Sports and Traditional Medicine

Аннотация

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 188 ACADEMIC RESEARCH IN MODERN SCIENCE International scientific-online conference 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 189 ACADEMIC RESEARCH IN MODERN SCIENCE International scientific-online conference 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 p