- Clinical picture
- Therapeutic tactic
Plexitis of the shoulder joint( shoulder) is an inflammation of the brachial plexus. Often the cervical plexus is involved in the pathological process because of the anatomically close arrangement of the nerves in the neck and upper humeral girdle.
The disease is more common in able-bodied patients aged 20-50 years, the defeat of the leading hand leads to disability and difficulty in self-service in everyday life. The cervico-brachial plexitis can develop in newborns due to birth trauma, which slows down the physical development and contributes to impairment of the motor capacity of the affected limb.
Early diagnosis of the disease and comprehensive treatment provide good chances for recovery. Running cases of the disease lead to complete functional failure of the left or right hand.
More details on what is plexitis and what other types of illness are there are written here.
The brachial plexus is formed by the first thoracic spinal nerve and the anterior branches of the four lower cervical nerves. The accumulation of nerve fibers is responsible for the innervation of the upper humeral girdle, arm, diaphragm. Sensitive, motor and vegetative fibers pass through it, which are responsible for various kinds of sensitivity, motility and trophism of innervated tissues. The cervical plexus is located above the brachial plexus, but is closely associated with it both anatomically and functionally.
When cervical plexitis, especially infectious-toxic nature, often develops shoulder plexitis and vice versa. As a result of the inflammatory process, the shoulder joint, the large joint responsible for the movement of the upper limb, suffers first. Involvement of the outgoing nerves from the plexus leads to a violation in the shoulder, forearm, elbow joint and small joints of the hand.
Shoulder plexitis leads to atrophy of shoulder muscles and upper shoulder girdle
Development of plexitis of the shoulder joint can provoke the following unfavorable factors:
- brachial plexus injuries in case of fracture of the collarbone, shoulder dislocations, sprain of the ligamentous apparatus of the upper humeral girdle, including during pathological births;
- ischemic defeat of the brachial nerve with a prolonged non-physiological position of the upper limb, which occurs in the case of narcotic sleep, unconsciousness, improper immobilization of the hand, the use of uncomfortable crutches, the development of tumors;
- enlargement of lymph nodes of an infectious or malignant nature;
- periarthritis( inflammation of the periarticular soft tissues) as a result of infections and injuries;
- large aneurysms of arterial vessels in the site of the nerve plexus;
- osteochondrosis of cervical and thoracic spine;
- infectious-toxic effect on nerve tissue due to bacterial( tuberculosis) and viral( herpes, influenza, cytomegalovirus) diseases, poisoning with alcohol substitutes, heavy metals, mercury salts;
- metabolic disorders in the body( gout, hyperthyroidism, diabetes mellitus);
- costochondral syndrome with the formation of additional cervical ribs;
- constant supercooling.
Brachial and cervical plexitis in newborns occurs with pelvic and leg presenting, loss of the fetal handle during childbirth, prolonged child finding in the mother's birth canal.
Clinical picture of
The manifestations of plexitis of the shoulder joint depend on the prevalence of the pathology and the stage of the development of the disease. The inflammatory process can affect the entire plexus, then talk about total plexitis, or only individual nerve fibers. When the upper nerve bundles become damaged, Duchenne-Erb's paralysis develops, and the involvement of lower nervous beams in the inflammation leads to Degerin-Clumpke paralysis. Rarely there is a bilateral process, which complicates the course of pathology. In the international classification of diseases of ICD 10, the defeat of the brachial plexus belongs to the subgroup G54.0.
According to clinical manifestations, two stages of plexitis flow are distinguished. The initial stage is called neurological and is characterized by pain syndrome, trophic, sensory, motor impairment in the upper limb. When carrying out a complex of therapeutic measures, the symptoms are reversible. Progression of the disease on the background of improper therapy or failure of treatment causes the transition of plexitis to the paralytic stage, in which persistent paralysis or paresis of the upper extremities develop.
Shoulder damage in plexitis disrupts the muscle contractility of the
For shoulder plexitis, the following clinical signs are characteristic:
- intense pain in the shoulder joint in a state of rest, sometimes paroxysmal, which increase during movement and spread to the arm, supraclavicular and subclavian area;
- trophic disorders - the skin of the affected upper limb becomes shiny, swollen, cold to the touch, pale or cyanotic in color, fragility of the nails and sweating of the palms;
- decreased sensitivity on the external surface of the hand in the case of Duchenne-Erba paralysis and the inner surface of the limb in the Clumpke-Dezherin paralysis;
- weakness and atrophy of the muscles of the hand, the inability to raise the upper limb, lead it behind the back, a violation of the fine motor skills of the fingers, resulting in difficulties with the implementation of elementary movements in everyday life and professional activities;
- painful hiccups and difficulty breathing when involved in the inflammatory process of the diaphragmatic nerve;
- seldom appear narrowing of the pupil and eyelash of the eyeball on the side of the lesion.
Unilateral or bilateral paralysis of the upper limbs causes not only loss of ability to work, but also leads to loss of self-service skills, which makes patients dependent on the help of people around them.
Before the treatment, a diagnostic examination is appointed, which helps differentiate plexitis from another neurological pathology. To do this, conduct electromyography, X-ray of the shoulder joint, computer and magnetic resonance imaging( CT, MRI), ultrasound. After the establishment of the final diagnosis, they start treating the disease. It should be remembered: the earlier therapy is started after the appearance of the first symptoms of the disease, the more favorable the prognosis for recovery.
Plexitis of the shoulder joint in the acute stage requires immobilization of the upper limb
The complex treatment includes measures aimed at etiologic disease, which led to the appearance of plexitis. In case of trauma, the integrity of the bone is restored, bone extracts are extracted, and the injured limb is immobilized. Osteochondrosis requires the appointment of chondroprotectors, and endocrine disorders - the normalization of metabolic processes in the body. Tumors, aneurysms, additional ribs are removed surgically. Infectious-toxic plexites are treated with antibacterial agents and detoxify the body.
Symptomatic therapy of the disease, aimed at its manifestations, includes:
- painkillers - novocain blockades, analgin, aspizol, oxadol;
- non-steroidal anti-inflammatory drugs( NSAIDs) - diclofenac, nimesulide, indomethacin;
- vitamin therapy based on vitamins B, A, C, E - neurovitan, milgamma, Aevit, ascorbic acid;
- anticholinesterase drugs that improve the conduct of nerve impulses - proserin, kalimin, invalid;
- decongestants - beckons, urea;
- trophic drugs - nicotinic acid, potassium orotate, nerobol, lidase;
- means for improving microcirculation - trental, komplamin;
- physiotherapy - ultrasound with hydrocartisone, electrophoresis with novocaine, magnetotherapy, ozocerite;
- massage during the remission of acute inflammatory process;
- medical gymnastics;
- folk treatment;
- reflexotherapy( acupuncture), laser therapy, balneotherapy( mineral water treatment), cryotherapy( local exposure to low temperatures).
Therapeutic gymnastics is prescribed to prevent muscle atrophy of the shoulder girdle
As an additional method of therapy and prophylaxis of plexitis, folk remedies can be used after approval by the attending physician. The most effective methods include the use of mummies with milk, herbal collections of sweet clover, hop, burdock, string. Apply ointments and baths on the basis of plant components. It should be remembered that such treatment does not exclude, but supplements conservative therapy of the disease.
To prevent exacerbation of plexitis, improve blood flow and metabolism in the lesion site, restore strength and elasticity of atrophied muscles, recommend a set of exercises for daily exercise.
- Shoulder lift and lowering 8-10 times in one approach.
- Maximum blade reduction up to 10-12 times.
- The starting position - the arms are bent in the joints, the brushes lie on the shoulders. Rotation in the humeral joint first forward, then back 6-8 times.
- Drawing the sick arm to the side at right angles to the floor and bringing it to the body 10-12 times.
- Straightened by a damaged hand in front of him to make circular movements clockwise and counterclockwise 12-15 times.
- The starting position is hands along the body. Flexion and extension of the patient upper limb in the elbow joint 6-8 times, at first you can help with a healthy arm.
- The starting position is the same, turn the wrist and forearm to the right and left sides 10-12 times.
The mechanics of the fingers are restored by grasping, feeling and shifting small objects - beads, peas, cogs. It is useful to do swimming and water aerobics. It is necessary to avoid hypothermia, intense exercise, heavy physical labor.
Plexitis of the shoulder joint with timely diagnosis and treatment has a favorable prognosis. Otherwise, there are persistent motor and sensitive disorders in the upper limbs, which leads to disability and loss of ability to self-service.