Anatomy of radiation nerve and treatment of lesions. Restoration of radiation nerve

Defeat (neuropathy) of the radiation nerve (G56.3) is pathological conditionwhere the radial nerve is affected. Manifests itself difficult to extension muscles of the forearm, wrists, fingers, difficulty of lead thumb, impaired sensitivity in the field of innervation of this nerve.

The ethiology of the neuropathy of the radiot nerve: the compression of the radial nerve in a dream (deep sleep, strong fatigue, alcoholic intoxication); Fracture shoulder bone; long movement with crutches; transferred infections; intoxication.

Clinical picture

Patients are concerned with pain and feeling of tingling, burning in the fingers of the brush and the rear surface of the forearm, weakness in the muscles of the brush. Gradually, numbness of the rear of the brushes gradually appears, bringing the brush-heading, is impaired, the extension of the brush and forearm finds it difficult.

With an objective examination of the patient detect:

paresthesia and hysthesis in the rear I, II, III fingers, the back surface of the forearm (70%);
weakness in the muscles-extensor brushes and fingers, the weakness of the supinator, the shoulder muscle (60%);
the impossibility of the lead and bringing the thumb (70%);
reducing the carboard reflex (50%);
muscle atrophy (40%);
the appearance of pain during the supination of the forearm with overcoming resistance and in a sample with an extension of the middle finger (50%);
palpation diseases in the course of radiation nerve (60%).

Diagnosis of lesion of radiation nerve

Electronomyography.
X-ray or computed tomography of urban and / or ray-taking joint.

Differential diagnosis:

Cressing the rear intercellate nerve.
Defeat shoulder plexus.

Treatment of radiation nerve lesion

Non-steroidal anti-inflammatory drugs, vitamins.
Physical, massage.
Temporary limit exercise on hand.
Novocaine and hydrocortisone blockades.
Surgical treatment (applied with a radiot nerve compression).

Treatment is assigned only after confirming the diagnosis by a specialist doctor.

Basic drugs

There are contraindications. Consultation of a specialist is necessary.

Ksefokam (Nonteroid anti-inflammatory agent). Dosing mode: To relieve acute pain syndrome, the recommended dose is 8-16 mg / day. For 2-3 receptions. Maximum daily dose - 16 mg. Tablets are taken before meal, drinking a glass of water.
(analgesic). Dosing mode: V / B, in / m, p / k in a single dose of 50-100 mg, it is possible to repeatedly administer the drug after 4-6 hours. Maximum daily dose - 400 mg.
(Nonteroid anti-inflammatory means). Dosing mode: in / m - 100 mg 1-2 times a day; After the relief of pain syndrome is prescribed inside in a daily dose of 300 mg in 2-3 reception, supporting dose of 150-200 mg / day.
(Diuretik from the carboangeyndase inhibitors group). Dosing mode: Adults are prescribed 250-500 mg once in the morning within 3 days, on the 4th day - a break.
(complex of vitamins of group B). Dosing mode: Therapy begins with 2 ml intramuscularly 1 p / d for 5-10 days. Supporting therapy - 2 ml / m two or three times a week.
Prezero (inhibitor of acetylcholinesterase and pseudocholinesterase). Dosing mode: inside adults 10-15 mg 2-3 times a day; subcutaneously - 1-2 mg 1-2 times a day.

- This is a complete or partial impaired integrity of the nerve due to injury, impact or compression. May occur with any kind of injuries. It is accompanied by a disruption of sensitivity, losing motor functions and the development of trophic disorders in the innervation zone. It is severe damage, often becomes partial or complete disability. The diagnosis is established on the basis of clinical signs and data of stimulation electromyography. Treatment is integrated, combines conservative and operational activities.

MKB-10

S44 S54 S74 S84

General

Nerva damage is a common severe injury due to a complete or partial break of the nervous barrel. Nervous tissue does not regenerate. In addition, with similar injuries in the distal part of the nerve, Valerova is developing degeneration - a process in which the nervous tissue is absorbed and replaced by Rubatova connective tissue. Therefore, the favorable outcome of treatment is difficult to guarantee even at high qualification of the surgeon and adequate restoration of the integrity of the nervous trunk. Damage to nerves often cause restriction of disability and disability. Treatment of such injuries and their consequences carry out neurosurgers and traumatologists.

The reasons

Closed nerve damage arise due to the compression of soft tissues by an extraneous object (for example, when it is under the bitch), a stupid item, an isolated nerve compression, a tumor, bone fragment with a fracture or dislocated bone end. Open damage to the nerve in peacetime more often become a consequence of cutting wounds, during the period of military operations - gunshot wounds. Closed damage, as a rule, are incomplete, so more favorably proceed.

Pathogenesis

The nerve damage is accompanied by the loss of sensitivity, impaired motor function and trophic disorders. In the autonomous innervation zone, the sensitivity is completely absent, in mixed zones (the regions of the transition of innervation from one nerve to another) detects sections of a reduction in sensitivity, interpretable sites of the hyperpathy (sensitivity perversion, in which, in response to the action of harmless stimuli, pain, itching or other unpleasant sensations occurs) . Violation of motor functions is manifested by sluggish paralysis of innervated muscles.

In addition, the lesion is developing an anhydrosis of the skin and vasomotor disorders. During the first three weeks there is a hot phase (red leather, its temperature is increased), which is replaced by a cold phase (the skin becomes cold and acquires a blue shade). Over time, in the affected area, trophic disorders occur, characterized by thinning of the skin, with a decrease in its turgore and elasticity. In long-term deadlines, the joints of the joints and osteoporosis is revealed.

Classification

Depending on the severity of nerve damage in practical neurology and traumatology, the following disorders allocate:

Shake. Morphological and anatomical disorders are absent. Sensitivity and motor functions are restored after 10-15 days. After injury.
Injury (contusion). The anatomical continuity of the nervous trunk is preserved, separate damage to the epineural shell and hemorrhage into the bottle of the nerve are possible. Functions are restored by about a month after damage.
Compression. The severity of disorders directly depends on the severity and duration of the compression, both minor transient disorders can be observed and the persistent loss of functions requiring operational intervention.
Partial damage. There is a loss of individual functions, often in combination with irritation phenomena. Spontaneous recovery, as a rule, does not occur, the operation is necessary.
Full break. The nerve is divided into two ends - peripheral and central. In the absence of treatment (and in some cases, with adequate treatment), the middle fragment is replaced by a piece of scar tissue. Spontaneous recovery is impossible, there is subsequently observed muscle atrophy, sensitivity impairment and trophic disorders. Surgical treatment requires, however, the result is not always satisfactory.

Symptoms of nerve damage

Damage to the elbow nerve, primarily manifested by motor disorders. Active flexion, breeding and mixing V and IV and partially III fingers are impossible, the strength of the muscles is sharply weakened. For 1-2 months, the atrophy of intercepted muscles is developing, as a result of which the contours of the psyatny bones be distressed on the rear of the brushes. In the remote period, the characteristic deformation of the brush in the form of clawing occurs. The average and distal phalanxes V and IV fingers are in bending state. The opposition of the mother's is impossible. On the elbow side of the brush, sensitivity disorders, secretory and vasomotor disorders are observed.

Damage to the median nerve is accompanied by a pronounced sensitivity disorder. In addition, in the initial period, trophic, secretory and vasomotor disorders are well noticeable. The skin of the innervated region of peeling, shiny, cyanotic, dry, smooth and easily plentiful. The nails of the I-III fingers are transversely exhausted, the subcutaneous fiber of the nail phalange is atrophied. Character motor disorders Determined by the level of nerve damage.

Low lesions are accompanied by a tensar muscle paralysis, high - impaired palm bending brushes, forearm, extension of medium phaeltage III and II finger, flexion of I-III fingers. Anti-finger contrasting and heading is impossible. Muscles are gradually atrophy, their fibrous degeneration is developing, so when an injury is given more than a year, the restoration of their function becomes impossible. Formed a "monkey brush".

Damage to the radial nerve at the level of shoulder or the axillary region is accompanied by bright motor disorders. Paralysis of the sprinklers of the brush and the forearm occurs, manifested by the symptom of a hanging or "falling" brush. In case of damage to the underlying departments, only sensitivity disorders are developing (usually by type of hypsheet). The back surface of the radiation side of the brush and the phalange of the I-III fingers suffers.

Damage sedal Nerva It is manifested by a breakdown of shin bending, palsy of the fingers and feet, loss of sensitivity on the back of the thigh and almost all over the tibia (with the exception of the inner surface), as well as the loss of the Achilles of the reflex. Causalgia is possible - painful burning pain in the innervation zone of the injured nerve, spreading to the entire limb, and sometimes on the body. Often there is a partial damage to the nerve with the loss of functions of its individual branches.

Damage to the tibial nerve is manifested by the fraud of the Achilles of the reflex, the disruption of the sensitivity of the outer edge of the foot, the soles and the rear surface of the lower leg. A typical deformation is formed: the foot is dispersed, the back of the leg muscles is atrophied, the fingers are bent, the stall arch is in-depth, the heel protrudes. Walking on socks, turning the foot of Knutrice, as well as the bending of the fingers and the foot is impossible. As in the previous case, Kauzalgia is often developing.

Damage to the small-terrestrial nerve is accompanied by paralysis of the extensors of the fingers and foot, as well as muscles that provide the turn of the foot of the bed. There are disorders of sensitivity on the rear of the foot and the outer surface of the lower leg. A characteristic gait is formed: the patient highly raises the shin, heavily flexing his knee, then lowers his leg on the sock and only then on the sole. Kauzalgia and trophic disorders are usually not expressed, Achilles Reflex is saved.

Diagnostics

In the formulation of the diagnosis, inspection, palpation and neurological examination play a crucial role. In case of inspection, pay attention to typical limb deformations, skin color, trophic disorders, vasomotor disorders and the state of various muscle groups. All data is compared with a healthy limit. At palpation, the humidity, elasticity, turgor and temperature of various sections of the limb are evaluated. Then conduct a survey of sensitivity, comparing sensations in a healthy and sore limb. Determine the tactile, painful and temperature sensitivity, the feeling of the localization of irritation, the articular and muscular feeling, stereogenesis (recognition of the subject to the touch, without vision control), as well as the feeling of two-dimensional irritations (defining figures, numbers or letters that the doctor "draws" on the patient's skin ).

The leading additional research method is currently stimulated electromyography. This technique allows you to estimate the depth and degree of nerve damage, find out the rate of pulses, the functional state of the reflex arc, etc. Along with the diagnostic value, this method has a certain prognostic value, since it allows you to identify early signs of nerve recovery.

Treatment of nerve damage

Treatment is integrated, used both surgical techniques and conservative therapy. Conservative events start from the first days after injury or operational intervention and continue until complete recovery. Their goal is to prevent the development of contractures and deformations, stimulation of reparative processes, improved trophic, maintaining muscle tone, prevention of fibrosis and scarring. Apply LFK

Prediction and prevention

The best results are achieved with early surgical interventions - on average no more than 3 months from the moment of injury, during injuries of the brush nerves - not more than 3-6 months from the moment of injury. If the operation for some reason was not carried out in early terms, it should be performed in a remote period, since restorative surgical measures almost always allow to improve the function of the limb to one degree or another. However, it is not necessary to calculate the essential improvement in motor functions with late interventions, since the muscles over time are subjected to fibrous reincarnation. Prevention includes injury prevention measures, timely treatment of diseases that may cause nerve damage.

The radial nerve is the largest branch of the shoulder plexus, and together with the branches from it, it innervates (supplies nerves) a lot of muscles hands. Therefore, his damage (neuropathy) is very dangerous.

Damage to the nerve is a frequent pathology that can be obtained, not even traumating the hand. Just enough to sleep on it.

Hence the expression "Sleepy paralysis" - the condition arising when a person accidentally fell asleep on his hand, and found it in the morning that it did not work. The defeat of the radiation nerve occurs with long-term use of crutches and with all types of traumatic damage.

Signs of lesions of radiation nerve

Feeling numbness and "crawling of goosebumps" in the field I-III fingers of the brush;
The inability to control the thumb of the damaged hand;
Pain when trying to move forearm;
Weakness in the hands - a brush hangs like a whip. Such a hand is called "seal";
Sensitivity disorders - superficial, deep, mixed - the hand does not respond or does not respond sufficiently to stimuli;
Motor disorders - it becomes impossible to move with hand or fingers;
Redness or pale the skin of the hand, violation of sweating.

The severity of clinical symptoms depends on the nature of damage:

When shaking, not accompanied by anatomical and morphological changes, disorders are reversible. Full recovery Nerva functions usually occurs about two weeks after damage;
When the nerve injury, anatomical integrity remains, however, there are foci of hemorrhage. Manifestations are more persistent in nature, but after a while the nerve will be fully restored;
The compression is more dangerous. If the nerve squeezed as a result of injury and tumor growth, you can get rid of the problem only with the help of the operation;
The gap is damage in which spontaneous cure is only with the minimum size of a broken portion. In other cases, benign formations are formed in the field of damage to the nerve - Nesuy, who do not give it to grow together. You can only restore the nerve using the operation.

Treatment

Treatment in the "open clinic" will depend on the type of damage, the duration of exposure, the degree of lost functions.

Conservative therapy is aimed at eliminating pain syndrome, stimulation of rehabilitation processes, normalization of blood circulation in the area of \u200b\u200bdamage, maintaining muscle tone. Patients prescribe physiotherapy, massage, leaf, electrical treatment, appliqués, electrophoresis.

Partial or complete intersection of the nerve is an indication for surgical treatment. The earlier the reconstructive operation was carried out, the higher its effectiveness.

Separation sections are stitched together. In the formation of the necris, its excision is carried out with the connection of the resulting ends.

When squeezing the nerve, neuroliza with transposition is carried out. The nerve frees from the injury impact, and if necessary, transfer to a new place to exclude re-compression.

Operations for the restoration of radiation nerve are considered "jewelry". They require special equipment and trained personnel.

In our center, experts of the Department of Neurosurgery and Neuroreanimations of the University Clinic MGMS themselves are carried out. Evdokimova and there is all the necessary medical equipment. Therefore, our specialists are successfully treated such damage.

In our center, experts of the Department of Neurosurgery and Neuroreanimations of the University Clinic MGMS themselves are carried out. Evdokimova

Hands and their sensitivity directly and indirectly depends on nervous system man. So, the radial nerve is responsible for flexing and extensing the hands of the hands and for the sensitivity of the skin in the shoulder area, the forearm, directly the brush itself, as well as the rear and the upper side of the thumb on their hands. Damage to the radiot nerve (neuritis, neuralgia or neuropathy) make itself felt almost instantly, but, about everything in order ...

So, radiation nerve and its anatomy. Topographic anatomy This nerve has a relatively complex structure, since, unlike other areas and branches of the nervous system, the radial nerve spreads on the specified area in the form of a spiral, constantly curving and as if entangling some of the muscles.

The structure of radiation nerve

Nerve is B. shoulder Sustain And is there the largest. It has three branches:

From shoulder to chest.
From the shoulder to the axillary depression.
From the shoulder down the forearm of the brush.

The topography of the first segment is not as important as the second and third, since it is the last two branches most often suffer from various defeats.

The presence of three branches (segments) does not mean the absence of other, smaller roots and rays. So, the radial nerve has the following important components:

the articular branch (responsible for the innervation of the shoulder joint);

Innervation is the main function of nerve endings, the transfer of pulses from the brain and back.

rear skin branch (responsible for the innervation of the rear side of the shoulder)
lower side skin branch (almost identical to the rear skin branch, but additionally is responsible for the innervation of the lower part and the side of the shoulder);
the proximal branch, the lateral branch and the medial branch (they are responsible for the innervation of the three-headed muscles, elbow, radiation and shoulder muscles, which in turn pass near the radiation and shoulder bone);
the rear skin branch of the forearm (responsible for the innervation of areas of the skin in the area of \u200b\u200bthe axillary depression);
surface branch (responsible for the innervation of the back of the brush and middle finger);
deep branch (responsible for extending and bending hands in the elbow joint).

Causes and risk factors

Rady nerve is the same component of the human body, as say bones or muscles. It has a completely tangible structure, and it can even be in hand. And since he is a full member of the body, it means that it can be tritely damaged or in any other way to bring out of a healthy state.

Some causes of lesions of radiation nerve

How exactly can cause damage to the radial nerve:

the introduction of the drug intramuscularly (especially if this procedure is produced by an incompetent specialist or a person who cannot make injections);
injury or squeezing the skin area to which this nerve is adjacent (it is often the wall of the axillary depression);
neakkurat or improper use of hemostatic devices (harness, etc.);
repeated bends of elbows during fast walking, running, or other manipulations with hands, during which multiple hands bending are required;
squeezing the nerve as a result of wearing handcuffs;
bone fracture (damage to the nerve often occurs when a fragment is hit on it or with squeezing it part of the broken bone);
dislocation of the forearm;
use of crutches;
infectious diseases (axonopathy may develop);

Axonopathy - inflammation of nerve processes

sediments of heavy metals as a result of long-term drug intake;
tuberculosis;
diabetes;
vitamin V. deficiency

Symptoms - from "goosebumps" to "insensitory"

The nervous system and directly the nervous endings and branches are playing an important binding role. They link the brain with the rest of the bodies and parts of the body. A kind of electrical system in a modern car. Only in the event of a malfunction in the car, a certain sign lights up on the instrument panel, with human organism Everything is different. Damage to the nervous system can have two consequences:

The inability to transfer the nervous impulse.
Nervous impulse, and accordingly, the information (signal) is transmitted to distortions or not completely.

Most damaged part of the nerve

Hence the lack of sensitivity (as an example, imagine the hose by which water comes, if it comes to it, the water will flow worse and with the nerve, if it is transmitted, sensitivity to decrease, due to numbness).

Signs of lesion of radiation nerve will be noticeable to the patient almost immediately, as they are bound primarily with impaired motor functions.

Symptoms can begin with banal "goosebumps", which over time increase and painful feeling from them is enhanced, gradually interpretated in the heat, to the complete numbness of the limb or its part.

As for the violation of the motor functions of the hand or one of the hands (paresis, paralysis, etc.), then they can manifest itself as a result of a more serious lesion at the level of the deep branches.

How to distinguish one form of defeat from another?

In modern neurology, there are three concepts that are somehow related to the defeat of certain nerves.

Neuropathy.
Neuralgia.
Neuritis.

Neuropathy is a phenomenon as a result of which all nerve is defeated in general

Neuritis - characterized by inflammation of nerve endings or roots (prefix - it means inflammatory process, for example, encephalitis, meningit, etc.)

The building of the nerve has a brush

Neuralgia is directly painful syndrome (either the nerve or its separate part).

Any neurologist will be able to distinguish the data of manifestation, as each of the terms has its own feature and the difference from others.

Neuropathic violation

The neuropathy of the radiot nerve is not a rare ailment, as it can meet absolutely from any healthy person, since the main reason for the occurrence of this manifestation is to squeezing the nervous channel or a furrow, in which the nerve is located as a result of a long stay in the same pose.

In particular, the pressure head on the hand of hands during sleep (often students or people are susceptible to alcohol intoxication).

The main symptoms of neuropathy can be:

hanging right or left hand (in particular brush);
combining large and index fingers;
difficulties in extension of hands in the elbow joint, as well as in its flexion;
goosebumps on the tips of fingers up to their numbness.

Neuralgic defeat

Since neuralgia is a direct pain syndrome, then with neuralgia of radiation nerve, the clinical picture is manifested directly in pain of different intensity. Most often, this occurs as a result of irritation of nervous fibers and segments in contact with other internal bodies.

For example, as a result of squeezing or pinching the nerve, it has to pass through narrow anatomical holes, it causes a neurogic pain.

Concentrating on this pain, the patient may not notice any other manifestations, including numbness and the absence of skin sensitivity.

Neuralgia can develop as a concomitant symptom, as well as as an individual defeat.

Neuritis and its manifestations

Neuritis, as mentioned above arises due to inflammation of the right or left side of the radiation nerve. This inflammation can develop as a result of infectious diseases, as well as as a result of nerve irritation in injuries of varying severity.

Symptoms of neuritis is similar to neuropathy, and it is for this reason that these concepts are sometimes interchanged by neurologist doctors, in order not to scare the abundance of patients's terms.

Diagnostics

Despite the fact that the banal "tracked her hand", refer to the defeat nerve, even such a manifestation can delay and end for patient with painful pain in this "lean" hand, if, for example, nerve, did not return to its original position, or do not give God has changed its usual location.

In order to eliminate the consequences and find out what is the reason for how serious it is both deep, it is necessary to conduct a comprehensive diagnosis that includes:

Polling neurologist and neurological examination

radiography;
electromyography;
electronography;
Ultrasound hands or hands (depending on the nature of damage);
cT scan.

Depending on the severity of the cause that caused the defeat of this nerve to the survey can be attracted:

traumatologist;
orthopedist;
endocrinologist;
rheumatologist.

There are several simple tests that can be performed at home. For example, the blockade of the beam nerve causes such a phenomenon as "hanging brush". It is quite simple to recognize it. It is necessary to compress the affected limb in a fist, or try to perform a handshake. These actions will lead to handwriting.

"Hanging brush" with handshake

The second test is the addition of two hands in a gesture of a praying person. From this position, it is necessary to reject the fingers alternately. In case of flexion with the finger, you can talk about such a phenomenon as pinching radiation nerve.

Treatment

Treatment of this ailment can be divided into several types, which can be used both comprehensively and separately, depending on the severity of the cause that caused the disorder.

Treatment happens:

Conservative.
Surgical.
Treatment with folk remedies.

Usually, doctors are limited to a conservative type of treatment, as the course medicinal preparations In combination with preventive activities, it is enough to eliminate the symptoms of neuropathy.

Conservative therapy

The conservative type of treatment may include:

drug therapy;
massotherapy;
medical physical culture (LFC);
physiotherapy;
electrostimulation;
manual therapy.

Medicase therapy may differ, depending on the cause.

For example, if the radial nerve was struck due to infection, the course of antibacterial and antiseptic drugs is appointed.

Naturally, non-steroidal medicines are used to relieve inflammation.

The course of conservative treatment does not exceed two months. Usually, after the end of this period, if there are no prerequisites for restoration assign operational intervention.

Surgery

Surgical intervention is carried out after two months, if there are no results of drugs and lies either in crosslinking damaged nerve, or in the removal of the resulting defeat (groove, where the nerve) tumor passes.

In order to sew the nerve or remove the doctor's tumor, it is necessary to access the nerve by exposing it on the shoulder or elsewhere (where the defeat was diagnosed).

In addition, the indication to operational intervention It is a neurolyz or state of limb after a fracture when the nerve was bone.

Neuroliz - the release of nerve from scar tissue

Folk remedies

Treatment by folk remedies with the defeat of the radial nerve also applies and gives good results.

It is important to remember that not all inflammation and lesions can be treated with folk remedies, since with ruptures or fractures of the limbs can only be aggravated by the situation.

For the treatment of folk remedies apply:

eleutherococcus root;
blue clay;
lemon;
sage;
topinambur;
oregano;
dates;
burdock;
carnation;
elecampane;
rosemary;
turpentine;
goat milk;
propolis.

Let us dwell on some of the listed methods.

Goat Milk - Milk-dipped in goat milk or gauze must be applied to the place of defeat for two minutes five times a day, before removing the pain syndrome.

Propolis - Propolis-based tincture prepare with alcohol. 100 grams of alcohol are mixed with 50 grams of propolis and insist 7 days periodically stirring. After 7 days, corn oil 1: 5 is added to the leaky tincture. The compress from this tincture must be done within 10 days.

Rosemary - Rosemary leaves are flooded with cold water and insist on 21 days. After that, this tincture wipes the sore place.

Date is the most delicious procedure. It consists of receiving dedicated dates for a month. It is allowed with milk.

Lemon - can be used as a night compress lemon peel.

Forecast

The forecast of the Parishechnic or other damage to the radiation nerve directly depends on its nature. For example, post-traumatic symptoms for fractures can last about 3-4 weeks, depending on the severity and location.

The usual nerve transmission during sleep passes within 2-4 days, and with proper treatment and at all during the day.

So, the lesions of the radial nerve are not always characterized by ordinary "goosebumps" or the numbness of the limb, sometimes it is pain syndromeswho make themselves felt suddenly. You should not neglect by such signals of the body, and it is better to immediately turn to a specialist to not exacerbate the situation. Take care of yourself and your loved ones.

The radial nerve is formed from the rear beam of the shoulder plexus and is the derivative of the ventral branches of CV - CVIII spinal nerves. At the rear wall of the armpit, the nerve descends down, being behind the axillary artery and located consistently on the babinet of the sublock muscle and on the tendons of the widest muscles of the back and a large round muscle. Having reached the lasure corner between inner part The shoulder and the lower edge of the rear wall of the axillary depression, the radial nerve adjacent to a dense connective tank formed by the connection of the lower edge of the widest muscle of the back and the back tendon part of the long head of the arm of the shoulder. Here is a possible, especially external, radiot nerve compression. Next, the nerve lies directly on the shoulder bone in the furrow of the radiot nerve, otherwise called the spiral chute. This furrow is limited to places of attachment to the bone of the outer and inner heads of the three-headed muscles of the shoulder. So the channel of the radiot nerve is formed, also called a spiral, a shoulder-choke or a playry non-pellish canal. In it, the nerve describes the spiral around the shoulder bone, passing from the inside and the stop in the front of the direction. Spiral channel second place potential radiation nerve compression. From him on the shoulder fit the branches to the three-headed muscles of the shoulder and the elbow muscle. These muscles extend the upper limbs in the elbow joint.

Test to determine their sics: the examined is suggested to break the limb pre-slightly bent in the elbow joint; The survey has resistance to this movement and palprates abbreviated muscle.

The radiot nerve at the level of the outer edge of the shoulder on the border of the middle and lower arm of the shoulder changes the direction of its turn, turns ahead, turns out the outer intermuscular partition, turning into the front shoulder compartment. Here the nerve is especially vulnerable when compressing. Below the nerve passes through the initial part of the shoulder muscle: innervates it and the long radial extensor of the brush and sinks between her and the shoulder muscle.

The shoulder muscle (innervated by the CV - CVII segment) bends the upper limb in the elbow joint and penetrate the forearm from the position of the suspension to the median position.

Test to determine its sieps: the examined is suggested to bend the limbs in the elbow joint and at the same time penetrate the forearm from the position of the suspension to the middle position between supination and the pronation; The survey has resistance to this movement and palprates abbreviated muscle.

Long radial sprier brush (innervated by the CV - CVII segment) extensions and removes the brush.

Test to determine the power of the muscles: offer to break and take the brush; The survey has resistance to this movement and palprates abbreviated muscle. Passing the shoulder muscle, the radial nerve crosses the capsule elbow Sustava And comes to the supinator. In the elbow area at the level of the outdoor shoulder superior, or a few centimeters above or below it, the main barrel of radiation nerve is divided into superficial and deep branches. The surface branch goes by the puffer muscle at the forearm. In its upper third, the nerve is located in the duck from the radial artery and above the stiliagehrough the beam passes through the gap between the bone and the tendon of the shoulder surface of the lower end of the forearm. Here this branch is divided into five rear finger nerves (NN. Digitales Dorsales). The latter are branched in the radial half of the back of the brush from the nail phalanx I, the average phalanx II and the radiation half of the III fingers.

The deep branch of the radiot nerve enters the gap between the surface and deep bundles of the supinator and heads on the back surface of the forearm. The dense fibrous top edge of the superficial bundle of the supinator is called an arcade frnom. Under the arcade from, there is also the place of the most likely occurrence of the tunnel syndrome of the radiation nerve. Passing through the Supinator canal, this nerve goes to the neck and the body of the radial bone and then goes to the back surface of the forearm, under the short and long surface extensors of the brushes and fingers. Before going to the rear of the forearm, this branch of the radiot nerve supplies the following muscles.

Short radiation wast extension (innervated by the CV -CVII segment) involved in the extension of the brush.
Supinator (innervated by the CV-CVIII segment) rotates and inspires the forearm.

Test to determine the strength of this muscle: the study is suggested from the position of the pronation to suspend the limb dislocated in the elbow; The survey has resistance to this movement.

On the back surface of the forearm, the deep branch of the beam nerve innerves the following muscles.

Innegrated trinker fingers (innervated by the CV segment - CVIII) extensions the main phalanges of the II V fingers and at the same time brush.

Test to determine its strength: the surveyed suggests to break the main phalanges of the II - V fingers, when the average and nail bent; The survey has resistance to this movement.

The elbow sprier of the brush (is innervated by the CVI segment - CVIII) extensions and brings the brush.

Test to determine its strength: the examined is suggested to break and bring the brush; The survey has resistance to this movement and palprates abbreviated muscle. A continuation of the deep branch of the radiot nerve is the rear interceptional nerve of the forearm. It passes between the extensors of the thumb to the ray-taking joint and sends a twig to the next muscles.

Long muscle, reducing the thumb of the brush (innervated by the CVI - CVIII segment), assigns the first finger.

Test to determine its strength: the examined is offered to take away and break the finger slightly; The survey has resistance to this movement.

A short thumb exterminator (innervated by the CVI -SVIII segment) extensions the main phalanx I finger and takes it.

Test to determine its strength: the examined is suggested to break the main phalanx I finger; The survey has resistance to this movement and palpates the intense tendon of the muscle.

Long thumb exterminant (innervated by the CVII -C VIII segment) extensions the nail phalanx I finger.

Test to determine its strength: the examined is suggested to break the nail phalanx I finger; The survey has resistance to this movement and palpates the intense tendon of the muscle.

The extensor of the index finger (innervated by the CVII -CVIII segment) extensions the index finger.

Test to determine its strength: the examined is suggested to break II finger; The survey has resistance to this movement.

Misina's extensor (innervated by the CVI segment - CVII) extensions the V finger.

Test to determine its strength: the examined is suggested to break the V finger; The survey has resistance to this movement.

The rear interceptional nerve of the forearm also gives thin sensitive branches for the inter-septum, perception of radiation and elbow bones, the rear surface of the cranky and custodial and milling joints.

Rady nerve is predominantly motor and supplies mainly muscles, extending the forearm, brush, fingers.

To determine the level of leaving the radiation nerve, you should know where and how motor and sensitive branches are departed from it. The rear skin nerve shoulder takes place in the axillary exit area. It supplies the rear surface of the shoulder almost to elbow process. The rear skin nerve of the forearm is separated from the main nerve trunk in the shoulder corner or in the spiral channel. Regardless of the place of branch, this branch always passes through a spiral channel, innervating the skin of the back surface of the forearm. The branches to the three heads of the three-headed shoulder muscles are departed in the area of \u200b\u200bthe axillary pits, the shoulder angle and a spiral canal. Branch to the shoulder muscle, as a rule, move below the spiral channel and above the outdoor shoulder. The branches to the long radiation spreader of the wrist usually depart from the main nerve trunk, albeit below the branches to the previous muscle, but above the supinator. The branches to the short radiation woven extension can be separated from the radial nerve, its surface or deep branches, but also usually higher than the entrance to the supinator canal. Nerves to the supinator can be branched higher or at the level of this muscle. In any case, at least some of them passes in the Supinator Channel.

Consider the levels of the lesion of the radial nerve. At the level of the shoulder angle, the beam nerve and the branches of the trigger arm of the shoulder from him in the armp can be added to the tight tendons of the widest muscles of the back and the big thoracic muscle in the tendon corner of the axillary exit area. This angle is limited to the tendons of the two mentioned muscles and the long head of the three-headed muscles of the shoulder. Here, the outer compression of the nerve can occur, for example, due to the incorrect use of the crutch - the so-called "crutch" paralysis. The nerve can also be squeezed with the back of the chair from the stationery or the edge of the operating table, over which the shoulder hangs during the operation. It is known to compress this nerve implanted under the skin chest Heart rhythm driver. The inner compression of the nerve at this level happens when the upper third of the shoulder is fractures. The symptoms of the lesion of the radiation nerve at this level differ primarily by the presence of hypsheat on the rear surface of the shoulder, to a lesser extent - the weakness of the exhibition of the forearm, as well as the absence or decrease in the reflex with the three-headed muscles of the shoulder. When pulling the upper extremities to the horizontal line, a "hanging or falling brush" is detected - a consequence of the breakfast pares of the brush in the rays-up joint and the II - V fingers in the psyche-phalange joints.

In addition, there is a weakness of extending and leads I finger. The suspension of the disintended upper limb and the supination of the disintegration of the upper limb, whereas with a preliminary bending in the elbow joint, supination is possible due to a double-headed muscle. Flexing at the elbow penetration of the upper limb is impossible due to the paralysis of the shoulder muscle. The hypotrophy muscles of the muscles of the shoulder and forearm can be detected. The hyptestesia zone captures, in addition to the rear surface of the shoulder and forearm, the outer half of the back of the brush and the first finger, as well as the main phalange of the II and the radiation half of the III of the finger. The compression lesion of the radial nerve in the spiral canal is usually a consequence of the shoulder fracture in the middle third. The nerve compression may occur shortly after the fracture due to the edema of tissue n enhanced pressure in the channel. Later, the nerve suffers when he squeezed by scar tissues or bone corner. With a spiral channel syndrome there is no hyptestesia on the shoulder. As a rule, the three-headed arm of the shoulder does not suffer, since the twig is located superficially - between the lateral and the medial heads of this muscle - in directly to the bone does not fit. In this tunnel, the radial nerve is shifted along the long axis of the shoulder bone during the reduction of the three-headed muscles. The bone corner formed after the shoulder fracture can prevent such nerve movements during muscle contraction and thereby contribute to its friction and compression. This explains the occurrence of pain and paresthesia on the back surface of the upper limb when extension in the elbow joint against the action of resistance force for 1 min with incomplete post-traumatic lesions of the radial nerve. Painful sensations can also be caused by a finger sampled for 1 min or a nerve-picking at the compression level. The rest of the symptoms are revealed, similar to those that were observed in the defeat of the radial nerve in the field of the shoulder angle.

At the level of the outer intermuscular septum of the shoulder, the nerve is relatively fixed. This is the place of the most frequent and simple on the mechanism of compression lesion of the radial nerve. It is easily attached to the outer edge of the radial bone during a deep sleep on a solid surface (gloss, bench), especially if the head presses the shoulder. Because of fatigue, and more often in a state of alcohol intoxication, the person does not awaken in time, and the function of the radial nerve is turned off ("sleepy", paralysis, "paralysis of a garden bench"). With a "sleepy paralysis" there are always motor loss, but at the same time there is never a weakness of the three-headed muscles of the shoulder, that is, the passage of the exlearch of the forearm and reducing the reflex with the trite muscles of the shoulder. In some patients, there may be a loss of not only motor functions, but also sensitive, but the hyptestesy zone does not apply to the rear surface of the shoulder.

In the lower third of the shoulder above the outer supervision of the radial nerve is covered with a shoulder muscle. Here, the nerve can also be squeezed with the fractures of the lower third of the shoulder bone or when the radial bone head is shifted.

The symptoms of the lesion of the radial nerve in the Nadanmark region may be similar to the "sleepy paralysis." However, in the nervous case there is no isolated detection of motor functions without sensitive. The mechanisms of these species of compression neuropathies are different. The level of nerve compression approximately coincides with the place of recessing the shoulder. In differential diagnosis, it helps the determination of the upper level of provoking the painful sensations on the back surface of the forearm and the brush when they are harvested with finger squeezing on the projection of the nerve.

In some cases, it is possible to determine the compression of the radial nerve of the fibrous arc of the lateral head M. Triceps. The clinical picture corresponds to the foregoing. Pain and numbness on the rear of the brushes in the zone of the radiation nerve periodically can increase with intense handmade work, while running on long distances, with a sharp flexion of the upper limbs in the elbow joint. At the same time, the nerve comes between the shoulder bone and the three-headed muscle of the shoulder. Such patients are advised to pay attention to the bending angle of bending in the elbow joint, stop manual labor.

Pretty frequent cause The defeats of the deep branch of the radiot nerve in the area of \u200b\u200bthe elbow joint and the top suit of the forearm is the compression of his lipoma, fibromy. They usually manage to palpate. Deleting the tumor, as a rule, leads to recovery.

Among other reasons for the lesion of the branches of the beam nerve should be mentioned about the bursite and synotation of the elbow joint, especially in patients with rheumatoid polyarthritis, about the fracture of the proximal head of the radial bone, traumatic aneurysm of vessels, about professional overvoltage with repetitive rotational movements of the forearm (conducting, etc.). Most often, the nerve is amazed in the air of the fascia of the supinator. Less often it happens at the level of the elbow joint (from the place of passage of the radiot nerve between the shoulder and the shoulder muscles to the head of the radial bone and the long radial flexor of the wrist), which is indicated as a radial tunnel syndrome. The cause of the compression-ischemic nerve damage can be a fibrous tape before the head of the radial bone, dense tendon edges of the short radiation sprier of wrist or arcade froms.

The supinator syndrome develops with the defeat of the rear intercellate nerve in the area of \u200b\u200bthe Arcade Froste. For him, night pains are characterized in the external departments of the elbow area, on the rear of the forearm and, often, on the rear of the wrist and brushes. Day pains usually occur during handmade. Especially contribute to the appearance of pains of the Rotary Movements of the forearm (supination and pronation). Often patients note weakness in the brush appearing during operation. This may be accompanied by a violation of the coordination of the movements of the brush and fingers. Local pain in palpation is found at a point located on 4 - 5 cm below the outdoor shoulder superior in the groove of a radially long radial wristure extension.

Samples causing or reinforcing pain in hand, such as a supinal test: Both palms of the subject are tightly fixed on the table, the forearm is bent at an angle of 45 ° and is installed in the maximum supination position; The survey is trying to transfer the forearm to the position of the Pronation. This sample is performed for 1 min, it is considered positive if over this period there is pain on the extensible side of the forearm.

Middle finger extension test: cause pain in hand can be long (up to 1 min) extension of the III finger with an extension resistance.

There is a weakness of the suspension of the forearm, the extension of the main phalanges of the fingers, sometimes there is no extension in bulk-phalangeal joints. The paresis of the first phase of finger is also detected, but the extension of the terminal phalanx of this finger is preserved. When the function of the short extensor and the long distinguishing muscle of the thumb makes it impossible to be a radius brush lead in the palm plane. With a dispere wrist, a deviation of the brush is observed in the radial side due to the fallout of the function of the elbow wrist extensor while preserving the long and short radial wast extensors.

The rear intercellate nerve can be squeezed at the level of the middle or lower part of the supinator with a dense connective tissue. Unlike the "classic" supinator syndrome caused by the nerve compression in the area of \u200b\u200bthe arcade from, in the latter case, the symptom of the finger compression turns out to be positive at the level of not the upper, but the lower edge of the muscle. In addition, the paresis of the extension of the fingers at the "lower syndrome" is not combined with the weakness of the suspension of the forearm.

The surface branches of the radial nerve at the level of the lower part of the forearm and wrists can be squeezed with a close watch strap or handcuffs ("Artanta paralysis"). However, the most common cause of nerve damage is the injury of the wrist area and the lower third of the forearm.

The compression of the surface branch of the radial nerve at a fracture of the lower end of the radial bone is known called the "Turner Syndrome", and the defeat of the sprigs of the radial nerve in the area of \u200b\u200banatomical tobaccoque is called radial tunnel wrist syndrome. The compression of this branch is a frequent complication of de cervane disease (Legameton I Channel of the Two Wrist Channel). Through this channel there are a short extensor and a long removing muscle I finger.

With damage to the surface branch of the radiot nerve, patients often feel numbness on the rear of brushes and fingers; Sometimes burning pain on the rear of the I finger. Pain can spread to the forearm and even on the shoulder. In the literature, such syndrome is called the passativetic neuralgia of Vartenberg. Sensitive fallouts are often limited to the path of hypsheat on the inner back of the I finger. Often hypshethesia can go beyond the first finger to the proximal phalanx II of the finger and even on the rear of the main and medium phalanx III and IV fingers.

Sometimes the surface branch of radiation nerve thickens in the wrist area. The finger compression of such "pseudonevromes" and causes pain. The symptom of the tenderness is also positive when heaving the radiot nerve at the level of anatomical tobacker or a cylinder radial bone process.

Differential diagnosis of radiation nerve damage is carried out with the cvii spinal roof syndrome, in addition to the weakness of the exlearch and the brush, the pair of leverage and bending brushes is detected. If the motor loss is absent, the localization of pain should be considered. With damage to the root of CVII pain is felt not only on the brush, but also on the back surface of the forearm, which is not typical to defeat the radial nerve. In addition, the root pain is provoked by the movements of the head, Chikhan, cough.

For breast exit syndromes, the occurrence or enhancement of painful sensations in the hand is characterized by turning into a healthy side, as well as when performing some other specific tests. At the same time, the pulse on the radial artery can regenerate. It should also be taken into account that if at the level of the breast exit, it will be squeezed mainly part of the shoulder plexus corresponding to the root of CVII, then a picture occurs, similar to the damage to this root described above.

Determine the level of leaving the radial nerve helps an electronomyography. It is possible to restrict ourselves to the study with the use of needle electrodes of the three-headed muscles of the shoulder, the shoulder muscles, the extensor of the fingers and the extensor of the index finger. In case of supinator syndrome, the first two muscles will be preserved, and in the last two during their complete random relaxation, spontaneous (denervational) activity in the form of fibrillation potentials and positive sharp waves can be detected, as well as at maximum arbitrary muscle tension - the absence or degradation of motor units. When irritating the radial nerve on the amplitude shoulder of the muscular potential of the action from the extensor of the index finger is significantly lower than when the nerve electrostimulation is below the supinator channel on the forearm. The level of latent periods, the time of the nerve pulse and the rate of propagation of the excitation on the nerve can also help to establish the level of radiation nerve damage. To determine the propagation rate of excitation by motor fibers. The current nerve is carried out electrostimulation at different points. Most. high levels Irritation is the Botkin-Erba point, located a few centimeters above the clavicle in the rear triangle of the neck, between the rear edge of the sternosco-curable-bed-like muscle and the clavicle. Below the radial nerve is irritated at the exit from the axillary fifth in the groove between the bezvoid-shoulder muscle and the rear edge of the arm of the shoulder, in the spiral goy at the middle of the shoulder, as well as on the border between the lower and middle third shoulder, where the nerve passes through the intermushny partition, Even distal than 5 - 6 cm above the outdoor shoulder supermarket, at the level of the elbow (shoulder) joint, on the rear of the forearm by 8 to 10 cm above the wrist or 8 cm above the cylinder beam's shirt. The registering electrodes (concentric needle) are introduced into place of the maximum response to the nerve stimulation of the three-headed muscles - shoulder, shoulder, the shoulder, the elaborate, the extensor of the fingers, the extensor of the index finger, the long extensor of the thumb, the long removal muscle or the short thumbs' extension. Despite some differences at the point of nerve stimulation and the places of registration of the muscular response, the close values \u200b\u200bof the rate of propagation of the excitation on the nerve are obtained. Its lower limit for the section "neck-axillary cotton" is equal to 66.5 m / s. On a long plot from the test point of Botkin Earba to the lower third of the shoulder average speed It happens 68-76 m / s. In the area "Morainnya - 6 cm above the outdoor shoulder supervision" The speed of excitation extension on average is 69 m / s, and on the 6 cm section above the outdoor shoulder superior - the forearm of 8 cm above the cylinder ray, 62 m / s Movement of muscle potential from an extensor of the index finger. It can be seen that the speed of excitation spread of the radiation nerve motor fibers on the shoulder is approximately 10% higher than on the forearm. Average values \u200b\u200bon the forearm - 58.4 m / s (oscillations - from 45.4 to 82.5 m / s). Since the lesions of the radiation nerve is usually unilateral, taking into account the individual differences in the rate of propagation of excitation on the nerve, it is recommended to compare the indicators on the sick and healthy sides. Exploring the speed and time of the nervous pulse ranging from the neck and ending with various muscles, innervated radiation first, you can differentiate the pathology of the plexus and various levels of nerve damage. The defeat of the deep and surface branches of the radial nerve differ easily. In the first case, only pains in the upper limb arise and motor loss can be detected, and the surface sensitivity is not disturbed.

In the second case, not only pain, but also paresthesia, there are no motor deposits, but surface sensitivity is disturbed.

It is necessary to differentiate the compression of the surface branch in the elbow area from involving it at the wrist level or the lower third of the forearm. The zone of painful sensations of sensitive fallouts can be the same. However, the test of an arbitrary forced extension of the wrist will be positive if the surface branch is squeezed only at a proximal level when passing through a short radiation spinner of the wrist. Samples should also be carried out with tendering or finger compression on the projection of the surface branch. The top level on which paresthesias on the rear of brushes and fingers are caused, is the likely place of compression of this branch. Finally, the level of nerve damage can be determined by introducing 2-5 ml of 1% novocaine solution or 25 mg of hydrocortisone into this place, which leads to a temporary cessation of pain and / or paresthesia. If the blockade of the nerve is below the place of its compression, the intensity of the painful sensations will not change. Naturally, it is possible to temporarily remove the pain, blocking the nerve not only at the compression level, but also above it. To distinguish the distal and proximal damage to the surface branch, it is first introduced with 5 ml of 1% novel solution on the border of the middle and lower third of the forearm at its outer edge. If the blockade is effective, it indicates the lower level of neuropathy. If there is no effect, repeated blockade is performed, but already in the area of \u200b\u200bthe elbow joint, which removes pain and indicates the upper level of damage to the surface branch of the radiot nerve.

The diagnosis of the space of the compression of the surface branch may also help the study of the propagation of excitation by sensitive fibers of the radiation nerve. Conducting the nervous impulse on them is completely or partially blocked at the level of the surfactant branch. With partial blockade, the time and speed of excitation of sensitive nerve fibers slow down. Various research techniques are used. With orthodromine method, the excitation of sensitive fibers is distributed towards the sensitive pulse. For this, irritating electrodes are placed on the limbs more distally than discharge. With an antidrome technique, the spread of the excitation of fibers in the opposite side is recorded - from the center to the periphery. In this case, the electrodes are proximally located on the limbs are used as irritants, and distal electrodes are like discharge. The disadvantage of the orthodosis technique, compared with the antidrome, is that lower potentials (up to 3-5 μV) are recorded (up to 3-5 μV), which may be within noise of electromiograph. Therefore, it is considered a more preferred antidrome technique.

The most distal electrode (irritating with orthodromic and removing - with an antidrome technique) is better to apply not to the back surface of the finger. And in the area of \u200b\u200banatomical tobackerka, approximately 3 cm below the host-shaped process, where the sprig of the surface branch of the radiot nerve passes above the tendon of the long-finger-finger brush. In this case, the amplitude of the response is not only higher, but also is subject to smaller individual fluctuations. The same advantages have the imposition of a distal electrode not on the first finger, but by the interval between the I and II, tie bones. The average excitation speeds of the excitation of the delicate fibers of the radial nerve on the site from the fleet electrodes to the lower departments of the forearm in orthodromine and antidrome directions are 55-66 m / s. Despite individual fluctuations, the rate of excitation of excitation by symmetric areas of the nerves of the extremities among individuals on both sides is approximately the same. Therefore, it is not difficult to detect the slowdown in the propagation rate of the excitation of the surface branch of the radiot nerve during its one-sided lesion. The speed of excitation of the excitation on sensitive radiation nerve fibers is somewhat different in separate areas: from the spiral gutter to the elbow area -77 m / s, from the elbow region until the middle of the forearm - 61.5 m / s, from the middle of the forearm to wrist - 65 m / s , from the spiral chute to the middle of the forearm - 65.7 m / s, from the elbow to the wrist - 62.1 m / s, from the spiral gutter to the wrist - 65.9 m / s. A significant slowdown in the speed of propagation of excitation by sensitive radiation nerve fibers on the two upper segments will indicate the proximal level of neuropathy. Similarly, a distal level of lesion of the surface branch can be detected.

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