Local percussion pain

Introduction Straight leg elevation test was positive, lumbar motion was limited, pre-spinal mutation, local pain, erector spinae. These symptoms are due to mononeuropathy and plexus neuropathy. Peripheral spinal neuropathy refers to the structural and dysfunction of spinal cord and brainstem motor neurons, primary sensory neurons, axons of surrounding autonomic neurons, and/or Schwann cells and myelin. The cause of intercostal neuralgia is mainly related to the involvement of adjacent tissues and organs in the intercostal nerve. Common causes are pleurisy, pneumonia, aortic aneurysm; trauma to the thoracic and ribs, tumors, deformities; cavities of the thoracic spinal cord, inflammation and tumors. Wait. Varicella or herpes zoster infection and post-infection of intercostal neuralgia are common in elderly, HIV patients, malignant tumors, and chemotherapy patients.

Cause

According to the medical history and various laboratory tests, various causes of neuropathy around the spinal cord can be identified.

1. The cause of brachial plexus is complex, mainly including the following aspects:

(1) Trauma: The most common cause of traumatic brachial plexus neuropathy is the pulling and impact of upper limbs during violent accidents and mechanical injuries.

(2) Thoracic outlet syndrome.

(3) Physical damage: such as electric shock and radioactive damage.

(4) Acute brachial plexus neuritis: also known as neuropathic muscle atrophy. It is often acute or subacute after the flu or after the use of drugs such as penicillin, which may be related to autoimmunity.

(5) genetic factors: such as familial recurrent brachial plexus neuropathy or genetic familial brachial plexus neuropathy, some patients with neurobiopsy showed myelin hypertrophy, a sausage-like change, similar to hereditary stress-susceptible peripheral neuropathy.

(6) Tumor: The most common is brachial plexus schwannomas, followed by brachial plexus fibroids.

(7) Perinatal brachial plexus neuropathy: During the delivery process, when the shoulder of the fetus is difficult to deliver, the fetal head is pulled hard, which may cause brachial plexus injury, which occurs in a large infant larger than 4000g. However, a considerable proportion of newborns weighing less than 4000g and having difficulty in delivering shoulders may also have brachial plexus injury, suggesting that there may be other causes other than birth injury.

(8) Chronic brachial plexus neuropathy: refers to a group of slowly progressive idiopathic brachial plexus neuropathy with unknown causes.

2. The cause of intercostal neuralgia is mainly related to the involvement of adjacent interstitial tissues and organs in the intercostal nerve. Common causes are pleurisy, pneumonia, aortic aneurysm; trauma of thoracic and ribs, tumors, deformities; cavity and inflammation of the thoracic spinal cord. And tumors, etc. Varicella or herpes zoster infection and post-infection of intercostal neuralgia are common in elderly, HIV patients, malignant tumors, and chemotherapy patients.

an examination

Related inspection

Spinal MRI examination of spinal activity Spinal vertebral body vertebral spine palpation spine motion test

1. Brachial plexus neuropathy, in the case of non-same plane cutting injury, any two or more brachial plexus branches should be considered for the possibility of brachial plexus.

Domestic Gu Yudong emphasized the importance of the five major nerve involvement of the upper extremity in the diagnosis of brachial plexus. One of the following conditions should be considered: the presence of brachial plexus injury should be considered:

1. Joint damage of any two of the phrenic nerve, musculocutaneous nerve, median nerve, ulnar nerve and sacral nerve.

2. Any of the median nerve, ulnar nerve, and phrenic nerve with dysfunction of the shoulder or elbow joint.

3. Any of the median nerve, ulnar nerve, and phrenic nerve combined with medial cutaneous nerve injury of the forearm.

2. Intercostal neuralgia is not difficult to diagnose based on its pain distribution area and characteristics.

3. The diagnosis of lumbosacral nerve roots, plexus and nerve trunk damage mainly depends on clinical manifestations. Because they are spatially a continuation relationship, sometimes it is difficult to identify, such as the lower part of the sacral plexus, the sciatic nerve and the common peroneal nerve can cause damage. The same motor dysfunction. Neurophysiological examination may be helpful for localization diagnosis. Lumbar vertebrae and pelvic CT and MRI can provide a basis for finding the cause.

4. Sciatica According to the distribution of pain, radiation path and tenderness, the cause of pain aggravation and relief, Lasegue sign, weak sputum reflex, calf and lateral sensation of the foot, it is not difficult to diagnose. Attention should be paid to distinguish between root and dryness. Symptoms and signs of lumbar disc herniation may occur suddenly or insidiously, or after trauma. Lumbar X-ray or MRI, pelvic and rectal examinations help to exclude tumors and other lesions.

Differential diagnosis

1. Lumbosacral nerve roots, plexus and nerve trunk damage must be differentiated from lumbar muscle strain, hip fibrosis, hip arthritis, etc., the latter can cause pain in the lower back, buttocks and lower extremities, but no radiation pain, no muscle strength Decreased, decreased reflexes, and sensory disturbances.

2. Etiology identification should pay attention to spinal horsetail tumor, degenerative spondylitis (proliferative spondylitis), spinal tuberculosis, tumor, crack and syringomyelia, biceps tenosynovitis, piriformis syndrome. Spinal X-ray, CT, or MRI can help confirm the diagnosis.

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