CLINICAL AND INSTRUMENTAL CRITERIA FOR SELECTING TREATMENT AND REHABILITATION TACTICS IN PATIENTS WITH CARPAL TUNNEL SYNDROME

The clinical relevance of carpal tunnel syndrome is associated with its high prevalence among working-age individuals and the risk of persistent pain, sensory disturbances, and functional impairment of the hand, which may substantially limit patients’ occupational and daily activities. Objective. To identify clinical, neurophysiological, and ultrasound criteria that enable differentiation of carpal tunnel syndrome severity and provide a rationale for selecting the appropriate scope of treatment and rehabilitation measures. Materials and Methods. A total of 147 individuals were examined, including 107 patients with carpal tunnel syndrome and 40 healthy participants who formed the control group. The main group included 57 patients, while the comparison group consisted of 50 patients. Clinical assessment included evaluation of pain using the Visual Analogue Scale, the Boston Carpal Tunnel Questionnaire, an upper extremity function questionnaire, as well as the Phalen, Tinel, and Durkan tests. Electroneuromyography was used to assess sensory and motor conduction of the median nerve, distal motor latency, and motor response ampli­tude. Ultrasound examination included assessment of the median nerve cross-sectional area, echostructure, vascu­larity, edema, tenosynovitis, and impaired nerve gliding. Results. The severity of carpal tunnel syndrome was found to be determined by a combination of clinical impairment, nerve conduction abnormalities, and morphofunctional changes in the median nerve. Mild disease was characterized predominantly by moderate sensory manifestations without pronounced motor deficit. Moderate disease was associated with clinical impairment combined with an in­crease in the median nerve cross-sectional area to 12–13 mm², hypervascularity, tenosynovitis, and impaired nerve gliding. Severe disease was accompanied by marked functional impairment, pronounced electroneuromyographic abnormalities, distal motor latency exceeding 6 ms, and a median nerve cross-sectional area greater than 13 mm². Conclusion. The choice of treatment and rehabilitation tactics in patients with carpal tunnel syndrome should be based not on a single diagnostic parameter, but on an integrated assessment of clinical, electrophysiological, and ultrasound criteria.