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Pain / numbness caused by peripheral nerves

Numbness and pain in the limbs can be caused by pressure on the nerves in the spinal cord, as well as peripheral nerves (nerves after branching from the spinal cord).

We will explain the nerves that are often seen in daily practice (nerves that are easily compressed) and the symptoms at that time. I chose nerves that are particularly vulnerable. If you are suffering from pain, numbness, weakness, etc. similar to those described below, the cause may be peripheral nerves.

If applicable, we recommend that you visit the clinic once.

Carpal tunnel syndrome

At the base of the wrist, there is a space called the “carpal tunnel” surrounded by bones and ligaments. The median nerve and the tendons of the muscles that bend the fingers of the hand pass through it. The ligament that looks like a lid is the lateral carpal ligament. (Figure: Cross section of right wrist)

赤線枠内のスペースを、手根管と呼びます

Carpal tunnel syndrome is a disorder of the median nerve that occurs when the median nerve is compressed for some reason in this space called the “carpal tunnel.” People who are on dialysis, tumors and masses may press on the nerves, but most people do not know what causes the nerves to be compressed. However, it tends to be more common among menopausal women and those who work hard with their hands.

(Symptoms)

□ Numbness and pain appear in the thumb, index finger, middle finger, and half of the ring finger (thumb side).

□ Numbness subsides when you sway your wrist.

□ Numbness becomes tight when driving a bicycle or motorcycle, or when sleeping.

□The base of the thumb becomes thinner

(Therapy)

First, take a medicine to remove numbness.

If the effect is inadequate, treatment such as median nerve block (a pain-relieving drug is injected into the carpal tunnel) is given.

If the effect is insufficient even if you take the medicine or block injection, or if it interferes with your life, we will consult with you about surgery..

Endoscopic carpal tunnel release

Surgery involves cutting the transverse carpal tunnel ligament, a ligament that resembles the lid of the carpal tunnel (see figure above) to eliminate pressure on the median nerve.

Common surgery is to make a 3 cm skin incision in the palm and then cut the ligaments. Although it is a well-established procedure that has been performed for a lomg time, the pain of scratches may remain on the palm after surgery.

At our hospital, we have also introduced an endoscope for carpal tunnel surgery.

It is a method of cutting the ligaments through a thin scalpel under the skin while checking the nerves and ligaments with an echo and checking with an endoscope inserted next to the median nerve.

injecting the drug solution while checking the median nerve with ultrasound
surgical wound is about 1cm length
cutting the transverse carpal ligament while checking inside of the carpal tunnel with endoscope

The size of the scratch is about 1 cm.

From the day after the surgery, you can do detailed work. There is almost no pain left in the palm.

Piriformis syndrome

The figure shows the right hip as seen from behind.

The piriformis muscle passes through a hole in the bone called the great sciatic foramen, and the sciatic nerve passes under it. When the piriformis muscle becomes tense or stretched, the underlying sciatic nerve is compressed, causing pain in the sciatic nerve, which is called piriformis syndrome.

(Symptoms)

□ Strong pain appears on the back and outside of the thighs from the buttocks.

□ The pain becomes stronger especially when sitting.

There are many patients who have not been diagnosed, because nerve compression cannot be detected by imaging tests such as MRI.

(Therapy)

Perform ultrasound-guided sciatic nerve block.

For those who have been blocked and the pain has eased, we will teach you to stretch the piriformis muscle. This is to prevent the piriformis muscle from compressing the sciatic nerve in the future.