Symptom >> Surgical >> Neurosurgery

Radiating pain in thumb, food and middle finger

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction At the proximal edge of the wrist ligament, the median nerve is slammed with a finger. The positive pain of the thumb, the food, and the middle finger are the clinical diagnosis of carpal tunnel syndrome. Carpal tunnel syndrome is a corresponding clinical symptom caused by compression and stimulation of the median nerve in the carpal tunnel. Any factor that increases or increases the content of the carpal tunnel or reduces the volume of the carpal tunnel can cause the disease. The carpal tunnel is a bone fiber tube in the palm of the hand. The flexor hallucis longus and the four flexor digitorum tendons, the four flexor digitorum tendons and the median nerve enter the hand through this tube. The carpal tunnel is on the side of the palm of the wrist and consists of the carpal bone and the transverse ligament of the wrist. The transverse ligament of the wrist is tough and the proximal margin is thickened, which is the main factor for compressing the median nerve. The median nerve is superficially located in the carpal tunnel and is easily compressed by the transverse ligament of the wrist, causing damage.

Cause

Cause

The onset of carpal tunnel syndrome is associated with chronic injury. Hand and wrist are prone to disease when the labor intensity is high.

(1) Chronic injury can cause tendon, synovium and nerve edema in the carpal tunnel, and there will be aseptic inflammation and secondary fibroplasia. Hypertrophy of the transverse ligament of the wrist, tissue edema in the carpal tunnel, and fibrosis can cause compression of the median nerve.

(2) Wrist fracture, dislocation, and malunion reduce the volume of the carpal tunnel and compress the median nerve. This is also a common cause of carpal tunnel syndrome.

(3) carpal tunnel masses, such as ganglion cysts, hemangioma, lipoma, etc., can compress the median nerve, causing carpal tunnel syndrome.

Therefore, carpal tunnel syndrome is caused by a variety of reasons. Although the performance of the median nerve in the carpal tunnel is compressed, the cause is different.

Examine

an examination

Related inspection

Wrist test

If carpal tunnel syndrome is suspected, the following tests should be performed to confirm the diagnosis:

1Tinel sign: Use the finger to slam the median nerve at the proximal edge of the wrist ligament. The thumb, food, and middle finger have positive radiation pain.

2 wrist test: the elbow rests on the table, the forearm is perpendicular to the tabletop, and the two wrists are naturally palmar. At this time, the median nerve was pressed to the proximal edge of the transverse carpal ligament, and the carpal tunnel syndrome quickly became painful.

3 Cortisone test: Hydrocortisone is injected into the carpal tunnel, and pain relief can help to confirm the diagnosis.

4 tourniquet test: inflation of the sphygmomanometer to 30 to 60 seconds above the systolic pressure can induce finger pain is positive.

5 Stretching wrist test: Maintaining the wrist in the over-extension position, and the pain is positive immediately.

6 acupressure test: positive pressure at the median nerve compression point near the lateral edge of the transverse ligament of the wrist with finger pressure can induce finger pain.

7 median nerve conduction velocity. Normally, the median nerve has a motor fiber conduction velocity from the proximal wrist transverse to the thumb to the palm muscle or the thumb abductor muscle that is less than 5 microseconds. If it is longer than 5 microseconds, it is abnormal. Carpal tunnel syndrome can be up to 20 microseconds, indicating damage to the median nerve. Surgical treatment should be considered for conduction times greater than 8 microseconds.

Diagnosis

Differential diagnosis

Finger pain or tenderness is a clinical manifestation of peripheral neuropathy syndrome or enteric dermatitis. Awakening of your fingers after numbness or burning pain.

Finger numbness: The sensory nerve of the finger is distributed by the nerve roots separated by the cervical spinal cord to the hands and fingers. When the nerve damage occurs in some parts, inflammation, tumor, pressure, etc. cause abnormalities, fingers appear. Numbness.

The end of the finger continues to symmetry and stinging numbness: the disease is associated with vitamin B12 deficiency. Myelin is a structure that promotes nerve impulse conduction around the nerve, and vitamin B12 is an essential coenzyme for myelin and nucleoprotein formation. Vitamin B12 deficiency causes myelin synthesis disorder and causes neurological and psychotic lesions; and vitamin B12 is also involved in hemoglobin. Synthetic, so lack of can lead to anemia.

The ingested vitamin B12 must be combined with the internal factors secreted by the cells in the stomach to form a stable complex that will not be absorbed by the intestinal bacteria and absorbed at the distal end of the ileum. Obstacles in any part of vitamin B12 uptake, absorption, binding and transport, such as congenital defects of endogenous factor secretion, atrophic gastritis, postoperative gastrectomy, primary intestinal malabsorption, ileal resection, etc. Causes vitamin B12 deficiency, causing clinical symptoms.

Fingers are stiff and painful: rheumatoid arthritis, often involving the proximal knuckles of the fingers, with morning stiffness (jammy fingers in the morning, difficulty in making fists), usually multiple joint pains, often symmetry, migratory specialty. May also be proliferative arthritis, generally older, more than 40 years old, X-ray examination has bone hyperplasia.