An outpatient with hand numbness: old prejudices, new strategies of differential diagnosis and treatment

Abstract

To search for 'diagnostic masks' of tunnel syndrome (TS) of the upper limbs and evaluate the efficacy of the antiacetylcholinesterase agent ipidakrine in the treatment of TS in a polyclinic. An analysis of outpatient cards showed that 597 people had complaints of numbness in their hands (23.9% of all neurological pathology). After exclusion of patients with vascular, demyelinating pathology, somatoform disorders, 92 people, who previously had the diagnosis of osteochondrosis, were first-time diagnosed with TS of upper limbs with mild to moderate severity. Kruskal-Wallis' nonparametric analysis of variance revealed homogeneity of clinical and instrumental manifestations in all patients. Patients were divided into 2 comparable groups: the control group (n=42), which received traditional therapy and the main group (n=50), which additionally received ipidacrine. The follow-up clinical-neurophysiological examination was carried out 4 weeks after treatment. A significant improvement was revealed during the use of ipidacrine in addition to the traditional therapy, despite the short period of drug administration. Positive dynamics was also observed in the group receiving traditional therapy, but no significant differences were recorded between baseline and after treatment. The key 'diagnostic masks' of TS are various syndromes caused by spinal osteochondrosis. The high efficacy of ipidacrine in the complex treatment of patients with mild to moderate TS is confirmed.