Nerve root stimulation

Introduction When the lateral cervical nerve is damaged, various types of sensory disturbances in the ipsilateral occipital, neck, shoulder and upper limbs may occur, accompanied by nerve root irritation symptoms - root pain, radiation pain, and if the single nerve root damage, the sensory disorder area Limitations, the number of correspondences: the neck is the neck, the neck is the neck 3, and the shoulder is the neck 4. The clinical manifestations of root nerve damage of the neck 58 are the same as the corresponding brachial plexus paralysis. Whether or not there is root pain is its main point of identification.

Cause

The most common cause of radiculopathy is intervertebral disc herniation, spinal cancer, osteoporosis or severe trauma. Degenerative arthritis (osteoarthritis) is another common cause of nerve root damage, which forms irregular bone protrusions (spurs) that compress nerve roots, and narrow space around the spinal cord (spinal stenosis) often occurs in the elderly. Uncommon causes are spinal cord tumors or infections such as meningitis or herpes zoster.

an examination

Related inspection

Electromyography blood routine

When a single nerve root administers areas of pain, loss of sensation, or weakness, there may be damage to the nerve roots. Based on the location of pain and loss of sensation, the doctor can infer which nerve is damaged. At the time of physical examination, doctors often find areas of tenderness in the patient's spine. X-ray examination can show whether the bone of the spine is thin and damaged, and whether there is a disorder. CT or MRI radiographs can more clearly show lesions in the spinal cord or around the spinal cord. If there is no MRI, myelography can show the lesion. Other tests, especially neurophysiological measurements of nerves and muscles, are sometimes necessary.

Differential diagnosis

1. Cervical nerve root damage: When one side of the cervical nerve is damaged, various types of sensory disturbances in the ipsilateral occipital, neck, shoulder and upper limbs may occur, accompanied by nerve root irritation symptoms - root pain, radiation pain, if it is a single Nerve root damage, the sensory disorder area is limited, the number of correspondences; the neck is the neck 2, the neck is the neck 3, and the shoulder is the neck 4. The clinical manifestations of root nerve damage of the neck 58 are the same as the corresponding brachial plexus paralysis. Whether or not there is root pain is its main point of identification.

2. Thoracic nerve root damage: When the thoracic nerve root damage, its segmental performance is most obvious, with segmental sensation loss or disappearance, hyperesthesia or hypersensitivity, with acupuncture-like pain, burning pain, pain along the intercostal nerve radiation. The sensation of single nerve root damage is not obvious or much smaller than the actual limit; multiple nerve root damage, the upper and lower boundaries of the sensory disturbance are lower or higher than the actual damage by 1-2 segments. The segmental distribution of nerve root damage and chest and abdomen sensory disturbances is: chest 2: first intercostal skin, chest 4: breast line, chest 7: lower edge of rib arch, chest 10: umbilical level, waist 1: groin.

3. Lum nerve root lesions:

(1) Lumbar 3 nerve damage: only in the lateral and front of the thigh, there is hyposensitivity or allergies. The pain radiates from the back of the arm to the femur, the anterior and lateral thigh, the lower end of the femur and the medial malleolus. The knee reflex is weakened or disappeared.

(2) lumbar 4 nerve root damage: the lateral side of the buttocks, the front of the femur to the front of the knee joint, the anterior medial aspect of the calf to the inner surface of the foot showed sensory disturbance, and the following paragraph is obvious, the pain along this distribution area radiates from the buttocks to the arch of the foot, accompanied by There are quadriceps and tibialis anterior muscle paralysis.

(3) Lumbar 5 nerve root damage: the lateral side of the calf, the back of the heel, the back and the lateral side of the big toe are reduced, and the pain is radiated from the thigh, the knee joint, and the lateral side of the calf to the big toe.

(4) lumbar 4 to 5 nerve root damage: in addition to the performance of the waist 4 and waist 5 nerve root damage, especially the lateral sensation of the calf to the back of the foot is prominent, accompanied by toe dorsiflexion, especially the big toe The dorsiflexion is impaired.

4. nerve root damage:

(1) 1 nerve root damage: the posterolateral thigh, the back of the calf to the lateral side of the foot showed sensory disturbance, and the pain radiated from the back of the hip along the nerve distribution area to the small toe.

(2) Lumbar 51 nerve root combined damage: all the sensory disturbances appear before and after the calf and from the lateral side to the bottom of the foot. The pain is radiated from the hip to the corresponding area, accompanied by calf triceps, flexor tendon paralysis, Achilles tendon reflex decline or disappear .

5. Cauda equina nerve root damage: When the cauda equina nerve root is damaged, it can be expressed as various neurological damage symptoms below the waist 2 . When the horsetail is damaged, the boundary of the sensory disorder is clear. The upper anterior border is the groin, and the posterior is the horizontal line at the upper end of the humerus. Below this, all the hips, perineum and lower limbs have sensory disturbances, accompanied by spontaneous pain (electrical pain) and abnormal perineum. Feeling and radiating to the lower extremities, often painful feelings are delayed. The height and extent of the horsetail damage are different. The upper and lower bounds can be different.

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