COMPANY DISEASE ( V. K. Roth , otechestvo. neuropathologist, 1848 — 1916; synonym: Roth — Berngardta a disease, meralgia paraesthetica) — neuralgia of a lateral cutaneous nerve of a hip.
For the first time the symptom complex of defeat of a lateral cutaneous nerve of a hip was described in 1895 independently from each other by V. K. Roth and Berngardt (M. Bernhardt).
In R.'s development. the main role belongs degenerative dystrophic to defeat of the intervertebral disks L2 — L4 and roots of spinal nerves (a radicular form) or to damage of the nerve (a peripheral form). In the mechanism of development of a radicular form P. (a discogenic radicular syndrome) along with the compression factor causing functional and structural changes of nerve fibrils, the important role belongs to reactive changes in roots and the fabrics (hypostasis, a hyperemia, an aseptic inflammation, distsirkulyatorny disturbances) surrounding them.
Peripheral form P. it is connected with defeat of a lateral cutaneous nerve of a hip in the most vulnerable places on its course: 1) an exit from under a big lumbar muscle; 2) the place of an excess under an upper front ileal awn; 3) the fibrous channel in a wide fascia; 4) place of escaping of this channel. Vascular disorders (atherosclerosis, an endarteritis, venous stagnation in a small basin, a varicosity of the lower extremities), a direct neurothlipsia (e.g. are the tumor increased by a uterus at pregnancy, myoma, etc., pressure upon a nerve outside the most frequent reasons of defeat of a lateral cutaneous nerve, at the wrong carrying a bandage). The infectious diseases (syphilis, a leprosy, etc.) proceeding with defeat of peripheral nerves, a drunkenness, and also bystry weight loss or obesity can matter.
Clinical manifestations River. are characterized by a thermalgia on the lateral (outside) surface of a hip amplifying preferential during the standing and walking. In position of the patient lying or sitting pain can disappear, but in a dorsal decubitus with the extended legs pain in nek-ry cases renews again. In the field of an innervation of a nerve paresthesias are noted (see. Paresthesia ), the pains preceding emergence, their degree it is various. The area of burning in the lower two thirds of a hip gradually extends to an upper third of a hip on its lateral surface. Spread of paresthesias depends on a ratio of zones of an innervation of a lateral cutaneous nerve of a hip, ilioinguinal and front skin branches femoral nerve (see). Besides, at R. decrease in tactile, temperature and painful sensitivity in the specified zone at preservation of pressure sense can be observed. Disturbances of a sympathetic innervation in the form of change of sweating, lack of a pilomotor reflex, thinning of skin are frequent.
R.'s development. is more often slow with the subsequent stationary current. Usually in 1 — 2 years after the beginning of a disease increase of paresthesias stops. More often the nerve is surprised on the one hand, at bilateral localization of process the pain syndrome arises not at the same time, is frequent at an interval of several years.
Diagnosis in typical cases does not represent difficulties and it is based on the analysis a wedge, manifestations.
River. it is necessary to differentiate with a pain syndrome at an urolithiasis (see. Nephrolithiasis ), an obliterating endarteritis (see. obliterating endarteritis ), Lerish's syndrome (see. Lerisha syndrome ), herpes zoster (see. Herpes ).
In an initial stage of R. dynamic observation for an exception of a neurinoma of roots of upper lumbar spinal nerves is required, to a tumor of a horse tail and a brain cone of a spinal cord (see. Neurinoma ).
Treatment it is carried out with use of pharmaceuticals, a fiziobalneoterapiya and orthopedic actions. Combined effect on patol. process first of all is directed to removal of a pain syndrome, improvement of microcirculation and exchange processes. Apply analgetics, vitamins of group B, vasodilating drugs, diadynamic currents (see. Impulse currents ), microwave therapy (see), ultrasound in pulsed operation (see. Ultrasonic therapy ), an electrophoresis of iodine, novocaine (see. Electrophoresis ), massage (see), and also extension on a special traction table or vertical and horizontal underwater extension in the pool (see. Extension ).
Forecast depends on the basic disease or a state which caused R.'s development.
Bibliography: Antonov I. P. Diseases of lumbosacral department of a peripheral nervous system, Zhurn. neuropath. and psikhiat., t. 78, No. 3, page 321, 1978; Antonov of Nominative and Sh and N ý-to about G. G. Lumbar pains, Minsk, 1981; And f about sh both S. A. N and Fast e A. A c. Treatment of spondilogenny lumbosacral radiculitises epidural novocaine-gidrokortizonovy-mi blockade, Zhurn. neuropath, and psikhiat., t. 76, «No I, page 1642, 1976, bibliogr.; Geller A. N. Juxtaspinal blockade by solution of proteolytic enzymes at lumbosacral radiculitis, in the same place, t. 73, No. 5, page 672, 1973; D r and in about t and N about in B. V. Neurologic disturbances at lumbar osteochondrosis, Minsk, 1979, bibliogr.; Kanareykin K. F. Lumbosacral pains, M., 1972, bibliogr.; Popelyansky Ya. Yu. Vertebralnye of a disease of a nervous system, t. 1, Kazan, 1974, bibliogr.; V. K. mouth of Meralgia paraesthetica, Medical obozr., t. 43, No. 7, page 678, 1895; Bernhardt M. t) ber isolirt im Gebiete des N. cutaneus femoris externus vorkommende Parasthesien, Neurol. Zbl., Bd 14, S. 242, 1895.
L. G. Yerokhina, H. H. Leskova.