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TUNNEL NEUROPATHIES OF THE UPPER EXTREMITIES:
IMPROVING TREATMENT EFFICACY THROUGH ULTRASOUND
THERAPY INTEGRATION
Hasanov Alisher Yuryevich
Independent Researcher, Department of Neurology
Samarkand State Medical University
Djurabekova Aziza Takhirovna
Doctor of Medical Sciences, Professor
Head of Department of Neurology
Samarkand State Medical University
Mavlyanova Zilola Farkhadovna
Doctor of Medical Sciences, Professor
Head of Department of Medical Rehabilitation,
Sports and Traditional Medicine
Samarkand State Medical University
https://doi.org/10.5281/zenodo.16527789
Abstract.
Tunnel syndromes of the upper extremities represent a group of
compression-ischemic neuropathies caused by compression of peripheral
nerves in anatomically narrow spaces. This pathology occupies a leading
position in the structure of occupational diseases of the nervous system,
comprising up to 35-40% of all cases of peripheral nerve damage in working-age
individuals. Epidemiological studies in recent years indicate a steady increase in
the incidence of tunnel syndromes, which is associated with changes in the
nature of work activity, an increase in the proportion of work requiring
prolonged static tension of the muscles of the hand and forearm, as well as the
widespread introduction of computer technologies in professional activities. The
most common forms are carpal tunnel syndrome (median nerve compression),
cubital tunnel syndrome (ulnar nerve compression), and Guyon's canal
syndrome. According to international statistical data, the incidence of carpal
tunnel syndrome is 1-3 cases per 1000 population per year, with women
suffering 3-5 times more often than men.
Keywords:
tunnel syndrome, upper extremities, ultrasound therapy
Introduction.
The pathophysiological mechanisms of tunnel syndrome
development include the complex effects of mechanical and ischemic factors.
Primary compression of the nerve trunk in the bone-fibrous canal leads to
impaired microcirculation, development of local edema, and increased
intratunnel pressure. This creates a vicious circle that aggravates compression
and leads to progressive impairment of nerve function. At the morphological
level, segmental demyelination, disruption of axonal transport, and in severe
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cases, Wallerian degeneration of axons distal to the compression site are
observed. The clinical picture of tunnel syndromes is characterized by staged
development. In the initial stages, sensory disturbances predominate in the form
of paresthesias, hypoesthesia, and pain syndrome, which tend to intensify at
night. As the disease progresses, motor disorders join in the form of weakness
and atrophy of muscles innervated by the affected nerve, which significantly
limits work capacity and quality of life of patients.
Research objective:
to study and evaluate the diagnostic capabilities of
clinical-neurological examination, electroneuromyography (ENMG) with
subsequent ultrasound therapy in the complex treatment of upper extremity
tunnel syndromes, with the aim of increasing the effectiveness of combined
therapy and improving functional outcomes in patients.
Materials and Methods.
The study included patients with tunnel
syndrome, with an average age of 34±5 years, totaling 47 people (main group).
Women comprised 58.5% of the examined group, men accordingly 41.5%.
Patients had different spheres of activity: midwives (nurses in delivery rooms),
obstetrician-gynecologists; bankers working mainly at computers; painters,
installers; auto mechanics; that is, patients were involved in intensive hand
loading while performing professional and domestic activities. In 89% of cases,
patients had signs of disease on the right side, on the left side accordingly 11%.
The average disease duration was more than 12 months from initial symptoms.
Disease comorbidity was noted in several patients in the form of chronic
diseases: mainly overweight 27% (1st-2nd degree obesity); ENT pathology
(sinusitis, frontal sinusitis) in 1.5%; arterial hypertension in two patients. From
the main group of patients with tunnel syndrome, separate subgroups were
identified by lesion level: carpal-type tunnel syndrome was most common, 32%.
Cubital-type tunnel syndrome was second in frequency, 28.8%. Syndromic
disorders were noted as: carpal tunnel syndrome, peroneal, pronator syndrome,
or combination of the presented syndromes. The research was conducted at the
Multidisciplinary Clinic of SamSMU, Regional Hospital of Samarkand city, and
the rehabilitation center of SamSMU during 2024-2025. All patients signed
consent for the study. The healthy control group consisted of volunteers from
among persons who applied to the MC SamSMU polyclinic for preventive
examination, of identical age and gender, totaling 31 people. All participants
without exception underwent clinical-neurological examination, additional
diagnostic measures, standard (blood analysis, ECG, ENMG, hand vessel
ultrasound with pain localization); separately, all patients in the main group
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underwent testing for diagnosis of disease specificity and type: Tinel's test,
Phalen's test, tourniquet test. Pain syndrome during the study was recorded
using the VAS scale. Additionally, the Boston Carpal Tunnel Syndrome
Questionnaire (BCTSQ) was used. Statistical data processing was performed on a
personal computer using statistical software with mean and standard deviation.
To assess the significance of parameter differences between some parameters in
patient groups, the Mann-Whitney U-test was used. The significance criterion for
differences (p) was taken as <0.05.
Results.
All patients in the main group at the time of application to the
polyclinic and hospitalization had identical complaints: pain in hands with
irradiation to fingers (1st, 2nd, 3rd, and 4th), difficulty in motor activity in
hands. At the same time, painful sensations most often intensified during sleep
or pain symptoms intensified with load (considering that predominantly disease
signs were localized in the working hand). With objective control of sensory
disturbance, signs of hypoesthesia were noted, totally over the entire hand
surface in 79% of cases; in other cases, changes in tactile sensitivity were not
noted. During neurological examination, in 95% of cases, weakness and motor
function disturbances in hand muscles, numbness sensation in fingers were
discovered. Tinel's test indicators (tapping causes tingling and pain) in the
examined main group was positive only in 27%, this in 13 patients. While
Phalen's test (hand flexion for 1 minute) was positive in 21 patients, which
constituted 44.6%, with hand pain signs noted on average at 30 seconds. Boston
questionnaire coefficient data showed the following results: symptom severity
(SSS) averaged 3 points; functional impairment (FSS) averaged 5 points,
indicating significant deviations in nerve impulse conduction. 39% of patients
experienced pain under temperature fluctuation effects (high or low). 66% of
patients complained of pain (like electric shock) when pressing with a finger in
the numbness zone. Continuous pain character was complained of by patients in
smaller numbers: 19.1%. Even less frequently, attack-type pains were noted:
12%. In 33% of cases, patients indicated pain irradiation to the proximal zone.
Standard pain presentation on the VAS scale revealed an average score of 6
points in most cases. The tourniquet test is considered not indicative for tunnel
syndromes when considered separately; however, in the examination complex it
is necessary, as a rule, a positive test result confirms the presence of
compression. Autonomic signs of changes were expressed in the following
symptoms: temperature change (either cold or hot hand), skin pallor, marbled
color (only in 2 patients).
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Conclusions.
Diagnostic
significance
of
the
comprehensive
approach. Combined use of clinical-neurological examination with the
application of specialized provocative tests (Tinel's, Phalen's, tourniquet test)
and instrumental research methods (ENMG, ultrasound of nerve trunks) ensures
high accuracy in diagnosing tunnel syndromes of the upper extremities and
allows objectification of the degree of functional disorders. Advantages of
combined therapy. Integration of therapeutic ultrasound with traditional
pharmacological therapy demonstrates statistically significant superiority over
monotherapy with nonsteroidal anti-inflammatory drugs.
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