Weakness and atrophy of the shoulder girdle, upper extremity, and chest and back muscles

Introduction The main clinical manifestations of brachial plexus include muscle weakness and muscle atrophy in the muscles of the shoulder muscles, upper limbs, and thoracodors, and numbness, pain, and sensation of the skin sensation area corresponding to the branches of the affected brachial plexus. Muscular atrophy refers to dystrophic dystrophic muscle, muscle volume shrinks normally, and muscle fibers become thinner or even disappear, which is one of the main symptoms of nerves, muscle disorders and major diseases. Whether the nutritional status of the muscle is normal depends not only on the pathological changes of the muscle tissue itself, but also on the nervous system. According to the primary lesions that produce muscle atrophy, muscle atrophy is clinically divided into three categories: neurogenic muscle atrophy, myogenic muscle atrophy, and disuse muscle atrophy.

Cause

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.

3. The etiology of lumbosacral plexus neuropathy is complex, mainly in the following aspects:

(1) Diabetic proximal muscle atrophy: It is thought to be caused by bilateral lumbosacral plexus involvement, and the immune mechanism plays an important role in nerve injury.

(2) trauma and hemorrhagic disease: pelvic fracture caused by trauma, psoas muscle or pelvic hematoma, hip dislocation, fracture, etc. can cause lumbosacral plexus injury. Patients with blood diseases or anticoagulant therapy may have a psoas muscle or iliopsoas muscle hematoma that directly invades the lumbosacral plexus.

(3) iatrogenic: abdominal and pelvic surgery such as hysterectomy, kidney transplantation, prostate and bladder surgery, etc. due to the use of self-limiting stretcher, its sharp leaves are easy to oppress the lumbosacral plexus, causing damage. In the kidney transplantation, due to the anastomosis of the donor renal artery and the inferior luminal artery of the recipient, it is easy to cause arterial stealing, which causes ischemia of the lumbosacral plexus. During hip arthroplasty, the adhesive is squeezed out of the pelvis to compress the nerve plexus.

(4) Aortic and pelvic artery malformations: abnormal blood vessel rupture and hemorrhage form a pelvic hematoma compression lumbosacral plexus.

(5) Production process: maternal primipara or large fetus due to long labor, long-term stone removal position makes the hip joint excessive abduction easily cause lumbosacral plexus injury.

(6) Tumor: Tumor lumbosacral plexus disease is more common, and the diagnosis is more difficult. CT, MRI and lumbar puncture often have no abnormal findings. Prostate, rectal, bladder, and kidney tumors can invade the lumbosacral plexus and surrounding lymph nodes by localized spread. Giant fibroids in the posterior wall of the uterus and endometriosis can directly compress the lumbosacral plexus. In addition, aneurysms formed by aortic atherosclerosis can also involve the nerve plexus.

(7) Infection: In the psoas muscle tuberculous abscess, lumbar osteomyelitis, appendicitis, inflammation can invade the lumbosacral plexus through the diaphragmatic fascia. Sometimes varicella or herpes zoster infection can also cause lumbosacral neuralgia and herpes. Systemic vasculitis can involve lumbosacral plexus causing vasculitis peripheral neuropathy.

(8) Radioactivity: Radiation of pelvic tumors can cause radiation lumbosacral neuropathy.

(9) Idiopathic: Corresponding to the acute brachial plexus neuritis of the upper extremity, the lower extremity may have idiopathic lumbosacral plexus neuritis, and the pathological mechanisms of both may be related to autoimmune abnormalities.

an examination

Related inspection

Electromyography triceps reflex

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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