Damage to the phrenic nerve symptoms. Damage to the phrenic nerve

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(plexus cervicalis) is formed by the anterior branches of the 4 upper cervical spinal nerves (C I -C IV), which have connections with each other. The plexus lies lateral to the transverse processes between the vertebral (posterior) and prevertebral (anterior) muscles (Fig. 1). The nerves emerge from under the posterior edge of the sternocleidomastoid muscle, slightly above its middle, and spread in a fan-like manner upward, forward and downward. The following nerves depart from the plexus:

Rice. 1.

1 - hypoglossal nerve; 2 - accessory nerve; 3, 14 - sternocleidomastoid muscle; 4 - great auricular nerve; 5 - lesser occipital nerve; 6 - greater occipital nerve; nerves to the anterior and lateral rectus capitis muscles; 8 - nerves to the long muscles of the head and neck; 9 - trapezius muscle: 10 - connecting branch to the brachial plexus; 11 - phrenic nerve: 12 - supraclavicular nerves; 13 - lower belly of the omohyoid muscle; 15 - neck loop; 16 - sternohyoid muscle; 17 - sternothyroid muscle; 18 - upper belly of the omohyoid muscle: 19 - transverse nerve of the neck; 20 - lower root of the neck loop; 21 - upper root of the neck loop; 22 - thyrohyoid muscle; 23 - geniohyoid muscle

1. Lesser occipital nerve(p. occipitalis mino) (from C I - C II) spreads upward to the mastoid process and further to the lateral parts of the back of the head, where it innervates the skin.

2. Greater auricular nerve(p. auricularis major) (from C III - C IV) runs along the sternocleidomastoid muscle upward and anteriorly, to the auricle, innervates the skin of the auricle (posterior branch) and the skin above the parotid salivary gland (anterior branch).

3. Transverse cervical nerve(p. transverses colli) (from C III - C 1 V) goes anteriorly and at the anterior edge of the sternocleidomastoid muscle it is divided into upper and lower branches that innervate the skin of the anterior neck.

4. Supraclavicular nerves(pp. supraclaviculares) (from C III - C IV) (numbering from 3 to 5) spread downwards in a fan-like manner under subcutaneous muscle neck; They branch in the skin of the posterior lower part of the neck (lateral branches), in the region of the clavicle (intermediate branches) and the upper anterior part of the chest to the third rib (medial branches).

5. Phrenic nerve(n. phrenicis) (from C III - C IV and partly from C V), predominantly a motor nerve, goes down the anterior scalene muscle into the chest cavity, where it passes to the diaphragm in front of the root of the lung between the mediastinal pleura and the pericardium. Innervates the diaphragm, gives off sensory branches to the pleura and pericardium (rr. pericardiaci), sometimes to the cervicothoracic nerve plexus. In addition, it sends diaphragmatic-abdominal branches (rr. phrenicoabdominales) to the peritoneum covering the diaphragm. These branches contain nerve ganglia (ganglii phrenici) and connect to the celiac nerve plexus. The right phrenic nerve especially often has such connections, which explains the phrenicus symptom - irradiation of pain to the neck area due to liver disease.

6. Lower root of the cervical loop (radix inferior ansae cervicalis) is formed by nerve fibers from the anterior branches of the second and third spinal nerves and goes anteriorly to connect with upper spine (radix superior), arising from the hypoglossal nerve (XII pair of cranial nerves). As a result of the connection of both roots, a cervical loop is formed ( ansa cervicalis), from which branches extend to the scapulohyoid, sternohyoid, thyrohyoid and sternothyroid muscles.

7. Muscular branches (rr. musculares) go to the prevertebral muscles of the neck, to the levator scapula muscle, as well as to the sternocleidomastoid and trapezius muscles.

Lies in front of the transverse processes of the cervical vertebrae on the surface deep muscles neck (Fig. 2). Each cervical region has 3 cervical nodes: superior, middle ( ganglia cervicales superior et media) and cervicothoracic (stellate) ( ganglion cervicothoracicum (stellatum)). The middle cervical node is the smallest. The stellate node often consists of several nodes. The total number of nodes in the cervical region can range from 2 to 6. Nerves extend from the cervical nodes to the head, neck and chest.

Rice. 2.

1 - glossopharyngeal nerve; 2 - pharyngeal plexus; 3 - pharyngeal branches of the vagus nerve; 4 - external carotid artery and nerve plexus; 5 - superior laryngeal nerve; 6 - internal carotid artery and sinus branch of the glossopharyngeal nerve; 7 - carotid glomus; 8 - carotid sinus; 9 - superior cervical cardiac branch of the vagus nerve; 10 - upper cervical cardiac nerve: 11 - middle cervical node of the sympathetic trunk; 12 - middle cervical cardiac nerve; 13 - vertebral node; 14 - recurrent laryngeal nerve: 15 - cervicothoracic (stellate) node; 16 - subclavian loop; 17 - vagus nerve; 18 - lower cervical cardiac nerve; 19 - thoracic cardiac sympathetic nerves and branches of the vagus nerve; 20 - subclavian artery; 21 — gray connecting branches; 22 - superior cervical ganglion of the sympathetic trunk; 23 - vagus nerve

1. Gray connecting branches(rr. communicantens grisei) - to the cervical and brachial plexuses.

2. Internal carotid nerve(p. caroticus internus) usually departs from the upper and middle cervical nodes to the internal carotid artery and forms around it internal carotid plexus(plexus caroticus internus), which extends to its branches. Branches off from the plexus deep petrosal nerve (p. petrosus profundus) to the pterygopalatine ganglion.

3. The jugular nerve (p. jugularis) starts from the upper cervical ganglion, within the jugular foramen it is divided into two branches: one goes to the upper node of the vagus nerve, the other to the lower node of the glossopharyngeal nerve.

4. Vertebral nerve(p. vertebralis) extends from the cervicothoracic node to the vertebral artery, around which it forms vertebral plexus (plexus vertebralis).

5. Cardiac cervical superior, middle and inferior nerves (pp. cardiaci cervicales superior, medius et inferior) originate from the corresponding cervical nodes and are part of the cervicothoracic nerve plexus.

6. External carotid nerves(p. carotid externi) extend from the upper and middle cervical nodes to the external carotid artery, where they participate in the formation external carotid plexus (plexus caroticus externus), which extends to the branches of the artery.

7. Laryngopharyngeal branches(rr. laryngopharyngei) go from the superior cervical ganglion to the pharyngeal nerve plexus and as a connecting branch to the superior laryngeal nerve.

8. Subclavian branches(rr. subclavii) depart from subclavian loop (ansa subclavia), which is formed by the division of the internodal branch between the middle cervical and cervicothoracic nodes.

Cranial division of the parasympathetic nervous system

Centers cranial region The parasympathetic part of the autonomic nervous system is represented by nuclei in the brain stem (mesencephalic and bulbar nuclei).

Mesencephalic parasympathetic nucleus - accessory nucleus of the oculomotor nerve(nucleus accessories n. oculomotorii)- located at the bottom of the midbrain aqueduct, medial to the motor nucleus of the oculomotor nerve. Preganglionic parasympathetic fibers go from this nucleus as part of the oculomotor nerve to the ciliary ganglion.

The following parasympathetic nuclei lie in the medulla oblongata and pons:

1) superior salivary nucleus(nucleus salivatorius superior), associated with facial nerve, - in the bridge;

2) inferior salivary nucleus(nucleus salivatorius inferior), associated with the glossopharyngeal nerve, - in the medulla oblongata;

3) dorsal nucleus of the vagus nerve(nucleus dorsalis nervi vagi), - in the medulla oblongata.

Preganglionic parasympathetic fibers pass from the cells of the salivary nuclei as part of the facial and glossopharyngeal nerves to the submandibular, sublingual, pterygopalatine and auricular nodes.

Peripheral department The parasympathetic nervous system is formed by preganglionic nerve fibers originating from the indicated cranial nuclei (they pass through the corresponding nerves: III, VII, IX, X pairs), the nodes listed above and their branches containing postganglionic nerve fibers.

1. Preganglionic nerve fibers running as part of the oculomotor nerve follow to the ciliary ganglion and end at synapses on its cells. They depart from the node short ciliary nerves(pp. ciliares breves), in which, along with sensory fibers, there are parasympathetic fibers: they innervate the sphincter of the pupil and the ciliary muscle.

2. Preganglionic fibers from the cells of the superior salivary nucleus spread as part of the intermediate nerve, from it through the greater petrosal nerve they go to the pterygopalatine ganglion, and through the chorda tympani - to the submandibular and hypoglossal nodes, where they end in synapses. From these nodes, postganglionic fibers follow along their branches to the working organs (submandibular and sublingual salivary glands, glands of the palate, nose and tongue).

3. Preganglionic fibers from the cells of the inferior salivary nucleus go as part of the glossopharyngeal nerve and further along the lesser petrosal nerve to the ear ganglion, on the cells of which they end in synapses. Postganglionic fibers from the cells of the ear ganglion emerge as part of the auriculotemporal nerve and innervate the parotid gland.

Preganglionic parasympathetic fibers, starting from the cells of the dorsal ganglion of the vagus nerve, pass as part of the vagus nerve, which is the main conductor of parasympathetic fibers. Switching to postganglionic fibers occurs mainly in small ganglia of the intramural nerve plexuses of most internal organs, therefore postganglionic parasympathetic fibers appear to be very short compared to preganglionic fibers.

Human anatomy S.S. Mikhailov, A.V. Chukbar, A.G. Tsybulkin

1. Traumatic rupture of the phrenic nerve(s) or rupture of one (or both) domes of the diaphragm can cause sudden cessation of breathing. Many diaphragmatic disorders may be asymptomatic or with progressive dyspnea, which is aggravated in the supine position when the organs abdominal cavity shift both domes of the diaphragm towards the head. A disorder of the diaphragm should be suspected in patients who cannot breathe independently without mechanical ventilation, since clinically significant or subclinical forms of dysfunction of the domes of the diaphragm probably complicate many types of respiratory failure.
2. Insufficiency or dysfunction of the domes of the diaphragm leads to the mobilization of other respiratory muscles during inspiration; including external intercostal and cervical muscles. The absence of up and down movement of one of the domes is reflected in the absence of lateral displacement of the corresponding half of the chest. If this movement is absent in both domes, then the contraction of the remaining respiratory muscles creates negative pressure in the pleural cavity, which pulls the domes of the diaphragm towards the head during inhalation, which in turn creates negative intra-abdominal pressure, due to which the abdominal wall, instead of moving outward, is pulled inward . This is a paradoxical movement abdominal wall may not be noticed by the doctor in a patient who is in a standing position, since both domes of the diaphragm will passively lower when inhaling, and in a patient who is in a lying position, inhalation leads to the manifestation of the phenomenon.
3. In 20% of healthy people, on a chest x-ray in direct projection, you can find that the right dome of the diaphragm is projected onto a plane, the level of which ranges from the upper edge of the fifth rib to the sixth intercostal space along the anterior wall of the chest. The left dome of the diaphragm is located lower than the right, at a distance of half to one intercostal space. The excursion of the diaphragm domes at maximum inspiration ranges from 3 to 6 cm.
4. Hernial displacement of abdominal organs can occur through a congenital defect in the lumbocostal triangle or as a result of traumatic rupture, usually due to blunt abdominal trauma. Damage to the left dome is more common, possibly due to the fact that the liver protects the right half of the diaphragm.
5. Eventration is a congenital anomaly consisting of impaired development of the muscles of part of the dome, one or both halves of the diaphragm; usually found only on the left side. Unilateral paralysis occurs as a result of disruption of the conduction of the phrenic nerve on the side of the disorder. This condition can be idiopathic, but most often occurs with trauma, surgery, or neoplastic disease. In adults, unilateral paralysis does not interfere or only slightly interferes with respiratory function, except in cases where another disease is associated, such as pneumonia; Treatment is required only for the second disease. At the same time, in newborns, a paradoxical shift of the paralyzed dome of the diaphragm towards the head can lead to the development of respiratory failure.
6. Lack of displacement or displacement towards the head of one or both domes detected during fluoroscopy or ultrasound examination in response to a sharp inspiratory movement (sucking in air through the nose) can occur in a wide variety of pulmonary pleural and subdiaphragmatic disorders. The diagnostic criterion for diaphragmatic paralysis is its paradoxical excursion of at least 2 cm towards the head during a sharp inspiration.
7. Bilateral paralysis of the diaphragm may be a sign of muscle weakness in patients with respiratory failure of various origins. Bilateral paralysis may also result from high-level injury to the cervical spinal cord, a manifestation of a generalized neuromuscular disease such as Guillain-Barré syndrome, or occur as an isolated phenomenon. In the latter cases, paralysis itself causes respiratory failure.
8. Since during inhalation the respiratory muscles contract, and the domes of the diaphragm passively shift towards the head, both the pressure in the pleural space and the pressure in the abdominal cavity remain negative; therefore, a transdiaphragmatic pressure gradient (TDG) does not occur. Measurement of this gradient by insertion of esophageal and gastric balloons serves as the definitive diagnostic test for recognizing bilateral diaphragmatic paralysis.
9. Successful treatment of the underlying disease in case of dysfunction of the diaphragm due to muscle weakness usually leads to the reverse development of existing disorders. Paralysis caused by a neuromuscular disease usually requires long-term mechanical ventilation, most often in the mode of intermittent positive pressure. For patients with intact diaphragm muscle, electrical stimulation of the phrenic nerves at the thoracic or cervical level should be considered.

For precise and differentiated control of head movements, numerous neck muscles require separate innervation. Therefore, a significant part of the fibers from the spinal roots and nerves, without intertwining, pass directly to the muscles or skin of the neck and head.

The first cervical nerve (n. cervicalis primus) leaves the spinal canal through the gap between occipital bone and atlas by sulcus a. vertebralis and is divided into anterior and posterior branches.

The anterior branch of CI enters the anterolateral surface of the spine between the lateral rectus capitis muscle and the anterior rectus capitis muscle and innervates them. Contraction of the lateral rectus capitis muscle on one side causes the head to tilt in the same direction; with bilateral contraction, it tilts forward. The anterior rectus capitis muscle tilts the head to its side.

The posterior branch of the CI is called the suboccipital nerve (n. suboccipitalis) and supplies the posterior rectus capitis major and posterior rectus minor, and the superior and inferior oblique capitis muscles. With a unilateral contraction, all these muscles tilt the head back and to the side, with a bilateral contraction - backwards.

Isolated damage to the first cervical spinal nerve is rare and is observed in pathological conditions in the upper cervical vertebrae. When the fibers of this nerve are irritated, convulsive contractions of the inferior oblique muscle of the capitis occur. With a unilateral clonic spasm of this muscle, the head rhythmically turns to the affected side; during her tonic spasm, the head turns slowly and this turn is longer. In the case of a bilateral spasm, the head turns in one direction or the other - a rotational spasm (tic rotatore).

The second cervical nerve (n. cervicalis secundus), emerging from the intervertebral foramen CII, is divided into anterior and posterior branches. The anterior branch is involved in the formation of the cervical plexus. The posterior branch passes posteriorly between the atlas and the axial vertebra, bends around the lower edge of the inferior oblique muscle of the capitis and is divided into three main branches: the ascending, descending and greater occipital nerve (n. occipitalis major). Two branches innervate part of the inferior oblique capitis muscle and the splenius muscle. With unilateral contraction of these muscles, the head rotates in the corresponding direction, with bilateral contraction, the head tilts back with neck extension.

Strength test posterior group head muscles: the patient is asked to tilt his head back, the examiner resists this movement.

The greater occipital nerve emerges from under the lower edge of the inferior oblique muscle of the capitis and is directed upward in an arcuate manner. Together with the occipital artery, this nerve pierces the tendon trapezius muscle near the external occipital protrusion, penetrates the skin and innervates the skin of the occipital and parietal regions. When this nerve is damaged (influenza, spondyloarthritis, trauma, tumors, reflex spasm of the inferior oblique muscle of the head), sharp pain appears in the back of the head. The pain is paroxysmal in nature and intensifies with sudden movements of the head. Patients hold their head still, tilting it slightly back or to the side. With neuralgia of the greater occipital nerve, the pain point is localized on the inner third of the line connecting the mastoid process and the external occipital protuberance (the exit point of this nerve). Hypo- or hyperesthesia in the occipital area and hair loss are sometimes observed.

Cervical plexus (plexus cervicalis). It is formed by the anterior branches of the CI - CIV spinal nerves and is located on the side of the transverse processes on the anterior surface of the middle scalene muscle and the levator scapula muscle; covered in front by the sternocleidomastoid muscle. Sensory, motor and mixed nerves depart from the plexus. Along the course of these nerves there are areas of perforation through the fascia or the muscle itself, where conditions can be created for compression-ischemic lesions of the nerve trunk.

The lesser occipital nerve (n. occipitalis minor) arises from the cervical plexus and consists of fibers of the spinal nerves CI – CIII. It passes through the fascial sheath of the superior oblique capitis muscle and branches in the skin of the outer part of the occipital region. The clinical picture of the lesion is represented by complaints of paresthesia (numbness, tingling, crawling) in the outer occipital region. They occur at night and after sleep. Hypesthesia is detected in the zone of branching of the lesser occipital nerve and pain on palpation of a point at the posterior edge of the sternocleidomastoid muscle at the site of its attachment to the mastoid process.

Similar sensations can occur in the temporo-occipital region, the auricle and the external auditory canal. In such cases, differential diagnosis is carried out with damage to the greater auricular nerve, which consists of fibers of the CIII spinal nerve. If paresthesia and pain are localized along the outer surface of the neck from the chin to the collarbone, one can think about damage to the transverse nerve of the neck (n. transversus colli) - branch of the CII - CIII spinal nerves.

From the anterior branches of the CIII and CIV spinal nerves, the supraclavicular nerves (nn. supraclavicularis) are formed. They emerge from under the posterior edge of the sternocleidomastoid muscle and are directed obliquely down into the supraclavicular fossa. Here they are divided into three groups:

the anterior supraclavicular nerves branch in the skin above the sternal area of the clavicle;
the middle supraclavicular nerves cross the collarbone and supply the skin from the chest area to the 4th rib;
The posterior supraclavicular nerves run along the outer edge of the trapezius muscle and end in the skin of the superior scapular region above the deltoid muscle.

Damage to these nerves is accompanied by pain in the neck, which intensifies when the head is tilted to the sides. With intense pain, tonic tension of the neck muscles is possible, which leads to a forced position of the head (tilted to the side and fixed motionless). In such cases, it is necessary to differentiate from the meningeal symptom (stiffness of the neck muscles). Surface sensitivity disorders (hyperesthesia, hypo- or anesthesia) are observed. Pain points detected by pressure along the posterior edge of the sternocleidomastoid muscle.

The muscular branches of the cervical plexus innervate: intertransverse muscles, which, with unilateral contraction, are involved in tilting the neck to the side (innervated by the CI - CII segment); longus muscle heads - tilts cervical region spine and head forward (innervated by the CI-CII segment); lower hyoid muscles(mm. omohyoideus, stenohyoideus, sternothyroideus), which retract the hyoid bone during the act of swallowing (innervated by the CI - CII segment); sternocleidomastoid muscle - with unilateral contraction, tilts the head in the direction of contraction, and the face turns in the opposite direction; with bilateral contraction, the head tilts back (innervated by the CII-CIII segment and n. accessorius).

Tests to determine the strength of the sternocleidomastoid muscle:

the examinee is asked to tilt his head to the side and turn his face in the direction opposite to the tilt of the head; the examiner resists this movement;
suggest tilting your head back; the examiner resists this movement and palpates the contracted muscle.

The muscular branches of the cervical plexus also innervate the trapezius muscle, which brings the scapula closer to the spine if the entire muscle contracts, raises the scapula when the upper fascicles contract, lowers the scapula when the lower portion contracts (innervated by segment CII - CIV, n. accessorius).

Test to determine the strength of the upper trapezius muscle: the subject is asked to shrug his shoulders; the examiner resists this movement. When contracting the upper part of m. trapezii, the scapula rises upward and its lower angle turns outward. When this muscle is paralyzed, the shoulder drops and the lower angle of the scapula rotates to the medial side.

Test to determine the strength of the middle part of the trapezius muscle: the examinee is asked to move the shoulder back, the examiner resists this movement and palpates the contracted part of the muscle. Normally, under the action of the middle part of m. trapezii the scapula is adducted to the spinal column; with paralysis, the scapula is abducted and slightly behind the chest.

Test to determine the strength of the lower part of the trapezius muscle: the examinee is asked to move the raised upper limb back, the examiner resists this movement and palpates the contracted bottom part muscles. Normally, the scapula lowers somewhat and approaches the spinal column. When this muscle is paralyzed, the scapula rises slightly and separates from the spinal column.

The phrenic nerve (n. phrenicus) - a mixed nerve of the cervical plexus - consists of fibers of the CIII-CV spinal nerves, as well as sympathetic fibers from the middle and lower cervical nodes of the sympathetic trunk. The nerve runs down the anterior scalene muscle and enters the chest cavity, passing between the subclavian artery and vein. The left phrenic nerve runs along the anterior surface of the aortic arch, in front of the root of the left lung and along the left lateral surface of the pericardium to the diaphragm. Right - located in front of the root of the right lung and runs along the lateral surface of the pericardium to the diaphragm. The motor fibers of the nerve supply the diaphragm, the sensory fibers innervate the pleura, pericardium, liver and its ligaments, and partially the peritoneum. This nerve anastomoses with the celiac plexus and the sympathetic plexus of the diaphragm.

When contracting, the dome of the diaphragm flattens, which increases the volume of the chest and facilitates the act of inhalation.

Test to determine the action of the diaphragm: the examinee is asked to take a deep breath while lying on his back; the examiner palpates the tense abdominal wall. With unilateral paralysis of the diaphragm, there is a weakening of the tension of the corresponding half of the abdominal wall.

Paralysis of the diaphragm leads to limited mobility of the lungs and some breathing problems. When inhaling, the diaphragm is passively raised by the muscles of the anterior abdominal wall. The type of respiratory movements becomes paradoxical: when inhaling, the epigastric region sinks, and when exhaling, it protrudes (normally, it’s the other way around); coughing movements become difficult. The mobility of the diaphragm is well assessed by fluoroscopic examination.

When the phrenic nerve is irritated, a spasm of the diaphragm occurs, which is manifested by hiccups, pain spreading to the area of the shoulder girdle, shoulder joint, neck and chest.

The phrenic nerve is affected by infectious diseases (diphtheria, scarlet fever, influenza), intoxication, trauma, metastases of a malignant tumor in the cervical vertebrae, etc.

Simultaneous damage to the entire cervical plexus is rare (due to infection, intoxication, trauma, tumor). With bilateral paralysis of the neck muscles, the head tilts forward and the patient cannot lift it. Irritation of the trunks of the cervical plexus leads to a spasm that spreads to the oblique muscles of the head, the splenius muscle of the neck and the diaphragm. With a tonic spasm of the splenius neck muscle, the head is tilted back and to the affected side; with a bilateral spasm, it is thrown back, which creates the impression of stiffness of the muscles of the back of the head.

It occurs as a result of infection, intoxication of the body, as well as compression of the nerve by a tumor of the cervical glands, thyroid gland, tumors of the neck and mediastinum, aneurysms of the subclavian artery and aorta.

Clinical signs. Paralysis or paresis of the diaphragm is established, but there is a feeling of lack of air, suffocation, a perverted or paradoxical type of breathing (during inhalation, the epigastric region sinks, and during exhalation it swells), rapid breathing, high standing of the liver, and difficult bowel movements. Pain in the diaphragm, in chest, shoulder, neck, which worsen when swallowing and breathing. Hiccups are often noted.

Neuritis of the axillary nerve

Caused by infection or injury.

Clinical signs. Neuritis of the axillary nerve is characterized by pain in the shoulder joint and limited movement in it. The shoulder does not rise to the horizontal level. Deltoid atrophies: Hypoesthesia (anesthesia) in the area of the shoulder joint and the outer surface of the upper third of the shoulder.

Neuritis of the musculocutaneous nerve

It is rare of infectious and traumatic origin.

Clinical signs. Characterized by pain and sensitivity disorder in the outer surface of the forearm, impaired flexion of the forearm.

Radial neuritis

Occurs during infections, intoxication of the body (alcohol, lead), after injuries.

Clinical signs. Paresthesia or pain that increases with pressure on the nerve trunk. Motor disorders predominate - paresis of the extensors of the hand and fingers. The hand hangs down and pronates: The fingers are bent at the metacarpophalangeal joints (see Radial nerve lesion syndrome).

Ulnar nerve neuritis

Develops as a result of infections, after injuries (shoulder fracture, supracondylar fracture, injury to the upper third of the forearm, etc.).

Clinical signs. Severe pain, mainly in the ulnar edge of the hand, sensitivity disorders, rifling small muscles hands, clawed paw, autonomic and trophic disorders (see Ulnar nerve syndrome).

Median nerve neuritis

More often it occurs after injuries, less often - due to intoxication of the body with arsenic compounds and occupational hazards (among carpenters, ironers, dentists).

Clinical signs. It manifests itself as intense and prolonged pain in the area of the hand and fingertips, often with a causalgic tinge, impaired sensitivity, severe vascular, secretory and trophic disorders, paresis of the muscles of the hand and fingers (see Median nerve lesion syndrome).

Femoral nerve neuritis

Develops in patients with disc herniations that compress the root due to injuries, neoplasms and inflammatory processes in the pelvic cavity, especially tuberculous leaky abscesses in the area of the iliopsoas muscle.

Clinical signs. Manifested by pain in the anterior inner surface thigh and lower leg, soreness of the nerve at its exit at the level of the middle third of the inguinal fold during palpation, symptoms of tension (Wasserman and Matskevich), limited flexion of the hip and extension of the lower leg, outward rotation of the hip (due to paresis of the quadriceps, iliopsoas and sartorius muscle), atrophy of the quadriceps femoris muscle, loss of the knee reflex.

Sciatica neuritis (sciatica)

There are radicular sciatica (damage to the extradural part of the root), or the so-called lumbosacral radiculitis, and trunk sciatica. Lower, or trunk, sciatica occurs primarily as a result of trauma to the nerve trunk and a rare seal tumor, and fractures of the pelvic bones.

Clinical signs. Spontaneous pain in the buttock area, back surface thighs, legs and feet, sharp pain along the sciatic nerve when pressed and at the place of its exit from the sciatic foramen, sharp symptoms of tension (Lasègue) and landing. In this case, there are sensitivity disorders along the back surface of the thigh, lower leg, dorsum of the foot and fingers, atrophy of the lower leg and foot muscles, paresis of the extensors and flexors of the foot and fingers (“horse foot”). The patient cannot walk on his toes and heels. Vasomotor and trophic disorders gradually develop (changes in color, temperature, sweating of the skin, trophic ulcers on the heel and in the area thumb, spastic-ischemic reactions of the vessels of the feet).

Tibial nerve neuritis

Diagnosed after injuries, sometimes with infections and intoxications of the body.

Clinical signs. Characterized by disturbances in plantar flexion of the foot and toes, walking and standing on toes, pain, sensitivity disorders and vasomotor-trophic dysfunction of the nerve.

Peroneal nerve neuritis

Occurs after various nerve injuries in the lower leg, popliteal fossa, due to dislocation of bones in knee joint and realignment of the hip hip joint, as well as nerve damage due to infections and intoxications of the body, especially when they are combined with damage to other nerves (in patients with polyneuritis).

Clinical signs. Paresis of the extensors of the foot and fingers, atrophy of the peroneal muscles, loss of sensitivity in the posterior surface of the leg, dorsum of the foot, inner surface of the 1st and 2nd fingers (see Peroneal nerve lesion syndrome).

N. Misyuk et al.

Article "Types, symptoms and signs of neuritis" from the section