TUNNEL SYNDROMES

TUNNEL SYNDROMES
– a group of peripheral nerve diseases that develop due to local compression of nerves in anatomical channels (muscle, fibrous or bone) – “tunnels”. This group also includes nerve damage when they are compressed from the outside in anatomical areas where nerves pass superficially.

CAUSES OF TUNNEL SYNDROMES
The reasons for which compression occurs can be divided into channel-related and nerve-related. The canal may be anatomically narrow from birth (a variant of the canal development), it may be narrowed by a callus or tumor, in particular, with tumor diseases of the musculoskeletal system and the blood system. It is possible to reduce its lumen due to surrounding tissues with edema (lymphogenic, inflammatory, etc.).

The causes associated with nerves include, in particular, diseases in which the volume of nerve membranes increases: metabolic and endocrine diseases – for example, diabetes mellitus, hypothyroidism; some infectious diseases (brucellosis, herpes), tumors of the nervous system, systemic connective tissue diseases (rheumatism, rheumatoid arthritis). Excessive physical exertion in certain areas can also injure the nerve sheaths and cause them to swell, nerves can be compressed in the muscle channels when the muscles forming the channel are overstressed. This is how “professional” tunnel syndromes arise in athletes, musicians, during prolonged work at the computer.

This is the mechanism of development of carpal tunnel syndrome (carpal tunnel syndrome, carpal tunnel syndrome), which is sometimes incorrectly referred to simply as “tunnel syndrome”, because it is the most common of tunnel neuropathies. The pathogenesis of the disease consists in compression of the median nerve in the carpal canal by the muscles responsible for flexion and extension of the hand, when they are overstressed. Carpal tunnel syndrome is an occupational disease of pianists, drummers, artists, people who work with a computer keyboard for a long time.

The defeat of the fourth plantar finger nerve of the foot, or Morton’s metatarsal neuralgia, can be triggered by overstrain of the foot muscles during prolonged wearing of high-heeled shoes.

Indirectly, tunnel syndrome can be caused by vascular pathology: with spasm, compression or thrombosis of a vessel, ischemia of the tissues supplied by it occurs, ischemia is accompanied by edema (including perineural tissues) and can cause compression of the nerve in the canal. This mechanism develops, in particular, facial nerve neuropathy, or Bell’s palsy, in the pathology of the shilosoceoid artery.

The cause of compression of the spinal nerve roots can be osteochondrosis of the spine, the presence of a cervical rib (for this reason, there is a syndrome of stair muscles, or scalenus syndrome).

When the nerve roots of the sacral spinal cord are compressed, there is swelling of the piriformis muscle, which leads to compression of the sciatic nerve and provokes piriformis syndrome.

The superficially located external cutaneous nerve of the thigh can be squeezed by tight clothing or adipose tissue with its excessive development, this leads to the development of the so-called paresthetic Roth meralgia.

Tunnel neuropathies of iatrogenic origin are considered separately – for example, injectable ones that develop during nerve compression by infiltrate formed as a result of medical manipulations during intravenous injections. Tunnel syndromes also develop due to prolonged forced position of the limbs during medical interventions (for example, with prolonged intravenous infusions).

SYMPTOMS OF TUNNEL NEUROPATHY
When a nerve is compressed in the anatomical channel, the transmission of electrical impulses along nerve fibers is disrupted, that is, the function of the nerve is completely or partially. The manifestations of the disease will depend on the function performed by a particular nerve (or part of the nerve fibers).

Most nerves are mixed, that is, they contain both sensitive and motor fibers, therefore, when they are affected, there is a violation of sensitivity in the innervated area (anesthesia or hypesthesia, paresthesia), and a violation of the innervated muscles (difficulty or inability to move, muscle atrophy, fasciculation).

Some formations also contain vegetative fibers, the traumatization of which leads, for example, to vascular spasm in the innervated zone (for example, when compressing the trunks of the brachial plexus, vegetative-vascular disorders occur in the arm – a feeling of numbness, a decrease in temperature and pallor of the skin, sweating, pain).

However, the most common complaint of patients with tunnel syndromes when contacting a doctor is pain along the nerves at rest and during movements, characterized as neuralgia.

DIAGNOSIS OF TUNNEL SYNDROMES
If tunnel neuropathy is suspected, you should contact a neurologist.

The diagnosis is made on the basis of the clinical picture and the examination.

Under the supervision of a neurologist, various kinds of active and passive movements are performed in the affected part of the body and their characteristics are evaluated. The appearance of sensitivity disorders, autonomic disorders, difficulty or inability to move in the area of nerve innervation indicate the presence of neuropathy in the patient.

electroneuromyography, changes in the tissues of the musculoskeletal system – radiography, CT, MRI – allows to evaluate the conduction of impulses along the nerve.

Therapeutic and diagnostic value has novocaine-hydrocortisone test (injection into the intended area of nerve compression).

TREATMENT OF TUNNEL SYNDROMES
Therapy involves influencing the cause of the syndrome. These can be muscle relaxants, decongestants, anti-inflammatory drugs, depending on the etiology of the disease.

A symptomatic and etiotropic effect is exerted by novocaine-hydrocortisone blockade.

If drug treatment does not give a positive result, surgical intervention is indicated – decompression and / or neurolysis.

If the tunnel syndrome is of a professional nature, it is recommended to change the work regime.

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