Severe radicular pain

Introduction Cervical cervical spondylosis refers to the general clinical manifestation of cervical vertebra disc degeneration and its secondary pathological changes caused by nerve root compression caused by corresponding nerve distribution area pain. In its etiology, the degenerative change of cervical disc is the most important cause of the pathogenesis of cervical spondylosis. On this basis, it causes a series of secondary pathological changes, such as intervertebral disc herniation, posterior margin and lateral margin of adjacent vertebral bodies. The formation of spurs, the hypertrophy of the facet joints and the hook joints, the thickening of the ligamentum flavum and the formation of folds into the spinal canal. These pathological factors and the intervertebral discs are interdependent and mutually influential, and can form pressure on the cervical nerve roots, thereby producing Clinical symptoms.

Cause

There are many reasons for this disease, and the following points are summarized.

(1) Stimulation and compression factors of the nerve roots.

Because of the degenerative pathological changes of the cervical vertebrae, the cervical vertebrae of the patient is prone to cause hyperplasia of the cervical vertebrae in the cervical vertebrae, and one of the factors that transform into the radiculopathy is the hardening of the Luschka joint or the articular process in the intervertebral foramen. The lining of the membrane may cause an increase in local vascular permeability and circulatory dysfunction, and the root sleeve is secondary to hypertrophy, adhesion and fibrotic lesions. The nerve root can be distorted and is an important factor causing cervical radiculopathy.

(2) affected vertebrae shift

Because of the soft tissue strains such as cervical discs, facet joints, joint capsules and surrounding ligaments, it often causes some cervical vertebrae to lose their stability. The neck and shoulder muscles are damaged, resulting in the loss of balance between the bilateral soft tissue muscles, which causes the cervical vertebrae to shift. In clinical practice, the common vertebrae rotates to one side, making the transverse diameter of the intervertebral foramen smaller, thus stimulating and Compresses the nerve roots and produces symptoms.

(3) Insufficient blood supply to the nerve root artery.

The cervical nerve root artery is a nutritional artery, which can cause the transverse diameter of the intervertebral foramen to be reduced due to the rotation and posterior movement of the tendon or the affected vertebrae of the Luschka joint, so that the anterior root artery in front of the nerve root is compressed. Symptoms occur due to ischemic lesions of the nerve roots.

(4) Anterior scalene tendon of the neck.

When the anterior scalene muscle contracts, the brachial plexus and the subclavian vein between the anterior and middle oblique angles are compressed. The patient has radiation pain from the shoulder to the upper limb. The ulnar nerve innervation area has numbness and the upper limb skin temperature is higher. Low, and neck activity is limited because of muscle spasms.

an examination

Related inspection

Brachial plexus traction test

Test inspection

1 Brachial plexus traction test is positive: the examiner holds the affected side of the patient's head with one hand, and the upper limb of the affected side with the other hand, and stretches it 90° with both hands in the opposite direction. If there is radiation pain or numbness, it is positive.

2 positive neck test: patient sitting position, neck extension, biased to the affected side, the examiner with the left hand to support the lower jaw, the right hand gradually pressed from the top of the head, or the examiner put both hands on the top of the head, when applying pressure according to the longitudinal axis, The affected limb was positive for radioactive pain.

3 Intervertebral foramen squeeze test is positive: the patient's head is biased to the affected side. The surgeon puts the left palm on the top of the patient's head, the right hand clenches the fist, gently slams the back of the left hand, and the patient has radioactive pain.

Differential diagnosis

1, occipital and atlantoaxial diseases: occipital neck injury often cause occipital neuralgia. The occipital nerve is the sensory nerve composed of the posterior branch of the neck 2 nerve. It is difficult to distinguish the pain caused by the damage of the neck 3 nerve root. The imaging examination can help to determine the cause and, if necessary, the cranial nerve, cerebellar function and fundus examination.

2, other diseases of the cervical spine: such as spinal stenosis, ossification of the posterior longitudinal ligament, infection, tumor, etc., imaging examination can confirm the diagnosis.

3, lung, mediastinal tumor: such as lung sulcus tumor, can violate the brachial plexus caused by shoulder and arm pain, physical examination can touch the mass in the supraclavicular fossa, imaging examination can determine the location and extent of the tumor.

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