What happens if you hit a nerve. Methods and consequences of damage to the sciatic nerve. Video "How to unblock the sciatic nerve"

If the injection hits a nerve, then post-injection neuropathy may develop.

We met 8 cases of post-injection lesions of the lower gluteal and sciatic nerves, as well as the posterior cutaneous nerve of the thigh. In one of these patients, the pudendal nerve was also affected, that is, it was noted complete syndrome sub-pear hole. When symptoms developed acutely and subacutely after injection, the apparent underlying cause of neuropathy was tissue. Post-injection late post-injection neuropathies were probably due to adhesion formation.

In coma or anesthesia, both the gluteal and sciatic nerves may be affected due to compression by the weight of the body lying on a hard surface.

A case of damage to the upper and lower gluteal nerves after an accidental injection in a patient with LIV-LV spondylolisthesis and osteolysis of the LIV vertebrae is described. Later, a fracture of the femoral neck developed on the side of the neuropathy (de Jong, Van Werden). The authors believe that there was compression of the gluteal nerves at the level of the piriformis muscle as a result of pronounced lumbar lordosis and lack of back stabilization.

In the domestic literature, there are indications of reflex syndrome of the piriformis muscle, which is associated with compression of the sciatic nerve alone. In 9 of our observations of spondylogenic syndrome of the piriformis, not only the sciatic but also the lower gluteal nerves were affected. In these cases probable cause the development of the syndrome of the infrapiriform opening was a spasm of the piriformis muscle.

Treatment after an injection in the nerve

In post-injection gluteal neuropathies after an accidental injection into the nerve, we alternately injected 25 mg of hydrocortisone at the injection site, then in the area of ​​the large sciatic foramen, with an interval of 5-7 days between injections of the drug. In 8 out of 11 patients, the result of such therapy was a significant improvement. We noted a similar effect in spondylogenic neuropathies of the lower gluteal and sciatic nerves. At the same time, 10 ml of a 1% solution of novocaine and 25 mg of hydrocortisone were injected, the course was 6-10 injections with a weekly interval between them. The technique of introducing drugs into the region of the subpiriform opening is given in the section on the sciatic nerve. Significant improvement occurred in 5 of 9 patients, improvement in 2, and 2 patients had no effect.

In case of failure conservative therapy operative neurolysis is carried out in the region of the epipiriform and (or) subpiriform openings.

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Peripheral nerve damage

What is Peripheral Nerve Injury?

Nerve damage are one of the frequent and severe types of injuries that cause complete or partial disability, force patients to change their profession and often cause disability. In everyday clinical practice Unfortunately, a significant number of diagnostic, tactical and technical errors are allowed.

What provokes / Causes of Damage to peripheral nerves:

Peripheral nerve damage may be closed or open.

Closed damage arise as a result of a blow with a blunt object, compression of soft tissues, damage by bone fragments, a tumor, etc. A complete interruption of the nerve in such cases is rare, so the outcome is usually favorable. Dislocation of the lunate bone, fracture of the radius in a typical place often leads to compression injuries median nerve in the area of ​​the carpal tunnel, a fracture of the hamate can cause a break in the motor branch of the ulnar nerve.

Open damage in peacetime, they are most often the result of injuries from glass fragments, a knife, sheet iron, a circular saw, etc. The upcoming changes appear depending on the nature and duration of exposure to a traumatic agent with various syndromes of dysfunction.

Pathogenesis (what happens?) during Peripheral Nerve Injuries:

Loss of sensitivity almost always observed with damage to the peripheral nerve. The prevalence of disorders does not always correspond to the anatomic zone of innervation. There are autonomous zones of innervation in which there is a loss of all types of skin sensitivity, i.e. anesthesia. This is followed by a zone of mixed innervation, in which, if one of the nerves is damaged, areas of hypesthesia alternate with areas of hyperpathy. In the additional zone, where innervation is carried out by neighboring nerves and only a slightly damaged nerve, it is not possible to determine the violation of sensitivity. The size of these zones is extremely variable due to individual features their distribution. As a rule, the diffuse area of ​​anesthesia that appears immediately after a nerve injury is replaced by hypesthesia after 3-4 weeks. Yet the process of substitution has its limits; if the integrity of the damaged nerve is not restored, then the loss of sensitivity persists.

Loss of motor function manifests itself in the form of flaccid paralysis of muscle groups innervated by branches extending from the trunk below the level of nerve damage. This is an important diagnostic feature that makes it possible to determine the area of ​​nerve damage.

Manifested in violation of the activity of the sweat glands; anhidrosis of the skin occurs, the area of ​​\u200b\u200bwhich corresponds to the boundaries of the violation of pain sensitivity. Therefore, by determining the presence and size of the anhidrosis zone, one can judge the boundaries of the anesthesia area.

Vasomotor disorders are observed approximately in the same range as secretory ones: the skin becomes red and hot to the touch (hot phase) due to paresis of vasoconstrictors. After 3 weeks, the so-called cold phase begins: the segment of the limb devoid of innervation is cold to the touch, the skin acquires a bluish tint. Often in this area, increased hydrophilicity, pastosity of soft tissues is determined.

Trophic disorders are expressed by thinning of the skin, which becomes smooth, shiny and easily injured; turgor and elasticity are markedly reduced. Clouding of the nail plate is noted, transverse striation, depressions appear on it, it fits snugly to the pointed tip of the finger. In the long term after injury, trophic changes spread to tendons, ligaments, joint capsule; joint stiffness develops; due to forced inactivity of the limb and circulatory disorders, osteoporosis of the bones appears.

The severity of nerve damage leads to various degree of disorders of its function.

With a concussion of the nerve, anatomical and morphological changes in the nerve trunk are not detected. Motor and sensory disorders are reversible, full recovery of functions is observed 1.5-2 weeks after the injury.

In the case of a bruise (contusion) of the nerve, the anatomical continuity is preserved, there are separate intra-stem hemorrhages, a violation of the integrity of the epineural membrane. Functional disorders are deeper and more persistent, but after a month their full recovery is always noted.

Nerve compression can occur from various reasons(prolonged exposure to a tourniquet, with injuries - bone fragments, hematoma, etc.). Its degree and duration are directly proportional to the severity of the lesion. Accordingly, prolapse disorders may be transient or persistent and require surgical intervention.

Partial damage to the nerve is manifested by the loss of functions, respectively, to those intratrunk formations that are injured. Quite often at the same time the combination of symptoms of loss with the phenomena of irritation is observed. Spontaneous healing in such situations is rare.

A complete anatomical break is characterized by the death of all axons, the disintegration of myelin fibers along the entire perimeter of the trunk; division of the nerve into peripheral and central is noted, or they are communicated by a strand of scar tissue, the so-called "false continuity". Restoration of lost functions is impossible, trophic disorders develop very soon, atrophy of paralyzed muscles in the denervated zone increases.

Symptoms of Peripheral Nerve Injury:

Damage to the radial nerve (Cv-Cvm). Nerve damage in armpit and at shoulder level cause a characteristic position - a "falling" or hanging brush. This position is due to paralysis of the extensors of the forearm and hand: the proximal phalanges of the fingers, the muscle that removes the thumb; in addition, supination of the forearm and flexion are weakened due to the loss of active contractions of the brachioradialis muscle. Nerve injuries in more distal regions upper limb, i.e., after the departure of the motor branches, they appear only as sensitivity disorders. The boundaries of these disorders run within the radial part of the rear of the hand along the III metacarpal bone, including the radial part of the proximal phalanx and the middle phalanx of the III finger, the proximal and middle phalanges index finger and the proximal phalanx of the first finger. Disorders of sensitivity proceed, as a rule, according to the type of hypoesthesia. They are almost never deeper due to a large number connections between the dorsal and external cutaneous nerves of the forearm with the dorsal branches of the median and ulnar nerves and therefore rarely serve as indications for surgical treatment.

With a combination of damage to the median nerve and the superficial branch of the radial nerve, the prognosis is more favorable than with a fairly common combination of injury to the median and ulnar nerves, leading to grave consequences. If in the first variant of combined nerve damage it is possible to a certain extent to replace the lost function due to the intact ulnar nerve, then in the second variant this possibility is excluded. Clinically, in the latter case, paralysis of all autochthonous muscles of the hand is expressed, there is a claw-like deformity. The combined injury of the median and ulnar nerves has a disastrous effect on the function of the hand as a whole. A denervated, numb hand is unsuitable for any kind of work.

Damage to the median nerve (Cvin-Di). The main clinical sign of damage to the median nerve in the hand area is a pronounced violation of its sensitive function - stereognosis. In the early stages after nerve damage, vasomotor, secretory and trophic disorders appear; skin folds are smoothed out, the skin becomes smooth, dry, cyanotic, shiny, flaky and easily injured. Transverse striation appears on the nails, they become dry, their growth slows down, Davydenkov's symptom is characteristic - "sucking" of I, II, III fingers; subcutaneous tissue atrophies and nails fit snugly against the skin.

The degree of movement disorders depends on the level and nature of nerve damage. These disorders are detected when the nerve is injured proximal to the level of the origin of the motor branch to the muscles of the eminences. thumb or isolated damage to this branch. In this case, flaccid paralysis of the thenar muscles occurs, and with a high nerve lesion, a violation of the pronation of the forearm, palmar flexion of the hand joins, flexion of the I, II and III fingers and extension of the middle phalanges of the II and III fingers falls out. In the own muscles of the hand, due to their small mass, atrophy quickly develops, which begins within the first month after a nerve injury, gradually progresses and leads to fibrous degeneration of the paralyzed muscles. This process continues for a year or more. After this period, the reinnervation of paralyzed muscles with the restoration of their function is impossible. Atrophy is revealed in the smoothing of the thenar convexity. The thumb is set in the plane of the other fingers, the so-called monkey hand is formed. Paralysis covers the short muscle that abducts the thumb and the muscle that opposes the thumb, as well as the superficial head of the short flexor of this finger. The function of abduction and, above all, opposition of the thumb of the hand falls out, which is one of the main motor symptoms damage to the trunk of the median nerve.

Sensitivity disorder - leading manifestation damage to the median nerve and is always observed regardless of the level of its damage. Skin sensitivity is absent in most cases on the palmar surface of the I, II and III fingers, as well as on the radial surface of the IV finger of the hand; on the back of the hand, sensitivity is disturbed in the region of the distal (nail) phalanges of fingers I, II, III and the radial part of the distal phalanx of the fourth finger. There comes a complete loss of stereognostic feeling, i.e., the ability to "see" an object with closed eyes by feeling it with your fingers. In this case, the victim can use the brush only under visual control. The replacement of sensitivity, which has fallen out after a complete interruption of the main trunk of the median nerve, occurs only to a certain level, mainly in the marginal zones of the area of ​​​​cutaneous anesthesia, due to the overlap of the branches of the median nerve in these areas with the superficial branch of the radial nerve, the external cutaneous nerve of the forearm, and also the superficial branch of the ulnar nerve.

Segmental damage to the trunk of the median nerve leads to a loss of sensitivity in a certain area of ​​the skin of the hand, the size of which strictly corresponds to the number of nerve fibers that innervate this area. Often partial damage median nerve causes excruciating pain on the palmar surface of the hand (sometimes like causalgia). Secretory disorders are characterized by a sharp hyperhidrosis of the skin on the palm in the zone of branching of the median nerve or anhidrosis and peeling of the epidermis. The intensity of disorders (sensory, motor, vegetative) always corresponds to the depth and extent of the damage to the nerve trunk.

Ulnar nerve injury (Cvn-CVIH). Leading clinical symptom ulnar nerve injury movement disorders. Branches from the trunk of the ulnar nerve begin only at the level of the forearm, in connection with this, the clinical syndrome of its complete defeat at the level of the shoulder up to the upper third of the forearm does not change. The weakening of the palmar flexion of the hand is determined, active flexion of the IV and V, partially III fingers is impossible, it is impossible to reduce and spread the fingers, especially IV and V, there is no adduction of the thumb according to the dynamometer. There is a significant loss muscle strength in the fingers of the hand (10-12 times less than in the fingers of a healthy hand). After 1-2 months after the injury, atrophy of the interosseous muscles begins to appear. The retraction of the first interosseous gap and the area of ​​​​the elevation of the little finger is detected especially quickly. Atrophy of the interosseous and worm-like muscles contributes to a sharp outlining of the contours of the metacarpal bones on the back of the hand. In the long term after the injury, a secondary deformity of the hand occurs, which acquires a peculiar form of a claw as a result of palmar flexion of the middle and distal phalanges of the IV-V fingers (due to paralysis of the worm-like muscles that flex the proximal phalanges and extend the middle and distal ones), as well as as a result of atrophy of the muscles of the eminence little finger (hypotenar).

When the fingers are clenched into a fist, the tips of the IV, V fingers do not reach the palm, it is impossible to bring the fingers together and apart. The opposition of the little finger is violated, there are no scratching movements to it.

Disturbances in skin sensitivity in case of damage to the ulnar nerve are always observed in the zone of its innervation, however, the length of the areas of complete anesthesia is variable due to the individual characteristics of the branching of the nerve, as well as depending on the distribution of the branches of the neighboring median and radial nerves. Violations capture the palmar surface of the ulnar edge of the hand along the IV metacarpal bone, half of the IV finger and completely the V finger. On the back of the hand, the boundaries of sensitivity disorders run along the third interosseous space and the middle of the proximal phalanx of the third finger. However, they are highly variable.

Vasomotor and secretory disorders spread along the ulnar edge of the hand, their boundaries are somewhat larger than the boundaries of sensitivity disorders.

Segmental damage to the outer section of the ulnar nerve trunk in the middle third of the forearm leads to a loss of sensitivity on the palmar surface of the hand, with their minimal severity on the back; in case of injury to the inner part of the trunk, the ratios are reversed.

Damage to the sciatic nerve (Uv-v-Si-sh). High nerve damage leads to a violation of the function of flexion of the lower leg in the knee joint due to paralysis of the biceps, semitendinosus and semimembranosus muscles. Often, nerve injury is accompanied by severe causalgia. The symptom complex also includes paralysis of the foot and fingers, loss of the calcaneal tendon reflex (Achilles reflex), loss of sensitivity along the back of the thigh, the entire lower leg, with the exception of its medial surface and feet, i.e. symptoms of damage to the branches of the sciatic nerve - the tibial and peroneal nerves. The nerve is large, its average diameter in diameter in the proximal section is 3 cm. Segmental lesions of the trunk are frequent, manifesting the corresponding clinical picture with a predominant loss of functions that control one of its branches.

Peroneal nerve injuries (Liv-v-Si). Form the trunk of the nerve roots (Liv-v-Si). Mixed nerve. Damage to the peroneal nerve leads to paralysis of the extensors of the foot and fingers, as well as the peroneal muscles that provide outward rotation of the foot. Sensitive disturbances spread across outer surface tibia and dorsum of the foot. Due to paralysis of the corresponding muscle groups, the foot hangs down, turned inwards, the fingers are bent. A typical gait of a patient with a nerve injury is “cock-like”, or peroneal: the patient raises his leg high and then lowers it on the toe, on the stable outer edge of the foot, and only then leans on the sole. The Achilles reflex, which is provided by the tibial nerve, is preserved, pain and trophic disorders are usually not expressed.

Damage tibial nerve(Liv-SHI). The mixed nerve is a branch of the sciatic nerve. Innervates the flexors of the foot (soleus and gastrocnemius muscles), the flexors of the toes, as well as the posterior tibial muscle, which rotates the foot inwards.

The back surface of the lower leg, the plantar surface, the outer edge of the foot and the back surface of the distal phalanges of the fingers are provided with sensitive innervation.

When the nerve is damaged, the Achilles reflex falls out. Sensory disturbances spread within the boundaries of the back surface of the leg, sole and outer edge of the foot, the back surface of the fingers in the region of the distal phalanges. Being functionally an antagonist of the peroneal nerve, it causes a typical neurogenic deformity: the foot is in the extension position, severe atrophy of the posterior muscle group of the lower leg and sole, sunken intertarsal spaces, deep arch, bent position of the fingers and protruding heel. While walking, the victim rests mainly on the heel, which makes walking much more difficult, no less than with damage to the peroneal nerve.

With damage to the tibial nerve, as well as with damage to the median, a causalgic syndrome is often observed, and vasomotor-trophic disorders are also significant.

Movement disorder tests: inability to flex the foot and toes and turn the foot inwards, inability to walk on toes due to instability of the foot.

Diagnosis of Peripheral Nerve Injuries:

staging correct diagnosis nerve injury depends on the sequence and systematic nature of the studies.

• Interview

Establish the time, circumstances and mechanism of injury. According to the guiding documents and from the words of the patient, the duration and volume of the first medical care. Clarify the nature of pain and the emergence of new sensations that appeared in the limb from the moment of injury.

• Inspection

Pay attention to the position of the hand or foot, fingers; the presence of their typical attitudes (positions) can serve as a basis for judging the nature and type of damage to the nerve trunk. The skin color, the configuration of muscle groups in the interested area of ​​the limb are determined in comparison with the healthy one; note trophic changes in the skin and nails, vasomotor disorders, the condition of the wound or skin scars resulting from trauma and surgery, compare the location of the scar with the course of the neurovascular bundle.

• Palpation

Get information about the temperature of the skin of the hand or foot, its turgor and elasticity, moisture content of the skin.

Pain in the area of ​​the postoperative scar during palpation is usually associated with the presence of a regenerative neuroma of the central end of the damaged nerve. Valuable information is provided by palpation of the region of the peripheral segment of the nerve, which, with a complete anatomical break, is painful, and in the event of projection pain, partial damage to the nerve or the presence of regeneration after neurorhaphy (Tinel's symptom) can be assumed.

Sensitivity study. When conducting a study, it is desirable to exclude factors that distract the patient's attention. He is offered to close his eyes in order to concentrate and not control the doctor's actions with his eyesight. It is necessary to compare sensations from similar irritations in symmetrical obviously healthy areas.

• Tactile sensitivity is examined by touching with a ball of cotton wool or a brush.
• The feeling of pain is determined by a prick with the tip of a pin. It is recommended to alternate painful stimuli with tactile ones. The subject is given the task to define the injection with the word "Acute", the touch - with the word "Stupidly".
• Temperature sensitivity is examined using two test tubes - with cold and hot water; areas of the skin with normal innervation are distinguished by a temperature change of 1-2°C.
• Feeling of localization of irritation: the subject indicates the place of skin injection with a pin (the injection is applied with eyes closed).
• The feeling of discrimination of two one-dimensional stimuli is determined by a compass (Weber's method). The result of a study on a symmetrical section of a healthy limb is taken as the normal amount of discrimination.
• Feeling of two-dimensional irritations: letters or figures are written on the skin of the area under study, which should be called by the patient without visual control.
• Joint-muscular feeling is determined by giving the joints of the limbs various positions that the subject must recognize.
• Stereognosis: the patient, with his eyes closed, must "recognize" the object placed in his hand, based on the analysis of versatile sensations (mass, shape, temperature, etc.). The definition of stereognosis is especially important in median nerve injuries. According to the results obtained, a functional assessment is given: if the stereognosis is preserved, the human hand is suitable for performing any work.

• Electrophysiological research methods

Clinical tests to assess the state of the functions of the peripheral nerve should be combined with the results of electrodiagnostics and electromyography, which allow determining the state of the neuromuscular apparatus of the injured limb and clarify the diagnosis.

Classical electrodiagnostics is based on the study of excitability - the reaction of nerves and muscles in response to irritation by faradic and constant electric shock. Under normal conditions, in response to irritation, the muscle responds with a quick, lively contraction, and with an injury to the motor nerve and degenerative processes, worm-like flaccid contractions are recorded in the corresponding muscles. Determination of the threshold of excitability on healthy and diseased limbs allows us to draw a conclusion about the quantitative changes in electrical excitability. One of the essential signs of nerve damage is an increase in the nerve conduction threshold: an increase in the strength of current impulses in the affected area compared to the healthy one in order to obtain a muscle contraction response. Long-term results on the use of this method have shown that the data obtained are not sufficiently reliable. Therefore, in last years electrodiagnostics in its traditional form is gradually being replaced by stimulation electromyography, which includes elements of electrodiagnostics.

Electromyography is based on the registration of electrical potentials of the muscle under study. electrical activity muscles are studied both at rest and during voluntary, involuntary and artificially induced muscle contractions. The detection of spontaneous activity - fibrillations and slow positive potentials at rest - are undoubted signs of a complete interruption of the peripheral nerve. Electromyography (EMG) allows you to determine the degree and depth of damage to the nerve trunk. The method of stimulation EMG (a combination of electrical stimulation of the nerves with simultaneous recording of the resulting muscle potential fluctuations) determines the speed of impulse conduction, studies the transition of impulses in the zone of myoneural synapses, and also examines the functional state of the reflex arc, etc. Electromyographic recording of action potentials can provide important data not only diagnostic, but also prognostic, allowing you to catch the first signs of reinnervation.

Treatment of Peripheral Nerve Injuries:

• Conservative treatment

Conservative and restorative treatment is no less important than surgery on the nerve, especially in case of associated injuries. If during the operation anatomical prerequisites are created for the germination of axons from the central segment of the nerve to the peripheral one, then the task conservative treatment- prevention of deformities and contractures of the joints, prevention of massive scarring and fibrosis of tissues, fight against pain, as well as improvement of conditions and stimulation of reparative processes in the nerve, improvement of blood circulation and trophism of soft tissues; maintaining the tone of denervated muscles. Measures aimed at achieving these goals should be started immediately after injury or surgery and carried out in a complex, according to a certain scheme, according to the stage of the regenerative process, up to the restoration of the function of limb injuries.

The course of treatment includes drug-stimulating therapy, orthopedic, therapeutic and gymnastic measures and physiotherapeutic methods. It is carried out for all patients both in the preoperative and in postoperative period, volume and duration of it depend on the degree of impaired function of the affected nerve and concomitant damage. The complex of treatment should be carried out purposefully, with a selective approach in each case.

Therapeutic exercises are carried out during the entire period of treatment, and in the most complete way - after the expiration of the period of immobilization of the limb. Purposeful active and passive movements in the joints of the injured limb lasting 20-30 minutes 4-5 times a day, as well as movements in light conditions - physical exercises in the water have positive influence to restore impaired motor function. The use of elements of occupational therapy (sculpting, sewing, embroidery, etc.) contributes to the development of various motor skills that become automatic, which has a positive effect on the restoration of professional skills.

Massage significantly improves the condition of soft tissues in power trauma or surgery, activates blood and lymph circulation, increases tissue metabolism of muscles and improves their contractility, prevents massive scarring, accelerates the resorption of soft tissue infiltrates in the area of ​​a former injury or surgery, which undoubtedly promotes nerve regeneration. The patient should be taught the elements of massage, which will allow it to be carried out 2-3 times a day during the entire course. rehabilitation treatment.

The use of physiotherapeutic methods involves the fastest resorption of the hematoma, the prevention of postoperative edema and the elimination of pain. For this purpose, on the 3-4th day after the operation, the patient is prescribed an UHF electric field and Bernard currents for 4-6 procedures, and later, in the presence of pain, novocaine electrophoresis according to the Parfyonov method, calcium electrophoresis, etc., on the 22nd a day - lidase electrophoresis (12-15 procedures), which stimulates the regeneration of the nerve and prevents the formation of rough scars. In this period, daily ozokerite-paraffin applications are also indicated, which promote the resorption of infiltrates, relieve pain, as well as soften scars that improve trophic function. nervous system and tissue metabolism, reducing stiffness in the joints. To maintain tone and prevent the development of atrophy of denervated muscles, it is rational to use electrical stimulation with a pulsed exponential current of 3-5 mA, duration 2-5 with a rhythm of 5-10 contractions per minute for 10-15 minutes. Electrical stimulation should be carried out daily or every other day; for a course of 15-18 procedures. This method helps to preserve the contractility of the muscles and their tone until the onset of reinnervation.

Medical treatment aims to create favorable conditions for nerve regeneration, as well as to stimulate the regeneration process itself. The course of drug therapy should be carried out as follows: on the 2nd day after the operation, injections of vitamin B 12, 200 mcg intramuscularly, are prescribed, which promotes the growth of axons of the injured nerve, ensures the restoration of peripheral nerve endings and specific connections of the damaged nerve. Injections of vitamin B 12 should be alternated every other day with the introduction of 1 ml of a 6% solution of vitamin B 1 (20-25 injections per course). This method of introducing B vitamins weakens the development of inhibitory processes in the central nervous system, accelerates the regeneration of nerve fibers.

For 2 weeks, dibazol is prescribed with nicotinic acid in powder, which has an antispasmodic and tonic effect on the nervous system.

After 3 weeks from the start of the course of treatment, ATP (1 ml of a 2% solution; 25-30 injections) and pyrogenal should be administered according to an individual scheme, which have a beneficial effect on the reparative process, stimulate it.

The complex of treatment should also include galantamine electrophoresis, which helps to increase functional activity neuron, improves the conduction of excitation in neuromuscular synapses due to inactivation of the cholinesterase enzyme. Galantamine is introduced from the anode in the form of a 0.25% solution; the duration of the procedure is 20 minutes, the course is 15-18 procedures.

The duration and volume of complex conservative and restorative treatment are determined by the number, level and degree of damage to the peripheral nerve, as well as the presence of concomitant injuries. After neurolysis surgery, as well as in cases of successful neurorhaphy in the area of ​​the distal third of the palm and at the level of the fingers, one course of conservative and restorative treatment is sufficient.

After neurorhaphy in the more proximal parts of the hand, forearm and shoulder, as well as at the level of the lower leg, thigh, taking into account the approximate period of axon regeneration and reinnervation of the peripheral nerve apparatus, it is necessary to repeat the course of treatment after 1.5-2 months. As a rule, the course of rehabilitation treatment started in the hospital ends in outpatient settings under the supervision of the operating surgeon.

Initially, signs of restoration of sensitivity in the form of paresthesia appear in the area adjacent to the level of nerve damage; over time, the sensitivity in the more distal parts of the limb improves. If there are no signs of regeneration within 3-5 months after the operation, with full conservative and restorative treatment, the issue of repeated surgical intervention should be considered.

Sanatorium-and-spa treatment in Tskhaltubo, Evpatoria, Saki, Matsesta, Pyatigorsk, etc. is indicated 2-3 months after neurography. They use such therapeutic factors as mud applications, balneotherapy.

• Surgical treatment

indications for surgery. The main indications for surgical intervention on damaged peripheral nerves are the presence of motor prolapses, impaired sensitivity, and autonomic-trophic disorders in the area of ​​innervation of the nerve concerned.

Experience in the treatment of patients with nerve injuries shows that the earlier a reconstructive operation is performed, the more fully the lost functions are restored. Nerve surgery is indicated in all cases of impaired conduction along the nerve trunk. The time between injury and surgery should be as short as possible.

In cases of failure of the primary suture of the nerve (increasing muscle atrophy, sensory and vegetative disorders), there are direct indications for reoperation.

The most favorable time for intervention is considered to be up to 3 months from the date of injury and 2-3 weeks after wound healing, although operations on the injured nerve are not contraindicated in the later period. In case of damage to the nerves of the hand, the optimal period for restoring their integrity is no more than 3-6 months after the injury. During this period, nerve functions, including motor functions, are most fully restored.

The following indicates a complete violation of conduction along the nerve trunk: paralysis of a certain muscle group, anesthesia in the autonomous zone of the nerve concerned with anhidrosis within the same limits, negative symptom Tinel, the absence of muscle contraction during electrodiagnosis - nerve irritation above the level of damage and gradually weakening, and then disappearing muscle contractions, under the influence of a pulsed current below the level of damage.

Surgical treatment can be carried out in more late dates after a nerve injury, if the intervention for one reason or another has not been performed earlier. It should be noted that a significant improvement cannot be expected in this case. motor function nerves. This is especially true for the muscles of the hand, where degenerative changes due to their small size. After the operation, in almost all cases, the focus of irritation is eliminated, sensitivity improves, and vegetative-trophic disorders disappear. These changes have a beneficial effect on the function of the damaged organ. Reconstructive surgery on a damaged nerve, regardless of the time elapsed after the injury, always improves the function of the limb as a whole to a greater or lesser extent.

Neurolysis. An incomplete interruption or compression of the nerve trunk is manifested by unsharp trophic and sensory disturbances in the autonomic zone of innervation of the nerve concerned. At the same time, a cicatricial process develops in the epineurium, which subsequently can cause the formation of a cicatricial stricture with impaired conduction. After bruised-lacerated wounds or severe combined injuries of the extremities, especially a part, a diffuse cicatricial process develops, leading to compression of the nerve trunks. In such cases, sensitivity disorders and autonomic disorders are observed, the depth of which is directly proportional to the degree of compression. In these situations, with the ineffectiveness of the full course of conservative treatment after a nerve injury, neurolysis is indicated - gentle excision of epineurium scars, which eliminates axonal compression, improves blood supply to the nerve and restores conductivity in this area.

An operative approach to the nerve must be carefully thought out and carried out with great methodicalness and the utmost care for the tissues. The nerve trunk is first exposed in the area of ​​obviously healthy tissues and gradually mobilized towards the area of ​​damage, while maintaining the integrity of the epineurium, as well as the vessels accompanying and feeding the nerve.

The best results are obtained by early neurolysis, when the process of degeneration due to compression is less deep and is reversible. The effectiveness of neurolysis, performed according to the correct indications, manifests itself in the shortest possible time after the operation: the function of the nerve concerned improves or completely restores, pain and vegetative-trophic disorders disappear, sensitivity improves, sweating is restored.

Surgical tactics and methods of performing operations on peripheral nerves depend on the duration of the injury, the nature of the former injury and previous surgical interventions, the degree of cicatricial tissue changes, the level of nerve damage and concomitant injuries.

Epineural suture. Until now, the classic direct epineural suture remains the most common method of peripheral nerve reconstruction. This is the simplest operational technique, although it requires some experience, otherwise technical errors are possible. It has a number of disadvantages, especially in mixed nerve repair, where precise matching of homogeneous intraneural bundles is required. With the help of an epineural suture, it is difficult to maintain the achieved longitudinal orientation of the bundles after the operation. Sprouting of the motor axons of the central end of the nerve into the sensory axon of the peripheral or inverse ratios due to mutual rotation of the ends is one of the reasons for the prolonged or incomplete recovery of the main functions of the nerve. The abundance of interfascicular connective tissue complicates the opposition of the bundles, there is a real danger of comparing the cut of the central bundle of the nerve with the interfascicular connective tissue, which makes it difficult for the maturation and germination of regenerating axons. This eventually leads to neuroma formation and loss of function.

Dissatisfaction with the results of surgical treatment of injuries of mixed peripheral nerves prompted physicians to search for new methods and types of surgical interventions. big step forward was the use of magnifying optics and especially special operating microscopes. Microneurosurgery is a new direction in neurosurgery of peripheral nerves, combining general surgical techniques with the use of qualitatively new techniques in a microfield: magnifying optics, special instruments and ultrathin suture material. Hemostasis during the operation is carried out using a special microelectrocoagulator. Stopping intraneural bleeding and bleeding in the wound cavity is important, and sometimes decisive, for the success of treatment.

A classic straight epineural suture can be placed up to the level of the distal interphalangeal joint of the finger. It is the most appropriate not only for conventional, but also for microneurosurgical techniques. The nerves of these areas contain homogeneous bundles of axons - either sensory or motor. Therefore, the rotation of the ends of the nerve along the axis, the probability of which is not excluded even with microtechnology, is of little importance.

In areas of mixed structure of peripheral nerves, it is most expedient to apply perineural or interfascicular sutures that connect axon bundles that are homogeneous in function. This is necessary because after refreshing the ends of the nerve, the intratrunk topography of the sections does not match, since the position and size of the bundles at different levels of the nerve are different. In order to identify intratruncal beams, you can use the Karagancheva scheme and electrodiagnostics on the operating table. In the process of using the epineural suture, its technique was modified: the sutures of one bundle are placed above or below the other due to their resection in different planes, which greatly simplifies their suturing with two or three perineural and sutures, allows you to accurately adapt the ends of each bundle, unlike the most common the applied technique of stitching beams in one plane of the cut. In conclusion, the epineurium of both ends of the nerve is brought together with separate interrupted sutures in the overlay. Due to this, the line of perineural sutures is well isolated from the surrounding tissues by its own epineurium, the sutures of which are outside the zone of interfascicular sutures. The nerve bundles are not compressed, as with a conventional epineural suture.

Nerve plasty. Particularly great difficulties in the reconstruction of the nerve arise in cases where there is a defect between its ends. Many authors refused to mobilize the nerve over a long distance, as well as excessive flexion in the joints of the limb to eliminate diastasis in order to sew the nerve end to end. Peripheral nerves are supplied by blood segmental type, and most of the nerves have a longitudinal direction along the epineurium and between the bundles. Therefore, mobilization of the nerve to eliminate diastasis is justified when separating them for no more than 6-8 cm. An increase in this limit leads to impaired blood circulation, which in such cases can only be carried out due to the ingrowth of new blood vessels from the surrounding soft tissues. There is no doubt that the developing fibrosis in the nerve trunk prevents the maturation and growth of regenerating axons, which ultimately will adversely affect the results of treatment. Tension along the line of sutures due to incompletely eliminated diastasis between the ends of the nerve leads to such violations. For these reasons, diastasis between the ends of the main trunks of peripheral nerves of 2.5-3.0 cm, and between the ends of the general digital and digital nerves proper - more than 1 cm is an indication for neuroautoplasty. The external cutaneous nerve of the leg should be used as a donor nerve, since it is most suitable for this purpose in terms of its anatomical and functional characteristics. During plastic surgery of the main nerve trunks, the defect is filled with several grafts, usually 4-5 depending on the diameter of the trunk, collected in the form of a bundle, without tension in the average physiological position of the limb joints. Between the nerve bundle and the graft, 3-4 stitches are applied with a 9/0-10/0 thread, and this area is additionally covered with epineurium. Plasty of the common digital and digital nerves usually requires one graft due to their identical diameter.

In most cases, peripheral nerve damage is combined with vascular damage, which is explained by their anatomical relationship. Along with the suture or plasty of the nerve, it is necessary to simultaneously suture or plasty the damaged blood vessel, which will allow optimizing the conditions for regeneration of the restored nerve, counting on a favorable final result of the treatment.

Thus, microsurgical technique for operations on peripheral nerves allows creating optimal anatomical conditions for restoring nerve function. Especially important is the use of microsurgical techniques in operations on mixed nerves, where an exact comparison of the ends of the nerve is required, followed by suturing of its identical bundles.

Which doctors should you contact if you have Peripheral Nerve Injury:

• Traumatologist
• Surgeon

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Other diseases from the group Injuries, poisoning and some other consequences of external causes:

An incorrectly made injection into the gluteal muscle threatens with serious consequences, and the most dangerous is a hit in the sciatic nerve. Injection method preference medicines due to the speed of action and high efficiency, but patients practically do not think about possible complications. Why is it dangerous to get an injection into a nerve?

What symptoms indicate that the sciatic nerve is affected?

Injury to the nerve fibers is transmitted by unbearable pain. For a person with a low pain threshold, it is fraught with loss of consciousness.

The main indicators of unsuccessful administration of the drug are reduced to the following criteria:

• pain attacks cannot be stopped even after the end of the procedure;
• the nature of the pain will change, it becomes paroxysmal, but the injury causes discomfort all the time;
• weakness in the legs, decreased movement activity;
• inability to walk independently;
• partial disruption of the functioning of the locomotor system.

The pain increases with pressure on the lower limbs (movement). Inaction can lead to complete paralysis of the patient.

First aid

What if the injection was carried out at home by an unqualified employee? It is necessary to urgently call an ambulance or go to the hospital on your own. It is very important to provide timely assistance in case of irritation or injury of the sciatic nerve.

If the symptoms arose due to the fault of medical personnel, be sure to consult a doctor with complaints of unrelenting pain or other abnormalities.

To reduce pain encircling the lower half of the spine, limbs, blockade is used. The following solutions are injected into the affected area with an injection:

• Novocaine;
• Diclofenac;
• Lidocaine;
• Disprospan.

The dose of the drug is determined by the doctor based on individual characteristics. To enhance the therapeutic effect, an injection of an additional substance, Hydrocartisone, is permissible.

Important! Patients diagnosed with diseases of the liver and kidneys, during pregnancy, lactation, the effects of the above drugs are contraindicated.

Such manipulations allow in a short time to achieve relief of the patient's condition, stop the inflammatory process, and reduce the chances of developing side effects.

Medical therapy

Treatment of the sciatic nerve requires conservative methods.

The basis medical method reception is laid medicines, such as:

1. Non-steroidal drugs that have an anti-inflammatory effect.
2. Pain is controlled with analgesics.
3. Muscle relaxants help reduce stress muscle tissue muscles.
4. It is possible to improve peripheral circulation with the help of myotropic antispasmodics.

An incorrect injection into the sciatic nerve entails consequences that are easier to defeat when complex therapy. Therapeutic exercises will help you recover quickly.

Nuance! Not to be confused physiotherapy exercises with the usual. the main task Exercise therapy - elimination of post-traumatic syndrome. A complex of gentle exercises is prescribed during the rehabilitation period to strengthen muscular frame, muscle endurance training.

During the treatment of an irritated nerve fiber, regular water procedures in the pool, cycling. You need to do it without straining the body, correctly measure physical activity with rest.

ethnoscience

When asked by a patient whether it is possible to treat a damaged sciatic nerve at home, the answer is yes. But only after coordinating the methodology with the health worker. Alternative therapy like independent way recovery, ineffective. Its purpose is general strengthening immunity and accelerate the elimination of side effects.

We must be careful with the gifts of nature. The components in the composition of some ointments or lotions have a warming effect and can provoke the appearance of allergic reactions.

Therapeutic baths with the addition of herbal remedies are recommended to be taken not only during the treatment of the consequences of an incorrect injection into the sciatic nerve, but also for preventive purposes.

At the end of the therapeutic course, a final examination by a doctor is required. Only a specialist can talk about treatment forecasts. As necessary, a second course is prescribed. To prevent sciatica from turning into chronic form, it should be completely eliminated.

And how to choose the right place for an injection?

If a person undertakes to independently inject his relatives or relatives, then he must understand the full degree of responsibility. The slightest mistake during the injection is fraught with a violation musculoskeletal system paralysis of the lower extremities.

Without a medical education, few people know that the nerve trunk can be palpated. To do this, visually divide the buttock into four parts with a horizontal and vertical line. Upper outer part the square is the only correct place to hit. Deviation from a given area or at a junction increases the risk that the sciatic nerve will be affected.

The length of the needle depends on how painlessly and competently the injection is administered. This issue is especially relevant when vaccinating children. The muscle mass of the gluteal hemispheres is less than in adults, so a long needle can injure the sciatic nerve and provoke the development of sciatica.

Risks of entering the sciatic nerve during insertion intramuscular injection health workers are minimal. Therefore, you should trust your health and the health of children to specialists.

Will be discussed in detail below. You will also learn about why this disease occurs and what are its symptoms.

Basic information

Infringement of the sciatic nerve, the symptoms of which are difficult to miss, as well as lumbar sciatica, accompanied by pinching of the roots of the sacral region, represent the same disease. The pain syndrome with it is localized in the thigh, lumbar region, foot and lower leg. It is also aggravated by walking and coughing.

At the very beginning of the development of the disease, it proceeds according to the type of lumbago, lumbalgia or lumboischialgia.

It is impossible not to say that sciatica is a synonym for this pathological condition. AT medical practice it is also called neuritis, inflammation or pinching of the sciatic nerve. Its main symptom is lower back pain that radiates to the leg.

In the absence of proper treatment, the pain syndrome in this disease is weak and unbearable. In the latter case, the sick person can neither sleep nor stay awake normally.

Main reasons

Why does the infringement of the sciatic nerve occur (symptoms of this condition will be presented below)? Modern medicine claims that such a disease may be associated with mechanical (for example, hernia, displacement of the vertebrae or osteochondrosis) or temperature (for example, severe hypothermia) factors.

It should also be noted that in some cases this pathological phenomenon occurs due to a tumor, Reiter's syndrome, infection, etc.

In addition to the listed diseases, pain in the buttock, radiating to the leg, may be associated with the development of the following pathologies:

• Ischialgia, accompanied by compression of the nerve fibers by a hematoma or post-injection abscesses.
• Ischialgia, accompanied (including with the syndrome
• Neuropathy associated with metabolic disorders (including alcoholism, diabetes, etc.).
• Sciatic nerve injury due to improper injection, hip and pelvic fractures.
• Ischialgia, which developed against the background of neuropathy under the influence of certain toxic substances.

Before telling you about how to cure the sciatic nerve, it should be told that adults most often suffer from this disease. Much less often, sciatica develops at the age of 20-26 years. In addition, this disease can occur in the last months of pregnancy due to the fact that the load on the spinal column of the future woman in labor increases significantly.

Other causes

Why does sciatica occur (symptoms and treatment of this disease will be presented later)? There are many reasons for the development of this disease. The most common factors are:

Location

Where does the sciatic nerve hurt? What is its location? Experts say that these are the two longest and largest nerves in the human body. They run on both sides from the lower back to the fingers of the lower extremities.

As a rule, with inflammation of this nerve, the patient begins to be disturbed by pain in only one of them, localized behind the thigh, as well as behind the knee along the calf, to the very foot.

Main symptoms

How is sciatica manifested? The symptoms and treatment of this disease are known to few. With neuritis, the pains can be burning, stabbing, sharp and cutting. They can appear suddenly and disappear just as suddenly. In more severe cases inflammation is chronic.

Typically, these attacks occur after physical or emotional overstrain. They can also disturb after hypothermia.

Sensitivity may be impaired along the course of the nerve with such a disease. skin and appear tingling, numbness, goosebumps and so on.

Other signs

It is the main symptom of the disease in question. Also, the pain syndrome can extend along the back of the thigh, gradually descending to the foot and lower leg.

After an attack, discomfort remains between the 1st sacral and 5th lumbar vertebrae, as well as in the center of the buttocks and under the knee.

Because of the severe pain syndrome, a person can lose consciousness. In addition, he may experience autonomic disorders such as excessive sweating feet, skin redness and swelling.

If the sciatic nerve is pinched, the pain may increase with prolonged walking, standing, and also when sitting on a hard surface. To improve his condition, the patient takes forced position body, in which it relies on a healthy lower limb. Therefore, one of the signs of the disease in question is a violation of gait.

In the case of severe inflammation of the sciatic fiber, the symptoms are expressed in a complete violation or a strong decrease in the function of the nerve. With such a disease, the femoral, gluteal or calf muscle may even decrease. In this case, the patient experiences difficulty when trying to bend the lower leg, toes, or turn the foot. This happens due to temporary immobilization of muscle tissue on the back of the thigh.

Diagnostics

The sciatic nerve hurts - what to do? For starters, you should contact a neurologist. Before prescribing treatment, the specialist must find out the cause of the development of pain in the area of ​​the sciatic nerve. Only after that, he can conduct an adequate diagnosis, because sciatica is only a syndrome that can accompany completely different pathological conditions.

First of all, the neurologist examines the patient, checking his reflexes on his legs by tapping with a hammer. It also determines the sensitivity on the skin, which allows you to assess the degree of damage to the National Assembly.

So what if the sciatic nerve hurts? What to do with such a pathological condition in order to identify the cause of its development? To make a diagnosis, the most accessible and simplest method is radiography. It is the picture taken that can confirm or exclude serious bone changes.

In the event that such a diagnosis is not enough, the specialist may recommend an MRI or CT scan.

If a tumor is suspected, radioisotope scanning may be used. spinal column. Most often, this procedure is recommended for people who have taken corticosteroids for a long time, as well as for HIV-infected patients.

The sciatic nerve hurts - what to do?

With the development of such a disease, treatment should be trusted only by a qualified neurologist. Modern medicine provides several ways to treat sciatica. Let's consider them in more detail.

Physiotherapy

According to experts, this method of treatment helps to significantly reduce pain, but does not eliminate true reason diseases. The doctor can prescribe to his patient such procedures as electrophoresis with vitamins, antispasmodics, anti-inflammatory drugs and muscle relaxants, as well as phonophoresis, UHF therapy, laser or magnetic laser therapy, paraffin applications, electrosleep, UVR of the affected area, and so on.

As practice shows, the effect of physiotherapy significantly improves blood circulation, and also relieves pain and swelling.

Reflexology and massage

How to cure the sciatic nerve? During the subsidence of acute inflammatory process general and cupping massage, moxibustion and acupuncture sessions are highly effective, acupressure. It should also be noted that the use of "needles" - - helps to significantly relieve pain and remove excessive tension in muscle tissue.

According to neurologists, absolutely any type of reflexology and massage can improve lymph flow, reduce pain, restore nerve function and prevent muscle hypotrophy.

Medications

What injections are prescribed for the sciatic nerve, pathologically inflamed? Non-steroidal pain relievers are the most effective. They are drugs that can stop the action of the COX enzyme and have a pronounced anti-inflammatory effect.

So what medications treat sciatic nerve? Drugs belonging to the mentioned pharmacological group are sold in all pharmacies. As they are usually used "Diclofenac", "Ibuprofen", "Indomethacin", "Ortofen", "Sulindak", "Ceberex", "Ketorolac" and "Naproxen". All of these funds have an irritating effect on the mucous organs of the gastrointestinal tract and negatively affect the kidneys, as well as reduce blood clotting. As a result, their use should be limited.

Also, with inflammation of the sciatic nerve, a neurologist may prescribe vitamins (especially B vitamins), mineral complexes and medicines that improve blood circulation and metabolic processes and also relax muscle tissue.

Physiotherapy

With sciatica, even the simplest exercises are very effective. However, they should be performed only after the acute process subsides, that is, during periods of remission.

Gymnastics should be done slowly and smoothly, without much tension.

At acute course sciatica patient should be observed. It is desirable to use a hard mattress. It is also necessary to limit physical activity (until acute inflammation). In addition, it is possible to alternately use heating pads and ice, massage in the area of ​​​​pain localization and other things.