Electric shock in the limbs

Introduction One of the symptoms of occipital and neck joint injury is the occipital neck () instability type. This type mainly includes: neck pain, limited mobility, forced position and tenderness at the junction of the neck and neck. In severe cases, there may be a feeling of electric shock in the limbs. More often when the position is not correct) or sudden quadriplegia.

Cause

(1) Causes of the disease

The most common cause of upper cervical spine injury is traffic accidents, followed by high altitude falls and sports injuries, including snorkeling or high diving.

(two) pathogenesis

Anatomically, the occipital-cervical joint is horizontal and easily causes dislocation, but there are not only a strong ligamentous tissue around it, but also the surrounding muscles are well developed, so in general, the chance of fracture dislocation here is Not much. On the contrary, the atlantoaxial joint of the next vertebra is easily damaged. However, if the lateral violence acting on the skull is sudden and rapid, so that the shear stress concentrates on the occipital neck joint, the displacement of the pair of elliptical joints can also be caused.

The cause of injury to the neck and joint dislocation is more common in traffic accidents. It occurs in traffic accidents where the pedestrian collides with the car, especially when the child runs on the road and collides with the opposite car. Low, the head is susceptible to the first violent impact and causes acute dislocation of the occipital ankle joint, and most of them die in the accident. This is mainly due to the fact that this displacement exceeds the maximum value of the interstitial space in the spinal canal and causes compression of the medulla. If only caused by subluxation, but not fatal compression of the medulla, the patient may survive, but this lucky person is very rare after all (Figure 1). In addition, pre-hospital treatment levels have a critical impact on the survival rate of this injury. On the other hand, it should be noted that this injury is easily accompanied by skull base and atlas fractures and brain trauma, etc., should be noted during the examination.

an examination

Related inspection

Limb perspective

The clinical classification of occipital neck () joint damage is mainly divided into the following two types.

1. Complete dislocation type: Mainly causes quadriplegia and life center crisis, mostly accompanied by brain stem injury, and died at the time of injury or short term. The cause of death after admission was mainly due to the disappearance of spontaneous breathing, which caused respiratory and circulatory system failure. The person who died immediately after the injury was injured and the brain stem or medulla, and the life center was involved. This case can also be combined with occipital condyle fractures. The author has encountered 5 cases of complete dislocation of the occipital neck () joint injury, the longest survival is no more than 1 month.

2. The occipital neck () instability type: that is, the trauma only causes partial ligament and muscle group damage. This type of performance mainly includes: neck pain, limited mobility, forced position and tenderness at the junction of the neck and neck. In severe cases, there may be a feeling of electric shock in the limbs (more often in the absence of position) or sudden quadriplegia. This type can also be seen in congenital cervical fusion disease (such as Klippel-Feil syndrome) and other occipital neck instability caused by compensatory stress.

1. Medical history: There is a clear history of trauma.

2. Clinical symptoms: mainly the local injury symptoms of the cervical neck, accompanied by neurological dysfunction above the cervical spinal cord, varying in severity. Mild manifestations of spinal cord irritation symptoms and signs; severe loss of consciousness and spontaneous breathing disappeared, and permanent ventilator dependence.

3. Imaging examination

(1) X-ray film: can show the widening of the vertebral shadow. X-ray film is mainly used to exclude other types of upper neck injury and to measure the distance between the teeth. Under normal circumstances, the interdental distance of adults is 4 ~ 5mm, more than 6mm indicates subluxation or dislocation of the occipital ankle joint.

(2) CT or MRI: It has a decisive effect on the diagnosis and can show the occipital condyle fracture sign.

Differential diagnosis

Distal numbness, pain, or abnormal sensory peripheral neuropathy of the extremities, mainly manifested by varying degrees of numbness, pain, or abnormal sensation at the distal extremities. The motor neuron spasm of the limbs is symmetrical. It is caused by motor neuron disease, which is characterized by the lower motor neuron symmetry of the limbs. Limb numbness The transmission of various sensations in the limbs of healthy people depends on the unimpeded access of the brain to the limbs. If there is a disorder in a certain part of this nerve pathway, symptoms such as limb numbness may occur.

The clinical classification of occipital neck () joint damage is mainly divided into the following two types.

1. Complete dislocation type: Mainly causes quadriplegia and life center crisis, mostly accompanied by brain stem injury, and died at the time of injury or short term. The cause of death after admission was mainly due to the disappearance of spontaneous breathing, which caused respiratory and circulatory system failure. The person who died immediately after the injury was injured and the brain stem or medulla, and the life center was involved. This case can also be combined with occipital condyle fractures. The author has encountered 5 cases of complete dislocation of the occipital neck () joint injury, the longest survival is no more than 1 month.

2. The occipital neck () instability type: that is, the trauma only causes partial ligament and muscle group damage. This type of performance mainly includes: neck pain, limited mobility, forced position and tenderness at the junction of the neck and neck. In severe cases, there may be a feeling of electric shock in the limbs (more often in the absence of position) or sudden quadriplegia. This type can also be seen in congenital cervical fusion disease (such as Klippel-Feil syndrome) and other occipital neck instability caused by compensatory stress.

1. Medical history: There is a clear history of trauma.

2. Clinical symptoms: Mainly for the local injury symptoms of the occipital neck segment, accompanied by neurological dysfunction above the cervical spinal cord, varying in severity. Mild manifestations of spinal cord irritation symptoms and signs; severe loss of consciousness and spontaneous breathing disappeared, and permanent ventilator dependence.

3. Imaging examination

(1) X-ray film: can show the widening of the vertebral shadow. X-ray film is mainly used to exclude other types of upper neck injury and to measure the distance between the teeth. Under normal circumstances, the interdental distance of adults is 4 ~ 5mm, more than 6mm indicates subluxation or dislocation of the occipital ankle joint.

(2) CT or MRI: It has a decisive effect on the diagnosis and can show the occipital condyle fracture sign.

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