What is traumatic neuritis. Trauma-induced neuropathy Treatment of post-traumatic neuropathy

• operations
• injuries, including after injection of the drug (post-injection neuritis)
• blows and long clamping
• bone fractures and joint dislocations

Traumatic neuritis (post-traumatic neuropathy), depending on the level and type of nerve damage, will manifest a variety of symptoms: movement disorders (paresis, paralysis) in a particular muscle or muscle group, numbness, changes in sensitivity (intensification, weakening or perversion).

Traumatic neuritis of the ulnar nerve with a fracture of the ulna.

Traumatic neuritis (post-traumatic neuropathy) that causes persistent pain symptoms (neuralgia), or hypesthesia (decrease in sensitivity), or muscle paresis (decrease in strength) takes time and patience and responds well to treatment.

Diagnosis of traumatic neuritis

Neuropraxia is a disease of the peripheral nervous system during which there is a temporary loss of motor and sensory function due to blockade of nerve conduction. Impaired transmission of the nerve impulse in neuropraxia usually lasts an average of 6-8 weeks before its full recovery.

Symptoms of damage to any peripheral nerve in traumatic neuritis consists of motor, reflex, sensory and vasomotor-secretory-trophic disorders. Examination of a patient with traumatic neuritis traditionally begins with the collection of anamnestic information.

Classical electrodiagnostics is of great importance in the system of a comprehensive study of a patient with traumatic neuritis in terms of 2 weeks and later after the injury, helping to separate degenerative from non-degenerative disorders. Thus, the prognosis is also determined to a certain extent, since closed injuries of the nerve trunks, in particular the brachial plexus, accompanied by degeneration, are always doubtful regarding the completeness and quality of the restoration of lost movements, especially in the distal limbs.

Restoration of movements up to a force of 4–5 points after traumatic neuritis is observed only in those muscles in which, during classical electrodiagnostics, reduced electrical excitability or a reaction of partial degeneration of the nerve is detected.

In the reaction of complete degeneration of the nerve after traumatic neuritis, restoration of movement in the muscles is not observed.

In very late periods after nerve injury in traumatic neuritis, the detection of a loss of electrical excitability of paralyzed muscles gives another reason in favor of refusing to operate on the nerves. Earlier than in other areas, the electrical excitability of the muscles of the dorsum of the forearm disappears. Contrary to conventional wisdom, the small muscles of the hand often turn out to be more stable in terms of their ability to respond to current stimulation.

Electromyography is a very promising research method for closed injuries of the brachial plexus, which makes it possible to record the dynamics of changes in the neuromuscular apparatus during the recovery process. The corresponding electromyographic curve with the appearance of previously absent action potentials in traumatic neuritis allows us to expect the restoration of movement long before the first clinical signs of this restoration.

Treatment of traumatic neuritis

Post-traumatic neuropathy of the radial nerve

Radial neuropathy is a pathological process in any part of the radial nerve of different origin. This is one of the often fixed peripheral mononeuropathy, for the development of which a simple abnormal position of the hand during sleep is enough. The pathological process is usually secondary and is associated with muscle stress and injury. There are three levels of localization of neurofiber damage:

• in the armpit;
• middle third of the shoulder;
• in the region of the elbow joint.

Causal factors

1. The compression form is mainly determined as a result of the incorrect position of the hand during sleep. The described "sleep paralysis" usually occurs in alcoholics and drug addicts, as well as in healthy people who fell asleep under the influence of alcohol or after hard work. The application of a tourniquet to the shoulder in order to eliminate bleeding, the presence of neoplasms in the places where the nerve passes, repeated and prolonged sharp bending in the elbow joint during running, conducting or manual work can lead to compression of nerve fibers with the further formation of a pathological condition. Neural compression in the axillary zone is noted during the use of crutches ("crutch paralysis"), compression at the wrist while wearing handcuffs ("prisoner's paralysis").
2. The post-traumatic form can occur during trauma to the humerus, articular joints, dislocation of the forearm, localized fracture of the head of the beam.
3. Pathological changes in the arm: bursitis, synovitis and post-traumatic arthrosis of the elbow joint, RA, epicondylitis of the elbow joint. And rarely, an infectious or intoxication process (poisoning with surrogate alcohol, lead, etc.) can become a causative factor.

Symptomatic picture

Damage in the axillary region manifests itself in the form of a violation of the extension of the forearm, hand and first phalanges of the fingers, the inability to perform the abduction of the thumb to the side. A “hanging” or “falling” hand is typical, which appears during the stretching of the upper limb forward, when the hand does not take a horizontal position and hangs down with the thumb pressed to the index finger. The supination of the forearm and hand is weakened, flexion at the elbow. There is a loss of the extensor elbow and a decrease in the carporadial reflex. Patients complain of slight numbness or decreased sensitivity on the back of the first, second and part of the third fingers. Neurological examination determines the hyposensitivity of the posterior plane of the shoulder, the dorsum of the forearm and the first fingers against the background of preserved sensitive perception of their distant phalanges. In some cases, hypotrophy of the posterior muscle group of the shoulder and forearm is observed.

Pathology in the middle third of the shoulder differs from the above described pattern by the preservation of extension in the ulnar articular joint, the presence of an extensor ulnar reflex and healthy dermal sensitivity of the posterior plane of the shoulder.

The pathological process at the level of the lower third of the shoulder, the ulnar joint and the upper third of the forearm often manifests itself in increased pain and paresthesia on the back of the hand during work. Pathological signs are determined mainly on the hand. Sometimes there is a preservation of sensory perception on the forearm.

Damage at the level of the wrist manifests itself in the form of two main syndromes:

• Turner's syndrome, which is noted during a fracture of the distal end of the radius;
• radial tunnel syndrome occurs during compression of the superficial branch of the radial nerve in the area of ​​the anatomical snuffbox.

Typical numbness of the back plane of the hand and fingers, a sharp pain sensation on the same side of the first finger, which sometimes radiates to the forearm and shoulder. Sensory disorders, as a rule, do not go beyond the boundaries of the thumb.

Diagnosis

The main method for diagnosing a pathological process is a neurological examination - an assessment of the sensory sphere, and the performance of certain functional tests that are aimed at examining functionality and muscle power. At the position of the patient with the limbs stretched forward and with the hands held in a horizontal position, the dangling of the damaged hand is determined. When the arms are lowered along the body and the hands are turned with the palmar surface forward, a supination disorder is observed. When the first finger is abducted with matched palms and the fingers are abducted on the side of the injury, the fingers bend and slide down.

Functional tests and sensory assessment allow for differential diagnosis with pathology of the ulnar and median nerve. Sometimes the pathology is clinically similar to radicular syndrome at the level of CVII.

Electromyographic studies, which reveal a decrease in the amplitude of myopotentials of action, and electroneurographic examinations, which indicate a slowdown in the neuroimpulse along the nerve fiber, will help determine the exact location of damage to neural fibers. It is also important to identify the nature and cause of the pathological process by means of radiography of the bone structures of the hand, hemoanalysis, etc.

Therapeutic measures

The main areas of treatment are:

• Elimination of etiopathogenetic causes in the form of the use of antibacterial, decongestant and anti-inflammatory drugs, as well as detoxification measures, elimination of endocrine disorders. The surgical method is used in case of violation of the integrity of bone structures or reduction of dislocations, etc.
• Supportive vascular-metabolic therapy.
• Normalization of muscle functioning and power - therapeutic massage, physiotherapy exercises, electromyostimulation.

Wrist tendonitis: how and how to treat the hand

Tendonitis is a disease in which tendons become inflamed. As a rule, the disease occurs due to injury, pathology of the joint or a stressful situation. Tendinitis is often accompanied by pain sensations of varying intensity.

Basically, the disease develops in people who lead an active life and in those who have deviations in musculoskeletal development. Wrist tendonitis or styloiditis is a type of inflammatory and dystrophic process in which injury (stretching) of the wrist joints occurs.

This pathology is localized in the zone of connection of the tendons with the styloid process of the ulna or radius.

Appearance factors and symptoms

The main cause of inflammation in the tendons lies in the excessive and intense load on the wrist joint, which in most cases appears as a result of microtrauma and strong physical activity.

If such loads are constant, then degenerative changes occur in the tendons and cartilage tissue, which causes:

1. areas of tissue necrosis;
2. salt deposits (a hard growth that damages soft tissues) that form at the site of a micro-rupture of the tendon;
3. areas with degenerate tendons and cartilage tissue.

In addition, due to the prolonged load on the tendons, the tissues located between them ossify, which causes the formation of osteophytes, bone growths and spikes that contribute to tendosis.

Moreover, tendinitis develops in the presence of:

• reactive arthritis;
• dislocations;
• arthritis
• gout;
• stretching.

In addition, tendinitis of the wrist appears if the profession of a person is associated with a systematic overstrain of the hand. For example, such a pathology often develops in typesetters and pianists.

The main manifestations of inflammation of the wrist are painful sensations localized in the tendons of the hand, which occur during probing or active movement. And when the limb is in a calm state, the pain disappears.

In addition, tendinitis of the wrist is characterized by redness, swelling and an increase in local temperature in the inflamed area. And in the process of moving the wrist of the affected limb through the phonekop or at a minimum distance, a specific crack can be heard.

In addition, due to inflammation of the joint, the tendon hardens and tightens, which leads to partial or complete immobilization of the wrist. At the same time, it is very difficult for the patient to perform characteristic movements with the diseased hand.

Diagnostics

Wrist tendinitis has no distinct symptoms that distinguish it from other pathologies, so diagnosing the disease is not easy. In addition, during the examination, using different devices, it is possible to detect only some manifestations that indicate inflammation of the tendons.

For these reasons, an important component of the detection of the disease is differential diagnosis, thanks to which tendinitis can be distinguished from:

To diagnose styloiditis of the wrist joint, the doctor conducts an examination, during which he determines the localization of pain during palpation and movement of the brush. Moreover, swelling appears in the area of ​​inflammation of the tendon. Moreover, the pain in such a disease is local and appears only when the patient makes hand movements.

In addition, an X-ray examination is carried out. This diagnostic method is effective in the presence of salt deposits (this phenomenon is typical for the late stages of pathology). Also, thanks to radiography, it is possible to identify changes that have occurred with arthritis, bursitis or tendonitis.

Moreover, the doctor prescribes an ultrasound examination. This method is optional, it makes it possible to examine changes and contractions in the tendon structure.

Important in the diagnosis of tendinitis of the wrist is given to laboratory tests, such as taking a blood test for rheumatic tests. This type of diagnosis is prescribed when tendinitis develops due to an infectious or rheumatoid process.

Ultrasonography can also reveal contractions and changes in the structure of the tendon. In the process of conducting this study, an important condition is to observe the direction of the ultrasonic wave.

To determine the presence of inflammation, computed tomography and magnetic resonance imaging of the wrist are not entirely effective methods.

But thanks to such methods, it is possible to identify tendon ruptures and areas where degenerative changes take place, which are treated through surgery.

Treatment

At an early stage of the progression of the disease, its treatment is carried out by a conservative method. In addition, the patient must be kept calm.

In this case, intense physical activity on the tendon fibers of the wrist should be avoided in order to minimize the likelihood of a rupture. In addition, rest is required when the pathology is at the stage of exacerbation.

Moreover, a cold compress should be applied to the affected area. This procedure should be carried out 3-4 times a day. This will help reduce pain and relieve swelling.

In addition, the treatment of styloiditis involves the imposition of a plaster splint and splint. In general, the use of any structures that have the effect of a bandage accelerates the healing process of the joint through its immobilization.

Conservative treatment also includes drug therapy. Basically, the doctor prescribes anti-inflammatory drugs, which include:

• Motrin;
• Hydrocortisone, with which injections are made into the sheaths surrounding the tendons;
• Piroxicam (taken at 10 mg per day);
• Methylprednisol (combine with Lidocaine 1%);
• Ibuprofen (taken at 2400 mg per day);
• Indomethacin (taken three times a day, 50 mg).

In addition, if necessary, the doctor can prescribe a special antibacterial treatment.

Treatment of styloiditis with the help of physical education and massage

After the acute stage of the disease subsides, for a speedy recovery, it is necessary to do special therapeutic exercises. The basis of such physical education is to perform exercises to strengthen and stretch the muscles of the hands of the upper limbs.

When tendinitis of the wrist is in a chronic form, then it is useful to treat with massage. Such therapy activates lymph and blood flow, thereby improving the process of tissue nutrition and providing an analgesic effect.

Massage for tendonitis of the wrist includes:

1. stroking the inflamed area;
2. semicircular and spiral rubbing with the thumbs;
3. stroking the base of the thumbs;
4. kneading the wrist in length and width.

In addition, it is useful to carry out stroking and rubbing movements with the pads of four fingers.

It is worth noting that all techniques must be done slowly, giving each type of movement a couple of minutes. And the total duration of the massage procedure takes about 10 minutes.

Physiotherapy treatment

One of the leading ways to treat tendonitis of the wrist, which has not had time to turn into a chronic form, is physiotherapy.

This treatment includes magnetic therapy, in which low-frequency magnetic fields are applied to the joints of the wrist. This procedure allows you to reduce pain and eliminate swelling and inflammation in the affected area.

Moreover, ultrasound treatment is used to improve the permeability of the skin for the use of topical preparations. Another procedure activates the lymph flow, starts the regeneration process and removes inflammation.

Laser therapy improves metabolism, has an analgesic effect, restores the affected areas of the tendons, removes salts and improves the supply of oxygen to the diseased hand.

In the chronic form of tendonitis, electrophoresis with lidase, paraffin baths, and therapeutic mud for the joints have a positive result.

In addition, shock wave therapy is often prescribed for styloiditis. This innovative treatment method is used when the pathology is in an advanced form in order to exclude surgical intervention. However, shock wave therapy is used after ultrasound and X-ray examination. As a rule, the procedure consists of several sessions (4-6), each of them should take no more than 20 minutes.

When carrying out physiotherapeutic procedures of this kind, energy shock waves of an average degree are used, after which the painful sensations decrease or disappear completely. But after such a physiotherapy procedure, it is necessary to protect the joint from intense and monotonous physical exertion.

© 2016–2018 Treat Joint - All about joint treatment

Please note that all information posted on the site is for reference only and

not intended for self-diagnosis and treatment of diseases!

Copying materials is allowed only with an active link to the source.

Neuritis

Neuritis is an inflammatory disease of the peripheral nerve (intercostal, occipital, facial or limb nerves), manifested by pain along the nerve, impaired sensitivity and muscle weakness in the area innervated by it. The defeat of several nerves is called polyneuritis. Diagnosis of neuritis is carried out by a neurologist during the examination and carrying out specific functional tests. In addition, electromyography, electroneurography and EP study are performed. Treatment of neuritis includes etiotropic therapy (antibiotics, antiviral, vascular drugs), the use of anti-inflammatory and decongestants, neostigmine therapy, physiotherapy, massage and exercise therapy.

Neuritis

Neuritis is an inflammatory disease of the peripheral nerve (intercostal, occipital, facial or limb nerves), manifested by pain along the nerve, impaired sensitivity and muscle weakness in the area innervated by it. Damage to several nerves is called polyneuritis.

Neuritis can occur as a result of hypothermia, infections (measles, herpes, influenza, diphtheria, malaria, brucellosis), trauma, vascular disorders, hypovitaminosis. Exogenous (arsenic, lead, mercury, alcohol) and endogenous (thyrotoxicosis, diabetes mellitus) intoxications can also lead to the development of neuritis. Most often, peripheral nerves are affected in the musculoskeletal canals, and the anatomical narrowness of such a canal may predispose to the onset of neuritis and the development of carpal tunnel syndrome. Quite often, neuritis occurs as a result of compression of the peripheral nerve trunk. This can happen in a dream, when working in an uncomfortable position, during an operation, etc. So in people who move for a long time with the help of crutches, neuritis of the axillary nerve may occur, while squatting for a long time - neuritis of the peroneal nerve, constantly in the process of professional activity flexors and extensors of the hand (pianists, cellists) - neuritis of the median nerve. There may be compression of the peripheral nerve root at the site of its exit from the spine, which is observed with herniated intervertebral discs, osteochondrosis.

Symptoms of neuritis

The clinical picture of neuritis is determined by the functions of the nerve, the degree of its damage and the area of ​​​​innervation. Most peripheral nerves consist of different types of nerve fibers: sensory, motor, and autonomic. The defeat of the fibers of each type gives the following symptoms, characteristic of any neuritis:

• sensitivity disorders - numbness, paresthesia (tingling sensation, "crawling"), decrease or loss of sensitivity in the area of ​​​​innervation;
• violation of active movements - a complete (paralysis) or partial (paresis) decrease in strength in the innervated muscles, the development of their atrophy, a decrease or loss of tendon reflexes;
• vegetative and trophic disorders - swelling, cyanosis of the skin, local hair loss and depigmentation, sweating, thinning and dryness of the skin, brittle nails, the appearance of trophic ulcers, etc.

As a rule, the first manifestations of nerve damage are pain and numbness. In the clinical picture of some neuritis, there may be specific manifestations associated with the region innervated by this nerve.

Neuritis of the axillary nerve is manifested by the inability to raise the arm to the side, decreased sensitivity in the upper 1/3 of the shoulder, atrophy of the deltoid muscle of the shoulder and increased mobility of the shoulder joint.

Radial neuritis can have different symptoms, depending on the location of the lesion. So the process at the level of the upper 1/3 of the shoulder or in the axillary fossa is characterized by the impossibility of extending the hand and forearm and abducting the thumb, difficulty in bending the arm at the elbow joint, paresthesia and decreased skin sensitivity of I, II and partially III fingers. With the arms stretched forward on the side of the lesion, the hand hangs down, the thumb is brought to the index finger and the patient cannot turn this hand with the palm up. Neurological examination reveals the absence of the extensor elbow reflex and a decrease in the carporadial reflex. With the localization of inflammation in the middle 1/3 of the shoulder, the extension of the forearm and the extensor elbow reflex were not disturbed. If neuritis develops in the lower 1/3 of the shoulder or the upper part of the forearm, then extension of the hand and fingers is impossible, sensitivity suffers only on the back of the hand.

Neuritis of the ulnar nerve is manifested by paresthesia and decreased sensitivity on the palmar surface of the hand in the region of half of the IV and completely V fingers, on the back of the hand - in the region of half of the III and completely IV-V fingers. Characterized by muscle weakness in the adductor and abductor muscles of the IV-V fingers, hypotrophy and atrophy of the muscles of the elevation of the little finger and thumb, interosseous and worm-like muscles of the hand. In connection with muscle atrophy, the palm looks flattened. The hand with ulnar neuritis is similar to a “clawed paw”: the middle phalanges of the fingers are bent, and the main ones are unbent. There are several anatomical areas of the ulnar nerve in which neuritis can develop according to the type of tunnel syndrome (compression or ischemia of the nerve in the musculoskeletal canal).

Neuritis of the median nerve begins with intense pain on the inner surface of the forearm and fingers. Sensitivity is disturbed on the half of the palm corresponding to the I-III fingers, on the palmar surface of the I-III and half of the IV fingers, on the back surface of the terminal phalanges of the II-IV fingers. The patient cannot turn his hand palm down, bend the hand at the wrist joint, bend fingers I-III. With neuritis of the median nerve, muscular atrophy of the elevation of the thumb is pronounced, the finger itself becomes in the same plane with the rest of the fingers of the hand and the hand becomes like a “monkey paw”.

Carpal tunnel syndrome - compression of the median nerve in the carpal tunnel and the development of neuritis by the type of carpal tunnel syndrome. The disease begins with periodic numbness of the I-III fingers, then paresthesias appear and the numbness becomes permanent. Patients note pain in the I-III fingers and the corresponding part of the palm, passing after brush movements. The pain occurs more often at night, it can spread to the forearm and reach the elbow joint. Temperature and pain sensitivity of fingers I-III is moderately reduced, atrophy of the thumb elevation is not always observed. There is a weakness in the opposition of the thumb and the occurrence of paresthesias when tapping in the carpal tunnel. Phalen's sign is characteristic - increased paresthesia with a two-minute flexion of the hand.

Lumbosacral plexopathy (plexitis) is manifested by weakness of the muscles of the pelvis and lower extremities, decreased sensitivity of the legs and loss of tendon reflexes on the legs (knee, Achilles). Characterized by pain in the legs, hips and lower back. When the lumbar plexus is affected to a greater extent, neuritis of the femoral and obturator nerves, as well as damage to the lateral cutaneous nerve of the thigh, comes to the fore. The pathology of the sacral plexus is manifested by neuritis of the sciatic nerve.

Neuritis of the sciatic nerve is characterized by dull or shooting pains in the buttock, spreading along the back of the thigh and lower leg. The sensitivity of the foot and lower leg is reduced, there is hypotension of the gluteal and calf muscles, a decrease in the Achilles reflex. For neuritis of the sciatic nerve, symptoms of nerve tension are characteristic: the occurrence or intensification of pain when the nerve is stretched while lifting the straight leg in the supine position (Lasegue's symptom) or when squatting. Pain is noted at the exit point of the sciatic nerve on the buttock.

Neuritis of the femoral nerve is manifested by difficulty in extending the leg at the knee joint and flexing the hip, decreased sensitivity in the lower 2/3 of the anterior surface of the thigh and along the entire anterior-inner surface of the lower leg, atrophy of the muscles of the anterior surface of the thigh and loss of the knee reflex. Pain with pressure under the inguinal ligament at the exit point of the nerve to the thigh is characteristic.

Complications of neuritis

As a result of neuritis, persistent movement disorders in the form of paresis or paralysis may develop. Violations of the innervation of the muscles in neuritis can lead to their atrophy and the occurrence of contractures as a result of the replacement of muscle tissue with connective tissue.

Diagnosis of neuritis

If neuritis is suspected, during the examination, the neurologist conducts functional tests aimed at identifying movement disorders.

Tests confirming neuritis of the radial nerve:

• the patient's hands lie with their palms on the table and he cannot put the third finger on the neighboring ones;
• the patient's hands lie with their back on the table and he cannot take his thumb away;
• attempts to spread the fingers of the hands pressed against each other lead to the fact that on the side of the neuritis the fingers are bent and they slide along the palm of a healthy hand;
• the patient stands with his arms lowered along the body, in this position he is unable to turn the affected hand with the palm forward and remove the thumb.

Tests confirming ulnar neuritis:

• the brush is pressed with the palmar surface to the table and the patient cannot make scratching movements with the little finger on the table;
• the patient's hands lie with their palms on the table and he cannot spread his fingers, especially IV and V;
• the affected hand does not fully clench into a fist, bending the IV and V fingers is especially difficult;
• the patient cannot hold a strip of paper between the thumb and forefinger, as the terminal phalanx of the thumb is bent.

Tests confirming median nerve neuritis:

• the hand is pressed with the palmar surface to the table and the patient is unable to make scratching movements with the second finger on the table;
• the hand on the side of the lesion does not fully clench into a fist due to difficult flexion of fingers I, II and partially III;
• the patient fails to oppose the thumb and little finger.

Treatment of neuritis

Therapy of neuritis is primarily aimed at the cause that caused it. In infectious neuritis, antibiotic therapy (sulfonamides, antibiotics), antiviral drugs (interferon derivatives, gamma globulin) are prescribed. With neuritis resulting from ischemia, vasodilators are used (papaverine, eufillin, xanthinol nicotinate), with traumatic neuritis, immobilization of the limb is performed. Apply anti-inflammatory drugs (indomethacin, ibuprofen, diclofenac), analgesics, B vitamins and conduct decongestant therapy (furosemide, acetazolamide). At the end of the second week, anticholinesterase drugs (neostigmine) and biogenic stimulants (aloe, hyaluronidase) are added to the treatment.

Physiotherapeutic procedures begin at the end of the first week of neuritis. Apply ultraphonophoresis with hydrocortisone, UHF, pulsed currents, electrophoresis of novocaine, neostigmine, hyaluronidase. Massage and special physiotherapy exercises are shown, aimed at restoring the affected muscle groups. If necessary, conduct electrical stimulation of the affected muscles.

In the treatment of tunnel syndrome, local administration of drugs (hydrocortisone, novocaine) is performed directly into the affected canal.

Surgical treatment of neuritis refers to peripheral neurosurgery and is performed by a neurosurgeon. In the acute period of neuritis with severe compression of the nerve, surgery is necessary to decompress it. In the absence of signs of nerve recovery or the appearance of signs of its degeneration, surgical treatment is also indicated, which consists in suturing the nerve; in some cases, nerve plastic surgery may be required.

Forecast and prevention of neuritis

Neuritis in young people with a high ability of tissues to regenerate responds well to therapy. In the elderly, patients with concomitant diseases (for example, diabetes mellitus), in the absence of adequate treatment of neuritis, paralysis of the affected muscles and the formation of contractures may develop.

Neuritis can be prevented by avoiding injury, infection and hypothermia.

Neuritis - treatment in Moscow

Directory of Diseases

Nervous diseases

Last news

• © 2018 "Beauty and Medicine"

is for informational purposes only

and is not a substitute for qualified medical care.

Traumatic neuritis

Description:

Traumatic neuritis is a disease of the nerve root of traumatic origin.

Damage to the radial nerve (neuritis of the radial nerve) at the site of a fracture of the humerus.

Symptoms of Traumatic Neuritis:

Traumatic neuritis (post-injection), depending on the level and type of nerve damage, will be manifested by a variety of symptoms: movement disorders (paresis, paralysis) in a particular muscle or muscle group, numbness, changes in sensitivity (intensification, weakening or perversion).

Often there are traumatic neuritis in fractures or dislocation of the bones and joints of the extremities due to their anatomical proximity. After diagnosing the level of nerve damage, treatment begins, taking into account the symptoms of damage to the nerve root.

Traumatic neuritis that causes persistent pain symptoms (neuralgia), or hypesthesia (decrease in sensitivity), or muscle paresis (decrease in strength) takes time and patience and responds well to treatment.

Injuries to a nerve as large as the sciatic nerve are rarely complete. More often one or another portion of the sciatic nerve suffers more.

Causes of traumatic neuritis:

Traumatic neuritis occurs after a mechanical injury to the nerve:

      * wounds, including after drug injection

      * punches and long clamps

      * bone fractures and joint dislocations

Treatment of traumatic neuritis:

Treatment for traumatic neuritis is selected individually in each case. It includes a complex of conservative procedures:

      * nerve and muscle stimulation

      * B, C and E vitamins

      * antivirals

      * homeopathic remedies

      * surgical treatment (neurolysis of the nerve trunk, etc.)

Neuritis

Disease classification

2) polyneuritis characterized by inflammation of several nerves at the same time.

Clinical picture

Causes of neuritis

The former accumulate in the body with bronchitis, cystitis, tonsillitis, otitis, the latter settle in it with viral infections (herpes, influenza). The occurrence of neuritis, in addition to microorganisms, can provoke other reasons.

Compression of the nerve (for example, radial - during surgery or in a dream; small tibia - in the process of work, forcing to take an uncomfortable position; axillary - with prolonged use of crutches).

Violation of metabolic processes,

Diseases of the endocrine system,

Inflammation of the middle ear

The action of hereditary factors.

Different types of neuritis are caused by their characteristic causes. So, for the occurrence of neuritis of the facial nerve, inflammation of the middle ear, infections, hypothermia, and others are of particular importance. These same factors contribute to inflammation of the facial nerve in a child.

Diagnosis of the disease

Treatment of neuritis

Means that improve blood flow in the vessels of the microcirculatory bed;

Drugs that increase the conductivity of nerve fibers;

Biological stimulants.

Neuropathy ( or neuropathy) called non-inflammatory nerve damage, related to diseases of the nervous system. Neuropathy can affect both peripheral and cranial nerves. Neuropathy, accompanied by damage to several nerves at the same time, is called polyneuropathy. The frequency of occurrence of neuropathy depends on the disease in which it develops. So, diabetic polyneuropathy develops in more than 50 percent of cases of diabetes mellitus. Asymptomatic alcoholic neuropathy in chronic alcoholism occurs in 9 cases out of 10. At the same time, clinically pronounced alcoholic polyneuropathy with cerebellar disorders, according to various sources, is observed in 75-80 percent of cases.

Various types of hereditary neuropathies occur with a frequency of 2 to 5 percent. With nodular periarteritis, polyneuropathies are noted in half of all cases. With Sjögren's syndrome, neuropathies are noted in 10 to 30 percent of cases. With scleroderma, neuropathy is noted in one third of cases. At the same time, 7 out of 10 patients develop trigeminal neuropathy. Multiple neuropathies in allergic angiitis develop in 95 percent of cases. Various types of neuropathies in systemic lupus erythematosus are observed in 25 percent of patients.

According to the average data, neuropathy of the facial nerve is observed in 2 - 3 percent of the adult population. One in ten neuropathy recurs ( flares up again after treatment). The frequency of trigeminal neuropathy is one case per 10-15 thousand of the population.

With multiple injuries, burns, crash syndromes, nerve damage almost always develops. Most often observed post-traumatic neuropathy of the upper and lower extremities. In more than half of the cases, these neuropathies develop at the level of the forearm and hand. In one fifth of cases, there is a combined injury of several nerves. The share of brachial plexus neuropathy accounts for 5 percent.

Vitamin B12 deficiency is accompanied by neuropathy in 100 percent of cases. With a lack of other vitamins from group B, neuropathy also occurs in 90-99 percent of cases. An interesting approach to the definition and treatment of neuropathy is used by representatives of traditional Chinese medicine. According to Chinese healers, this disease is a disorder of the "Wind" type ( influence of air on human well-being) against the background of failures of the immune system. Despite the fact that many people do not inspire confidence in the methods of Chinese medicine, using an integrated approach, doctors achieve a positive result in about 80 percent of cases of treatment of this disease.

The ways in which Chinese doctors treat neuropathy are:

• manual therapy;
• hirudotherapy ( use of leeches);
• stone therapy ( massage with stones);
• vacuum ( canned) massage.

Massage in Chinese traditional medicine
Manual therapy is used not only for treatment, but also for the diagnosis of neuropathy, as it allows you to quickly determine which muscles are clamped. Acupressure improves blood circulation, gives freedom to organs and muscles, and increases the body's resources to fight neuropathy.

Hirudotherapy
The use of leeches in the treatment of neuropathy is due to several effects that this method has.

The healing effects that hirudotherapy has are:

• The effect of enzymes– in the process of treatment, the leech injects about 150 different compounds into the blood, which have a beneficial effect on the body. The most common enzymes are hirudin ( improves the rheological properties of blood), anesthesin ( acts as an analgesic), hyaluronidase ( improves the absorption of nutrients).
• Relaxation- leech bites have a calming effect on the patient and make him more resistant to stress factors.
• Strengthening immunity- most of the compounds introduced by the leech are of protein origin, which has a beneficial effect on nonspecific immunity.
• Draining effect- leech bites, due to increased blood supply, improve lymph outflow, which has a positive effect on the general condition of the patient.
• Anti-inflammatory action– secretion of leeches has an antimicrobial and anti-inflammatory effect, while not causing side effects.

Cupping massage
Vacuum therapy improves soft tissue drainage and causes vasodilation. This method activates metabolic processes, which positively affects the general tone of the patient.

How do nerves work?

All structures of the human nervous system consist of billions of nerve cells ( neurons), which unite with glial elements to form nervous tissue ( gray and white matter). Nerve cells, differing from each other in form and function, form simple and complex reflex arcs. Many reflex arcs form pathways that connect tissues and organs with the central nervous system.

All nerve cells consist of an irregularly shaped body and processes. There are two types of neuron processes - axon and dendrite. An axon is a thickened thread extending from the body of a nerve cell. The length of the axon can reach one meter or more. The dendrite has a conical shape with many branches.
It is much thinner than the axon and shorter. The length of the dendrite is usually a few millimeters. Most nerve cells have many dendrites, however, there is always only one axon.

The processes of nerve cells unite and form nerve fibers, which, in turn, unite to form a nerve. Thus, the nerve is a "cord", consisting of one or more bundles of nerve fibers, which are sheathed.

Neurons are diverse in their shape, length, number of processes, and functions.

Types of neurons

• sensory nerves;
• motor nerves;
• mixed nerves.

All nerve cells communicate with each other through their processes through synapses ( nerve connections). On the surface of the dendrites and the body of a nerve cell, there are many synaptic plaques, through which a nerve impulse arrives from another nerve cell. Synaptic plaques are equipped with synaptic vesicles containing neurotransmitters ( neurochemicals). During the passage of a nerve impulse, neurotransmitters are released in large quantities into the synaptic cleft and close it. When the impulse travels further, the neurotransmitters are destroyed. From the body of the neuron, the impulse is conducted along the axon to the dendrites and body of the next neuron, or to muscle or glandular cells.

The axon is covered with a myelin sheath, the main task of which is the continuous conduction of a nerve impulse along the entire axon. The myelin sheath is made up of several up to 5 - 10) protein layers that are wound like cylinders around the axon. Myelin layers contain a high concentration of ions. The myelin sheath is interrupted every 2 to 3 millimeters, forming special areas ( interceptions of Ranvier). In the interception zones of Ranvier, the ion current is transmitted along the axon, which increases the speed of the nerve impulse by tens and hundreds of times. The nerve impulse jumps from one node of Ranvier to another, covering a great distance in a shorter time.

Depending on the presence of myelin, all nerve fibers are divided into three types:

• type A nerve fibers;
• type B nerve fibers;
• type C nerve fibers.

Nerve fibers are supplied with various nerve endings ( receptors).

The main types of nerve endings of neurons are:

• sensory or afferent nerve endings;
• motor nerve endings;
• secretory nerve endings.

Causes of neuropathies

Endogenous causes of neuropathies are:

• endocrine pathologies, for example, diabetes mellitus;
• demyelinating diseases - multiple sclerosis, disseminated encephalomyelitis;
• autoimmune diseases - Guillain-Barré syndrome;
• alcoholism;
• beriberi.

Endocrine pathologies

The mechanism of diabetic neuropathy is reduced to malnutrition of nerve endings. These disorders develop due to damage to the small vessels that feed the nerves. As you know, in diabetes mellitus, small vessels are the first to suffer. In the wall of these vessels, various pathological changes are noted, which subsequently lead to impaired blood flow in them. The speed of blood movement and its volume in such vessels decreases. The less blood in the vessels, the less it enters the tissues and nerve trunks. Since the nerve endings are supplied with small vessels ( which are affected first), then their nutrition is quickly disrupted. In this case, dystrophic changes are noted in the nervous tissue, which lead to impaired nerve function. In diabetes mellitus, sensitivity disorder develops first. There are various paresthesias in the limbs in the form of heat, goosebumps, sensations of cold.

Due to metabolic disorders characteristic of diabetes mellitus, edema develops in the nerve and the formation of free radicals increases. These radicals act like toxins on the nerve, leading to their dysfunction. Thus, the mechanism of neuropathies in diabetes mellitus lies in toxic and metabolic causes.

In addition to diabetes mellitus, neuropathies can be observed in pathologies of the thyroid gland, adrenal glands, Itsenko-Cushing's disease.

demyelinating diseases ( DZ)

Demyelinating diseases that can cause neuropathy are:

• multiple sclerosis;
• acute disseminated encephalomyelitis;
• concentric sclerosis;
• Devic's disease or acute neuromyelitis optica;
• diffuse leukoencephalitis.

The mechanism of destruction of the myelin sheath covering the nerve fiber is complex and not fully understood. It is assumed that under the influence of various factors, the body begins to produce anti-myelin antibodies. These antibodies perceive myelin as a foreign body, that is, as an antigen. An antigen-antibody complex is formed, which triggers the destruction of the myelin sheath. Thus, foci of demyelination are formed in the nervous tissue. These foci are located both in the brain and in the spinal cord. Thus, the destruction of nerve fibers occurs.

At the initial stages of the disease, edema and inflammatory infiltration develop in the nerve. Depending on the nerve, this stage is manifested by various disorders - gait disorder, weakness in the limbs, dullness of sensitivity. Further, there is a violation of the conduction of the impulse along the nerve fiber. Paralysis develops at this stage.

With opticomyelitis ( Devic's disease) of the cranial nerves, only the optic nerve is affected. The spinal nerves are affected at the level of the spinal cord where the focus of demyelination is located.

Autoimmune diseases

Bacteria and viruses involved in the development of Guillain-Barré syndrome are:

• campylobacter;
• hemophilic bacillus;
• Epstein-Barr virus.

Types of neuropathy in Guillain-Barré syndrome are:

• acute demyelinating polyneuropathy;
• acute motor neuropathy;
• acute sensory axonal neuropathy.

As a rule, with rheumatoid arthritis, mononeuropathy is observed, that is, damage to one nerve. In 10 percent of cases, patients develop multiple mononeuropathy, that is, several nerves are affected at the same time.

scleroderma
With scleroderma, the trigeminal, ulnar, and radial nerves can be affected. Nerve endings in the lower extremities may also be affected. First of all, systemic scleroderma is characterized by the development of trigeminal neuropathy. Sometimes this can be the first symptom of the disease. The development of peripheral polyneuropathy is typical at later stages. The mechanism of nerve damage in scleroderma is reduced to the development of systemic vasculitis. Vessels of the nerve sheaths ( endoneurium and perineurium) become inflamed, thickened and subsequently sclerosed. This leads to oxygen starvation of the nerve ( ischemia) and the development of dystrophic processes in it. Sometimes, at the border of two vessels, zones of necrosis, which are called heart attacks, can form.

With scleroderma, both sensory neuropathies develop - with impaired sensitivity, and motor neuropathies - with motor insufficiency.

Sjögren's syndrome
In Sjogren's syndrome, predominantly peripheral nerves are affected, and much less often craniocerebral. As a rule, sensory neuropathy develops, which is manifested by various paresthesias. In one third of cases, tunnel neuropathies develop. The development of neuropathy in Sjögren's syndrome is explained by damage to the small vessels of the nerve sheath, infiltration of the nerve itself with the development of edema in it. In the nerve fiber, as well as in the blood vessel that feeds it, connective tissue grows and fibrosis develops. At the same time, degenerative changes are noted in the spinal nodes, which cause dysfunction of the nerve fibers.

Wegener's granulomatosis
With this pathology, cranial neuropathy, that is, damage to the cranial nerves, is very often noted. Most often, optic neuropathy, neuropathy of the oculomotor, trigeminal and abducens nerves develop. In rare cases, neuropathy of the laryngeal nerves develops with the development of speech disorders.

Alcoholism

In alcoholism, as a rule, the nerves of the extremities are affected and the lower extremities are primarily affected. Diffuse symmetrical damage to the nerve plexuses at the level of the lower extremities in alcoholism is called distal or peripheral alcoholic neuropathy. At the initial stage, this is manifested by the "spanking" of the feet when walking, later pain in the legs, a feeling of numbness join.

The mechanism of alcoholic neuropathy is reduced to the direct toxic effect of alcohol on nerve cells. Later, with the development of metabolic disorders in the body, a disorder of blood supply in the nerve endings joins. The nutrition of the nervous tissue is disturbed, since microcirculation suffers from alcoholism. With advanced alcoholism, a disorder and macrocirculation develops ( at the level of large vessels). In addition, due to damage to the gastric mucosa by alcohol, the absorption of substances is impaired. At the same time, alcoholics have a deficiency of thiamine or vitamin B1. It is known that thiamine plays an important role in the metabolic processes of the nervous tissue and, in its absence, various lesions occur at the level of the nervous system. Nerve fibers are damaged, followed by a slowdown in the passage of a nerve impulse through them.

Distal alcoholic neuropathy can last for a long time. It is characterized by an erased, latent course. However, later it can be complicated by paresis and paralysis. In alcoholism, cranial nerves, namely the nerves located in the brain stem, can also be affected. In the later stages of alcoholism, neuropathies of the visual, facial and auditory nerves are noted.

Wood alcohol poisoning or methyl, which is used as a substitute for ethyl) there are various degrees of damage to the optic nerve. However, visual impairment is usually irreversible.

Avitaminosis

Vitamin B12 is also actively involved in the metabolic processes of the body. It activates the synthesis of methionine, fatty acids and has an anabolic effect. With its deficiency, the syndrome of funicular myelosis develops. It consists in the process of demyelination of the nerve trunks of the spinal cord with their subsequent sclerosis. The lack of this vitamin is characterized by the so-called patchy demyelination of gray matter in the spinal cord and brain in the peripheral nerve endings. Neuropathy with a lack of B12 is accompanied by a violation of statics and movements, muscle weakness and impaired sensitivity.

Exogenous causes of neuropathy are:

• trauma, including prolonged compression;
• poisoning;
• infections - diphtheria, HIV, herpes virus.

Injuries

With prolonged compression of the nerve fiber ( crash syndromes) or their pinching, neuropathies also occur. The mechanism of their development in this case is a violation of the blood supply to the nerve sheath and, as a result, problems in the nutrition of the nerve. Nervous tissue, experiencing starvation, begins to atrophy. Various dystrophic processes develop in it, which are the cause of further nerve dysfunction. Most often, such a mechanism is observed in people trapped in rubble ( as a result of some disaster) and long-term immobile. As a rule, the nerves of the lower extremities are affected ( sciatic) and upper limbs ( ulnar and radial nerves). The risk areas for this mechanism of neuropathy development are the lower third of the forearm, hand, lower leg and foot. Since these are the most distally located parts of the body, the blood supply in them is worse. Therefore, at the slightest squeezing, squeezing, stretching in these areas, there is a lack of blood supply. Since the nervous tissue is very sensitive to a lack of oxygen, after a few hours the cells in the nerve fibers begin to die. With prolonged hypoxia, most of the nerve fibers can die and lose their functions. In this case, the nerve may become non-functional. If the nerve did not experience a lack of oxygen for a long time, then various degrees of its dysfunction are observed.

Traumatic damage to the cranial nerves can be observed with head injuries. In this case, compression of the nerve or its direct damage can also be observed. Nerves can be damaged in both open and closed head injuries. Most often observed post-traumatic neuropathy of the facial nerve. Damage to the facial, trigeminal nerve can also be the result of surgery. Traumatic injury to the third branch of the trigeminal nerve may develop after treatment or tooth extraction.

Traumatic nerve injury also includes traction ( pulling) mechanism. It is observed when falling from transport, dislocations, uncomfortable turns. Most often, this mechanism damages the brachial plexus.

poisoning

The following chemicals and medications can cause neuropathy:

• isoniazid;
• vincristine;
• lead;
• arsenic;
• mercury;
• phosphine derivatives.

Lead has a direct psychotropic and neurotoxic effect. It very quickly penetrates the body and accumulates in the nervous system. For poisoning with this metal, the so-called "lead polyneuritis" is characteristic. Basically, lead affects motor fibers and therefore motor failure predominates in the clinic. Sometimes a sensitive component is attached, which is manifested by pain in the legs, soreness along the nerve. In addition to peripheral neuropathy in pigs, it causes encephalopathy. It is characterized by damage to the nervous tissue of the brain, including symmetrical nerve damage due to lead deposition in the central nervous system.

Mercury and the anticancer drug vincristine also have a direct neurotoxic effect on neurons.

Isoniazid and other anti-tuberculosis drugs with long-term use are complicated by both cranial and peripheral neuropathy. The mechanism of nerve damage is due to inhibition of the synthesis of pyridoxal phosphate or vitamin B6. It is the coenzyme of most metabolic reactions in the nervous tissue. Isoniazid, on the other hand, enters into a competitive relationship with it, blocking its endogenous ( inside the body) education. Therefore, to prevent the development of peripheral neuropathy in the treatment of anti-tuberculosis drugs, vitamin B6 should be taken.

infections

Neuropathy also develops when the body is affected by the herpes virus, namely the type 3 virus, as well as the HIV virus. The herpes virus type 3 or the Varicella-Zoster virus, upon initial penetration into the human body, penetrates into the nerve nodes and remains there for a long time. Further, as soon as unfavorable conditions arise in the body, it reactivates and affects the nerve fibers. With this infection, neuropathies of the facial, oculomotor nerves, as well as polyneuropathy of various nerve plexuses, can develop.

There are also hereditary neuropathies or primary ones that develop on their own without the background of any disease. These neuropathies are passed down from generation to generation or through one generation. Most of them are sensory neuropathies ( in which sensitivity is impaired), but there are also motor ( with impaired motor function).

Hereditary neuropathies are:

• Charcot-Marie-Tooth pathology- with this neuropathy, the peroneal nerve is most often affected, followed by atrophy of the leg muscles;
• Refsum syndrome- with the development of motor neuropathy;
• Dejerine Sotta syndrome or hypertrophic polyneuropathy - with damage to the stem nerves.

Symptoms of neuropathy

Also, the symptoms of neuropathy depend on the type of fibers that make up the nerve. If motor fibers are affected, then movement disorders develop in the form of muscle weakness, gait disturbance. In mild and moderate forms of neuropathy, paresis is observed, in severe forms, paralysis is observed, which are characterized by a complete loss of motor activity. At the same time, after a certain time, atrophy of the corresponding muscles almost always develops. So, if the nerves of the lower leg are affected, then atrophy of the muscles of the lower leg develops; if the nerves of the face, then mimic and chewing muscles atrophy.

If sensory fibers are affected, then sensitivity disorders develop. These disorders are manifested in a decrease or increase in sensitivity, as well as various paresthesias ( feeling cold, warm, crawling).

Violation of the work of the glands of external secretion ( for example salivary) is caused by damage to the autonomic fibers, which also go as part of various nerves or are represented by independent nerves.

Symptoms of neuropathy of the facial nerve

Symptoms of neuropathy of the facial nerve are:

• facial asymmetry;
• hearing disorders;
• lack of taste, dry mouth.

Facial asymmetry
It is the main symptom of neuropathy of the facial nerve. It develops due to damage to the motor fibers in the facial nerve and, as a result, paresis of the facial muscles. Asymmetry manifests itself with unilateral nerve damage. If the nerve was affected on both sides, then paresis or paralysis of the muscles of the face is observed on both sides.

With this symptom, half of the face on the side of the lesion remains motionless. This is best seen when a person shows emotions. At rest, it may not be noticeable. The skin on the surface of the forehead, namely above the superciliary surface, does not gather into folds. The patient cannot move his eyebrows, this is especially noticeable when trying to surprise him. The nasolabial fold on the side of the lesion is smoothed, and the corner of the mouth is lowered. The patient is not able to close the eye completely, as a result of which it always remains ajar. Because of this, tear fluid constantly flows out of the eye. It looks like the person is crying all the time. This symptom of neuropathy leads to such a complication as xerophthalmia. It is characterized by dry cornea and conjunctiva of the eye. The eye looks red and swollen. The patient is tormented by the sensation of a foreign body in the eye, burning.

When eating, a patient with paralysis of mimic muscles has difficulty. Liquid food constantly flows out, and solid food gets stuck behind the cheek and must be removed from there with the tongue. Certain difficulties arise during the conversation.

Hearing disorders
With neuropathy of the facial nerve, both hearing loss, up to deafness, and its strengthening can be observed ( hyperacusis). The first option is observed if the facial nerve was damaged in the pyramid of the temporal bone after the large petrosal nerve departed from it. There may also be an internal auditory canal syndrome, which is characterized by hearing loss, tinnitus, and paralysis of the facial muscles.

Hyperacusia ( painful sensitivity to sounds, especially low tones) is observed when the facial nerve is damaged before the large stony nerve departs from it.

Lack of taste, dry mouth
With damage to the taste and secretory fibers that go as part of the facial nerve, the patient has a taste disorder. The loss of taste sensations is observed not on the entire surface of the tongue, but only on its anterior two-thirds. This is due to the fact that the facial nerve provides gustatory innervation to the two anterior thirds of the tongue, and the posterior third is provided by the glossopharyngeal nerve.

Also, the patient has dry mouth or xerostomia. This symptom is due to a disorder of the salivary glands, which are innervated by the facial nerve. Since the fibers of the facial nerve provide innervation to the submandibular and sublingual salivary glands, dysfunction of these glands is observed with its neuropathy.

If the root of the facial nerve is involved in the pathological process, then at the same time there is a lesion of the trigeminal, abducent and auditory nerves. In this case, the symptoms of neuropathy of the corresponding nerves join the symptoms of neuropathy of the facial nerve.

Symptoms of trigeminal neuropathy

Symptoms of trigeminal neuropathy are:

• violation of the sensitivity of the skin of the face;
• paralysis of chewing muscles;
• facial pain.

When part of the third branch of the trigeminal nerve is affected, a decrease or increase in sensitivity is diagnosed in the chin, lower lip, lower jaw, gums and teeth. If there is a lesion of the trigeminal nerve node, then in the clinical picture of neuropathy there is a violation of sensitivity in the region of all three branches of the nerve.

Paralysis of the chewing muscles
This symptom is observed when the motor fibers of the mandibular branch are affected. Paralysis of the chewing muscles is manifested by their weakness and afunctionality. In this case, a weakened bite is observed on the side of the lesion. Visually, muscle paralysis is manifested in the asymmetry of the oval of the face - muscle tone is weakened, and the temporal fossa on the side of the lesion sinks. Sometimes the lower jaw may deviate from the midline and sag slightly. With bilateral neuropathy with complete paralysis of the masticatory muscles, the lower jaw can completely sag.

facial pain
The pain symptom in trigeminal neuropathy is the leading one. Facial pain in this pathology is also called trigeminal neuralgia or facial tic.

Pain in neuropathy is not constant, but paroxysmal. Trigeminal neuralgia is characterized by short-term ( from a few seconds to a minute) attacks of shooting pains. In 95 percent of the case, they are localized in the zone of innervation of the second and third branches, that is, in the area of ​​the outer corner of the eye, lower eyelid, cheek, jaw ( along with teeth). The pain is always one-sided and rarely radiates to the opposite side of the face. The main characteristic of pain in this case is their strength. The pains are so severe that the person freezes for the duration of the attack. In severe cases, pain shock may develop. Sometimes an attack of pain can cause a spasm of the facial muscles - a facial tic. Excruciating pain accompanied by facial numbness or other paresthesias ( goosebumps, cold).

If one of the branches of the trigeminal nerve was damaged separately, then the pain may not be paroxysmal, but aching.

An attack of pain can provoke any, even a slight touch on the face, talking, chewing, shaving. With often recurring attacks, the mucous membrane of the eye becomes swollen, red, the pupils are almost always dilated.

Symptoms of neuropathy of the ulnar nerve

Symptoms of neuropathy of the ulnar nerve are:

• disturbances of sensitivity in the area of ​​the corresponding fingers and elevation of the little finger;
• violation of the function of flexion of the hand;
• violation of breeding and information of fingers;
• atrophy of the muscles of the forearm;
• development of contractures.

With long-term neuropathy, contractures develop. A contracture is a permanent limitation of joint mobility. With neuropathy of the ulnar nerve, Volkmann's contracture or contracture in the form of a "clawed paw" occurs. It is characterized by a claw-like position of the fingers, a bent joint of the wrist, and a flexion of the distal joints of the fingers. This position of the hand is due to atrophy of the interosseous and vermiform muscles.

The decrease in sensitivity ends with its complete loss on the little finger, ring finger and ulnar edge of the palm.

Diagnosis of neuropathy

Neurological examination

If neuropathy exists for a long time, then the asymmetry of the face is visible to the naked eye - with neuropathy of the facial and trigeminal nerve, limbs - with neuropathy of the ulnar nerve, polyneuropathy.

Visual examination and questioning for neuropathy of the facial nerve
The doctor asks the patient to close his eyes tightly and wrinkle his forehead. With neuropathy of the facial nerve, the fold on the forehead from the side of the damage is not collected, and the eye does not completely close. Through the gap between the non-closing eyelids, a strip of sclera is visible, which gives the organ a resemblance to the eye of a hare.

Next, the doctor asks the patient to puff out his cheeks, which also does not work, since the air on the side of the lesion comes out through the paralyzed corner of the mouth. This symptom is called a sail. When you try to bare your teeth, there is asymmetry of the mouth in the form of a tennis racket.

When diagnosing neuropathy of the facial nerve, the doctor may ask the patient to do the following:

• close your eyes;
• furrow your forehead;
• raise eyebrows;
• bare teeth;
• puff out cheeks;
• try to whistle, blow.

Symptoms such as pain and paresthesia in the face, ear can be very blurred. They are present in the neuropathy clinic for the first 24-48 hours, and therefore the doctor also asks how the disease proceeded in the first hours.
With neuropathy of the facial nerve, the corneal and blink reflexes are weakened.

Visual examination and questioning for trigeminal neuropathy
In trigeminal neuropathy, the main diagnostic criterion is paroxysmal pain. The doctor asks questions about the nature of pain, its development, and also reveals the presence of specific trigger ( triggering pain) zones.

Characteristics of the pain syndrome in trigeminal neuropathy are:

• paroxysmal character;
• strong intensity ( patients compare an attack of pain with the passage of an electric current through them);
• the presence of a vegetative component - an attack of pain is accompanied by lacrimation, nasal discharge, local sweating;
• facial tic - an attack of pain is accompanied by spasm or muscle twitching;
• trigger zones - those zones, when touched, paroxysmal pain occurs ( e.g. gum, sky).

To identify areas with impaired sensitivity, the doctor examines the sensitivity of the facial skin in symmetrical areas of the face, while the patient evaluates the similarity of sensations. With this manipulation, the doctor can detect a decrease in overall sensitivity, its increase, or loss in certain areas.

Visual examination and questioning for neuropathy of the ulnar nerve
Initially, the doctor examines the patient's hands. With long-term neuropathy of the ulnar nerve, the diagnosis is not difficult. The characteristic position of the hand in the form of a “clawed paw”, atrophy of the muscles of the elevation of the little finger and the ulnar part of the hand immediately indicates the diagnosis. However, at the initial stages of the disease, when there are no obvious signs of atrophy and characteristic contracture, the doctor resorts to special techniques.

When detecting neuropathy of the ulnar nerve, the following phenomena are noted:

• The patient is not able to fully clench his hand into a fist, because the ring finger and little finger cannot fully bend and move to the side.
• Due to atrophy of the interosseous and worm-like muscles, the patient fails to fan out his fingers and then bring them back.
• The patient fails to press the brush against the table and scratch it with the little finger.
• The patient is unable to fully bend the hand in the palm.

Examination for other neuropathies
Neurological examination in case of nerve damage is reduced to the study of their reflexes. So, with neuropathy of the radial nerve, the reflex from the triceps muscle weakens or disappears, with neuropathy of the tibial nerve, the Achilles reflex disappears, with damage to the peroneal nerve, the plantar reflex. Muscle tone is always examined, which can be reduced at the initial stages of the disease, and then completely lost.

Methods of laboratory diagnostics

Laboratory diagnosis in diabetic neuropathy
In diabetic neuropathy, the main laboratory marker is the level of glucose in the blood. Its level should not exceed 5.5 millimoles per liter of blood. In addition to this parameter, the indicator of glycated hemoglobin is used ( HbA1C). Its level should not exceed 5.7 percent.

Serological ( with detection of antibodies and antigens) the examination is reduced to the detection of specific antibodies to insulin, to pancreatic cells, antibodies to tyrosine phosphatase.

Laboratory diagnostics for neuropathies caused by autoimmune diseases
Autoimmune diseases, including connective tissue diseases, are characterized by the presence of specific antibodies in the blood serum. These antibodies are produced by the body against its own cells.

The most common antibodies found in autoimmune diseases are:

• anti-Jo-1 antibodies- are detected in dermatomyositis and polymyositis;
• anticentromeric antibodies- with scleroderma;
• ANCA antibodies- with Wegener's disease;
• ANA antibodies- with systemic lupus erythematosus and a number of other autoimmune pathologies;
• anti-U1RNP antibodies- with rheumatoid arthritis, scleroderma;
• anti-Ro antibodies- with Sjögren's syndrome.

Laboratory diagnostics for post-infectious neuropathies
Laboratory markers in this case are antibodies, antigens and circulating immune complexes. In viral infections, these are antibodies to the antigens of the virus.

The most common laboratory findings in post-infectious neuropathies are:

• VCA IgM, VCA IgG, EBNA IgG- when infected with the Epstein-Barr virus;
• CMV IgM, CMV IgG- with cytomegalovirus infection;
• VZV IgM, VZV IgG, VZM IgA- when infected with the Varicella-Zoster virus;
• antibodies to Campylobacter- with enteritis caused by campylobacter. With this type of enteritis, the risk of developing Guillain-Barré syndrome is 100 times higher than with a common infection.

Instrumental Research

In the first case, muscle responses to irritation of certain points of the nerve fiber are recorded. These responses are recorded as an electrical signal. To do this, the nerve is irritated at one point, and the response is recorded at another. The speed between these two points is calculated from the latency period. At different points of the body, the speed of propagation of impulses is different. On the upper limbs, the speed is 60 - 70 meters per second, on the legs - from 40 to 60. With neuropathies, the speed of the nerve impulse is significantly reduced, with nerve atrophy it is reduced to zero.

Electromyography records the activity of muscle fibers. For this, in the muscle ( for example, on the hand) introduce small needle electrodes. Skin electrodes may also be used. Next, the responses of the muscle are captured in the form of a bioelectric potential. These potentials can be recorded with an oscilloscope and recorded as a curve on film or displayed on a monitor screen. With neuropathies, there is a weakening of muscle strength. At the onset of the disease, only slight decreases in muscle activity may be noted, but subsequently the muscles may completely atrophy and lose their electrical potential.

In addition to these methods that directly study the activity of the nerve, there are diagnostic methods that identify the causes of neuropathy. These methods are primarily computed tomography ( CT) and nuclear magnetic resonance ( NMR). These studies can reveal structural changes in the nerves and in the brain.

The indicators detected by CT and NMR are:

• thickening of the nerve - in inflammatory processes;
• focus of demyelination or plaque of multiple sclerosis;
• compression of the nerve by various anatomical structures ( vertebrae, joint) - in traumatic neuropathy.

Treatment of neuropathy

Medications to eliminate pain symptoms in neuropathy

Medicines for the treatment of neuropathy

Treating diseases that cause neuropathy

Hypoglycemic drugs are:

• sulfonylurea preparations– glibenclamide ( or maninil), glipizide;
• biguanides– metformin ( trade names metfogamma, glucophage);

Metformin is currently the most widely used antidiabetic drug. It reduces the absorption of glucose in the intestines, thereby lowering its blood levels. The initial dose of the drug is 1000 mg per day, which is equal to two tablets of metformin. The drug should be taken with meals, drinking plenty of water. In the future, the dose is increased to 2000 mg, which is equivalent to 2 tablets of 1000 mg or 4 to 500 mg. The maximum dose is 3000 mg.

Metformin treatment should be carried out under the control of kidney function, as well as a biochemical blood test. The most common side effect is lactic acidosis and therefore, with an increase in the concentration of blood lactate, the drug is canceled.

Demyelinating diseases
With these pathologies, corticosteroid therapy is performed. For this purpose, prednisolone, dexamethasone are prescribed. At the same time, the doses of these drugs are much higher than therapeutic ones. This method of treatment is called pulse therapy. For example, 1000 mg of the drug is prescribed intravenously every other day, in a course of 5 injections. Next, they switch to the tablet form of the drug. As a rule, the dose in this period of treatment is 1 mg per kg of the patient's weight.

Sometimes they resort to the appointment of cytostatics, such as methotrexate and azathioprine. The regimen for the use of these drugs depends on the severity of the disease and the presence of comorbidities. The treatment is carried out under the continuous control of the leukocyte formula.

Avitaminosis
With avitaminosis, intramuscular injections of the corresponding vitamins are prescribed. With a lack of vitamin B12 - injections of cyanocobalamin ( 500 micrograms daily), with a lack of vitamin B1 - injections of 5% thiamine. If there is a simultaneous deficiency of several vitamins, then multivitamin complexes are prescribed.

infections
In infectious neuropathies, treatment is aimed at eliminating the infectious agent. For viral neuropathies, acyclovir is prescribed, for bacterial neuropathies, appropriate antibiotics. Vascular drugs such as vinpocetine are also prescribed ( or cavinton), cinnarizine and antioxidants.

Injuries
With injuries, the main role is played by rehabilitation methods, namely massage, acupuncture, electrophoresis. In the acute period of injury, methods of surgical treatment are used. In the event that the integrity of the nerve has been completely violated, the ends of the damaged nerve are sutured during the operation. Sometimes they resort to the reconstruction of the nerve trunks. Prompt surgical intervention in the first hours after injury) and intensive rehabilitation is the key to restoring the work of the nerve.

Physiotherapy for the treatment of neuropathy

The main physiotherapeutic procedures used to treat neuropathy are:

• electrophoresis;
• darsonvalization;
• massage;
• reflexology;
• magnetic therapy;
• hydrotherapy.

Most often, electrophoresis is prescribed for neuropathy of the facial nerve. Of the medicines, eufillin, dibazol, prozerin are used. Contraindications to the use of electrophoresis are skin diseases, acute, as well as chronic, but in the acute stage, infections and malignant tumors.

Darsonvalization
Darsonvalization is a physiotherapeutic procedure in which the patient's body is exposed to a pulsed alternating current. This procedure has a vasodilating and tonic effect on the body. Through dilated vessels, blood flows to the nerve fiber, delivering oxygen and necessary substances. The nutrition of the nerve improves, its regeneration increases.

The procedure is performed using special devices, which consist of a source of pulsed sinusoidal currents. A contraindication to its implementation is pregnancy, the presence of arrhythmias or epilepsy in the patient.

Massage
Massage is especially indispensable for neuropathies accompanied by muscle spasm. With the help of various techniques, muscle relaxation and pain relief are achieved. During the massage, blood rushes to the muscles, improving their nutrition and functioning. Massage is an integral method of treatment for neuropathies, which are accompanied by muscle paresis. Systematic warming up of the muscles increases their tone and contributes to accelerated rehabilitation. Contraindications to massage are also acute, purulent infections and malignant tumors.

Reflexology
Reflexology is called massage of biologically active points. This method has a relaxing, analgesic and sedative effect. The advantage of this method is that it can be combined with other methods, as well as the fact that it can be resorted to already a week or two after the onset of the disease.

Magnetic Therapy
Magnetic therapy uses low frequency ( constant or variable) a magnetic field. The main effect of this technique is aimed at reducing pain.

Hydrotherapy
Hydrotherapy or hydrotherapy includes a wide range of treatments. The most common are douches, rubdowns, circular and rising showers, baths and underwater massage showers. These procedures have many positive effects on the body. They increase the stability and resistance of the body, increase blood circulation, accelerate metabolism. However, the main advantage is the reduction of stress and muscle relaxation. Contraindications to hydrotherapy are epilepsy, tuberculosis in the active stage, as well as mental illness.

Prevention of neuropathy

• taking precautions;
• carrying out activities aimed at increasing immunity;
• formation of skills to resist stress;
• health procedures ( massage, therapeutic gymnastics of facial muscles);
• timely treatment of diseases that can cause the development of this pathology.

Precautions for Neuropathy

Factors to be avoided for preventive purposes are:

• hypothermia of the body;
• trauma;
• drafts.

Immunity Boost

• maintaining an active lifestyle;
• ensuring a balanced diet;
• the use of products that help strengthen immunity;
• hardening of the body.

The rules for performing physical exercises are:

• you should choose those types of activities that do not bring discomfort to the patient;
• the chosen sport should be practiced regularly, since with long pauses the acquired effect is quickly lost;
• the pace and time of the exercises carried out at the beginning should be minimal and not cause severe fatigue. As the body gets used to it, the duration of classes should be increased, and the loads should be more intense;
• it is necessary to start classes with aerobic exercises that allow you to warm up and prepare the muscles;
• The best time to exercise is in the morning.

• swimming;
• gymnastics in water water aerobics);
• a ride on the bicycle;
• ballroom dancing.

Ways to increase the level of stress without special sports exercises are:

• refusal of the elevator- climbing and descending stairs can strengthen the cardiovascular and nervous systems and prevent a wide range of diseases;
• walking Hiking increases the overall tone of the body, improves mood and has a beneficial effect on the immune system. Walking also helps to maintain muscle tone, has a positive effect on the condition of bones and joints, which reduces the likelihood of injury and
  The lack of the required amount of vitamins causes a decrease in the activity of immune cells and worsens the body's resistance to manifestations of neuralgia. Therefore, for prevention purposes, foods rich in these beneficial substances should be included in the diet. Particular attention should be paid to such vitamins as C, A, E.

  Foods that are a source of vitamins that help strengthen immunity are:

  • vitamin A- chicken and beef liver, wild garlic, viburnum, butter;
  • vitamin E- nuts ( almonds, hazelnuts, peanuts, pistachios), dried apricots, sea buckthorn;
  • vitamin C- kiwi, sweet peppers, cabbage, spinach, tomatoes, celery.
  Trace elements and products that contain them
  Deficiency of trace elements causes a decrease in immunity and inhibits the recovery processes in the body.

  The most important trace elements for the proper functioning of the immune system are:

  • zinc- yeast, pumpkin seeds, beef ( boiled), beef tongue ( boiled), sesame, peanuts;
  • iodine- cod liver, fish ( salmon, flounder, sea bass), fish fat;
  • selenium- liver ( pork, duck), eggs, corn, rice, beans;
  • calcium- poppy, sesame, halva, powdered milk, hard cheeses, cow cheese;
  • iron- red meat beef, duck, pork), liver ( beef, pork, duck), egg yolk, oatmeal, buckwheat.
  Foods high in protein
  Proteins are a source of amino acids that are involved in the formation of immunoglobulins ( substances involved in the formation of immunity). For the full functionality of the immune system, proteins of both plant and animal origin are needed.

  Protein-rich foods include:

  • legumes ( beans, lentils, soy);
  • cereals ( semolina, buckwheat, oatmeal);
  • dried apricots, prunes;
  • Brussels sprouts;
  • eggs;
  • cottage cheese, cheese;
  • fish ( tuna, salmon, mackerel);
  • liver ( beef, chicken, pork);
  • meat ( poultry, beef).
  Foods that provide the body with the required amount of fat
  Fats are involved in the production of macrophages ( cells that fight germs). According to the type and principle of action, fats are divided into useful ( polyunsaturated and monounsaturated) and harmful ( saturated, cholesterol and artificially processed fats).

  Fat-containing foods that are recommended to strengthen the immune system are:

  • oily and semi-fat fish ( salmon, tuna, herring, mackerel);
  • vegetable oil ( sesame, rapeseed, sunflower, corn, soy);
  • walnuts;
  • seeds ( sunflower, pumpkin);
  • sesame;
  Foods with enough carbohydrates
  Carbohydrates are an active participant in the processes of energy formation, which the body needs to fight the disease. Depending on the mechanism of action, carbohydrates can be simple or complex. The first category is quickly processed in the body and contributes to weight gain. Complex carbohydrates normalize the digestive system and maintain a feeling of satiety for a long time. This type of carbohydrate has the greatest benefits for the body.

  Foods that contain an increased amount of slow (complex) carbohydrates are:

  • beans, peas, lentils;
  • pasta from durum wheat;
  • rice ( uncleaned, brown);
  • oats;
  • buckwheat;
  • corn;
  • potato.
  Probiotic Sources
  Probiotics are types of bacteria that have a complex beneficial effect on the human body.

  The effects that these microorganisms produce are:

  • improving the functionality of the immune system;
  • replenishment of the lack of vitamins of group B ( common factor in neuropathy);
  • stimulating the strengthening of the intestinal mucosa, which prevents the development of pathogenic bacteria;
  • normalization of the digestive system.
  
  

  Foods with enough probiotics are:

  • yogurt;
  • kefir;
  • sauerkraut ( you should choose an unpasteurized product);
  • fermented soft cheese;
  • sourdough bread ( without yeast);
  • acidophilic milk;
  • canned cucumbers, tomatoes ( no added vinegar);
  • soaked apples.
  Foods that inhibit the functionality of the immune system
  Foods that harm the immune system include alcohol, tobacco, sweets, preservatives, and artificial colors.

  Drinks and foods that should be reduced in the prevention of neuropathy include:

  • pastries, confectionery - contain a large amount of unhealthy fats and sugar, which causes a deficiency of B vitamins;
  • fish, meat, vegetable, fruit canned industrial production - include a large number of preservatives, dyes, flavor enhancers;
  • sweet carbonated drinks - contain a lot of sugar, and also cause increased gas formation in the intestines;
  • fast food ( fast food) - a large amount of modified harmful fats is used in the manufacture;
  • alcoholic beverages of medium and high levels of strength - alcohol inhibits the absorption of nutrients and reduces the body's tolerance to various diseases.
  Dietary recommendations for the prevention of neuropathy
  To increase the effect of nutrients in the selection, preparation and use of products, a number of rules should be observed.

  The principles of nutrition in the prevention of damage to the facial nerve are:

  • fresh fruits should be consumed 2 hours before or after the main meal;
  • The healthiest fruits and vegetables are those that are brightly colored ( red, orange, yellow);
  • the most preferred types of heat treatment of products are boiling, baking and steaming;
  • vegetables and fruits are recommended to be washed in running water.
  The main rule of a healthy diet is a balanced menu, which should include 4 to 5 meals a day.

  Food groups, each of which should be included in the daily diet, are:

  • cereals, cereals, legumes;
  • vegetables;
  • fruits and berries;
  • dairy and dairy products;
  • meat, fish, eggs.
  Drinking regimen for strengthening immunity
  To ensure the functionality of the immune system, an adult should consume from 2 to 2.5 liters of fluid per day. To determine the exact volume, the patient's weight must be multiplied by 30 ( the number of milliliters of water recommended per 1 kilogram of weight). The resulting figure is the daily fluid intake ( in milliliters). You can diversify drinking with fortified drinks and herbal teas.

  Recipes to strengthen immunity
  Drinks to improve the protective functions of the body, which can be prepared at home, are:

  • chamomile tea- steam a spoonful of dried flowers with half a liter of boiling water and drink 3 times a day, one third of a glass;
  • ginger drink- Grate 50 grams of ginger root, squeeze and mix the juice with lemon and honey; pour hot water and consume in the morning a few hours before meals;
  • infusion of needles- Grind 2 tablespoons of needles and pour hot water; three hours later, filter, add lemon juice and take half a glass twice a day after meals.

  Hardening of the body

  Hardening is a systematic effect on the body of such factors as water, sun, air. As a result of hardening, a person develops endurance and increases the level of adaptability to changing environmental factors. Also hardening activities have a positive effect on the nervous system, developing and strengthening resistance to stress.
  The main rules for effective hardening are gradual and systematic. You should not start with long sessions and immediately use low temperatures of influencing factors. Long pauses between hardening procedures reduce the acquired effect. Therefore, hardening the body should adhere to the schedule and regularity.

  Methods of hardening the body are:

  • walking barefoot- to activate the biological points located on the feet, it is useful to walk barefoot on sand or grass;
  • air baths (exposure to air on a partially or completely naked body) - the first 3 - 4 days, procedures lasting no more than 5 minutes should be carried out in a room where the temperature varies from 15 to 17 degrees; further sessions can be carried out outdoors at a temperature of at least 20 - 22 degrees, gradually increasing the duration of air baths;
  • rubbing- with a towel or sponge dipped in cold water, rub the body, starting from the top;
  • pouring cold water- for the initial procedures, water at room temperature should be used, gradually lowering it by 1 - 2 degrees; people with weak immunity should start with dousing their legs and arms; after the end of the session, dry and rub the skin with a terry towel;
  • cold and hot shower- you need to start with cool and warm water, gradually increasing the temperature difference.

  Stress management

  One of the reasons that can provoke the development or relapse ( re-aggravation) neuropathy, is stress. An effective way to counter negative events is emotional and physical relaxation. Both methods of relaxation are closely related, because when the nervous system is excited, tension in the muscles occurs unconsciously and automatically. Therefore, in order to develop resilience to stress, the ability to relax both mentally and emotionally should be trained.

  Muscle relaxation
  For the effective development and use of muscle relaxation techniques when performing exercises, a number of rules should be observed.

  The positions that must be followed during relaxation are:

  • regularity - in order to master the relaxation technique and use it at the moments of approaching anxiety, you should devote 5 to 10 minutes to training daily;
  • You can engage in relaxation in any position, but the best option for beginners is the “lying on your back” position;
  • you need to carry out exercises in a secluded place, turning off the phone and other distractions;
  • light music will help increase the effectiveness of the sessions.
  Shavasana exercise
  This technique combines physical exercises and auto-training ( repeating aloud or silently certain commands).

  The stages of this exercise for muscle relaxation are:

  • you should lie on the floor or other horizontal surface, slightly spreading your arms and legs to the sides;
  • raise the chin up, close the eyes;
  • within 10 minutes, pronounce the phrase “I am relaxed and calm” according to the following scenario - while saying “I”, you should inhale, on the word “relaxed” - exhale, “and” - inhale, and on the last word “calm” - exhale;
  • You can increase the effectiveness of the exercise by simultaneously imagining how the body is filled with bright light on inhalation, and heat spreads throughout all parts of the body on exhalation.
  Relaxation according to Jacobson
  The principle of this set of exercises is to alternate tension and relaxation of body parts. The method is based on the contrast between tight and relaxed muscles, which motivates the patient to quickly get rid of tension. The presented method includes several stages designed for each part of the body. To begin relaxation, you need to lie down, spread your arms and legs apart, close your eyes.

  The stages of relaxation according to Jacobson are:

  1. Relaxation of the muscles of the face and head:

  • you should tighten the muscles of the forehead and relax after 5 seconds;
  • then you need to close your eyes tightly, close your lips and wrinkle your nose. After 5 seconds, release the voltage.
  2. Hand exercise- you need to squeeze the muscles into a fist, tighten your forearms and shoulders. Hold this state for a few seconds, then slowly relax the muscles. Repeat several times.

  3. Work with the muscles of the neck and shoulders- this area during stress is most exposed to stress, therefore, sufficient attention should be paid to working with these parts of the body. You should raise your shoulders, trying to strain your back and neck as much as possible. After relaxing, repeat 3 times.

  4. Relaxation of the chest- on a deep breath, you need to hold your breath, and on the exhale - ease the tension. Alternating inhalations and exhalations for 5 seconds, you should fix the state of relaxation.

  5. Exercise for the abdomen:

  • you need to take a breath, hold your breath and tighten the press;
  • on a long exhalation, the muscles should be relaxed and linger in this state for 1 - 2 seconds.
  6. Relaxation of the buttocks and legs:
  • you should tighten the gluteal muscles, then relax. Repeat 3 times;
  • then you need to strain all the muscles of the legs, holding them in this position for a few seconds. After relaxing, do the exercise a few more times.
  As this technique is performed, a person may encounter the fact that certain muscle groups do not lend themselves to rapid relaxation. These parts of the body should be given more attention and the number of alternations of relaxation and tension should be increased.

  Alternative relaxation methods
  In situations in which it is not possible to perform muscle relaxation exercises, other methods of dealing with stress can be used. The effectiveness of the method depends on the individual characteristics of the patient and the situation that provoked anxiety.

  • green tea- this drink has a beneficial effect on the functioning of the nervous system, improves the overall tone of the body and helps to resist negative emotions;
  • dark chocolate- this product contains a substance that promotes the production of a hormone involved in the fight against depression;
  • change of activity- in anticipation of anxiety, one should be distracted from this state, switching attention to household duties, pleasant memories, doing what one loves; a great way to not succumb to excitement is to exercise or walk in the fresh air;
  • cold water- experiencing excitement, you need to dip your hands under a stream of cold running water; moisten the earlobes with water, and if possible, wash the face;
  • music- correctly selected musical compositions will help to normalize the emotional background and cope with stress; according to experts, the most tangible effect on the nervous system has a violin, piano, natural sounds, classical music.

  Wellness measures for neuropathy

  Such procedures as massage or facial gymnastics, which the patient can carry out independently, will help prevent this disease.

  Massage for neuralgia
  Before starting a course of massages, you should consult with your doctor. In some cases, a special device may be used instead of hands ( massager) with vibrating action.

  Massage techniques for the prevention of neuralgia are:

  • rubbing ( shoulders, neck, forearms);
  • stroking ( occiput);
  • circular motion ( in the area of ​​cheekbones, cheeks);
  • tapping with fingertips ( eyebrows, forehead, area around the lips).
  All movements should be light, without pressure. The duration of one session should not exceed 5 minutes. Massage should be carried out daily for 3 weeks.

  Gymnastics in order to prevent attacks of neuralgia
  Performing a set of special exercises improves blood circulation and prevents stagnation in the muscles. To better control the process, gymnastics should be carried out in front of a mirror.

  Facial gymnastics exercises are:

  • tilts and circular movements of the head;
  • stretching the neck and head to the right and left side;
  • folding lips into a tube, into a wide smile;
  • swelling and retraction of the cheeks;
  • opening and closing of the eyes with great tension of the eyelids;
  • lifting the eyebrows up while pressing the fingers on the forehead.

  Treatment of pathologies contributing to the development of neuropathy

  To reduce the likelihood of development or recurrence of neuropathy, it is necessary to identify and eliminate the causes that can provoke these processes in a timely manner.

  Factors that increase the risk of this disease include:

  • diseases of the teeth and oral cavity;
  • infectious processes of any localization;
  • inflammation of the middle ear, parotid gland;
  • colds;
  • herpes and other viral diseases;
  • disorders of the cardiovascular system.

Neuritis

Neuritis called an inflammatory disease of the peripheral nerve (intercostal, occipital, facial or limb nerves), manifested by pain along the nerve, impaired sensitivity and muscle weakness in the area innervated by it. The defeat of several nerves is called polyneuritis. Diagnosis of neuritis is carried out by a neurologist during the examination and carrying out specific functional tests. In addition, electromyography, electroneurography and EP study are performed. Treatment of neuritis includes etiotropic therapy (antibiotics, antiviral, vascular drugs), the use of anti-inflammatory and decongestants, neostigmine therapy, physiotherapy, massage and exercise therapy.

Neuritis

Neuritis called an inflammatory disease of the peripheral nerve (intercostal, occipital, facial or limb nerves), manifested by pain along the nerve, impaired sensitivity and muscle weakness in the area innervated by it. Damage to several nerves is called polyneuritis.

Neuritis can occur as a result of hypothermia, infections (measles, herpes, influenza, diphtheria, malaria, brucellosis), trauma, vascular disorders, hypovitaminosis. Exogenous (arsenic, lead, mercury, alcohol) and endogenous (thyrotoxicosis, diabetes mellitus) intoxications can also lead to the development of neuritis. Most often, peripheral nerves are affected in the musculoskeletal canals, and the anatomical narrowness of such a canal may predispose to the onset of neuritis and the development of carpal tunnel syndrome. Quite often, neuritis occurs as a result of compression of the peripheral nerve trunk. This can happen in a dream, when working in an uncomfortable position, during an operation, etc. So in people who move for a long time with the help of crutches, neuritis of the axillary nerve may occur, while squatting for a long time - neuritis of the peroneal nerve, constantly in the process of professional activity flexors and extensors of the hand (pianists, cellists) - neuritis of the median nerve. There may be compression of the peripheral nerve root at the site of its exit from the spine, which is observed with herniated intervertebral discs, osteochondrosis.

Symptoms of neuritis

The clinical picture of neuritis is determined by the functions of the nerve, the degree of its damage and the area of ​​​​innervation. Most peripheral nerves consist of different types of nerve fibers: sensory, motor, and autonomic. The defeat of the fibers of each type gives the following symptoms, characteristic of any neuritis:

• sensitivity disorders - numbness, paresthesia (tingling sensation, "crawling"), decrease or loss of sensitivity in the area of ​​​​innervation;
• violation of active movements - a complete (paralysis) or partial (paresis) decrease in strength in the innervated muscles, the development of their atrophy, a decrease or loss of tendon reflexes;
• vegetative and trophic disorders - swelling, cyanosis of the skin, local hair loss and depigmentation, sweating, thinning and dryness of the skin, brittle nails, the appearance of trophic ulcers, etc.

As a rule, the first manifestations of nerve damage are pain and numbness. In the clinical picture of some neuritis, there may be specific manifestations associated with the region innervated by this nerve.

Neuritis of the axillary nerve is manifested by the inability to raise the arm to the side, decreased sensitivity in the upper 1/3 of the shoulder, atrophy of the deltoid muscle of the shoulder and increased mobility of the shoulder joint.

Radial neuritis may have different symptoms, depending on the location of the lesion. So the process at the level of the upper 1/3 of the shoulder or in the axillary fossa is characterized by the impossibility of extending the hand and forearm and abducting the thumb, difficulty in bending the arm at the elbow joint, paresthesia and decreased skin sensitivity of I, II and partially III fingers. With the arms stretched forward on the side of the lesion, the hand hangs down, the thumb is brought to the index finger and the patient cannot turn this hand with the palm up. Neurological examination reveals the absence of the extensor elbow reflex and a decrease in the carporadial reflex. With the localization of inflammation in the middle 1/3 of the shoulder, the extension of the forearm and the extensor elbow reflex were not disturbed. If neuritis develops in the lower 1/3 of the shoulder or the upper part of the forearm, then extension of the hand and fingers is impossible, sensitivity suffers only on the back of the hand.

Neuritis of the ulnar nerve manifested by paresthesia and decreased sensitivity on the palmar surface of the hand in the region of half of the IV and completely V fingers, on the back of the hand - in the region of half of the III and completely IV-V fingers. Characterized by muscle weakness in the adductor and abductor muscles of the IV-V fingers, hypotrophy and atrophy of the muscles of the elevation of the little finger and thumb, interosseous and worm-like muscles of the hand. In connection with muscle atrophy, the palm looks flattened. The hand with ulnar neuritis is similar to a “clawed paw”: the middle phalanges of the fingers are bent, and the main ones are unbent. There are several anatomical areas of the ulnar nerve in which neuritis can develop according to the type of tunnel syndrome (compression or ischemia of the nerve in the musculoskeletal canal).

Neuritis of the median nerve begins with intense pain on the inner surface of the forearm and fingers. Sensitivity is disturbed on the half of the palm corresponding to the I-III fingers, on the palmar surface of the I-III and half of the IV fingers, on the back surface of the terminal phalanges of the II-IV fingers. The patient cannot turn his hand palm down, bend the hand at the wrist joint, bend fingers I-III. With neuritis of the median nerve, muscular atrophy of the elevation of the thumb is pronounced, the finger itself becomes in the same plane with the rest of the fingers of the hand and the hand becomes like a “monkey paw”.

Carpal tunnel syndrome - compression of the median nerve in the carpal tunnel and the development of neuritis by the type of carpal tunnel syndrome. The disease begins with periodic numbness of the I-III fingers, then paresthesias appear and the numbness becomes permanent. Patients note pain in the I-III fingers and the corresponding part of the palm, passing after brush movements. The pain occurs more often at night, it can spread to the forearm and reach the elbow joint. Temperature and pain sensitivity of fingers I-III is moderately reduced, atrophy of the thumb elevation is not always observed. There is a weakness in the opposition of the thumb and the occurrence of paresthesias when tapping in the carpal tunnel. Phalen's sign is characteristic - increased paresthesia with a two-minute flexion of the hand.

Lumbosacral plexopathy (plexitis) is manifested by weakness of the muscles of the pelvis and lower extremities, decreased sensitivity of the legs and loss of tendon reflexes on the legs (knee, Achilles). Characterized by pain in the legs, hips and lower back. When the lumbar plexus is affected to a greater extent, neuritis of the femoral and obturator nerves, as well as damage to the lateral cutaneous nerve of the thigh, comes to the fore. The pathology of the sacral plexus is manifested by neuritis of the sciatic nerve.

Neuritis of the sciatic nerve characterized by dull or shooting pains in the buttock, spreading along the back of the thigh and lower leg. The sensitivity of the foot and lower leg is reduced, there is hypotension of the gluteal and calf muscles, a decrease in the Achilles reflex. For neuritis of the sciatic nerve, symptoms of nerve tension are characteristic: the occurrence or intensification of pain when the nerve is stretched while lifting the straight leg in the supine position (Lasegue's symptom) or when squatting. Pain is noted at the exit point of the sciatic nerve on the buttock.

Neuritis of the femoral nerve manifested by difficulty in extending the leg at the knee joint and flexing the hip, decreased sensitivity in the lower 2/3 of the anterior surface of the thigh and along the entire anterior-inner surface of the lower leg, atrophy of the muscles of the anterior surface of the thigh and loss of the knee reflex. Pain with pressure under the inguinal ligament at the exit point of the nerve to the thigh is characteristic.

Complications of neuritis

As a result of neuritis, persistent movement disorders in the form of paresis or paralysis may develop. Violations of the innervation of the muscles in neuritis can lead to their atrophy and the occurrence of contractures as a result of the replacement of muscle tissue with connective tissue.

Diagnosis of neuritis

If neuritis is suspected, during the examination, the neurologist conducts functional tests aimed at identifying movement disorders.

Tests confirming neuritis of the radial nerve:

• the patient's hands lie with their palms on the table and he cannot put the third finger on the neighboring ones;
• the patient's hands lie with their back on the table and he cannot take his thumb away;
• attempts to spread the fingers of the hands pressed against each other lead to the fact that on the side of the neuritis the fingers are bent and they slide along the palm of a healthy hand;
• the patient stands with his arms lowered along the body, in this position he is unable to turn the affected hand with the palm forward and remove the thumb.

Tests confirming ulnar neuritis:

• the brush is pressed with the palmar surface to the table and the patient cannot make scratching movements with the little finger on the table;
• the patient's hands lie with their palms on the table and he cannot spread his fingers, especially IV and V;
• the affected hand does not fully clench into a fist, bending the IV and V fingers is especially difficult;
• the patient cannot hold a strip of paper between the thumb and forefinger, as the terminal phalanx of the thumb is bent.

Tests confirming median nerve neuritis:

• the hand is pressed with the palmar surface to the table and the patient is unable to make scratching movements with the second finger on the table;
• the hand on the side of the lesion does not fully clench into a fist due to difficult flexion of fingers I, II and partially III;
• the patient fails to oppose the thumb and little finger.

Treatment of neuritis

Therapy of neuritis is primarily aimed at the cause that caused it. In infectious neuritis, antibiotic therapy (sulfonamides, antibiotics), antiviral drugs (interferon derivatives, gamma globulin) are prescribed. With neuritis resulting from ischemia, vasodilators are used (papaverine, eufillin, xanthinol nicotinate), with traumatic neuritis, immobilization of the limb is performed. Apply anti-inflammatory drugs (indomethacin, ibuprofen, diclofenac), analgesics, B vitamins and conduct decongestant therapy (furosemide, acetazolamide). At the end of the second week, anticholinesterase drugs (neostigmine) and biogenic stimulants (aloe, hyaluronidase) are added to the treatment.

Physiotherapeutic procedures begin at the end of the first week of neuritis. Apply ultraphonophoresis with hydrocortisone, UHF, pulsed currents, electrophoresis of novocaine, neostigmine, hyaluronidase. Massage and special physiotherapy exercises are shown, aimed at restoring the affected muscle groups. If necessary, conduct electrical stimulation of the affected muscles.

In the treatment of tunnel syndrome, local administration of drugs (hydrocortisone, novocaine) is performed directly into the affected canal.

Surgical treatment of neuritis refers to peripheral neurosurgery and is performed by a neurosurgeon. In the acute period of neuritis with severe compression of the nerve, surgery is necessary to decompress it. In the absence of signs of nerve recovery or the appearance of signs of its degeneration, surgical treatment is also indicated, which consists in suturing the nerve; in some cases, nerve plastic surgery may be required.

Forecast and prevention of neuritis

Neuritis in young people with a high ability of tissues to regenerate responds well to therapy. In the elderly, patients with concomitant diseases (for example, diabetes mellitus), in the absence of adequate treatment of neuritis, paralysis of the affected muscles and the formation of contractures may develop.

Neuritis can be prevented by avoiding injury, infection and hypothermia.

Post-traumatic neuralgia - traumatic neuritis

Injuries of the peripheral nervous system occur together with injuries of the limbs - from dislocations and fractures to sprains of the ligamentous apparatus.

Causes of traumatic neuritis

Second name post-traumatic neuralgia – traumatic neuritis. This is the name of a condition in which the body of the nerve, or nerve root, is damaged after mechanical, thermal, or chemical injury to the nerve or ganglion. The following conditions can be the cause of such injuries:

• complete or partial interruption of sensory nerve trunks;
• chemical damage to the nerve branch with an incorrect injection of a medicinal substance;
• blows, compression of nerves to bone formations with the development of compression-ischemic neuropathies, or post-traumatic tunnel syndromes;
• consequences of fractures and dislocations of large bones.

Signs of post-traumatic neuritis

As a rule, in post-traumatic neuropathy, isolated damage to sensory nerves is rare. Thus, in the complex symptoms of post-traumatic neuritis, there are both sensory and motor, as well as autonomic and secretory-trophic disorders.

Therefore, the full signs of post-traumatic neuritis of a large nerve will be the following complaints:

• neuralgic pains, dysesthesia, violation and perversion of sensitivity, as well as persistent neuropathic pains, which have a pronounced painful burning color;
• in addition to neuralgia and neuropathic pain, there are sensory disorders such as dysesthesia (numbness), paresthesias (goosebumps), decreased temperature and pain sensitivity, as well as the manifestation of more complex types of disorders - for example, a decrease in discriminatory feelings. (Discriminatory feeling is the distinction of the smallest distance, with irritations applied to the skin at the same time);
• Movement disorders that occur with post-traumatic neuritis are reduced to paralysis, partial paralysis - paresis, muscle hypotrophy below the site of injury, as well as the occurrence of other disorders. Most often, malnutrition develops several weeks and even months after the injury. In the event that malnutrition progresses, without any positive effect, most likely, there was a complete break in the motor nerve fiber;
• Vegetative-trophic disorders include blanching of the skin in the area of ​​injury or below; reddening of the skin, or their plethora, a feeling of heat on the skin, which can be replaced by a feeling of cold, hair loss, dry skin, brittle nails and other signs indicating insufficient blood supply to tissues with nutrients. Trophic disorders are caused by the fact that autonomic nerve branches take part in the regulation of vascular tone, changing, if necessary, the lumen of the vessels, the volume of the capillary bed, and thus regulate the supply of nutrients to organs and tissues.

Pale skin after injury to the big toe

Diagnosis of post-traumatic neuralgia and neuropathy

Diagnosis of post-traumatic neuralgia is complex. A neurologist, a traumatologist and a neurosurgeon can take part in it. To do this, you need to:

• Thorough neurological examination;
• conduct an electroneuromyography procedure, during which it will be found out whether there is a connection between the muscles of the limb and between the overlying sections of the peripheral nervous system. In the event that a complete rupture of the nerve trunk is not diagnosed, then the restoration of functions will go much faster.

In the photo session of electroneuromyography

Treatment of post-traumatic neuralgia

Treatment of traumatic neuritis should be complex. What matters is: timely physiotherapy procedures, which include:

• acupuncture and all types of acupuncture;
• stimulation of the nerve and muscle with weak currents;
• electrophoresis with vitamins of various groups, especially group B (thiamine, pyridoxine);
• electrophoresis with dibazol is used, which has a pronounced neuroprotective and restorative effect;

In the photo, an electrophoresis session with intercostal neuralgia

• The use of homeopathic remedies, both tableted and recommended for topical use, has a good effect;
• The most important stage in the restoration of nerve conduction is massage and therapeutic exercises (see articles of exercise therapy for sciatic neuralgia and exercise therapy for intercostal neuralgia).
• Ayurveda techniques

In the event that the recovery period is accompanied by severe neuralgic pain, then for the relief of symptoms it is recommended:

• taking anticonvulsants (carbamazepine, finlepsin, topamax);
• drugs for the treatment of neuropathic pain. These drugs include gabapentin, pregabalin;
• It is possible to use therapeutic patches with capsaicin, which has a local irritant effect, and also reduces the level of pain sensation.

In case of ineffectiveness of conservative treatment, surgical treatment is indicated. As a rule, the effectiveness of the operation increases if the integrity of the nerve is restored in the first minutes or hours after the injury, and also if there was only a partial break in the nerve fiber. Also important is the existence of collateral nerve branches, which can "help" in expanding the zone of recovery of post-traumatic innervation.

Causes of development, manifestations and therapy of traumatic neuritis

Traumatic neuritis is an inflammation of the nerve trunk of the peripheral system, which develops after mechanical damage. It is manifested by impaired motor functions and sensitivity, as well as severe pain in the affected area.

Athletes are more susceptible to this type of disease because of the heavy loads and the constant risk of injury.

Most often, traumatic neuritis develops after:

• injured
• unsuccessful injection of medications (for example, improper conduction anesthesia can provoke the development of trigeminal neuritis);
• blows;
• pinching (for example, peroneal neuritis can develop from sitting in a cross-legged position);
• operations;
• bone fractures;
• damage or dislocation of the joint (for example, tibial neuritis).

Symptoms

Depending on the degree of damage and the type of nerve, symptoms may vary. In this case, sciatic nerve neuritis is the most severe, since the pain sensations spread to the entire leg and are so strong that during an attack a person may lose consciousness. However, both parts are rarely affected. Usually neuritis develops only on one side.

The following general symptoms can be distinguished:

• violations of motor functions (which over time can turn into paresis or paralysis);
• numbness of the affected area;
• changes in sensitivity (it can become stronger or weaker, and also take a perverted form).

Traumatic neuritis causes persistent severe pain. It also affects muscle function, over time causing a decrease in strength and gradual muscle atrophy.

Trophic and vegetative disturbances in the affected area are also often visible. The skin changes color and may become blue, swells, the epithelium becomes dry and thin. Hair often begins to fall out, nails break. In a neglected situation, a trophic ulcer may even develop.

Diagnostics

Diagnosis should be carried out by a neurologist. He collects an anamnesis and must find out the type and nature of the injury that provoked the development of inflammation of the nerve.

He must determine the disorders of the motor, reflex, sensory and other functions of the body.

Electrodiagnostics allows for a comprehensive study of a person with traumatic neuritis after 2 weeks from the moment of injury. It separates degenerative disorders from non-degenerative ones. This allows you to make a prognosis of treatment.

Whether a more or less complete restoration of muscle strength after this type of neuritis can only be in the muscle that, during electrodiagnosis, shows reduced electrical excitability or a reaction of partial degeneration of the nerve.

If the reaction of complete degeneration of the nerve is shown, then the restoration of movement does not occur.

There are also features of the reaction to this analysis. For example, in the muscles of the anterior surface of the forearm, electrical excitability always disappears earlier than in other places. And the muscles of the hand are often more stable in the ability to respond to the current.

Treatment

Treatment of traumatic neuritis is carried out using a number of procedures: muscle and nerve stimulation, acupuncture, etc.

The patient is prescribed a large amount of vitamins B, C and E. If necessary, surgery is performed.

The patient is prescribed anti-inflammatory drugs and analgesics to relieve pain.

Alternative methods can help improve the general condition. Decoctions can have analgesic, anti-inflammatory and soothing effects.

Prevention consists in good nutrition, taking vitamins, and, if possible, reducing the risk of injury.

Manifestations and treatment of post-traumatic neuritis of the radial nerve

Post-traumatic neuritis of the radial nerve is a condition in which damage to the specified nerve tissue occurs, which occurs after a hand injury. This is one of the most popular hand injuries and is diagnosed not only by neuropathologists, but also by traumatologists.

In addition to injury, the cause of neuritis can be an incorrect posture in a dream, when the hand is either motionless for a long time, or is squeezed by the weight of the body. The second reason is poisoning with mercury, lead, alcohol, or carbon monoxide.

Another reason is compression of the nerve in the armpit area when moving with crutches. Therefore, before use, they should be selected according to all the rules, strictly in size.

Another factor is past infection. Nerve damage can occur as a complication of diseases such as influenza, pneumonia, sepsis, and some others.

Symptoms

Traumatic neuritis of the radial nerve is manifested by symptoms characteristic of this pathology. First of all, its function is completely disrupted. The patient complains that a complete loss of sensitivity occurs in one or another part of the arm. If the nerve is affected frequently or the cause is chronic trauma, as well as the presence of a keloid scar, then paresis or paralysis may develop. This applies to the extensor muscles not only of the forearm, but also of the hand, as well as the phalanges of the fingers.

The rest of the symptoms will depend on the area in which the lesion occurred. The higher this level, the more pronounced the symptoms, and the motor activity of the hand will be in this case almost completely impaired. Each level of damage has its own symptoms, which allow you to make the correct diagnosis.

If the upper part of the arm is affected, then the manifestations will be as follows:

1. Numbness and loss of sensation.
2. There is no way to bend the arm at the elbow.
3. There is no possibility to straighten the arm in the area of ​​the wrist joint.
4. When stretching the arm, the brush hangs down.
5. The second and third fingers are limited in movement.
6. The first finger cannot be extended.

If the middle part is affected, then the symptoms will be almost the same, but the ability to bend the forearm remains, and the sensitivity of the skin remains, but the movements of the brush are sharply limited.

If the lower part is affected, it is impossible to straighten the wrist joint, the hand constantly hangs down and is in one position. There is a loss of sensation on the back of the hand. Fingers are almost impossible to unbend.

And finally, if the wrist is damaged, severe pain occurs in the area of ​​\u200b\u200bthe first finger, which can radiate to the shoulder. Sensitivity is also lost.

How to get rid

Treatment of post-traumatic neuritis of the radial nerve is strictly individual and depends on the location of the lesion and the symptoms present.

If necessary, antibiotics are used, as well as drugs that help improve blood circulation. For the same purpose, vitamin preparations are prescribed, especially those that contain vitamins B, C and E. After a full course, rehabilitation is required, which includes physiotherapy procedures that help increase muscle tone and reduce pain.

Since the cause of post-traumatic neuritis is trauma, the limb is immobilized with a plaster cast, and anti-inflammatory drugs from the NSAID group are also used.

You definitely need a massage, which is best entrusted to a professional. If you try to massage yourself, you can injure your hand even more.

To develop a joint, physiotherapy exercises are required, and the training scheme should be strictly individual. It is best to practice in a specially equipped room. At home, you can do exercises with the ball. You need to attend these classes every day.

If you wish, you can go to the pool and do exercises in the water. If treatment is not carried out, then with traumatic neuritis of the radial nerve, contracture may occur, in which it will be impossible to restore the function of the muscle fiber or joint.

Therefore, when the first signs of illness appear, you should immediately consult a doctor - a neurologist or traumatologist.

By the way, you may also be interested in the following FREE materials:

Free Books: "TOP 7 Bad Morning Exercises You Should Avoid" | "6 Rules for Effective and Safe Stretching"

Restoration of knee and hip joints with arthrosis - free video recording of the webinar, which was conducted by the doctor of exercise therapy and sports medicine - Alexandra Bonina

Free low back pain treatment lessons from a certified exercise therapy doctor. This doctor has developed a unique system for the restoration of all parts of the spine and has already helped over 2000 clients with various back and neck problems!

Want to learn how to treat a pinched sciatic nerve? Then carefully watch the video at this link.

10 Essential Nutrition Components for a Healthy Spine - In this report, you will learn what your daily diet should be like so that you and your spine are always in a healthy body and spirit. Very useful information!

Development and recommendations for the treatment of neuropathy after injury

Post-traumatic neuropathy (neuropathy) is a heterogeneous disease characterized by damage to nerve fibers as a result of trauma. This pathology is not fatal, however, it is characterized by the development of sufficiently strong painful sensations in the patient. Consider the features of this disease in more detail.

General characteristics of the pathology

Injuries that cause the development of neuropathy can be of two types:

1. Acute - cut, blow, bruise or fracture.
2. Chronic - prolonged compression of the nerve (for example, as a result of bone displacement). Most often, this pathology is localized in the median or radial nerve and affects the upper limbs.

In most cases, the symptoms of the disease appear immediately after the injury. However, in some cases, the pathology develops later, when the process of inflammation begins in the damaged tissues and the resulting scar tissue compresses the nerve. After the cessation of the nerve supply, all its underlying sections undergo irreversible destructive changes.

The literature describes cases when post-traumatic neuritis developed after fractures due to improper plastering. Due to the prolonged compression of the nerve by the swollen tissues and the plaster itself, a pathological area was formed, due to which impulses stopped passing to the limb. Therefore, after the application of plaster, it is mandatory to examine a neurologist and control a specialist throughout the entire healing period.

The characteristic manifestations of post-traumatic neuropathy are:

• weakening of the grip of the hand or the sensitivity of the foot;
• numbness;
• tremor;
• discomfort in the hand, foot, fingers;
• decreased skin sensitivity.

Patients often complain of discomfort in the affected limb, which intensifies at night. Without timely treatment, the disease can lead to atrophy of the nerve ending and loss of sensation and ability to move the limb. However, if the treatment began immediately after the injury, the patient has every chance of a complete restoration of the functionality of the nerve.

Neurologists are involved in the diagnosis and treatment of the disease. In some cases, surgery is required to release pressure from surrounding tissues. Traumatic neuritis can lead to disability of the patient if its first signs were not noticed in time.

The main method of diagnosis is a medical examination by a neurologist and functional tests. To do this, the doctor conducts tests on reflexes, on sensitivity and on the mobility of the limb, in order to establish the degree of nerve damage and the presence of muscle atrophy.

Types and diagnosis of the disease

Post-traumatic neuropathy is divided into different types according to certain criteria. The first of these can be called the mechanism of the onset of the disease. There are the following forms of pathology:

In addition, the forms of the disease are distinguished according to its localization. Neuropathy can develop in any nerve of the body, but most often the nerves of the extremities suffer from pathology, because. they are most susceptible to injury due to low tissue protection. For example, the ulnar nerve is not protected by any bones and is located almost under the skin, so it is often damaged when a bent elbow strikes any surface.

The most common forms of pathology by localization:

• neuropathy of the peroneal or tibial nerve - with injuries of the lower extremities;
• neuropathy of the radial, ulnar or median nerve - with hand injuries;
• shoulder plexitis - with a dislocation of the shoulder joint.

The main diagnostic method, as mentioned above, is an examination by a neurologist with functional tests. However, examination may not always give an unambiguous answer to the question of diagnosis. In such cases, as additional methods, methods of computed tomography, electroneuromyography, ultrasound, X-ray are used. All these methods are aimed at visualizing the area under study and allow more accurately identifying the integrity of the nervous tissue.

Treatment of pathology

As noted earlier in the article, the success of treatment directly depends on how soon the first symptoms were noticed and help was provided. This is especially true of the upper limbs: the movements and sensitivity of the hands are very difficult, therefore, in order to fully restore them, treatment must begin as soon as possible.

The essence of the treatment is to release the nervous tissue from compression by bone fragments or inflamed surrounding tissues. Often this requires surgery, but in most cases the operation is not very difficult.

Patients with neuropathy are shown complete immobilization of the limb in a physiological position - for this purpose, plaster or other types of fixing bandages are applied. In some cases, for immobilization, a forced position with the least nerve tension is preferred.

Also during the treatment, drug therapy is used:

1. Vitamin complexes (vitamins of group B).
2. Preparations that facilitate and accelerate the healing process and the proper formation of scar tissue (Contractubex).
3. Painkillers, which is especially important for patients who have suffered an injury (Voltaren, Indomethacin, Ketonal).

Physiotherapy has an effective effect: exposure to heat, light, ultrasound. These methods allow minimizing the formation of scars and adhesions that can further disrupt the function of nerve conduction.

After the injury has healed, the patient is prescribed a complex of physiotherapy exercises, which is necessary for the complete restoration of mobility and sensitivity of the limb. Useful measures include massage, acupuncture and other ways to restore sensitivity. The complex of restorative procedures is selected individually in each case, taking into account the capabilities of the body.

During treatment and rehabilitation, patients are advised to eat a variety of foods rich in vitamins, especially group B. Proper nutrition contributes to the speedy healing of wounds and the restoration of the functions of the nerve roots.

Thus, post-traumatic neuropathy is a treatable disease, but for its favorable outcome, you should consult a doctor in a timely manner and be patient during the restoration of impaired functions. Ignoring symptoms can lead to permanent loss of sensation and mobility of the affected limb.

Traumatic neuritis (post-traumatic neuropathy)

Traumatic neuritis (post-traumatic neuropathy) is a disease of the nerve root that occurs after a mechanical injury to the nerve:

• operations
• injuries, including after injection of the drug (post-injection neuritis)
• blows and long clamping
• bone fractures and joint dislocations

Traumatic neuritis (post-traumatic neuropathy), depending on the level and type of nerve damage, will manifest a variety of symptoms: movement disorders (paresis, paralysis) in a particular muscle or muscle group, numbness, changes in sensitivity (intensification, weakening or perversion).

Traumatic neuritis of the ulnar nerve with a fracture of the ulna .

Often there are traumatic neuritis in fractures or dislocation of the bones and joints of the extremities due to their anatomical proximity. After diagnosing the level of nerve damage, treatment begins, taking into account the symptoms of damage to the nerve root.

Traumatic neuritis (post-traumatic neuropathy) that causes persistent pain symptoms (neuralgia), or hypesthesia (decrease in sensitivity), or muscle paresis (decrease in strength) takes time and patience and responds well to treatment.

Injuries to a nerve as large as the sciatic nerve are rarely complete. More often one or another portion of the sciatic nerve suffers more.

Diagnosis of traumatic neuritis

neuropraxia- This is a disease of the peripheral nervous system, during which there is a temporary loss of motor and sensory function due to blockade of nerve conduction. Impaired transmission of the nerve impulse in neuropraxia usually lasts an average of 6-8 weeks before its full recovery.

Symptoms of damage to any peripheral nerve in traumatic neuritis consists of motor, reflex, sensory and vasomotor-secretory-trophic disorders. Examination of a patient with traumatic neuritis traditionally begins with the collection of anamnestic information.

Classical electrodiagnostics is of great importance in the system of a comprehensive study of a patient with traumatic neuritis in terms of 2 weeks and later after the injury, helping to separate degenerative from non-degenerative disorders. Thus, the prognosis is also determined to a certain extent, since closed injuries of the nerve trunks, in particular the brachial plexus, accompanied by degeneration, are always doubtful regarding the completeness and quality of the restoration of lost movements, especially in the distal limbs.

Restoration of movements up to a force of 4–5 points after traumatic neuritis is observed only in those muscles in which, during classical electrodiagnostics, reduced electrical excitability or a reaction of partial degeneration of the nerve is detected.

In the reaction of complete degeneration of the nerve after traumatic neuritis, restoration of movement in the muscles is not observed.

In very late periods after nerve injury in traumatic neuritis, the detection of a loss of electrical excitability of paralyzed muscles gives another reason in favor of refusing to operate on the nerves. Earlier than in other areas, the electrical excitability of the muscles of the dorsum of the forearm disappears. Contrary to conventional wisdom, the small muscles of the hand often turn out to be more stable in terms of their ability to respond to current stimulation.

Electromyography is a very promising research method for closed injuries of the brachial plexus, which makes it possible to record the dynamics of changes in the neuromuscular apparatus during the recovery process. The corresponding electromyographic curve with the appearance of previously absent action potentials in traumatic neuritis allows us to expect the restoration of movement long before the first clinical signs of this restoration.

The work of the organs and systems of our body is regulated by nerve impulses - signals coming from the brain. "Outgoing" and "incoming" impulses are transmitted through the nerves, as if through wires. Damage to the nerves disrupts this connection and can cause serious malfunctions in the body. After all, along with a violation of nerve transmission in the affected area, there is a deterioration in cellular nutrition and blood supply.

A condition characterized by damage to nerve fibers and accompanied by a violation of the conduction of a nerve impulse along a nerve fiber is called neuropathy (neuropathy) .

If one nerve is affected, we are talking about mononeuropathies if there is multiple symmetrical damage to the peripheral nerves (for example, when the process covers both lower and / or upper limbs at once, etc.) - about polyneuropathy . The pathological process can cover both cranial and peripheral nerves.

Damage to the peripheral nerve trunks, which are based on the infringement of the nerve increased as a result of inflammation and swelling in the muscle-bone tunnel, are called tunnel syndrome (there is also a name compression-ischemic neuropathy ).

There are dozens of tunnel syndromes, the most famous of which is carpal tunnel.

Causes and types of neuropathy

In 30% of cases, neuropathy is considered idiopathic (that is, arising from unknown causes).

Otherwise, the causes of the disease can be divided into internal and external.

Causes associated with various internal pathologies:

• endocrine diseases, of which about a third of all neuropathies account for;
• beriberi, especially deficiency of B vitamins;
• autoimmune diseases;
• multiple sclerosis;
• and etc.

External factors that provoke the development of neuropathy include:

• alcoholism (a frequent consequence is neuropathy of the lower extremities);
• intoxication;
• infections.

Often the cause of nerve damage is a hereditary factor. In such cases, the disease can develop autonomously, without any additional harmful effects.

Neuropathy is a very serious disease that needs qualified diagnosis and adequate treatment. If you are concerned about any of the following symptoms, contact your !

Depending on the localization of the disease, there are neuropathies of the upper, lower extremities and cranial nerves, for example:

Neuropathy of the facial nerve

It can develop as a result of a viral infection, hypothermia, unsuccessful dental intervention, depression, pregnancy and childbirth, and also due to a neoplasm. Signs of the disease are: weakening of the muscles on the part of the affected nerve, salivation and lacrimation, the inability to completely close the eyelids.

trigeminal neuropathy

Caused by various reasons (maxillofacial operations, dentures, difficult childbirth, heredity) damage to the nerve endings of the gums, upper and lower lips, chin. Patients complain of severe facial pain from the affected nerve, radiating to the upper and lower jaws, which are not relieved by analgesics. There is also discharge from one nostril, lacrimation and redness of the eye.

Radial nerve neuropathy

It often occurs against the background of the so-called "sleep paralysis", i.e. nerve compression due to the incorrect position of the hand. It occurs in people who use drugs or alcohol. It also progresses with the hand, bursitis or. It is manifested by a violation of the dorsiflexion of the hand (the hand hangs), numbness of the thumb and forefinger, pain can occur along the outer surface of the forearm.

median nerve neuropathy

The defeat of this area of ​​the upper limb can occur with sprain, gout, neoplasm, as well as in case of nerve compression. It is manifested by severe pain (as well as numbness and burning) in the forearm, shoulder, hand, thumb, index and middle fingers.

Ulnar nerve neuropathy

The cause of this ailment may be traumatic (, tear and rupture) or other damage to the ulnar nerve (for example, caused by bursitis,). It is manifested by numbness of the first and half of the fourth fingers, a decrease in the volume of the hand, and a decrease in the range of motion.

Neuropathy of the sciatic nerve

Usually it becomes the result of a serious injury or disease (knife or gunshot, hip or pelvic bones, oncology). It is manifested by pain on the back of the thigh, lower leg, buttocks from the side of the nerve lesion.

Neuropathy of the lower extremities

It can develop due to excessive physical overload, tumors in the pelvic area, hypothermia, and also due to the use of certain drugs. Symptoms - the inability to bend forward, pain in the back of the thigh, numbness of the lower leg.

Neuropathy of the peroneal nerve

Occurs on the basis of, and other injuries, as well as due to tunnel syndrome, wearing tight, uncomfortable shoes. Manifestations: impossibility of dorsiflexion of the foot, cock's gait (the patient cannot bend the foot "on itself").

Symptoms of neuropathy

The variety of types of the disease explains a huge number of specific manifestations. However, one can single out the most characteristic signs of neuropathy :

• swelling of tissues in the affected area;
• violation of sensitivity (soreness, numbness, coldness, burning of the skin, etc.);
• muscle weakness;
• spasms, convulsions;
• difficulty in movement;
• soreness / sharp pain in the affected area.

Mononeuropathies extremities are never accompanied by cerebral symptoms (nausea, vomiting, dizziness, etc.), cranial neuropathies can manifest with similar symptoms and, as a rule, accompany more serious diseases of the nervous system of the brain.

Polyneuropathies are manifested by a violation of sensitivity, movement, vegetative disorders. This is a serious pathology, which initially manifests itself in the form of muscle weakness (paresis), and then can lead to paralysis of the lower and upper limbs. The process can also cover the trunk, cranial and facial nerves.

Diagnosis and treatment of neuropathy

When diagnosing neuropathy, the doctor is given primary information by questioning and examining the patient, as well as by palpation, checking the sensitivity and motor activity of the affected area.

Post-traumatic neuralgia - traumatic neuritis

Injuries of the peripheral nervous system occur together with injuries of the limbs - from dislocations and fractures to sprains of the ligamentous apparatus.

Causes of traumatic neuritis

Second name post-traumatic neuralgia – traumatic neuritis. This is the name of a condition in which the body of the nerve, or nerve root, is damaged after mechanical, thermal, or chemical injury to the nerve or ganglion. The following conditions can be the cause of such injuries:

• complete or partial interruption of sensory nerve trunks;
• chemical damage to the nerve branch with an incorrect injection of a medicinal substance;
• blows, compression of nerves to bone formations with the development of compression-ischemic neuropathies, or post-traumatic tunnel syndromes;
• consequences of fractures and dislocations of large bones.

Signs of post-traumatic neuritis

As a rule, in post-traumatic neuropathy, isolated damage to sensory nerves is rare. Thus, in the complex symptoms of post-traumatic neuritis, there are both sensory and motor, as well as autonomic and secretory-trophic disorders.

Therefore, the full signs of post-traumatic neuritis of a large nerve will be the following complaints:

• neuralgic pains, dysesthesia, violation and perversion of sensitivity, as well as persistent neuropathic pains, which have a pronounced painful burning color;
• in addition to neuralgia and neuropathic pain, there are sensory disorders such as dysesthesia (numbness), paresthesias (goosebumps), decreased temperature and pain sensitivity, as well as the manifestation of more complex types of disorders - for example, a decrease in discriminatory feelings. (Discriminatory feeling is the distinction of the smallest distance, with irritations applied to the skin at the same time);
• Movement disorders that occur with post-traumatic neuritis are reduced to paralysis, partial paralysis - paresis, muscle hypotrophy below the site of injury, as well as the occurrence of other disorders. Most often, malnutrition develops several weeks and even months after the injury. In the event that malnutrition progresses, without any positive effect, most likely, there was a complete break in the motor nerve fiber;
• Vegetative-trophic disorders include blanching of the skin in the area of ​​injury or below; reddening of the skin, or their plethora, a feeling of heat on the skin, which can be replaced by a feeling of cold, hair loss, dry skin, brittle nails and other signs indicating insufficient blood supply to tissues with nutrients. Trophic disorders are caused by the fact that autonomic nerve branches take part in the regulation of vascular tone, changing, if necessary, the lumen of the vessels, the volume of the capillary bed, and thus regulate the supply of nutrients to organs and tissues.

Pale skin after injury to the big toe

Diagnosis of post-traumatic neuralgia and neuropathy

Diagnosis of post-traumatic neuralgia is complex. A neurologist, a traumatologist and a neurosurgeon can take part in it. To do this, you need to:

• Thorough neurological examination;
• conduct an electroneuromyography procedure, during which it will be found out whether there is a connection between the muscles of the limb and between the overlying sections of the peripheral nervous system. In the event that a complete rupture of the nerve trunk is not diagnosed, then the restoration of functions will go much faster.

In the photo session of electroneuromyography

Treatment of post-traumatic neuralgia

Treatment of traumatic neuritis should be complex. What matters is: timely physiotherapy procedures, which include:

• acupuncture and all types of acupuncture;
• stimulation of the nerve and muscle with weak currents;
• electrophoresis with vitamins of various groups, especially group B (thiamine, pyridoxine);
• electrophoresis with dibazol is used, which has a pronounced neuroprotective and restorative effect;

In the photo, an electrophoresis session with intercostal neuralgia

• The use of homeopathic remedies, both tableted and recommended for topical use, has a good effect;
• The most important stage in the restoration of nerve conduction is massage and therapeutic exercises (see articles of exercise therapy for sciatic neuralgia and exercise therapy for intercostal neuralgia).
• Ayurveda techniques

In the event that the recovery period is accompanied by severe neuralgic pain, then for the relief of symptoms it is recommended:

• taking anticonvulsants (carbamazepine, finlepsin, topamax);
• drugs for the treatment of neuropathic pain. These drugs include gabapentin, pregabalin;
• It is possible to use therapeutic patches with capsaicin, which has a local irritant effect, and also reduces the level of pain sensation.

In case of ineffectiveness of conservative treatment, surgical treatment is indicated. As a rule, the effectiveness of the operation increases if the integrity of the nerve is restored in the first minutes or hours after the injury, and also if there was only a partial break in the nerve fiber. Also important is the existence of collateral nerve branches, which can "help" in expanding the zone of recovery of post-traumatic innervation.

Causes of development, manifestations and therapy of traumatic neuritis

Traumatic neuritis is an inflammation of the nerve trunk of the peripheral system, which develops after mechanical damage. It is manifested by impaired motor functions and sensitivity, as well as severe pain in the affected area.

Athletes are more susceptible to this type of disease because of the heavy loads and the constant risk of injury.

Most often, traumatic neuritis develops after:

• injured
• unsuccessful injection of medications (for example, improper conduction anesthesia can provoke the development of trigeminal neuritis);
• blows;
• pinching (for example, peroneal neuritis can develop from sitting in a cross-legged position);
• operations;
• bone fractures;
• damage or dislocation of the joint (for example, tibial neuritis).

Symptoms

Depending on the degree of damage and the type of nerve, symptoms may vary. In this case, sciatic nerve neuritis is the most severe, since the pain sensations spread to the entire leg and are so strong that during an attack a person may lose consciousness. However, both parts are rarely affected. Usually neuritis develops only on one side.

The following general symptoms can be distinguished:

• violations of motor functions (which over time can turn into paresis or paralysis);
• numbness of the affected area;
• changes in sensitivity (it can become stronger or weaker, and also take a perverted form).

Traumatic neuritis causes persistent severe pain. It also affects muscle function, over time causing a decrease in strength and gradual muscle atrophy.

Trophic and vegetative disturbances in the affected area are also often visible. The skin changes color and may become blue, swells, the epithelium becomes dry and thin. Hair often begins to fall out, nails break. In a neglected situation, a trophic ulcer may even develop.

Diagnostics

Diagnosis should be carried out by a neurologist. He collects an anamnesis and must find out the type and nature of the injury that provoked the development of inflammation of the nerve.

He must determine the disorders of the motor, reflex, sensory and other functions of the body.

Electrodiagnostics allows for a comprehensive study of a person with traumatic neuritis after 2 weeks from the moment of injury. It separates degenerative disorders from non-degenerative ones. This allows you to make a prognosis of treatment.

Whether a more or less complete restoration of muscle strength after this type of neuritis can only be in the muscle that, during electrodiagnosis, shows reduced electrical excitability or a reaction of partial degeneration of the nerve.

If the reaction of complete degeneration of the nerve is shown, then the restoration of movement does not occur.

There are also features of the reaction to this analysis. For example, in the muscles of the anterior surface of the forearm, electrical excitability always disappears earlier than in other places. And the muscles of the hand are often more stable in the ability to respond to the current.

Treatment

Treatment of traumatic neuritis is carried out using a number of procedures: muscle and nerve stimulation, acupuncture, etc.

The patient is prescribed a large amount of vitamins B, C and E. If necessary, surgery is performed.

The patient is prescribed anti-inflammatory drugs and analgesics to relieve pain.

Alternative methods can help improve the general condition. Decoctions can have analgesic, anti-inflammatory and soothing effects.

Prevention consists in good nutrition, taking vitamins, and, if possible, reducing the risk of injury.

Manifestations and treatment of post-traumatic neuritis of the radial nerve

Post-traumatic neuritis of the radial nerve is a condition in which damage to the specified nerve tissue occurs, which occurs after a hand injury. This is one of the most popular hand injuries and is diagnosed not only by neuropathologists, but also by traumatologists.

In addition to injury, the cause of neuritis can be an incorrect posture in a dream, when the hand is either motionless for a long time, or is squeezed by the weight of the body. The second reason is poisoning with mercury, lead, alcohol, or carbon monoxide.

Another reason is compression of the nerve in the armpit area when moving with crutches. Therefore, before use, they should be selected according to all the rules, strictly in size.

Another factor is past infection. Nerve damage can occur as a complication of diseases such as influenza, pneumonia, sepsis, and some others.

Symptoms

Traumatic neuritis of the radial nerve is manifested by symptoms characteristic of this pathology. First of all, its function is completely disrupted. The patient complains that a complete loss of sensitivity occurs in one or another part of the arm. If the nerve is affected frequently or the cause is chronic trauma, as well as the presence of a keloid scar, then paresis or paralysis may develop. This applies to the extensor muscles not only of the forearm, but also of the hand, as well as the phalanges of the fingers.

The rest of the symptoms will depend on the area in which the lesion occurred. The higher this level, the more pronounced the symptoms, and the motor activity of the hand will be in this case almost completely impaired. Each level of damage has its own symptoms, which allow you to make the correct diagnosis.

If the upper part of the arm is affected, then the manifestations will be as follows:

1. Numbness and loss of sensation.
2. There is no way to bend the arm at the elbow.
3. There is no possibility to straighten the arm in the area of ​​the wrist joint.
4. When stretching the arm, the brush hangs down.
5. The second and third fingers are limited in movement.
6. The first finger cannot be extended.

If the middle part is affected, then the symptoms will be almost the same, but the ability to bend the forearm remains, and the sensitivity of the skin remains, but the movements of the brush are sharply limited.

If the lower part is affected, it is impossible to straighten the wrist joint, the hand constantly hangs down and is in one position. There is a loss of sensation on the back of the hand. Fingers are almost impossible to unbend.

And finally, if the wrist is damaged, severe pain occurs in the area of ​​\u200b\u200bthe first finger, which can radiate to the shoulder. Sensitivity is also lost.

How to get rid

Treatment of post-traumatic neuritis of the radial nerve is strictly individual and depends on the location of the lesion and the symptoms present.

If necessary, antibiotics are used, as well as drugs that help improve blood circulation. For the same purpose, vitamin preparations are prescribed, especially those that contain vitamins B, C and E. After a full course, rehabilitation is required, which includes physiotherapy procedures that help increase muscle tone and reduce pain.

Since the cause of post-traumatic neuritis is trauma, the limb is immobilized with a plaster cast, and anti-inflammatory drugs from the NSAID group are also used.

You definitely need a massage, which is best entrusted to a professional. If you try to massage yourself, you can injure your hand even more.

To develop a joint, physiotherapy exercises are required, and the training scheme should be strictly individual. It is best to practice in a specially equipped room. At home, you can do exercises with the ball. You need to attend these classes every day.

If you wish, you can go to the pool and do exercises in the water. If treatment is not carried out, then with traumatic neuritis of the radial nerve, contracture may occur, in which it will be impossible to restore the function of the muscle fiber or joint.

Therefore, when the first signs of illness appear, you should immediately consult a doctor - a neurologist or traumatologist.

By the way, you may also be interested in the following FREE materials:

Free Books: "TOP 7 Bad Morning Exercises You Should Avoid" | "6 Rules for Effective and Safe Stretching"

Restoration of knee and hip joints with arthrosis - free video recording of the webinar, which was conducted by the doctor of exercise therapy and sports medicine - Alexandra Bonina

Free low back pain treatment lessons from a certified exercise therapy doctor. This doctor has developed a unique system for the restoration of all parts of the spine and has already helped over 2000 clients with various back and neck problems!

Want to learn how to treat a pinched sciatic nerve? Then carefully watch the video at this link.

10 Essential Nutrition Components for a Healthy Spine - In this report, you will learn what your daily diet should be like so that you and your spine are always in a healthy body and spirit. Very useful information!

Development and recommendations for the treatment of neuropathy after injury

Post-traumatic neuropathy (neuropathy) is a heterogeneous disease characterized by damage to nerve fibers as a result of trauma. This pathology is not fatal, however, it is characterized by the development of sufficiently strong painful sensations in the patient. Consider the features of this disease in more detail.

General characteristics of the pathology

Injuries that cause the development of neuropathy can be of two types:

1. Acute - cut, blow, bruise or fracture.
2. Chronic - prolonged compression of the nerve (for example, as a result of bone displacement). Most often, this pathology is localized in the median or radial nerve and affects the upper limbs.

In most cases, the symptoms of the disease appear immediately after the injury. However, in some cases, the pathology develops later, when the process of inflammation begins in the damaged tissues and the resulting scar tissue compresses the nerve. After the cessation of the nerve supply, all its underlying sections undergo irreversible destructive changes.

The literature describes cases when post-traumatic neuritis developed after fractures due to improper plastering. Due to the prolonged compression of the nerve by the swollen tissues and the plaster itself, a pathological area was formed, due to which impulses stopped passing to the limb. Therefore, after the application of plaster, it is mandatory to examine a neurologist and control a specialist throughout the entire healing period.

The characteristic manifestations of post-traumatic neuropathy are:

• weakening of the grip of the hand or the sensitivity of the foot;
• numbness;
• tremor;
• discomfort in the hand, foot, fingers;
• decreased skin sensitivity.

Patients often complain of discomfort in the affected limb, which intensifies at night. Without timely treatment, the disease can lead to atrophy of the nerve ending and loss of sensation and ability to move the limb. However, if the treatment began immediately after the injury, the patient has every chance of a complete restoration of the functionality of the nerve.

Neurologists are involved in the diagnosis and treatment of the disease. In some cases, surgery is required to release pressure from surrounding tissues. Traumatic neuritis can lead to disability of the patient if its first signs were not noticed in time.

The main method of diagnosis is a medical examination by a neurologist and functional tests. To do this, the doctor conducts tests on reflexes, on sensitivity and on the mobility of the limb, in order to establish the degree of nerve damage and the presence of muscle atrophy.

Types and diagnosis of the disease

Post-traumatic neuropathy is divided into different types according to certain criteria. The first of these can be called the mechanism of the onset of the disease. There are the following forms of pathology:

In addition, the forms of the disease are distinguished according to its localization. Neuropathy can develop in any nerve of the body, but most often the nerves of the extremities suffer from pathology, because. they are most susceptible to injury due to low tissue protection. For example, the ulnar nerve is not protected by any bones and is located almost under the skin, so it is often damaged when a bent elbow strikes any surface.

The most common forms of pathology by localization:

• neuropathy of the peroneal or tibial nerve - with injuries of the lower extremities;
• neuropathy of the radial, ulnar or median nerve - with hand injuries;
• shoulder plexitis - with a dislocation of the shoulder joint.

The main diagnostic method, as mentioned above, is an examination by a neurologist with functional tests. However, examination may not always give an unambiguous answer to the question of diagnosis. In such cases, as additional methods, methods of computed tomography, electroneuromyography, ultrasound, X-ray are used. All these methods are aimed at visualizing the area under study and allow more accurately identifying the integrity of the nervous tissue.

Treatment of pathology

As noted earlier in the article, the success of treatment directly depends on how soon the first symptoms were noticed and help was provided. This is especially true of the upper limbs: the movements and sensitivity of the hands are very difficult, therefore, in order to fully restore them, treatment must begin as soon as possible.

The essence of the treatment is to release the nervous tissue from compression by bone fragments or inflamed surrounding tissues. Often this requires surgery, but in most cases the operation is not very difficult.

Patients with neuropathy are shown complete immobilization of the limb in a physiological position - for this purpose, plaster or other types of fixing bandages are applied. In some cases, for immobilization, a forced position with the least nerve tension is preferred.

Also during the treatment, drug therapy is used:

1. Vitamin complexes (vitamins of group B).
2. Preparations that facilitate and accelerate the healing process and the proper formation of scar tissue (Contractubex).
3. Painkillers, which is especially important for patients who have suffered an injury (Voltaren, Indomethacin, Ketonal).

Physiotherapy has an effective effect: exposure to heat, light, ultrasound. These methods allow minimizing the formation of scars and adhesions that can further disrupt the function of nerve conduction.

After the injury has healed, the patient is prescribed a complex of physiotherapy exercises, which is necessary for the complete restoration of mobility and sensitivity of the limb. Useful measures include massage, acupuncture and other ways to restore sensitivity. The complex of restorative procedures is selected individually in each case, taking into account the capabilities of the body.

During treatment and rehabilitation, patients are advised to eat a variety of foods rich in vitamins, especially group B. Proper nutrition contributes to the speedy healing of wounds and the restoration of the functions of the nerve roots.

Thus, post-traumatic neuropathy is a treatable disease, but for its favorable outcome, you should consult a doctor in a timely manner and be patient during the restoration of impaired functions. Ignoring symptoms can lead to permanent loss of sensation and mobility of the affected limb.

Traumatic neuritis (post-traumatic neuropathy)

Traumatic neuritis (post-traumatic neuropathy) is a disease of the nerve root that occurs after a mechanical injury to the nerve:

• operations
• injuries, including after injection of the drug (post-injection neuritis)
• blows and long clamping
• bone fractures and joint dislocations

Traumatic neuritis (post-traumatic neuropathy), depending on the level and type of nerve damage, will manifest a variety of symptoms: movement disorders (paresis, paralysis) in a particular muscle or muscle group, numbness, changes in sensitivity (intensification, weakening or perversion).

Traumatic neuritis of the ulnar nerve with a fracture of the ulna .

Often there are traumatic neuritis in fractures or dislocation of the bones and joints of the extremities due to their anatomical proximity. After diagnosing the level of nerve damage, treatment begins, taking into account the symptoms of damage to the nerve root.

Traumatic neuritis (post-traumatic neuropathy) that causes persistent pain symptoms (neuralgia), or hypesthesia (decrease in sensitivity), or muscle paresis (decrease in strength) takes time and patience and responds well to treatment.

Injuries to a nerve as large as the sciatic nerve are rarely complete. More often one or another portion of the sciatic nerve suffers more.

Diagnosis of traumatic neuritis

neuropraxia- This is a disease of the peripheral nervous system, during which there is a temporary loss of motor and sensory function due to blockade of nerve conduction. Impaired transmission of the nerve impulse in neuropraxia usually lasts an average of 6-8 weeks before its full recovery.

Symptoms of damage to any peripheral nerve in traumatic neuritis consists of motor, reflex, sensory and vasomotor-secretory-trophic disorders. Examination of a patient with traumatic neuritis traditionally begins with the collection of anamnestic information.

Classical electrodiagnostics is of great importance in the system of a comprehensive study of a patient with traumatic neuritis in terms of 2 weeks and later after the injury, helping to separate degenerative from non-degenerative disorders. Thus, the prognosis is also determined to a certain extent, since closed injuries of the nerve trunks, in particular the brachial plexus, accompanied by degeneration, are always doubtful regarding the completeness and quality of the restoration of lost movements, especially in the distal limbs.

Restoration of movements up to a force of 4–5 points after traumatic neuritis is observed only in those muscles in which, during classical electrodiagnostics, reduced electrical excitability or a reaction of partial degeneration of the nerve is detected.

In the reaction of complete degeneration of the nerve after traumatic neuritis, restoration of movement in the muscles is not observed.

In very late periods after nerve injury in traumatic neuritis, the detection of a loss of electrical excitability of paralyzed muscles gives another reason in favor of refusing to operate on the nerves. Earlier than in other areas, the electrical excitability of the muscles of the dorsum of the forearm disappears. Contrary to conventional wisdom, the small muscles of the hand often turn out to be more stable in terms of their ability to respond to current stimulation.

Electromyography is a very promising research method for closed injuries of the brachial plexus, which makes it possible to record the dynamics of changes in the neuromuscular apparatus during the recovery process. The corresponding electromyographic curve with the appearance of previously absent action potentials in traumatic neuritis allows us to expect the restoration of movement long before the first clinical signs of this restoration.