Carpal tunnel syndrome: from optimization of differential diagnosis to rational therapy

Abstract

The possibility of optimizing the differential diagnosis and rational treatment of carpal tunnel syndrome is substantiated. It was established that clinical and neurological examination of patients with an assessment of the symptom of «shaking» is a specific (93,2%) and sensitive (95,9%) marker of carpal tunnel syndrome. The use of B vitamins and ipidacrine as part of a combination therapy allows reliably (p>0,05) to lower the severity of sensory and motor disorders, improve the functional activity of the affected hand, which correlates with positive changes in electroneuromyography parameters (restoration of sensory conductivity). A multidimensional analysis of the study results revealed clinical predictors of the effectiveness of conservative therapy in patients of this profile: the total duration of the disease is less than 3 weeks, the absence of pronounced hypotrophy of the tenar muscles, the amplitude of the motor response during stimulation n. medianus with a voltage of electric current >5,5 mV, motor conduction along the median nerve >51,6 m/s, elimination of sensory disturbances after the 1st session of local blockades with glucocorticosteroid agent, use of B vitamins and ipidacrine. With these clinical predictors of the effectiveness of conservative therapy, the probability of relieving pain and achieving results on the outcome questionnaire and the inability of the arm and hand ≤ 10 points using conservative therapy in patients diagnosed with carpal tunnel syndrome was about 90%. Thus, the identification of carpal tunnel syndrome should be carried out taking into account the diagnostic value of clinical symptoms (the symptom of «shaking», hypoesthesia in the area of innervation of the median nerve) and tests of Tinel and Falen. Treatment of patients with carpal tunnel syndrome should be regulated based on clinical predictors of the effectiveness of conservative therapy and indications for surgical intervention. When planning a conservative treatment of carpal tunnel syndrome, it is advisable to include vitamins of group B and ipidacrine in the basic therapy.

Keywords

carpal canal / local injection therapy / clinical predictors of therapy efficacy / «shaking» symptom / Tinel test / Falen test / electroneuromyography / questionnaire of outcomes and hand and hand disabilities

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RIGHTS & PERMISSIONS

Zhivolupov S.A., Samartsev I.N., Rashidov N.A., Nazhmudinov R.Z., Vorobyova M.N., Kravchuk A.Yu.