatment may include the following steps:
  1. Absorption therapy has a good effect in relieving nerve compression. It involves taking various medications and enzymes, agents that absorb and soften scar tissue. If the compression is not severe, manual therapy and special massage are often sufficient.
  2. Nerve restoration. Special medications prescribed by a doctor help “revitalize” the nerve.
  3. Muscle rehabilitation. The goal of therapy is to restore their muscle volume. Treatment procedures are prescribed by a rehabilitation doctor.
  4. Conservative treatment of the radial and ulnar nerves may include wearing special splints.

What other means are used?

  1. Demixidol in the carpal tunnel area.
  2. Acupuncture.
  3. Interstitial electrical stimulation.
  4. Therapeutic blockades in the carpal tunnel (diprospan plus lidocaine), intramuscular injections (movalis plus novocaine)
  5. Non-steroidal anti-inflammatory drugs, in addition to blockades (artrosilene).

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

Initially, medicinal, conservative methods of therapy are always used. If physiotherapeutic treatment is ineffective, surgery is performed in the clinic. The decision in favor of surgical intervention is made when the integrity of the nerve trunk is damaged and there is severe weakness in the fingers.

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

Exercise therapy and special exercises are usually prescribed in the postoperative period. Physiotherapy is carried out during conservative treatment or also after surgery.

For patients with the disease, sanatorium-resort treatment may be indicated. A contraindication to it is the acute period of the disease.

Prognosis and prevention

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

  1. Physical exercises for the arms. They include a simple warm-up for the hands.
  2. It is important to take breaks when working at a computer. When working with a computer mouse, you need to hold it in different hands alternately.
  3. Taking the vitamin is beneficial, as well as strengthening the overall health of a person. This reduces the risk of diseases of the neurology of the extremities.

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