TUNNEL SYNDROMES —
the group of mononeuropathies (defeats of separate nervous trunks), to-rykh is the reason a compression and the related ischemia of nervous trunks in patholologically the changed fibrous and fibrous and bone canals (so-called tunnels), through to-rye these trunks pass.
The compression of nervous trunks arises at a thickening of the fibrous fabric surrounding a nerve, its razvolok-neniya, hypostasis and at the so-called stenosing tendovaginitis (see the Tendovaginitis). Development of these changes is promoted by professional microtraumas (e.g., at bricklayers, loaders, milkmaids, polishers, etc.), nek-ry physiological and pathological changes of the hormonal status (e.g., at pregnancy, aging of an organism, a hypothyroidism, an acromegalia), and also the increased ability to release of oradikshshn substances, a histamine. heparin, etc. In nervous trunks, especially in the sites of a nerve adjacent to a zone a stenozirova-niya, spindle-shaped thickenings are formed; in fibers of a trunk occur various iatomorfol. changes (from demyelination before fragmentation of axial cylinders and disappearance of axons).
Clinically T. pages are shown by symptoms of irritation and loss of functions in the zone innervated by the restrained nerve, and also constant or periodic pains in the field of the wounded fibrous structures, morbidity at stretching, pressure, effleurage on them. These symptoms can amplify after an exercise stress or at night in connection with changes of blood supply of the affected nerves. Patients complain of paresthesias (see) and pains; in the respective sites of skin reveal hyper - or a hypesthesia (see Sensitivity), sometimes with a hyper-patichesky shade; weakness, a hypotrophy of muscles with signs of denervation at an elektromio-graphic research are noted, reduction of speed of carrying out an impulse on a nerve distalny zones of a compression. At percussion in the place of a compression pains in a zone of an innervation of the struck trunk (Tinel's symptom) amplify. The current of tunnel syndromes is more often chronic, progressing.
K T. pages carry all compression neuropathic syndromes, e.g. a piriformis-syndrome (see), syndromes of a long fibular muscle, lower oblique muscle of the head, small chest and front ladder muscles (see the Scalene a syndrome), and also a compression of a facial nerve or branches of a trifacial in bone channels of a skull, a side cutaneous nerve of a hip in the fibrous channel in a wide fascia of a hip (see Roth a disease).
The following T are most widespread. page. The syndrome of a compression of a nadlopatochny nerve (a syndrome of nadlopatochny dredging) develops at infringement of a nerve under an upper cross ligament of a shovel, in its cutting (fig., a). It is characterized by a hypotrophy over - and podostny muscles of a shovel, dystrophic changes and pain in a shoulder joint; sometimes also the are tr and that accompanies humeroscapular nep
The syndrome of a compression of an elbow nerve under the collateral sheaf tense between an elbow shoot and a medial epicondyle of a humeral bone is shown by pain and paresthesias in an elbow half of a brush, the IV—V fingers, weakness, and sometimes and an atrophy of small muscles of a brush.
C11 of N d rum a lump] f Ross and 11 not re a dny interosseous nerve, a palmar (motive) branch of a median nerve (a pron that rn ohm e d news agency and a mustache of N y y with in d r< >m) develops at infringement of a trunk of a nerve in proximal department of a forearm between heads of a round ironator and is shown by a hypotrophy and weakness of muscles — deep sgibatel of the I—III fingers, especially weakness nail a falant of I and II fingers, and also muscles-nrona-torov of a brush.
The syndrome of a compression of a back interosseous nerve (motive branch of a beam nerve) is caused by its infringement under aponeurotic edge of a proximal portion of a short beam razgibatel of a wrist, directly distalny an elbow or in a crevice of a muscle instep support of a forearm (fig., b); it is shown by pain in extensor muscles of a forearm; the epika but silt and volume is sometimes combined with humeral outside (see).
The syndrome of a compression of a deep branch of an elbow nerve arises at infringement of this branch at the level of pea-shaped or ankyroid bones (fig., c), at the same time the hypotrophy and weakness of interosseous muscles, worm-shaped muscles
of the III—IV fingers, an adductor of the I finger, and also sometimes develops and mice, giving the V finger, at the same time pains can not be or it extends to all brush.
The syndrome of a compression of a median nerve under a cross ligament of a wrist (a syndrome of a carpal tunnel) represents the most widespread T. to page, a thicket it is observed at women aged 40 years are more senior. the compression of a trunk occurs between the wide sheaf covering deepening of a wrist and the cross ligament of a wrist holding sinews of sgibatel (fig., d). The main symptoms are paresthesias and pains in the I—III, and sometimes and in all fingers of a hand, pains amplify in horizontal position, during the lifting of a hand up; during the progressing of a compression paresis and a hypotrophy of muscles of an eminence of a thumb develop.
The syndrome of a compression of the general fibular nerve a sinew of a long fibular muscle at the level of a neck of a fibular bone is shown by weakness of razgibately foot and its fingers, an otvisaniye of foot with turn of its knutra, a hypesthesia of skin of a dorsum of foot and anteroexternal surface of an average and lower third of a shin.
A syndrome of a compression of a tibial nerve in an internal lodyzhech-
of Fig. The diagrammatic representation of mechanisms of development of some tunnel syndromes (the dashed line designated the squeezed site of a nerve): and — a prelum
of a nadlopatochny nerve in cutting of a shovel under an upper cross ligament of a shovel: 1 — the supraspinal muscle (is cut), 2 — a nadlopatochny nerve, z — an upper cross sheaf over cutting of a shovel, 4 — an awn of a shovel, 5 — the lower cross ligament of a shovel, 6 — a small round muscle, 7 — the podostny muscle (is dissected away and turned away), 8 — a shovel; — a prelum of the deep branch of a beam nerve pro-butting an instep support and a back interosseous nerve under a short beam razgibatel of a wrist: 1 — a humeral muscle, 2 — a beam nerve, z — the humeroradial muscle (is cut off), 4 — a superficial branch of a beam nerve, 5 — a deep branch of a beam nerve, 6 — an instep support, 7 — the short beam razgibatel of a wrist (is dissected away), 8 — a back interosseous nerve, 9 — muscular branches of a back interosseous nerve, 10 — the razgibatel of fingers (is dissected away and turned off); in — a prelum of a deep branch of an elbow nerve on a palmar surface of a brush: 1 — an elbow nerve, 2 — a pea-shaped bone, z — the retinaculum of sgibatel of a wrist (is cut), 4 and 7 — a deep branch of an elbow nerve, 5 — a pea-shaped and metacarpal sheaf, 6 — a hook of an uncinatum, 8 — the muscle opposing a little finger; — a prelum of a median nerve in a carpal tunnel under a retinaculum of sgibatel: 1 — a median nerve, 2 — an elbow nerve, z — sinews
of sgibatel of fingers, 4 — a retinaculum of sgibatel.
the number the channel (the tarzalny channel) is characterized by paresthesias,
howled owing to a prelum of this nerve under the sheaf tense between heads of the third and fourth plusnevy bones (see Mortoiov-s to and I am m e t and t are zal N aya the N ev r is scarlet and I).
Differential diagnosis with other mononeuropathies is carried out taking into account local manifestations
by the burning or aching plantalgias and fingers, especially at pronation and extension of foot.
A syndrome of a compression of the 4th bottom a manual nerve of a razvineyroosteofibroz in a zone of infringement of a nerve, Tinel's symptom, and also on the basis of the yielded elektromio-graphic research and results of a research of conductivity on the struck nervous trunk.
Treatment consists in repeated introduction of a hydrocortisone to places of a compression of nervous trunks, and also in a neurolysis (see) and a section of the fibrous fabric squeezing a nerve.
The forecast at active rational treatment, as a rule, favorable.
Bibliography: N. I. bikes and Goal-d ying L. B. The stenosing tendovaginitis in a wrist, Noz. hir., t. 11, No. g of page 87, 1930; B of e r z and N sh Yu. E., Bre-maniye E. B. and C and p and r with about N e R. T. Sindr of a carpal tunnel, an etiology, a pathogeny, Riga, 1982; B of p e m of An and with E. B, the Syndrome of a carpal tunnel and its treatment, Riga, 1964; And p e the Central Committee and I am M. V., etc. Little-known forms of compression neuritis of upper extremities, Saturday. nauch. works of hospital of Ya. M. Sverdlov, century 2, page 142, L.,
1970; Popelyansky Ya. Yu. Ver-tebrogennye of a disease of a nervous system, page 203, Kazan, 1981; G. I. Saba foxes, etc. Peripheral mechanisms of a pathogeny of an epileptiform neuralgia, Zhurn. neuropath, and psikhiat., t. 82, century 4, page 505, 1982; E l to and M. A. and Li A. N. D. The stenosing tendovaginites of a wrist and fingers, L., 1968; In e-n i n i A. Das Karpaltunnelsyndrom und die iibrigen Kompressionssyndrome des Nervus medianus, Stuttgart, 1975; Handbook of clinical neurology, ed. by P. J. Vinken a. G. W. Bruyn, v. 7, p. 285, v. 8, p. 525, Amsterdam — N. Y., 1975; To
o-p e 1 1 H. P. a. Thompson W. A. L. Peripheral entrapment neuropathies, N. Y.,
1976. Ya. Yu. Popelyansky.