CERVICOBRACHIAL SYNDROMES — the name of group of the neurologic syndromes of various origin which are shown pains, muscular and tonic, neuro and trophic and vasculomotor frustration in a neck, a shoulder girdle and a hand.
III. - items of page are observed more often at the age of 30 — 50 years. The main reasons leading to development of III. - items of page, are dystrophic or, more rare, inflammatory processes in cervical department of a backbone (cervical osteochondrosis, a spondylarthrosis and a spondylarthritis) with damage of the IV—VII cervical vertebras. The reasons of development of Sh. - items of page can be also changes and dislocation-fractures of a clavicle, dislocations of a shoulder, an injury of a neck, muscles of a shoulder girdle (an acute overload or a remuscle strain at the athletes and persons doing manual work and also at unexercised people because of a lack of coordination of activity of separate muscular groups), the chronic professional tension of hands (e.g., at current-yards-grinders, painters, hairdressers, etc.).
Factors, p re dr and the joint venture about l and hectare Sh., yushchy to development, - the item of page, are
nek-ry anatomic anomalies of a backbone (e.g., splitting of arches of vertebrae, an asymmetric arrangement of joint cracks, cervical edges, etc.), postural defects, the general and local overcooling, acute infectious and allergic diseases, etc.
The main pathophysiological mechanism of development of Sh. - the item of page serves excitement of a vertebral nerve as the afferent impulses arriving from receptors of fibrous rings of intervertebral disks, a back longitudinal ligament of a backbone. capsules of joints of a backbone, shoulder girdle. In response to irritation of receptors there are pains in the field of defeat, a tonic muscle tension, various vasculomotor, painful symptoms and dystrophic disturbances in the areas innervatsionno connected with the struck department of a backbone (see). A pathogenetic role is played also by the pathophysiological processes caused by a prelum, a tension, dislocation of roots of spinal nerves and the vessels accompanying them. The compression can be caused by hernia and a protrusion of intervertebral disks, an incomplete dislocation of cervical vertebrae, osteophytes, reactive inflammatory and commissural process in cervical department of a backbone.
Most often reflex syndromes — a cervical lumbago, a humeroscapular periarthrosis, a syndrome a shoulder — a brush, epikondilez a shoulder meet beliefs-tebrogennye.
The cervical lumbago — intensive pristupoobrazno arising (as blow by current) or constant neck pain, a cut is the reason defeat of connective tissue educations in cervical department of a backbone (see Osteochondrosis), and also the reflex tonic tension of cervical muscles. Pains quite often irradiate to the area of a nape and a shoulder girdle, arise and amplify at the movements of a neck or at long stay in the same situation. Occasionally at a tonic muscle tension of a neck the wryneck is noted (see). At a deep palpation on the party of defeat find morbidity on the juxtaspinal (paravertebral) line, is more rare at a palpation of separate acanthas of cervical vertebrae. Reflex tonic tension can arise in the muscles located behind, and sometimes and ahead of a backbone, napr in a front scalene (see the Scalene a syndrome), the muscle raising a shovel, etc.
A humeroscapular periarthrosis — a neurodystrophic extraarticular latent injury, mucous bags, and also sinews of the muscles of a shoulder girdle which are attached in a shoulder joint (see the Periarthritis). Most often this process arises as a result patol. impulsation from the struck cervical department of a backbone, and sometimes and from internals (e.g., at cholecystitis). In a wedge, a picture the pains in a shoulder joint amplifying at the movements of a hand and irradiating in in a neck and a hand dominate spontaneous (more often night). The tonic tension of the muscles giving a shoulder is observed, owing to-rogo assignment of a shoulder becomes limited, the shoulder can only be taken slightly away together with a shovel, at the same time the pendulum movements of a hand in the sagittal plane are rather free. Rotation of a shoulder, especially knutr, is complicated and painful. Morbidity at a palpation of a coracoid, a subacromial zone is noted (sometimes in connection with accession of an aseptic bursitis), an outer surface of a shoulder joint. At a X-ray analysis of a shoulder joint sometimes find symptoms of the deforming arthrosis or osteoporosis of a big hillock of a humeral bone, extraarticular calcifications of soft tissues.
The syndrome a shoulder — a brush is characterized by a combination of manifestations of a syndrome of a humeroscapular periarthrosis to hypostasis (preferential on a dorsum of a brush) and other vegetative changes in area of a brush and a radiocarpal joint (cyanosis, hypo - or the hyperhidrosis, change of temperature of skin, is more often than it increase). Because of pains and hypostasis the volume of movements of fingers decreases. The syndrome a shoulder — a brush more often happens is caused by an impulsation from patol. the centers of various localization (at dystrophic changes or an injury of cervical vertebrae, a brachial plexus, diseases of bodies of a chest cavity, etc.)*. The main reason for emergence of a syndrome a shoulder — the brush is involvement in process of cervical nodes of a sympathetic trunk.
Epikondilez of a shoulder (an elbow periarthrosis) — dystrophic defeat of connecting formations of an elbow joint and sinews of the muscles which are attached to lateral less often medial to epicondyles of a shoulder. Emergence of it sind-
rum is usually connected with microtraumas at ryvkovy, especially rotary, the movements in an elbow joint at fencing, playing tennis (see E pikon dilitas). The syndrome develops not earlier than the third decade of life when action of exogenous factors happens against the background of dystrophic changes of fabrics in a neck, a shoulder girdle, a hand. The main symptoms are spontaneous pain and morbidity at a palpation in the field of epicondyles, is more often lateral, especially distalny than it on 2_3 Cm, in the depth of a humeroradial muscle. Spontaneous pains happen intensive, quite often are followed by a burning sensation, amplify at the movements in an elbow joint.
In a wedge, practice also following painful Sh. - the item of page are observed: a syndrome of a cervical edge, at Krom there are paresthesias in a hand, blanching and a cold snap of a brush, sometimes its hypostasis, weakening of pulse on a beam artery, weakness and a hypotrophy of muscles of a brush; the scapular and costal syndrome which is followed by the pains which are localized on a back surface of a thorax and in a shovel; the syndrome of a front chest wall, at Krom is noted morbidity of soft tissues of a front chest wall that can imitate cardiogenic pains; the syndrome of a small pectoral muscle which is shown paresthesias on a front surface of a thorax and in a shovel and the pain irradiating in a hand; a mezhlopatoch-ny syndrome with heavy feeling in interscapular area, pains of vertebralny localization juxtaspinal less often; the costoclavicular syndrome which is characterized by diffusion pains and paresthesias in hands, especially at night, Pedzhet's syndrome — Schröter (see Pedzhe-ta — Schröter a syndrome).
The diagnosis quite often causes difficulties since many Sh. - the item of page have similar a wedge, a picture and are often combined with each other. Make a X-ray analysis of cervical department of a backbone for specification of the diagnosis (sometimes using functional trials) and a shoulder joint. Occasionally there is a need for X-ray contrast researches (a pnevmomiyelografiya, etc.). In all diagnostically doubtful cases conduct a research of cerebrospinal liquid (see), an electromyography (see), a reovazografiya (see Reografiya), sometimes a spinal angiography (see).
Differential diagnosis of vertebrogenny Sh. - items of page at dystrophic changes of a backbone carry out with clinically similar syndromes at inflammatory, tumoral and other diseases of a backbone and surrounding fabrics (muscles, sinews, nerves and vessels), compression neyropatiya, nek-ry forms of angio-trophoneuroses (see).
Treatment is appointed taking into account etiological and pathogenetic factors. At the expressed vertebro-gene syndrome carry out treatment of osteochondrosis (see) and a diskosis (see). For the purpose of relaxation of muscles use sedative drugs and muscle relaxants — Seduxenum, Mydocalmum, skutamil-Ts. Introduction of 1% of solution of novocaine or Trimecainum (1 — 5 ml) in the field of an exit of cervical spinal nerves, a point of the maximum morbidity, in tight muscles is shown (see. Novocainic blockade). Blockade by mix of novocaine and a hydrocortisone sometimes gives good effect. For improvement of fabric blood circulation appoint komplamin, nicotinic to - that, xavinum. Apply fonoforez an Euphyllinum and a hydrocortisone, UF-
about spearing, impulse currents, an inductothermy, a diathermy, a paraffin therapy (see), an ozoceritotherapy (see), different types of acupuncture (see Reflexotherapy), massage, remedial gymnastics. Use hyposensibilizing and antiedematouses, stimulators of trophic and regenerative processes (an injection of ATP, vitamins of Vg, B6, B12, drugs of apitoxin, Rumalonum, a lidaza, a vitreous). Operational treatment takes the limited place in complex therapy of Sh. - the item of page. Operative measures make on cervical department of a backbone (a decompression, wedging) and is rare on dystrophic the changed fabrics of a shoulder girdle, a hand and thorax.
The forecast is favorable, however a recurrence is possible.
Prevention includes measures of individual and social character. The systematic gymnastic exercises directed to strengthening of muscles of a neck, thorax and a shoulder girdle, correction of the scoliosis caused by the wrong pose behind a school desk, a table, etc. are recommended. Expansion of the motive mode at slow-moving professions is important and the rational organization of a workplace.
In prevention of aggravations holding the actions providing the correct physical development, timely employment of patients with Sh. - the item of page, a hardening of an organism and strengthening of muscular system, a dignity matters. - hens. treatment (radonic and hydrosulphuric bathtubs).
Bibliography: Antonov I. P. Questions of classification and the formulation of the diagnosis of vertebrogenny (spondilogenny) diseases of a nervous system, in book: A peripheral nervous system, under the editorship of I. P. Antonov, page 49, Minsk, 1983; B about with N e in V. Sindr a shoulder hand, the lane with bolg., Plovdiv, 1978; To and a per you I. P. Neurovascular syndromes of a shoulder girdle and hands, M., 1975, bibliogr.; P about p e l I am N-sky Ya. Yu. Cervical osteochondrosis, M., 1966, bibliogr.; it, Vertebrogen-ny diseases of a nervous system, t. 3, Kazan, 1981; Ratner A. Yu. Cervical osteochondrosis and cerebral disturbances, Kazan, 1970, bibliogr. I. P. Antonov.