Edema of the shoulder
Cervical-brachial syndromes are a complex of symptoms,developing in the defeat of the cervical roots and brachial plexus and characterized by pain sensations of varying intensity, paresthesia. muscle weakness, a change in the color of the skin (pallor, cyanosis) in the region of the forelegs, arm.
The origin of cervico-brachial syndromes can beis caused by degenerative-dystrophic changes in the cervical spine. tumors of the vertebrae or neck, traumas (fracture of the clavicle and the first ribs with displacement of the fragments) and other pathological factors.
Progressive development of osteochondrosis in the cervicalthe spine section most often occurs after 40 years and is accompanied by deformation of the vertebral bodies and the formation of bone growths (osteophytes) and intervertebral hernias. Pain syndrome in the form of unremitting acute, aching, drilling, pulling pains arises after physical overload of the cervical spine, after the infection, etc. The pains from the cervical spine are irradiated in the foreleg, forearm and hand. Palpation of the paravertebral points of the cervical spine is painful. On radiographs, the signs of osteochondrosis and spondylosis are different.
Congenital factors causing compressionbrachial plexus, the cervical accessory rib or its fibrous degeneration is displaced anteriorly from the place of attachment of the middle staircase muscle. Clinically, this abnormality is manifested by pain along the inner surface of the shoulder. in the whole hand. Pain can be firing, blunt, burning. They appear and grow towards the end of the working day. Pain depends on the posture. Raising and supporting the elbow, tilting the head to the side leads to a weakening of pain. The pains are combined with hyperesthesias, paresthesias or anesthetics in the hand (see Sensitivity). There is a decrease in strength in the hand, atrophy of the muscles of the hand and forearm, vegetative disorders.
The cause of the occurrence of cervico-brachial syndromescan be benign and malignant tumors. Benign tumors of the trunk of the brachial plexus, as a rule, are neurinomas. The dimensions of the neurin of the brachial plexus can be from a few millimeters to 5-10 cm.
With their localizations above the collarbone, they are usually small. With the location below the clavicle neurinomas reach a large size and easily accessible palpation.
Malignant tumors arising in the neighborhoodwith brachial plexus, can pass to its tissues, causing unquenchable pain along the nerve trunks and loss of motor and sensitive functions of the hand.
Patients with cervico-brachial syndromes should be referred by a paramedic to neurological hospitals for examination.
Treatment. In acute pain, the firstFirst aid, namely: to reduce the tension of the roots of the cervical spinal cord, the arm in the bent elbow joint is fixed on the kerchief, prescribed painkillers (analgin, amidopyrine). In a neurological hospital with osteochondrosis, the spine is sometimes stretched, physioprocedures. In the compression of the brachial plexus and vessels in the case of unsuccessful conservative treatment, surgical intervention is shown (removal of intervertebral hernias, additional ribs, dissection of hypertrophied stair muscles, removal of displacement of clavicle fragments, ribs, removal of tumor).
Cervical-brachial syndromes are a group of syndromes,characterized by painful sensations of varying degrees, extending from the neck or shoulder region to the upper limb. Painful syndromes in the cervico-brachial region are observed in about 10% of patients with peripheral nerve diseases.
The most common cause of pain in the cervico-brachialarea is the involvement of the nerve structures of the neck in the pathological process as a result of degenerative-dystrophic changes in the cervical spine. Significantly less common manifestations may accompany tumors of the cervical spinal cord or its roots, tumors of the vertebrae or neck, as well as some anomalies in the development of the cervical region.
With degenerative-dystrophic lesionsthe spine compression occurs insofar as the usual relationships between the vertebrae change, the diameter of the intervertebral apertures decreases, posterior hernia of intervertebral discs may form; the latter with lateral and median-lateral localization lead to compression of roots in the vertebral canal. The progressive course of osteochondrosis is accompanied by deformation of the vertebral bodies and the formation of bone growths - osteophytes, which can grow ventrally, laterally, into the lumen of the intervertebral foramen and dorsally into the vertebral canal.
Along with changes in intervertebral discs andbone apparatus develops degenerative and reactive changes in the ligamentous apparatus and soft tissues of the spine - fibrosis of the yellow ligament and vagina roots, epidural tissue packing, venous stasis, disruption of the cerebrospinal fluid and lymphatic circulation, changes in the spinal cord envelopes.
Changes in the spine are the causeirrigation or compression of not only the spinal roots, but also the vertebral artery and nerve, the border cervical sympathetic trunk and the spinal cord itself. Most affected is the most mobile lower cervical spine (CV -CVII ).
The disease usually develops after the40 years; Persons who have sustained a trauma to the cervical spine or who work in adverse conditions can get sick at an earlier age. The manifestation of the disease can be facilitated by overload of the cervical spine, awkward movements of the head and neck, sudden temperature fluctuations. Women are sick more often than men. The appearance of the first symptoms of the disease in women often coincides with a violation of the menstrual cycle.
Pain syndrome in the form of stubborn, aching,drilling, pulling pain of varying intensity occurs after physical exertion, after the infection, and sometimes without apparent external cause. The pain is localized in the lower cervical spine, irradiated in the foreleg, shoulder, forearm and hand. They may be accompanied by pain in the back of the head, interlopar area, in the sternum; with left-sided localization of the syndrome, there are sometimes pains in the heart that resemble angina.
The head of the patient and the cervical spineare usually fixed. The head is slightly tilted forward and sometimes to the side. The inclination of the head back is painful. Movement in the cervical region may be accompanied by a crunch. Painful palpation of spinous processes and interstitial spaces in the cervical region. Pain, as a rule, spreads downward from the neck to the periphery. Typical are the so-called dorsolateral painful fields that capture the posterior-outer surface of the shoulder and shoulder. Typical points, the pressure on which causes pain: between the transverse processes CIII -ThI on the anterior margin of the trapezius muscle, insubclavian fossa at the level of the coracoid process, between the acromial process and the large tubercle of the shoulder. The load along the spine axis when the head is tilted to the side of the lesion causes pain in the arm. In acute cases of the disease associated with severe physical overstrain, it is possible to observe pronounced contracture of the muscles of the neck and shoulder girdle.
From the area of the shoulder and shoulderhalf of the patients spread to the forearm and hand. Here, more often than in the proximal departments, there are paresthesias. In the case of the spread of radicular disorders on the distal limb, it is clinically possible to establish quite clearly the level of lesion and the affected rootlet.
With a disc herniation or osteophytes at CIV -CV Affects the spine CV. With this, pain from the cervico-brachial regionspread over the outer surface of the forearm on the back of the 1st finger. In the same zone, sensitivity disorders can also be detected. The CV of the spine is accompanied by a decrease or loss of the reflex from the biceps arm muscle, the strength of the flexors of the forearm decreases.
With pathology at the level of intervertebral disc CV -CVI suffers predominantly spine CVI. The pain spreads along the dorsal surface of the forearm and passes to the rear of the II, III and IV fingers of the hand, the strength of the triceps muscle of the shoulder decreases, the reflex from it falls or falls.
Spine CVII is affected by involvement of the intervertebral disc C in the degenerative processVI -CVII. Pain and sensitivity disorderslocalized along the ulnar surface of the hand and V finger. Sensitivity disorders in the zones of the affected roots are not gross, more often zones of hypoesthesia with areas of hyperpathy are identified. Motor disorders develop later sensitive and rarely reach the degree of paresis.
Monoradicular picture of neurologicalviolations occurs in only 1/3 of patients. In the remaining patients, two or even three roots are affected at the same time. There are also bilateral forms of lesions with radicular pain.
Cervical spine can be acute,have a remitting nature, exacerbated after exposure to various pathogenic factors, or take a chronic form of the course. The intensity of the pain syndrome can be different. The nature of pain is largely determined by the degree of involvement of the autonomic parts of the nervous system. With their involvement, the pains are especially painful, their zones become more common.
Along with compression rootletsdisorders Ya. Yu. Popelyansky proposes to distinguish a group of reflex neurodystrophic cervico-brachial syndromes, to which he includes the humeropathy periarthritis, the syndrome of the anterior staircase, epicondylitis, cervical "lumbago".
Pleuralopathy periarthritis is characterized byacute pain in the shoulder joint, sharp restriction of movements in it. Hyperesthesia is revealed in the zone of innervation of the cutaneous branch of the axillary nerve. Pain can radiate to the neck, elbow, fingers of the hand. In the process, periarticular tissues are usually involved: the walls of mucous bags, tendons swell, lime salts are deposited in them.
Developing with cervical osteochondrosisreflex spasm of the anterior staircase (Scalenus syndrome, Nuffziger syndrome) leads to compression of the neurovascular bundle, which is manifested by pain in the forearm and the ulnar part of the hand. The brush becomes cold, cyanotic. The role of additional ribs in the onset of the Scalenus syndrome is rejected by most authors, since it occurs equally frequently in the absence of them.
With a scalenus syndrome is similar in mechanism of the syndromeWright. It is characterized by pain in the pectoralis muscle with predominant irradiation of pain in the shoulder, blanching of the hand. With the removal of the shoulder, one can observe the disappearance of the pulse on the radial artery. The mechanism of this syndrome, described as an independent disease, consists in squeezing the neurovascular bundle with a small pectoral muscle; when leaning the shoulder, it is pressed against the coracoid process of the scapula. The syndrome occurs with the variants of the subclavian region that are favorable for its development. It arises after sharp and unusual movements in the shoulder joint.
Exceptionally rare pain in the hand areare caused by an anomaly of large vessels providing blood supply to the upper limb (Paget-Shreter syndrome). In this case, there may be a picture of arterial insufficiency with blanching of the hand and a weakening of the pulse on the radial artery or more often venous insufficiency, accompanied by swelling of the hand.
Almost the most often you have to meetwith cervical-shoulder pain due to cervical osteochondrosis. In these cases, the diagnosis of the disease is based on an anamnesis, the typical nature of the pain syndrome, the neurological examination and the x-ray of the cervical spine. When X-rays are usually detected different degrees of osteochondrosis and spondylosis against the background of a violation of normal statics. Radiographs produced in the posterior, lateral and oblique (in 3/4) projections allow to detect straightening of the cervical lordosis or kyphosis of any segment, decrease of the disc height, disruption of the vertebral body configuration, narrowing of the intervertebral foramen, posterior osteophytes of vertebral bodies. The severity of clinical symptoms does not always correspond to the degree of radiological changes in the spine.
In most cases, diagnosis of typical cervico-brachial syndromes does not cause difficulties.
Treatment. especially with acute pain, it is better to conduct in a hospital.
With cervico-brachial syndromes caused bycervical osteochondrosis, a set of therapeutic measures includes unloading the cervical spine, which is achieved by applying a cardboard-cotton-gauze (such as Shantz) bandages, special plastic locks or cervical corsets. Careful traction of the cervical spine is recommended, which can be performed manually or with the help of the Glisson loop with a weight of 2-6 kg twice a day for 10-15 minutes.
With acute radicular pain,Novocaine in the front staircase (1% solution - 5-10 ml). The vegetative component of the pain syndrome, especially with the humeropathy periarthritis, significantly decreases or ceases after the Novocain blockade of the stellate node and the side of the lesion.
To reduce the tension of the roots of the armit is advisable to fix it on a kerchief. With all pain syndromes, the use of painkillers (amidopyrine, analgin, etc.) is shown, with severe pain for several days it is permissible to use drugs in combination with desensitizing drugs (diphenhydramine, belloid, B-complex vitamins).
With cervico-brachial syndromes (with the exception ofcaused by tumors) prescribe physiotherapy procedures - diadynamic therapy, ultrasound in the cervical region, electrophoresis with novocaine, dicaine, chlorine. The use of thermal procedures on the neck area with osteochondrosis leads to aggravation of pain.
Conservative integrated treatment in mostof cases is effective. However, pain syndrome and disability can sometimes last 2-3 months. With a low efficiency of conservative treatment, a course of X-ray therapy (analgesic doses) is performed on the cervical spine from the anterior-external and posterior-external fields.
Complete failure of conservative treatment withcontinuing stance painful radicular-vegetative syndrome in the result of those cervical osteochondrosis gives, the basis to turn to surgical methods of treatment.
Patients with cervico-brachial syndromes producethe following operations: foraminotomy with root decompression, removal of hernial disc after hemilaminectomy or laminectomy, anterior spondylodesis of the affected segment of the spine, or some of these interventions.