Humeral pleksit — the defeat of a humeral nervous texture which is shown a pain syndrome in combination with motive, touch and vegetative dysfunction of the top extremity and a humeral belt. The clinical picture varies depending on the level of defeat of a texture and its genesis. Diagnostics is performed by the neurologist together with other experts, she can demand carrying out elektromio-or elektroneyrografiya, ultrasonography, a X-ray analysis, KT or MPT of a shoulder joint and area of a texture, a research of biochemistry of blood, level of S-jet protein and the Russian Federation. To cure humeral pleksit and completely it is possible to restore function of a texture only within the first year, on condition of elimination of a cause of illness, performing adequate and complex therapy and rehabilitation.
The humeral texture is created by branches of the lower cervical spinal nerves of C5-C8 and the first chest back of Th1. The nerves proceeding from a humeral texture innervate skin and muscles of a humeral belt and all top extremity. The clinical neurology distinguishes total defeat of a texture — Kerer's paralysis, defeat only of its top part (C5-C8) — proximal paralysis of Dyushena-Erba and defeat only of the lower part (C8-Th1) — distalny paralysis Dezherin-Klyumpka.
Depending on an etiology humeral pleksit it is classified as post-traumatic, infectious, toxic, compression and ischemic, dismetabolichesky, autoimmune. Among pleksit of other localization (cervical pleksit, lumbar and sacral pleksit) humeral pleksit is the most often meeting. Wide circulation and a polietiologichnost of a disease causes its relevance both for neurologists, and for experts in the field of traumatology - orthopedics, obstetrics and gynecology, rheumatology, toxicology.
Among the factors causing humeral pleksit, injuries are most widespread. Damage of a texture is possible at a clavicle fracture, shoulder dislocation (including habitual dislocation), sprain or injury of sinews of a shoulder joint, a shoulder bruise, cut, chipped or gunshot wounds of area of a humeral texture. Often humeral pleksit arises against the background of a chronic mikrotravmatization of a texture, for example, during the work with the vibrating tool, use of crutches. In obstetric practice the obstetric paralysis of Dyushena-Erba which is a consequence of a patrimonial trauma is well-known.
The second place on prevalence is taken by humeral pleksit compression and ischemic genesis, arising at a sdavleniye of fibers of a texture. Similar can occur at long finding of a hand in an uncomfortable position (during sound sleep, at bed patients), at a texture sdavleniye the aneurism of a subclavial artery, a tumor, a post-traumatic hematoma increased by lymph nodes, an additional cervical edge at Pankost's cancer.
Humeral pleksit an infectious etiology is possible against the background of tuberculosis, a brucellosis, a herpetic infection, a cytomegalic inclusion disease, syphilis, after the postponed flu, quinsy. Dismetabolichesky humeral pleksit can take place at diabetes, a disproteinemiya, gout, etc. exchange diseases. Yatrogenny damage of a humeral texture at various surgeries in the field of its arrangement is not excluded.
Humeral pleksit demonstrates a pain syndrome — the pleksalgiya carrying shooting, the aching, drilling, aching character. Pain is localized in a clavicle, a shoulder and extends to all top extremity. Strengthening of pain is observed at night, provoked by the movements in a shoulder joint and a hand. Then to a pleksalgiya muscular weakness in the top extremity joins and progresses.
The hypotonia and decrease in force in muscles of proximal departments of a hand leading to difficulty of movements in a shoulder joint, assignments and raisings of a hand (especially in need of deduction of freight in it), its bendings in an elbow joint are typical for paralysis of Dyushena-Erba. Paralysis Dezherin-Klyumpka, on the contrary, is followed by weakness of muscles of disteel departments of the top extremity that is clinically shown by difficulty of performance of movements by a brush or deduction in it various objects. As a result the patient cannot hold a cup, is full use tableware, button, open a key a door, etc.
Motive frustration are followed by decrease or loss of elbow and karporadialny reflexes. Touch violations in the form of a gipesteziya affect lateral edge of a shoulder and forearm at proximal paralysis, internal area of a shoulder, forearm and a brush — at disteel paralysis. At defeat of the sympathetic fibers entering the lower part of a humeral texture Dezherin-Klyumpka can act as one of displays of paralysis Horner's symptom (, expansion of a pupil and ).
Except motive and touch violations, humeral pleksit is followed by the trophic frustration developing owing to dysfunction of peripheral vegetative fibers. Pastosity and a mramornost of the top extremity, the increased perspiration or , an excessive istonchennost and dryness of skin, the increased fragility of nails is noted. Skin of the affected extremity easily is injured, wounds is long do not heal.
Partial defeat of a humeral texture with developing of either proximal paralysis of Dyushena-Erba, or disteel paralysis Dezherin-Klyumpka is often observed. It is more seldom noted total humeral pleksit, including clinic of both listed paralyzes. In exceptional cases pleksit has bilateral character that is more typical for defeats of infectious, dismetabolichesky or toxic genesis.
The neurologist can establish the diagnosis "humeral pleksit" according to the anamnesis, to the complaints and results of survey confirmed with an electroneurographic research, and at its absence — an electromyography. It is important to distinguish pleksit from neuralgia of a humeral texture. The last, as a rule, demonstrates after overcooling, is shown by a pleksalgiya and paresteziya, is not followed by motive violations. Besides, humeral pleksit it is necessary to differentiate with a polyneuropathy, mononeuropathies of nerves of a hand (a neuropathy of a middle nerve, a neuropathy of an elbow nerve and a neuropathy of a beam nerve), pathology of a shoulder joint (arthritis, bursity, arthrosis), a plechelopatochny periartrit, radiculitis.
For the purpose of differential diagnostics and establishment of an etiology of a pleksit if necessary consultation of the traumatologist, orthopedist, rheumatologist, oncologist, infectiologist is held; Ultrasonography of a shoulder joint, X-ray analysis or KT of a shoulder joint, MRT of area of a humeral texture, X-ray analysis of lungs, blood sugar level research, biochemical blood test, definition of the Russian Federation and S-jet protein, ave. of inspection.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
The differentiated therapy is defined by genesis of a pleksit. According to indications antibiotic treatment, antiviral treatment, an immobilization of the injured shoulder joint, removal of a hematoma or tumor, desintoxication, correction of violations of exchange is carried out. In some cases (is more often at obstetric paralysis) the solution of a question, joint with the neurosurgeon, on expediency of surgical intervention — plasticity of nervous trunks of a texture is required.
As the general direction in treatment the vazoaktivny and metabolic therapy providing the improved food, so and the fastest restoration of nervous fibers acts. The patients having humeral pleksit, receive , complex medicines of vitamins of group B, nicotinic to - that, ATP. Traffic of the struck texture are directed to improvement also some physiotherapy — an electrophoresis, mud cure, thermal procedures, massage.
Important value is allocated for the symptomatic therapy including knocking over of a pleksalgiya. To patients appoint NPVP (diclofenac, sodium metamizol, etc.), medical blockade with novocaine, a hydrocortisone, UVCh, reflexotherapy. For support of muscles, improvement of blood circulation and prevention of contractures of joints of the affected hand the LFK special complex and massage of the top extremity is recommended. In the recovery period repeated courses of neurometabolic therapy and massage are conducted, LFK with gradual building of loading is continuously carried out.
Forecast and prevention
The timely initiation of treatment, successful elimination of the causal trigger (a hematoma, a tumor, a trauma, an infection and so forth), adequate recovery therapy usually promote a complete recovery of function of nerves of the struck texture. At the overdue beginning of therapy and impossibility to completely eliminate influence of a causal factor humeral pleksit has the forecast, not really favorable in respect of recovery. Eventually in muscles and fabrics there are irreversible changes caused by their insufficient innervation; muscular atrophies, contractures of joints are formed. As the leading hand most often is surprised, the patient loses not only the professional opportunities, but also abilities to self-service.
To the measures allowing to prevent humeral pleksit, refer traumatism prevention, the adequate choice of a way of a rodorazresheniye and professional conducting childbirth, observance of operating rooms the technician, timely treatment of injuries, infectious and autoimmune diseases, correction of dismetabolichesky violations. Observance of the normal mode, the revitalizing physical activities, healthy nutrition helps to increase resistance of nervous tissues to various adverse effects.