Intercostal neuralgia( or "chest radiculitis") is a pathology that occurs when the intercostal nerve is compressed or irritated and manifests itself mainly with pain, and the intensity of the pain syndrome is very high. The main danger of this disease is that the symptoms of intercostal neuralgia can mimic a large number of diseases of internal organs, including very dangerous for life, for example, myocardial infarction. Therefore, for any pain in the chest area, it is necessary to exclude dangerous causes, if there are none, then the diagnosis is inclined in favor of intercostal neuralgia.
Often, even experienced doctors, the signs of neuralgia are misleading: stenocardia are exhibited where there is none or the infarction is missed where it is present. Therefore it is very important to study in detail the symptoms of intercostal neuralgia on the right and left, and also to learn about the diseases that can hide under the neuralgic mask. This is exactly what will be discussed below.
Symptoms depend on the location of the damaged nerve
The figure shows the course of the intercostal nerves and, accordingly, the localization and spread of pain
The fact is that the neuralgia of the various intercostal nerves( a total of 12 pairs) manifests itself in different ways. All intercostal nerves are anatomical continuation of the thoracic nerves, which come out through the intervertebral openings from the spinal canal. They are directed forward from the thoracic spine and pass in the thickness of each intercostal space from the right and left sides of the thorax.
The lower pairs of intercostal nerve fibers reach the upper part of the anterior abdominal wall. Therefore, with neuralgia, pain can be localized not only in the chest, but also the abdomen, while simulating diseases of the stomach, liver, pancreas.
All intercostal nerves consist of 3 components:
- sensitive fibers( innervate the skin);
- motor fibers( provide intercostal muscles, diaphragms, which directly affect the frequency and depth of breathing);
- of vegetative fibers( control the tone of blood vessels, the work of sweat glands of the skin of the chest).
Depending on which part of the intercostal nerve is most affected, and the various symptoms of neuralgia develop. For example, when the motor fibers are compressed, the patient is disturbed by shortness of breath, sensitive - pain, vegetative - increased sweating of the skin of the chest. Sometimes the nerve is squeezed evenly, which is manifested by a complex of symptoms.
It's important to remember! Symptoms of intercostal neuralgia directly depend on the localization of the inflamed nerve and the degree of its damage.
Pain is the main symptom of
As a rule, only one intercostal nerve suffers, which leads to unilateral pain, very rarely two or more nerve fibers can be affected simultaneously and the pathology can acquire a symmetrical character( if the inflamed nerves are on both sides of the trunk).
So, the leading sign of intercostal neuralgia is pain, without which the diagnosis does not exist. With the localization, we figured out - this is any intercostal space of the chest on one side. Tenderness beyond its limits does not go away( shingles), which is an important diagnostic feature.
Pain is intense and is assessed by patients on a visually analogous pain scale as strong. The character of soreness is burning and piercing in an acute period, aching and dull in the subsequent. The duration of pain is several hours or days.
Visually analogue scale of pain. Intercostal neuralgia is assessed by patients in 7-9 points( strong)
Pain is enhanced by physical movements, in an uncomfortable position. Also, the increase in soreness is facilitated by coughing, deep breathing, sneezing, and abrupt movements.
Characteristic is the presence of painful points, when pressed, the pain intensifies:
- paravertebral points( on both sides of the vertebral column) that correspond to the affected intercostal space;
- on both sides near the sternum;
- along the nerve path.
Intercostal neuralgia can proceed according to the type of acute attacks, which are repeated at regular intervals throughout the day. During such an attack the pain is so pronounced that a person stops in the position in which it appeared, is afraid even to breathe in order not to provoke a new wave of soreness. It is this type of neuralgia that, if localized on the left side, is most often diagnosed as angina pectoris. Sometimes these two states can be distinguished only by additional laboratory and instrumental diagnostic methods.
Women can see stabbing pains in the mammary glands, which are given in the nipple, which is not found in men.
In a case of pain, patients may complain of the following symptoms( but this is not necessary).
Because of damage to sensitive fibers, patients complain of numbness at the point of nerve exit from the spine, along the patient's intercostal space. Paresthesia may also appear( a feeling of crawling on the skin).
Respiratory disorders can occur for two reasons:
- Pain that prevents the patient from breathing into full breasts.
- Damage to the motor part of the intercostal nerve, which leads to paralysis of the respiratory musculature( occurs rarely, because for such respiratory disorders requires the simultaneous defeat of most of the intercostal nerves).
Respiratory disorders occur with frequent and shallow breathing.
Vegetative manifestations of
Among such symptoms, it can be noted:
- cold and sticky skin of the chest;
- change in the color of the skin - blue or pale;
- increased sweating.
Symptoms of the underlying disease
It is important to know that intercostal neuralgia is not a separate nosological form of the disease but a consequence of a large number of both degenerative-dystrophic diseases of the spine and general infectious diseases, traumas and some other pathologies that can lead to secondary compression,irritation or inflammation of the intercostal nerve. Therefore, in parallel with the described symptoms, signs of osteochondrosis, intervertebral protrusion and hernia, muscle spasms, trauma( muscle contusions and fractures of the vertebrae, ribs), SARS, herpes zoster, spinal tumors, posture disorders, Bekhterev's disease should be looked for.
Let us briefly consider the most frequent pathologies, which manifest similar symptoms, as well as their difference from intercostal neuralgia.
Coronary pains( stenocardia and myocardial infarction)
With coronary pain the pain is very strong, but it is in most cases described by patients as burning, squeezing, "stone" in the chest, and not standard pain. Lasts a few minutes( up to 15), if more, then the development of a heart attack is possible. Locates behind the sternum and occupies more than 1 intercostal space. Appears after a strong emotional stress and physical activity, does not depend on the position of the body, does not increase when pressing painful points, with breathing and coughing.
Accompanied by true dyspnoea, not by fear of breathing because of a new painful wave, fear of death, cold sticky sweat, lowering or raising blood pressure. Gives to the left side of the body( arm, jaw, shoulder, shoulder blade).Removed nitroglycerin or narcotic analgesics in case of a heart attack. Clear the situation can ECG, Echo-KG.
The figure shows the spread of pain in coronary heart disease
Gastritis and stomach ulcer
Pain of varying intensity and character. It is localized in the epigastric region, in the left hypochondrium region. It is possible to trace the connection with the ingestion of food - it increases after eating and hunger. It is accompanied by nausea, vomiting, which brings relief, heartburn, and stool disorders. Decreases after taking antacid and enveloping medications. Diagnosis will help fibrogastroduodenoscopy.
Pleura and pneumonia
In pneumonia, pain in the chest is found only in the case of pleurisy layering, since there is no pain receptor in the lung tissue and it can not hurt. Another thing is the pleura. The patient complains of stitching pains in the side of the chest, which are intensified by coughing, deep inspiration, when inclined to the side in the opposite side from the sore spot( with neuralgia the pain will increase when tilted to the sore side).
In parallel, there are other signs of pleurisy and pneumonia: fever, cough with phlegm, shortness of breath, general malaise. Pain decreases after taking anti-inflammatory and analgesic agents, as in neuralgia. To exclude pneumonia, it is necessary to perform radiography of OGC.
Herpes zoster, lesion of 12 intercostal nerve on the right
In fact, herpes zoster is neuralgia, only of an infectious nature. All the symptoms described for intercostal neuralgia will be characteristic for this disease. But the herpetic etiology of the disease will be indicated by specific skin rashes along the course of the affected intercostal space.
Basically, from the phased elimination of disease-imitators and consists of the diagnosis of intercostal neuralgia, because it is the diagnosis of exclusion. A doctor can be sure of a diagnosis only after a complete examination of the patient.
Summing up, it can be noted that in itself, intercostal neuralgia is not dangerous to humans, but the quality of life is seriously affected. Danger is a condition that can hide under the guise of this disease. Therefore, any pain in the chest should be taken seriously and mandatory visit a doctor and go through all the necessary examinations.
- Neuralgia localization
- Pain is the main symptom of
- Other symptoms
- Differential diagnosis