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First, peripheral neuritis is a disease in which the nerves themselves are affected.The most common cause of its occurrence is diabetes. In addition, there may be inflammation, ischemic disease*, fungal infections, toxic substances, neuritis caused by trauma, etc. The neurology department will treat the disease accordingly.
*Hermogeneous disease: Any disease caused by a decrease or cessation of blood flow
Second, compressive peripheral neuropathy is a disease in which nerves are intact but cause problems with nerve function by stimulating nerves from the outside. There may be a variety of causes, such as inflammation of the surrounding tissues, arthritis, trauma or tumors, or calcification.
The typical symptom of compressive peripheral neuropathy is numbness in the area of pressure and the area where it runs from the body to the distal direction. Symptoms such as numbness are triggered. Symptoms begin with numbness, followed by loss of sensation and weakness.
There are two main types of hematomopathy: arteriopathy and reflux phlebopathy. In the case of reflux phlebopathy, symptoms similar to neuropathy may occur.
The difference is that in the case of reflux phlebopathy, the symptoms actually improve when the reflux is pressed, but in the case of compressive neuropathy, the symptoms worsen when pressed. The reason for this is that in the case of compressive neuropathy, pressing on the area in a situation where it is already pressed is to increase the pressure.
The first is a herniated disc or arthritis in the neck.
It is caused by pressure on the nerve in the area from 1 to 2 in the picture above. Symptoms include numbness, weakness, and numbness in the arms.
Second, thoracic outlet syndrome
The rib cage outlet is the area that passes from the chest to the arm. It occurs when the muscles in the neck area, the collarbone, and the nerves that pass under the pectoralis minor, which is the muscle in the chest underneath it, are compressed. Thoracic outlet syndrome may not have a familiar name, but it is a condition with a high incidence.
Numbness, weakness, and pain in the hand when using the arm are typical symptoms.
Because these symptoms are similar to those of a herniated disc in the neck, it is sometimes treated for a herniated disc in the neck. If, despite this, there is no improvement in the symptoms, it is thoracic outlet syndrome.
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There are five nerves that go to the arm, starting from the inside of the body.
1. Axillary nerve
2. Myodermal nerve
3. Median nerve
4. Ulnar nerve
5. Radial nerve
Among them, the most common disease caused by problems with the median nerve is carpal tunnel syndrome. Shrinking of the shriveled muscle at the bottom of the thumb is a typical symptom of carpal tunnel syndrome. According to statistics from the Health Insurance Review and Assessment Service, about 180,000 patients are treated for carpal tunnel syndrome every year in Korea. About 80% of them are women, and the most common cases occur in people in their 50s. |
There are also anatomical factors such as tumors and abnormal muscles, systemic factors such as pregnancy and obesity, and occupational factors such as employees of meat processing companies, but in most cases, they are idiopathic factors of unknown cause.
Most of them progress gradually. Most carpal tunnel syndrome is chronic, and the sequence is numbness, numbness, and muscle atrophy. At the time of treatment, recovery is carried out in the same order.
There are two main ways to diagnose carpal tunnel syndrome.
First, the physical examination method
After listening to and feeling the patient's symptoms, a test called a 'Phalen test*' is performed.
*Phalen test: Put your hands in a position with the backs of your hands facing each other and see if your symptoms worsen.
Second, neuromyography
Neuroelectromyography is a test in which wires are connected with instruments to check the smoothness of the nerves. It is a useful test that can determine the degree of nerve damage and check the degree of nerve recovery after treatment, as it allows you to quantify the degree of nerve damage by quantifying whether the nerve is communicating well, amplitude, speed, etc. It is also a helpful test for differentiating neuropathy that appears in various parts of the body at the same time
If the cause is obvious, the first step is to eliminate the cause. If it is accompanied by a disease such as ossification, which causes a certain area to harden, it should be removed. However, the cause is often unclear. When the symptoms began and how advanced they are, the following treatment options are determined based on a combination of factors.
First, conservative treatment
In the early stages, when numbness is the main symptom, conservative treatment is first tried instead of surgery. This means using less hands, wearing a brace, or physical therapy to relieve symptoms.
Symptoms can be alleviated by using anti-inflammatories, nerve medications, and vitamins, and steroids can be injected into the carpal tunnel to reduce inflammation in the surrounding tissues to reduce pressure and relieve symptoms.
However, this type of treatment is only useful for the early treatment of the disease, and the effect of the treatment may be limited as the disease progresses.
Second, surgical treatment
Surgical treatment may be considered if the disease has progressed to the late stage of muscular atrophy and if there is no improvement or recurrence of symptoms after conservative treatment. When the transverse carpal ligament that surrounds the nerve is enlarged and the carpal tunnel space narrows, it is a condition that cannot be resolved with medication, and this is called "irreversible gradual thickening."
In these cases, treatment is given to open the ligaments. The surgery involves making an incision in the palm of the hand and releasing the carpal tunnel and the surrounding median nerve.
In most cases, the numbness will gradually disappear within 6 weeks of surgery, and the numbness will gradually recover over a period of 6 months to 1 year. And the symptoms of muscle weakness will gradually recover over 1~2 years. There may also be pain that lasts for up to three months after surgery, called 'pillar pain*', which is a natural pain that occurs when the ligaments are opened and the nerves move upwards.
*Pillar pain: Pain persists for several months when you place your hand through the palm of your hand.
The postoperative recurrence rate is about 1%, and if you exert too much force or do anything that may compress the surgical site within 3 months, a lot of scar tissue will form. In this case, the thickened scar tissue can press on the nerve and cause irritation, which can lead to recurrence.
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