Tunnel diabetes or compression-ischemic neuropathy (CIN)
What is tunnel syndrome or compression-ischemic neuropathy (CIN)?
This is a group of diseases, the main reason for the development of which is the compression of a nerve, vessel or neurovascular bundle in the places of anatomical narrowing (tunnels), bone-fibrous or fibro-muscular bed, aponeurotic cracks, as well as hypertrophied ligamentous apparatus. Initially, the role of overstrain of the ligaments and muscles around the nerve, compression, stretching of the nerve, swelling and aseptic inflammation of the vaginal tendons. These phenomena contribute to the proliferation of the walls of the canals, hyperplasia of the connective and fibrous tissue in places of attachment to bone protrusions. Osteofibrosis develops.
What factors accompany the occurrence of CIN?
- osteochondrosis with neurodystrophic diabetes
- congenital narrowness of the channel and anomaly
- chronic injuries (professional microtrauma and overload)
- pathology of the endocrine system (acromegaly, hormonal contraception, lactation hypothyroidism, menopause)
- tunnel post-traumatic strain
- tumor formations
- systemic diseases (rheumatoid arthritis, myeloma, amyloidosis)
- atrophy of subcutaneous fat, exhaustion
What types of compression-ischemic neuropathy exist?
There are acute and chronic compression-ischemic neuropathies.
What are the clinical signs of compression-ischemic neuropathy?
Consider the clinical signs of CIN
| 1 group Local changes |
Tension, pain, hypo- or hypertrophy of certain muscles determined by palpation, pain in the projection of nerves |
| 2 group Neurological disorders |
Sensitivity changes distal to the painful tunnel, hypalgesia, paresis of the hands or feet, individual fingers, muscle atrophy |
| 3 group Vegetative-vascular disorders |
Trophic changes in the skin and appendages, changes in skin temperature, changes in pressure, pulse, regional disorders in the area of nerve innervation |
What are the options for the development of compression-ischemic neuropathy (CIN)?
Possible options for the development of CIN:
- with a predominance of demyelination processes
- with a predominance of vasomotor disorders
What are the stages of compression-ischemic neuropathy (CIN)?
Consider the stages of compression-ischemic neuropathy:
- Irritative – acute CIN
- Irritatively deficient - subacute CIN
- Chronic CIN – deficiency (electrophysiological indicators reduced)
- Deficit-dystrophic CIN (electrophysiological indicators are significantly reduced or absent)
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What examination is necessary for a patient with compression-ischemic neuropathy?
Examination of patients includes a medical history, neurological examination, radiography of the relevant areas, MRI, ENMG.
What is the treatment for compression-ischemic neuropathy (CIN)?
Treatment of compression-ischemic neuropathy in " Medical practice Health " is comprehensive and includes drug therapy:
decongestants, venotonics, analogues of gamma-aminobutyric acid, metabolic and antioxidant agents, anticholinesterase, vitamins with an increased dose of vitamin B6, hormonal or novocaine blockade, resolving topical therapy, muscle relaxants, dehydrating agents, reflex and physiotherapy.
Physiotherapeutic treatment reflexology
Magnetotherapy with variable or pulsating MP
The use of magnetotherapy is indicated in the acute phase! It is justified by a pronounced decongestant, anti-inflammatory effect, stimulation of venous outflow, a beneficial effect on the rheological properties of blood.
Magnetotherapy can be the main treatment method for CIN; its effectiveness has been proven in the acute, subacute and chronic period of the disease. In the case of severe microcirculation disorders (lymphostasis, edema, local venous congestion), we use a frequency of 10 Hz. Magnetic induction parameters – selection-individual! The course of therapy with a daily regimen is up to 7 days.
Segmental laser therapy is indicated due to the action features: biostimulating microcirculation improvement, immunomodulating, analgesic, trophotropic. We apply red (wavelength 0.63 mkm) and infrared LI (wavelength 0.78-0.9 mkm)
The peculiarity of laser therapy – is the ability to combine the application of the procedure directly on the CIN zone and on the segmental zones of the spinal cord: in the case of CIN of the upper limb –C8-Tn2-Tn4, in the case of CIN of the lower limb-Tn12-11-12
Laser puncture is shown in all periods of CIN. The course of treatment is 14-15 procedures every other day or 10 procedures with a daily regimen. Exposure 7-10 minutes.
Segmental electrotherapy
Electropuncture using on the TA along the compressed nerve.
The exposure time and parameters are selected individually. The treatment period is 10 days.
Medication includes counter-current, venotonic, gabapentin derivatives, calcium channel blockers, topical hormone-novocaine blockade, applications.
It is advisable to massage, post-isometric relaxation and kinesitherapy taking into account individual indications.
If ineffective, neurosurgical treatment is recommended.