Neuritis call the inflammatory disease of a peripheral nerve (intercostal, occipital, front or nerves of extremities) which is shown pain on the nerve course, violation of sensitivity and muscular weakness in the area innervated by it. Damage of several nerves carries the name polyneuritis. Diagnosis of neuritis is performed by the neurologist during survey and conducting specific functional tests. The electromyography, an elektroneyrografiya and research VP is in addition carried out. Treatment of neuritis includes etiotropny therapy (antibiotics, antiviral, vascular medicines), application of anti-inflammatory and antiedematous means, therapy neostigminy, physiotherapy, massage and LFK.
Neuritis call the inflammatory disease of a peripheral nerve (intercostal, occipital, front or nerves of extremities) which is shown pain on the nerve course, violation of sensitivity and muscular weakness in the area innervated by it. Damage of several nerves carries the name polyneuritis.
Neuritis can result from overcooling, infections (measles, herpes, flu, diphtheria, malaria, a brucellosis), injuries, vascular disorders, hypovitaminoses. Exogenous (arsenic, lead, mercury, alcohol) and endogenous (a thyrotoxicosis, diabetes) intoxications can also lead to development of neuritis. The most often peripheral nerves are surprised in bone and muscular channels and the anatomic narrowness of such channel can contribute to developing of neuritis and development of a tunnel syndrome. Quite often neuritis results from a sdavleniye of a trunk of a peripheral nerve. It can occur in a dream, during the work in an inconvenient pose, during operation, etc. So at people, it is long moving by means of crutches there can be neuritis of an axillary nerve, long squating - neuritis of a low-tibial nerve, is constant in the course of professional activity bending and unbending a brush (pianists, cellists) — neuritis of a median nerve. There can be a sdavleniye of a back of a peripheral nerve on the place of its exit from a backbone that is observed at hernias of intervertebral disks, osteochondrosis.
The clinical picture of neuritis is defined by functions of a nerve, extent of its defeat and area of an innervation. The majority of peripheral nerves consists of nervous fibers of different type: sensitive, motive and vegetative. Defeat of fibers of each type gives the following symptoms characteristic of any neuritis:
- disorders of sensitivity — a sleep, paresteziya (feeling of a pricking, "crawlings of goosebumps"), decrease or loss of sensitivity in an innervation zone;
- violation of active movements — full (paralysis) or partial (paresis) decrease in force in the innervated muscles, development of their atrophy, decrease or loss of tendinous reflexes;
- vegetative and trophic violations — puffiness, cyanosis of integuments, a local hair loss and a depigmentation, perspiration, thinning and dryness of skin, fragility of nails, emergence of trophic ulcers, etc.
As a rule, the first manifestations of damage of a nerve are pain and a sleep. In a clinical picture of some neuritis the specific manifestations connected with the area innervated by this nerve can be noted.
Neuritis of a podkryltsovy nerve is shown by impossibility to raise aside a hand, decrease in sensitivity in the top 1/3 shoulders, an atrophy of a deltoid muscle of a shoulder and the increased mobility of a shoulder joint.
Neuritis of a beam nerve can have different symptoms, depending on defeat localization. So process at the level of the top 1/3 shoulders or in an axillary pole is characterized by impossibility of extension of a brush and a forearm and assignment of a thumb, difficulty of bending of a hand in an elbow joint, paresteziya and decrease in sensitivity of skin of I, II and partially the III fingers. At the hands extended forward on the party of defeat the brush hangs down, the thumb is given to index and the patient cannot turn this hand palm up. At neurologic inspection lack of a razgibatelny elbow reflex and decrease in karporadialny comes to light. At localization of an inflammation in average 1/3 shoulders extension of a forearm and a razgibatelny elbow reflex are not broken. If neuritis develops in the lower 1/3 shoulders or the top part of a forearm, then extension of a brush and fingers is impossible, sensitivity suffers only on the brush back.
Neuritis of an elbow nerve is shown by paresteziya and decrease in sensitivity on a palmar surface of a brush in the field of a half of IV and completely the V finger, on the back of a brush — in the field of a half of III and completely the IV-V fingers. Muscular weakness in the bringing and taking away muscles of the IV-V fingers, hypotrophies and atrophies of muscles of an eminence of a little finger and a thumb, interosseous and worm-shaped muscles of a brush is characteristic. Due to the muscular atrophies the palm looks flattened. The brush at elbow neuritis is similar to "a sharp-clawed paw": average phalanxes of fingers are bent, and the main — are unbent. There are several anatomic sites of an elbow nerve in which development of neuritis as a tunnel syndrome is possible (a sdavleniye or ischemia of a nerve in the bone and muscular channel).
Neuritis of a median nerve begins with intensive pain on the internal surface of a forearm and in brush fingers. Sensitivity on a half of the palm corresponding to the I-III fingers on a palmar surface of I-III and a half of the IV fingers, on the back surface of final phalanxes of the II-IV fingers is broken. The patient cannot turn a hand a palm down, bend a brush in a luchezapyastny joint, bend the I-III fingers. At neuritis of a median nerve the muscular atrophy of an eminence of a thumb is brightly expressed, the finger becomes in one plane with other fingers of a brush and the brush becomes similar to "a monkey paw".
Syndrome of a carpal tunnel — a sdavleniye of a middle nerve in a carpal tunnel and development of neuritis as a tunnel syndrome. The disease begins with a periodic sleep of the I-III fingers, then there are paresteziya and the sleep accepts constant character. Patients note the I-III finger pain and the part of a palm corresponding to them, passing after movements by a brush. Pain arises more often at night, it can extend to a forearm and reach an elbow joint. Temperature and painful sensitivity of the I-III fingers is moderately reduced, the atrophy of an eminence of a thumb is observed not always. Weakness of opposition of a thumb and emergence of paresteziya at percussion in a carpal tunnel is noted. Falen's sign — strengthening of paresteziya at two-minute bending of a brush is characteristic.
The lumbar and sacral pleksopatiya (pleksit) is shown by weakness of muscles of a basin and the lower extremities, decrease in sensitivity of legs and loss of tendinous reflexes standing (knee, akhill). Leg, coxofemoral joints and waist pains are characteristic. At defeat to a large extent of a lumbar texture to the forefront there is neuritis of femoral and locking nerves, and also damage of a side skin nerve of a hip. Pathology of a sacral texture is shown by neuritis of a sciatic nerve.
Neuritis of a sciatic nerve is characterized by the stupid or shooting buttock pains extending on the back surface of a hip and shin. Sensitivity of foot and a shin is reduced, hypotonia of buttock and gastrocnemius muscles, decrease in an akhillov of a reflex is noted. Nerve tension symptoms are characteristic of neuritis of a sciatic nerve: emergence or strengthening of pain at nerve stretching during raising of a direct leg in a prone position on a back (a symptom of Lasega) or at squat. Morbidity in a point of an exit of a sciatic nerve on a buttock is noted.
Neuritis of a femoral nerve is shown by difficulty of extension of a leg in a knee joint and bendings of a hip, decrease in sensitivity in the lower 2/3 forward surfaces of a hip and on all front and internal surface of a shin, an atrophy of muscles of a forward surface of a hip and loss of a knee reflex. Morbidity when pressing under an inguinal sheaf in a nerve exit point to a hip is characteristic.
As a result of neuritis permanent violations of movements in the form of paresis or paralyzes can develop. Can give violations of an innervation of muscles at neuritis to their their atrophy and emergence of contractures as a result of replacement of muscular tissue by connecting.
Diagnosis of neuritis
At suspicion of neuritis during survey the neurologist carries out the functional tests directed to identification of motive violations.
The tests confirming neuritis of a beam nerve:
- brushes of the patient lie palms on a table and he cannot put the III finger on next;
- brushes of the patient lie the back on a table and it cannot take away a thumb;
- attempts to part fingers of the brushes pressed to each other lead to the fact that on the party of neuritis there is a bending of fingers and they slide up to a palm of a healthy hand;
- the patient costs with the hands lowered along a trunk, in such situation he does not manage to turn the struck brush a palm forward and to take away a thumb.
The tests confirming neuritis of an elbow nerve:
- the brush is pressed by a palmar surface to a table and the patient cannot make the scratching movements a little finger on a table;
- brushes of the patient lie palms on a table and he does not manage to part fingers, especially IV and V;
- the struck brush does not contract in a fist completely, bending IV and V fingers is especially complicated;
- the patient cannot hold a paper strip between big and index fingers as the trailer phalanx of a thumb is bent.
The tests confirming neuritis of a median nerve:
- the brush is pressed by a palmar surface to a table and the patient does not manage to make the scratching movements II a finger on a table;
- the brush on the party of defeat does not contract in a fist completely due to the complicated bending of I, II and partially the III fingers;
- the patient does not manage to oppose a thumb and a little finger.
For determination of level and a damage rate of a nerve, its restoration in the course of treatment use electrophysiological methods of a research (an elektroneyrografiya, an electromyography, the caused potentials).
Treatment of neuritis
Therapy of neuritis first of all is directed to the reason which caused it. At infectious neuritis appoint antibacterial therapy (sulfanylamides, antibiotics), antiviral medicines (interferon derivatives, gamma globulin). At the neuritis which resulted from ischemia apply vasodilating medicines (a papaverine, , a ksantinola ), at traumatic neuritis make an extremity immobilization. Apply resolvents (indometacin, an ibuprofen, diclofenac), analgetics, vitamins of group B and carry out antiedematous therapy (furosemide, acetazoleamide). At the end of the second week connect antikholinesterazny medicines to treatment () and biogenous stimulators (an aloe, a gialuronidaza).
Physiotherapeutic procedures begin at the end of the first week of neuritis. Apply with a hydrocortisone, UVCh, pulse currents, an electrophoresis of novocaine, a neostigmin, a gialuronidaza. Massage and the special physiotherapy exercises directed to recovery of the struck muscular groups are shown. If necessary carry out electrostimulation of the affected muscles.
In therapy tunnel a syndrome make local introduction of medicines (a hydrocortisone, novocaine) directly to the struck canal.
Surgical treatment of neuritis belongs to peripheral neurosurgery and is carried out by the neurosurgeon. In the sharp period of neuritis at the expressed nerve sdavleniye operation is necessary for its decompression. In the absence of signs of restoration of a nerve or emergence of signs of its regeneration expeditious treatment which consists in sewing together of a nerve is also shown, plasticity of a nerve in certain cases can be required.
Forecast and prevention of neuritis
Neuritis at persons of young age with high ability of fabrics to regeneration well gives in to therapy. At elderly, patients with associated diseases (for example, diabetes), in the absence of adequate treatment of neuritis development of paralysis of the affected muscles and formation of contractures is possible.
It is possible to warn neuritis avoiding a trauma, an infection and overcooling.