Pleksita (pleksopatiya) — group of diseases which cornerstone defeat of the nervous texture formed by spinal nerves is. Pleksit it is shown by a pleksalgiya and loss of the functions entering the struck texture of nervous trunks (paresis, muscular hypotonia and an atrophy, lack of tendinous reflexes, trophic and vegetative frustration). To diagnose pleksit it is possible on typical neurologic symptomatology taking into account the given anamnesises, results elektromio-and elektroneyrografiya, radiological, tomographic and ultrasonographies, consultations of adjacent experts. Tactics of treatment is defined by an etiology. Generally it is conservative ways, operation is necessary at a traumatic and compression pleksit.
After an exit from a spine column spinal nerves are divided into back and forward branches. The last are grouped and intertwine the fibers, forming pair nervous textures. The cervical texture is made by forward branches of backs of C1-C4 and settles down for - a clavicular and mastoidal muscle. In an interladder interval with transition to an axillary pole there is a humeral texture formed by branches C5-Th1. Spinal nerves of chest level, except Th1 do not form textures. The following nervous texture settles down in the depth of a big lumbar muscle and lumbar carries the name. It is made by separate fibers of a forward branch of a nerve Th12, forward branches of L1-L3 and partially L4 nerve. Other part of fibers of a forward branch of a spinal nerve of L4 together with L5, S1-S4 forms the sacral texture which is in a cavity of a small pelvis. The coccygeal texture is localized sideways from a sacrum, behind it the sacral muscle is located. The texture is formed by a part of forward branches of S5 and two coccygeal nerves.
Causes of a pleksit
The important place among factors, defiant pleksit, belongs to a trauma. It can be strong blow to the area of a texture (a hand bruise around a shoulder, a bruise of lumbar or cervical area, a spine injury, falling on a tailbone); gunshot, reasonable or chipped wound; stretching of nervous trunks of a texture at sharp traction for a leg or a hand, at dislocation of a shoulder or dislocation of a hip, a fracture of bones of a basin. Post-traumatic pleksit meets in practice of obstetricians-gynecologists and neonatolog, as a result of a patrimonial trauma (for example, patrimonial paralysis of Dyushena-Erba). The leading pathogenetic mechanisms at a trauma are: damage of branches of a nervous vpleteniye with a partial or complete separation of their fibers, a sdavleniye of nervous trunks of a texture a post-traumatic hematoma or hypostasis. Most often post-traumatic meets pleksit a humeral texture.
Among other reasons causing pleksit, are: the tumors or the lymph nodes increased as a result of lymphadenitis located in the field of a texture, anomalies of development of a backbone, a backbone curvature (scoliosis), overcooling, some infections (surrounding herpes, syphilis, flu, tuberculosis, a brucellosis), autoimmune diseases (a syndrome to Giyena-Barra), exchange violations (gout, diabetes). In some cases inflammatory processes (adneksit, salpingit, cystitis, prostatitis and so forth) and thrombophlebitis of veins of a small pelvis act as etiofaktor of sacral and coccygeal pleksit. To cause cervical pleksit aneurism of a subclavial artery, an additional cervical edge can.
Symptoms of a pleksit
As a rule, pleksit has unilateral character. In its current allocate several stages. In a neuralgic stage as the leading symptom the pleksalgiya — the pain arising in a nervous texture and irradiating on the periphery on its nervous trunks acts. Pleksalgiya often has spontaneous character, amplifies when pressing in the field of a nervous texture, at night and during movements. Easy touch violations are possible.
Emergence of signs of loss of function of nerves of the struck texture marks transition of a pleksit to a paralytic stage. Paresis or paralyzes, hypotonia and a hypotrophy of the muscles innervated by the specified nerves are observed; loss of the corresponding tendinous reflexes is noted. In zones for which innervation the struck texture is responsible all types of sensitivity suffer and trophic frustration — vasomotorial reactions, pastosity, or , pobledneny skin appear. Pleksit can be full or partial. In the latter case symptoms of a paralytic stage are shown more narrowly — only in the areas innervated by the struck part of a texture.
Further pleksit passes into a recovery stage which can last about one year. Extent of restoration of the lost nervous functions varies. At incomplete restoration pleksit leads to the irreversible residual phenomena in the form of persistent sluggish paresis, muscular atrophies, contractures of joints.
Cervical pleksit demonstrates the diffusion pains on the front and lateral surface of a neck irradiating in an ear and a nape. At irritation of nerves of a cervical texture the musculodystonic syndrome in the form of a spastic wryneck can develop. The irritation of a diafragmalny nerve which is followed by a hiccups is possible. In a paralytic stage cervical pleksit is shown by diaphragm paresis, an atrophy of back and cervical and suboccipital muscles.
Humeral pleksit can be top, lower and total. Total humeral pleksit is characterized by all top extremity pains carrying separate signs of a simpatalgiya; sluggish paresis of a hand; atrophies of muscles of a hand and humeral belt; loss of tendinous reflexes and symptoms of vegetative and trophic dysfunction in tissues of the top extremity. Because of muscular atrophies developing of habitual dislocation of a shoulder is possible. In a stage of the residual phenomena the contracture of an elbow joint is possible.
Lumbar pleksit is followed by a pleksalgiya with irradiation of pain on the forward surface of a hip and in a buttock. Reduction and bending of a hip, extension in a knee joint is broken. For this reason for the patient it is difficult to go and stand. There is no knee reflex and touch perception of buttock area of a hip and the medial surface of a shin. In muscles of buttocks and forward side of a hip atrophic changes are noted. The contracture of a knee joint can develop.
Sacral pleksit often is combined with lumbar. The pains irradiating on a leg around a sacrum, existence of trigger points on the course of buttock and sciatic nervous trunks, a gipesteziya and a muscular atrophy on the back surface of a hip, foot and a shin are typical for it. Pleksit a coccygeal texture it is characterized by lack of an anal reflex, disorder of defecation, an urination and sexual function.
Diagnostics of a pleksit
To establish the preliminary diagnosis "pleksit" data of the anamnesis and neurologic survey allow. Definition of muscular groups with the lowered muscular force, zones of a gipesteziya, the dropped-out reflexes gives the grounds for diagnostics of level of defeat of peripheral nervous system. The elektroneyrografiya and an electromyography help to specify to a defeat topic to the neurologist. In some cases can be required: consultation of the traumatologist, orthopedist, urologist, gynecologist, oncologist; X-ray analysis of a shoulder joint, backbone X-ray analysis, X-ray analysis of a coxofemoral joint, KT of a joint, backbone KT; Ultrasonography of bodies of a small pelvis.
To differentiate pleksit it is necessary from a siringomiyeliya, poliomyelitis, radiculitis, neuritis, a radikulopatiya at backbone diseases (osteochondrosis, hernia of an intervertebral disk, a spondiloartroza), a polyneuropathy, pathology of joints (arthrosis, arthritis, injury of ligaments, etc.). Depending on localization pleksit differentiate from a neuropathy of a femoral nerve, a low-tibial neuropathy, a neuropathy of a sciatic nerve, an elbow and beam neuropathy.
Treatment of a pleksit
In case of a post-traumatic pleksit experts in the field of traumatology and neurology in common supervise the patient. It is necessary to create rest of an affected area. The extremity immobilization a bandage or longety is for this purpose possible. At infectious genesis of a pleksit carry out the corresponding etiotropny therapy, apply anti-inflammatory pharmaceuticals (, diclofenac, an ibuprofen). If pleksit has a toxic etiology, then carry out dezintoksikatsionny actions.
Pleksit any genesis is the indication for purpose of neurometabolic treatment (B6, B1, B12 vitamins) and therapies, directed to improvement of exchange processes in muscular tissue and neuro and muscular synapses (ATP, , ). The pain syndrome is stopped by reception of anesthetics and carrying out medical blockade. For improvement of blood circulation in fabrics of a texture and the affected muscles in complex treatment recommend to use vascular medicines (, a ksantinola , nicotinic acid).
Among physiotherapeutic procedures in therapy of a pleksit UVCh, diadynamic currents, an electrophoresis on the corresponding spinal segments, an amplipulsterapiya, with a hydrocortisone on area of a texture, with novocaine are effective. After knocking over of sharp symptoms, or approximately in 2-3 weeks after a trauma, include LFK and massage directed to strengthening of muscles and prevention of development of contractures in a complex of treatment. Acupuncture is applied in an initial stage of a pleksit to removal of a pain syndrome, then passed to electroacupuncture. In the recovery period (not earlier, than in 6 months after a trauma) balneotherapyradonicmud cure, an ozokeritoterapiya is recommended and hydrosulphuric bathtubs.
Surgical treatment demands post-traumatic pleksit, resistant to conservative therapy, and pleksit caused by a texture sdavleniye. In the first case plasticity of a nervous trunk, in the second — removal of a hematoma, tumor and so forth the squeezing factors is carried out.
Forecast and prevention of a pleksit
In the absence of treatment pleksit can have not really favorable forecast as expressiveness of the residual phenomena (paresis, contractures) often leads to the patient's invalidization. In other cases the forecast depends on an etiology of a pleksit, age of the patient, existence of background diseases, timeliness of an initiation of treatment.
To warn traumatic pleksit the actions directed to prevention of traumatism at adults, children and especially at athletes help. The leading role in prevention of pleksit at newborns is played by the correct conducting pregnancy and the adequate choice of a way of a rodorazresheniye. To warn pleksit an infectious etiology timely treatment of infections can.