Resistance to tuberculosis drugs. Modern strategy for the treatment of drug-resistant pulmonary tuberculosis. Methods for determining LU MBT

Neck pain is a very common complaint. It occurs at any age in both men and women. Its main causes are osteochondrosis and osteoarthritis of the cervical spine. The sources of pain in these diseases can be intervertebral joints and discs, as well as ligaments of the spine and back muscles (Fig. 1).

Rice. 1. The structure of the cervical spine

The pain is usually localized in the back of the neck and may radiate to the head, shoulders, and chest wall. In addition to pain, osteochondrosis and osteoarthritis of the spine are manifested by tension in the muscles of the neck and limitation of head movements. More details on the causes of neck pain are given in Table. one.

Basic information

• At any given time, one in ten adults will have neck pain.
• Pain in the neck is usually caused by damage to the intervertebral joints, somewhat less often - intervertebral discs.
• The intervertebral discs of the lower cervical spine are most commonly affected, with unilateral neck pain and sensory disturbances in the hand on the side of the lesion usually occurring.
• The prevalence of osteochondrosis and osteoarthritis increases with age. So, radiological signs of osteochondrosis of the cervical spine are found in 50% of people over 50 years old and in 75% over 65 years old.
• According to a study conducted in the UK, radiological signs of osteochondrosis are found in 40% of men and 28% of women aged 55-64 years.
• Whiplash injuries of the spine are characterized by damage to the ligaments of the intervertebral joints and fractures of the articular processes of the vertebrae. These lesions often go undiagnosed and can be the cause of long-term neck pain.
• Osteophytes in osteochondrosis can compress the spinal roots (radiculopathy) and the spinal cord (myelopathy).
• The main causes of radiculopathy are herniated discs, masses and osteophytes.
• Neck pain is often worsened by shaking, such as while driving.
• The study of the cervical spine begins with the determination of anatomical landmarks - the spinous processes of the vertebrae C2, C6 and C7.
• The main method of physical examination for neck pain is careful (but careful) palpation.
• In most cases, neck pain lasts 2-10 days, and within a month it disappears in 70% of patients.
• With degenerative diseases of the spine, the main thing is to restore joint mobility.
• If there is no tumor, injury or radiculopathy, then the most effective methods for neck pain are manual therapy and exercise therapy.

Diagnostics

Differential diagnosis for neck pain is presented in Table. 2.

Most likely cause

The main causes of neck pain are osteochondrosis and osteoarthritis of the cervical spine, as well as damage to the neck muscles and ligaments of the spine. The prevalence of osteoarthritis of the spine increases with age. The main source of pain in osteoarthritis is the intervertebral joints. It is believed that damage to the intervertebral joints is the cause of myofascial pain and acute torticollis. Herniated discs usually occur in the lower cervical spine: C5-C6 and C6-C7 intervertebral discs are commonly affected.

The most dangerous diseases

Neck pain and limited head movement are seen with meningitis, subarachnoid hemorrhage, brain tumors, and pharyngeal abscess. With pain localized along the anterior surface of the neck, IHD is excluded - angina pectoris and myocardial infarction.

Tumors of the cervical spine are usually metastatic. The tumor should be excluded with prolonged, constant pain that bothers the patient both day and night. Metastases in malignant neoplasms in 5-10% of cases are localized in the spine, while the defeat of the cervical spine is observed in 15% of cases. Breast, prostate, and lung cancers most often metastasize to the spine, and somewhat less commonly, melanoma, kidney cancer, and thyroid cancer.

Sources of misdiagnosis

Difficulties most often arise in the diagnosis of rheumatoid arthritis and spondyloarthropathies, especially ankylosing spondylitis, psoriatic arthritis and arthritis in inflammatory bowel diseases. Pain in the lower part of the neck can be seen with polymyalgia rheumatica, although many people mistakenly believe that pain in this disease is localized only in the shoulders.

Diffuse pain in the neck is observed with fibromyalgia. When examining a patient with fibromyalgia, pain points of a certain localization are revealed. The disease is difficult to treat.

Causes of errors

• Ignorance of how often osteochondrosis of the cervical spine occurs.
• Ignorance of the fact that with a herniated disc, only one spinal root is affected; if several roots are affected at once, then a malignant neoplasm (metastases to the spine, lymphoma, etc.) should be suspected.
• Late diagnosis of myelopathy: it is characterized by a gradual onset, which leads to diagnostic errors; myelopathy is also observed in rheumatoid arthritis, osteochondrosis and osteoarthritis of the spine.

Seven major pretenders

Among diseases-pretenders, the main cause of neck pain is osteochondrosis of the cervical spine. Severe pain in the neck is also observed in acute thyroiditis. Acute thyroiditis is a rare disease, it can be purulent, it is also observed with syphilis. Less intense pain, thyroid enlargement, and dysphagia are seen in subacute granulomatous thyroiditis. Depression can also be the cause of neck pain.

Mental disorders and simulation

After an injury, the neck very often becomes a zone of psychological fixation. Depression, anxiety and conversion disorders, and simulation can be both a cause and a consequence of neck pain. Persistent pain in the neck, such as after a whiplash injury or with osteochondrosis, often provokes depression.

Survey

Anamnesis

During the collection of anamnesis, the nature of the pain, the circumstances of its occurrence, localization and irradiation, and accompanying symptoms are clarified in detail. An important role in the diagnosis is played by information about the daily rhythm of pain.

Main questions

• Show the place of the greatest pain.
• Is there pain early in the morning? Do you wake up in pain?
• Does it hurt when you tilt your head back?
• Is it easy for you to turn your head?
• Were there head and neck injuries?
• Are there any restrictions in head movements, is there a crunch during movements?
• Is there a headache and dizziness?
• Is the pain paroxysmal or constant?
• Is there pain, tingling, numbness, weakness in the arms?
• Does the pain increase with movement?
• Do your shoulders hurt?

Physical examination

The study is carried out in the following sequence - inspection, palpation, assessment of active movements (including measuring their volume), physical tests. Research objectives:

• reproduce the symptoms
• determine the level of injury
• determine the cause of the pain.

With radicular pain, impaired sensitivity and movements in the hands, as well as pain in the arm below the elbow level, a neurological examination is indicated.

Inspection

During the examination, the patient should sit on the couch with his hands on his hips. Evaluate:

• voluntary movements in the cervical spine,
• shoulder position,
• head position,
• contours of the neck when viewed from the side.

In acute torticollis, the head is tilted to the side and slightly turned in the direction opposite to the pain. After a whiplash injury and with severe osteochondrosis, the head is fixed, motionless: when you need to turn your head, the patient turns with his whole body.

Palpation

First of all, the main anatomical landmarks are determined. During palpation, the patient lies on his stomach, his shoulders are relaxed, his forehead rests on his palms, his head is slightly tilted.

Palpation of the spinous processes:

• the spinous process of vertebra C2 is palpated immediately under the occiput,
• due to cervical lordosis, the spinous processes of vertebrae C3, C4 and C5 are difficult to palpate, their location is estimated approximately (Fig. 2),
• the spinous process of the C6 vertebra is palpable only when the neck is flexed,
• the spinous process of C7 is the largest and most prominent, located at the base of the neck.

Rice. 2. Cervical spine: side view

Palpation is carried out with the thumbs of both hands. The fingers are placed against each other along the midline, palpation is carried out from top to bottom - from the C2 vertebra to the C7 vertebra. During palpation, the arms should be kept straight. Having set the fingers on the spinous process, they press on it 3-4 times; in this way, soreness and trigger points are revealed.

Palpation of the articular processes:

• projections of the articular processes are located on the same line 2-3 cm to the side of the posterior midline,
• palpation is carried out from top to bottom with thumbs facing each other.
• Palpation of lymph nodes, thyroid gland, neck muscles.

Assessment of active movements

During the study, the patient sits on the couch. The range of motion in the cervical spine is normal:

• bending - 45 0,
• extension - 50 0,
• tilts to the sides (abduction and adduction) - 45 0 in each direction,
• rotation (twisting) - 75 0 in each direction.

If there is no restriction of movements and pain, then at the end of each active movement, a short-term additional effort is applied in the same direction and asked if pain has appeared. According to the results of the study, fill out the form (Fig. 3).

Rice. 3. Range of motion in the cervical spine: crossed lines indicate limitation and pain when tilting and turning the head to the right

Neurological examination

A neurological examination is performed for pain, paresthesia, movement and sensitivity disorders in the hand, i.e., in the zone of innervation of the C5-Th1 roots. Signs of compression of the spinal root include:

• pain and paresthesia in the zone of its innervation,
• sensitivity disorders,
• decrease in muscle strength
• hyporeflexia.

Symptoms of compression of individual roots are presented in Table. 3. They need to be known in order to accurately determine the level of damage.

Cutaneous innervation from the cervical and upper thoracic segments of the spinal cord is shown in Fig. four.

Rice. 4. Cutaneous innervation of the head, neck and hand

Laboratory and instrumental research

Additional research methods are used to clarify the cause of neck pain and exclude organic diseases of the spine.

The appointment of CT must be justified. A CT scan should not be performed for everyone with neck pain. Thus, CT is absolutely indicated before a neurosurgical operation and if an organic disease of the spine is suspected, which is not detected by radiography.

For neck pain, the following research methods are used:

• general blood analysis,
• ESR study,
• blood test for rheumatoid factor,
• determination of HLA B27,
• spinal x-ray,
• spine CT,
• CT with myelography (before surgery for a herniated disc),
• bone scintigraphy,
• MRI of the spine.

Neck pain in children

In children and adolescents, neck pain and limitation of head movements are often a manifestation of cervical lymphadenitis (a complication of tonsillitis).

Neck stiffness is seen with meningitis and other severe infections such as pneumonia (meningismus). Pain in the neck can also be accompanied by poliomyelitis, a rare disease at the present time.

Some causes of neck pain in children are the same as in adults: intracranial hemorrhages, abscesses, and tumors. In children, in addition, acute torticollis is often observed (see below). Neck pain can also be a manifestation of juvenile rheumatoid arthritis.

Neck pain in the elderly

In the case of neck pain in the elderly, the following diseases should be suspected first of all:

• osteochondrosis of the cervical spine, complicated by radiculopathy or myelopathy,
• rheumatic polymyalgia,
• subluxation of the atlantoaxial joint in rheumatoid arthritis,
• metastatic tumors of the spine,
• pancoast cancer,
• abscess or swelling of the pharynx or pharynx.

The main causes of neck pain in the elderly are osteochondrosis and osteoarthritis of the spine. Neck pain is also observed with damage to the brain and its membranes, rheumatoid arthritis and spondyloarthropathies, such as ankylosing spondylitis.

In the elderly, acute torticollis is common, and it is more often caused by damage to the intervertebral joints and less often by a herniated disc.

A herniated disc usually presents with radicular pain. Radicular pain also occurs with osteoarthritis of the spine due to compression of the spinal nerves in the intervertebral foramens.

Clinical picture of a lesion of the cervical spine

With the defeat of the cervical spine can be observed:

• pain in the neck,
• limitation of head movements
• headache, including migraine
• facial pain,
• arm pain (reflected and radicular),
• myelopathy (manifested by motor and sensory disorders in the arms and legs),
• violation of the sensitivity of the scalp on the side of the lesion,
• earache,
• pain in the scapula,
• pain in the upper part of the chest wall,
• torticollis,
• dizziness,
• visual impairment.

On fig. 5 shows the possible localization of referred pain in diseases of the cervical spine. It should be noted that pain in diseases of the cervical spine often occurs in the shoulder and arm.

Rice. 5. Referred pain in diseases of the cervical spine

Microdamages of the intervertebral joints and osteoarthritis of the cervical spine

The defeat of the intervertebral joints of the spine is the main cause of pain in the neck. Microdamages of these joints occur at any age, frequent microdamages lead to osteoarthritis in old age.

Damage to the intervertebral joints can be primary, or it can occur due to damage to the intervertebral discs, as a result of a single injury, such as a blow to the head, or with minor but frequent injuries, such as painting the ceiling, wrestling.

The intervertebral joints are richly innervated, so their defeat almost always causes pain, often this pain is myofascial in nature. Damage to the intervertebral joints is characterized by the following:

• dull (rarely acute) pain in the neck, more often in the morning, after sleeping in an uncomfortable position (patients often say that they are “blown out”),
• irradiation of pain in the back of the head, ear, face and temple (with lesions of the upper cervical spine) or in the shoulder, especially in the suprascapular region (with lesions of the lower cervical spine),
• increased pain on movement and lessened at rest
• limitation of head movements (turns are most often limited) and neck muscle tension,
• unilateral pain on palpation in the projection of the affected joint,
• no changes on radiographs.

Irradiation of pain to the hands for microdamages of the intervertebral joints is not typical.

Treatment

The patient is explained the causes of his illness, emphasizing that if you follow the doctor's recommendations, then a full recovery will come.

• sit upright while reading, writing, working on a computer,
• watch your posture
• sleep on a small elastic or on a special orthopedic pillow,
• sleep on the side of defeat
• Rub the neck with a cream containing analgesics 3 times a day: heat and massage reduce pain.

• throw your head back for a long time
• often turn your head in the direction of pain,
• tilt your head while lifting weights
• for a long time to read or write leaning over,
• wear a collar splint for a long time,
• sleep on a high pillow.

The patient is regularly examined.

The condition usually improves slowly, so it takes some time to evaluate the effectiveness of the treatment.

Analgesics, such as paracetamol, are prescribed.

As soon as the pain subsides, physiotherapy exercises begin. Its combination with manual therapy is very effective (the latter should be carried out by a specialist).

For prolonged pain, additionally apply:

• antidepressants,
• transcutaneous nerve stimulation, especially with drug intolerance,
• hydrotherapy,
• acupuncture,
• injections of corticosteroids into the intervertebral joints (after CT or MRI),
• denervation of the intervertebral joints.

Osteochondrosis of the cervical spine

Osteochondrosis of the cervical spine is much more common than that of the lumbar. The intervertebral discs C5-C6 and C6-C7 are usually affected. Degeneration of the intervertebral discs causes secondary changes in the intervertebral joints, which in turn leads to narrowing of the intervertebral foramen and compression of the spinal roots (usually C6 and C7).

Osteochondrosis is a chronic disease with periodic exacerbations, which, however, can remain asymptomatic for a long time. In some patients with osteochondrosis, all manifestations decrease with age, when movements in the spine are limited.

Clinical picture

• Dull, aching, often unilateral pain just below the back of the head (Fig. 6), which often wakes up patients in the morning.
• Head movement limitation.
• Increased pain in the morning, with a sharp flexion or extension of the neck, as well as with prolonged constant stress on the cervical spine, for example, when repairing a car, painting the ceiling.
• Reducing pain in warmth, such as during a warm shower.
• Irradiation of pain in the head, shoulder blade or arm.
• Paresthesia in the hands.
• Dizziness.
• During the examination - limitation and soreness of movements in the cervical spine, especially turns and tilts to the side, soreness of the intervertebral joints on palpation.
• On radiographs - a decrease in the height of the intervertebral discs, osteophytes, degenerative changes in the intervertebral joints.

Rice. 6. Osteochondrosis of the cervical spine: localization of pain and results of studies of active movements

Complications

• Unilateral or bilateral radiculopathy.
• Myelopathy.

Treatment

• Psychological support, patient education.
• Physiotherapy, including hydrotherapy.
• Analgesics such as paracetamol.
• NSAIDs for 3 weeks (then evaluation of their effectiveness and the need for further use).
• Special complex of physical exercises.
• Manual therapy.
• Recommendations for daily activities, sleep and. etc.

Acute torticollis

Torticollis is a deformity of the neck, manifested by the deviation of the head from the midline. Torticollis often occurs due to spasm of the muscles of the neck in diseases of the spine, while it is usually short-lived, accompanied by pain in the neck. Most often, acute torticollis occurs at the age of 12-30 years.

The causes of acute torticollis are not fully known. It is believed that it is caused by microdamages of the intervertebral discs and especially of the intervertebral joints. The level of damage can be anything, but more often it is C2-C3, C3-C4 and C4-C5.

Clinical picture

• * Head tilted and slightly turned in the direction opposite to the pain.
• * Pain is usually localized in the neck and does not radiate
• * Pain most often occurs in the morning, after sleep.
• * Limited head extension.
• * Neurological symptoms are usually absent.

Treatment

Manual therapy, including post-isometric relaxation, is very effective.

Postisometric relaxation

The method of post-isometric relaxation is based on the fact that when a muscle contracts, its antagonists relax reflexively. To treat torticollis with the post-isometric relaxation method, tilt and turn the head in the direction opposite to the pain.

• * The patient is explained the essence of the method, emphasizing that it will not hurt.
• * First, carefully turn the patient's head in the direction of the lesion. If pain occurs, the movement is immediately stopped.
• * Place one hand on the patient's head from the side opposite to the pain, and with the other hand fix the neck at the level of the spinal lesion (usually this is the level C3-C4).
• * The patient is asked to turn his head in the direction opposite to the pain, overcoming the resistance of the doctor's hand, while isometric tension of the neck muscles occurs (Fig. 7a). The main condition at this stage is not to turn the patient's head, but only to resist his movement.
• * After 5-10 seconds, the patient is asked to relax. Then carefully turn his head in the direction of pain (Fig. 7b) - an increase in the range of motion is noted.
• * The procedure is repeated 3-5 times until the range of motion is fully restored.
• * The next day, the procedure is carried out again, although there may no longer be torticollis.

The patient can be taught to perform post-isometric relaxation independently.

Rice. 7. Postisometric relaxation in left-sided acute torticollis:
a) isometric contraction phase,
b) relaxation phase

Whiplash

Whiplash injury usually occurs in car accidents. In a rear impact, a sudden overextension of the neck occurs, followed by a sharp flexion, in a frontal collision, a sudden flexion followed by extension. Whiplash damages muscles and ligaments, spinal roots, sympathetic trunk, intervertebral joints, and discs. Intervertebral joints are especially affected, even their microfractures are possible (invisible on radiographs).

Symptoms usually appear in the first 6 hours, less often - 1-4 days after the injury, their severity may be different.

Whiplash is usually accompanied by pain and limited movement of the head. The pain is localized in the neck and shoulders, can radiate to the back of the head, to the interscapular region and to the arms. First of all, flexion is limited, then extension of the head.

Whiplash injuries often cause headaches that can last for months. The pain is usually localized in the back of the head, but may radiate to the temple and orbit. Dizziness and nausea are also observed. Damage to the nerve roots during an injury or their compression by a herniated disc is accompanied by radicular pain. Another manifestation of whiplash is mood changes (anxiety, depression).

Complications of whiplash injury are listed in Table 1. four.

In case of whiplash injury, an X-ray of the spine is mandatory.

Treatment

The goal of treatment is to restore working capacity as soon as possible, refuse to wear a collar splint and achieve a complete restoration of range of motion in the cervical spine. In the process of treatment, methods of both physical and psychological influence are used.

• Establish a trusting relationship with the patient, provide the necessary psychological support.
• Explain to the patient the mechanism of injury.
• It is emphasized that after an injury, within a few (usually two) weeks, mood changes may occur - irritability, depression.
• Recommend rest, wearing a collar splint for 2 days.
• Analgesics, such as paracetamol, are prescribed. Narcotic analgesics are not used.
• NSAIDs and small doses of tranquilizers are prescribed for up to 2 weeks.
• The patient is consulted by a physiotherapist (with whiplash injury, thermal procedures and massage are effective).
• As early as possible, they begin therapeutic exercises (a special set of exercises for the muscles of the neck).
• The patient is consulted by a specialist in manual therapy - mobilization is performed, manipulations are not used.

Cervical neuralgia is a fairly common ailment in which the nerve endings of the neck are infringed, since the structure of the intervertebral disc is destroyed or simply broken. Such an ailment can have different types, that is, it can be primary and even secondary. The primary variant (also called idiopathic) is caused by signs of the disease that occur quite suddenly and, very importantly, there are no good reasons for this. The secondary or symptomatic form manifests itself after any ailments or tumor processes. The symptoms and treatment of such a disease have long been carefully studied by leading physicians of all countries.

Neuralgia of the cervical spine has two forms of the course of the disease, so for the effectiveness of therapy they must be distinguished from each other:

• if there is a violation of the small fibers of the nerve and pains of a superficial nature begin, then we are talking about a dysesthetic form;
• if we are talking about a pinched nerve of the spinal cord or the hands are paralyzed, then the form of the disease is truncal.

Neuralgia of any cervical region can occur for a variety of reasons. It should be noted that it is the cervical region that is the most mobile component of the spinal column, and the size and mass of such vertebrae are significantly less than in the lumbar region. And this despite the fact that it is on the cervical vertebrae that a very large load is placed. Neurological changes in the neck can have a number of reasons:

• muscles undergo spasms, and the reason for this is a lack of physical activity;
• the metabolism in the tissues of the spine is destroyed or disrupted, cervical osteochondrosis occurs in a complex form, a hernia may occur, and protrusions may also occur;
• injuries of a traumatic nature (muscles can come off, the arches and bodies of the cervical vertebrae can break), all this is complicated by the involvement of the nerve, and the tumor develops in the occipital and cervical parts;
• the body is subjected to severe hypothermia.

Such an ailment happens and arises as a result of various kinds of complications that are indirect in nature of already existing ailments of a chronic nature. However, for such reasons, the disease appears much less frequently, so they are secondary. However, they should be told in more detail:

• the central nervous system undergoes inflammatory processes;
• the body is affected by encephalitis or meningococcal infection;
• there are ailments of a viral nature;
• there is a disease of diabetes mellitus 1 or 2 degrees;
• the vertebrae that are in the neck and spine are affected by tuberculosis;
• there are articular ailments that are caused by an excess of salts, here we can say about arthritis, gout;
• autoimmune disorders;
• vascular diseases of a peripheral nature;
• the occurrence of polyneuropathy, which occurs after complications associated with diabetes;
• a person is constantly under the influence of stress, constantly emotionally tense.

It should also be said about an additional factor that complicates the picture of such a pathology, this is when the central and peripheral nervous system is affected. Nerve damage can be due to other reasons.

Symptoms of manifestation

Signs of such a pathology can be of a different nature, but the main one is a strong pain syndrome that affects the area of ​​​​the cervical nerve, then begins to spread to nearby vertebral sections, and all this is often quite strange:

• it is sometimes worth turning your head (and not in the most abrupt way) or touching the nerves near the occipital region, as it starts to hurt sharply;
• localization is very different: first it hurts in the lower cervical part, in the area of ​​\u200b\u200bthe ears and the back of the head, then the pain goes into the eye areas;
• nerve endings are affected mainly in a unilateral form, but it happens that in a bilateral one;
• painful sensations so sharp that they are very similar to being struck by lightning or electric shock, and such pain appears and disappears in a completely sudden way;
• a person begins to react negatively to bright light, with it the eyeball hurts;
• if you touch the scalp, then there are sensations that are not of the most pleasant nature.

One of the dangers of such an ailment is that the symptoms are in many ways similar to migraine, otitis, osteochondrosis. So, in order not to get confused, you should not guess, but you need to go straight to the doctor, who will conduct an accurate diagnosis. Cervical neuralgia and its symptoms should only be studied by a specialist, no self-diagnosis.

If we talk about the causes of headaches, then here it is impossible not to say about the spinal artery syndrome, or as it is also called cervical migraine. Such a pathology causes circulatory disorders in the posterior cerebral regions and the symptoms here are as follows:

• the headache is unilateral in nature, it is aching and constant, its spread begins from the forehead to the back of the head. This is called cranialgia;
• skin scalps are painful, and even the lightest touches can cause negative sensations, even if, for example, the hair is combed;
• cochleovestibular changes occur: severe dizziness, ringing in the ears, slight hearing problems, the person begins to lose balance for no reason;
• visual disturbances: flies flash in the eyes, darkens or may double;
• manifestations of a neurasthenic character: a person becomes irritable for no reason, he is emotionally unstable, he is tormented by insomnia;
• changes that are vegetative in nature: a person is shivering, he has a strong fever, his hands become cold;
• blood pressure is unstable, constant jumps are observed.

Pathogenetic manifestations of the disease

If the syndromic symptoms of neuralgia that affects the cervical region are described, then it is necessary to talk about a number of manifestations, without which the picture will be incomplete:

• the neck begins to hurt, and the pains are aching in nature, negative sensations intensify if a person begins to rotate his head, laugh and cough. This is called cervicalgia;
• the pain is mainly deployed in the cervical and occipital regions, this is called cervicocranialgia;
• if pain occurs on one side, and it is aching in nature and becomes much stronger when a person turns his head;
• if there is pain in the neck and the upper corner of the scapula, which radiates to the chest and shoulder, also hurts, then this is a costal-scapular syndrome. If you put your hands behind your back, the pain becomes even stronger.

If the first signs of such a pathology are observed, it hurts in the occipital or cervical part, seeking medical help should be immediate, nerve damage does not lead to anything good. It is very important to make a diagnosis on time and correctly so that the therapy is successful. In no case should self-treatment be allowed, otherwise there may be complications of the most negative nature, even deaths are not rare.

About diagnostics and methods of treatment

In order to make a high-quality diagnosis, it is necessary to use anamnesis data, analyze signs of a clinical nature and make hardware-type studies (here, doctors use computed tomography, X-ray or MRI, it all depends on the specific case). Treatment of neuralgia of the affected cervical region provides for different options, modern medicine does not stand still.

How to treat such an ailment? Treatment can only be prescribed by a neurologist, the method of treatment depends on how severely the nerve tissues are affected and what are the causes of the pathology. During the period of therapy, the first thing to do is to cope with pain, after which measures can be taken to restore the motor abilities of the neck. And this is where drug treatment is most often prescribed, since it gives the greatest effect:

• you can use a local anesthetic in the form of novocaine, lidocaine can also be used;
• antidepressants are actively and successfully used;
• drugs that can effectively deal with the epileptic syndrome;
• the use of non-steroidal anti-inflammatory drugs.

When the disease is in an aggravated form, it is very important, first of all, to observe the regimen and lie on the surface for a long time, which should be hard. It is very important to relieve inflammation in time and make every effort to increase blood flow in the affected area, for this you can use warming compresses or intensively but gently rub your neck. If we talk about the restoration of motor functions, then such means as acupuncture, physiotherapy exercises and therapeutic massage will perfectly help here.

If the disease is severe, and the therapy does not bring the desired effect, then it is time to intervene in an operative way. The goal of surgery is to remove the nerve that is compressing the tissue. You can use in the treatment and folk remedies, which can also be very effective.

However, no matter what means are used, it is initially necessary to consult with the attending physician, nothing can be done without his knowledge! Alternative medicine cannot be the only treatment method, but it is excellently used as a method of supplementing the main treatment.

Another name for this disease is a degenerative-destructive lesion of the spine, affecting the vertebral body, ligamentous and articular apparatus, intervertebral discs. Equally often diagnosed in men and women, as a rule, it develops after 30 years. According to statistics, this disease affects from 50 to 80% of the population.

Classification of symptoms in cervical osteochondrosis

The development of this disease sometimes occurs earlier than 30-35 years, so signs of the disease may appear even in adolescence. The signs of cervical osteochondrosis are discussed in detail below, the disease has become a real problem in the modern world. Sedentary work, long stay in front of the computer negatively affect the state of health, well-being of a person. All symptoms of cervical osteochondrosis are associated with malfunctions of several systems:

1. In advanced cases, there are signs of compression, the integrity of the spinal cord located in the spinal canal is broken.
2. The pathological process can affect the peripheral nervous system. The roots of the spinal cord, located next to the foci of deformation of the bone and cartilage tissue, are negatively affected.
3. In some cases, pinching of the vertebral arteries occurs. These blood vessels deliver nutrients and oxygen to the brain cells. Violation of these processes leads to a sharp deterioration in human well-being.

pain

It is known that one of the first signs of the development of the disease is pain in the cervical region. At first, it passes quickly, is of a periodic nature, but then becomes chronic. The main places of localization of pain are:

• occipital muscles (increased when turning the neck, tilting the head);
• shoulder area;

It can hurt in different ways depending on the location of the lesion, discomfort can be sharp, shooting, periodically subside, wear aching and permanent. Over time, head movements become more difficult, which is associated with tension in the muscles of the neck. If an artery is pinched, a cervical migraine is sometimes observed (with a weakening of the blood supply, a lack of oxygen, a headache appears).

Nausea

In some cases, there is compression of the vessels of the circulatory system, which provide oxygen and nutrients to the human brain, the inner ear. Because of this, nausea occurs with osteochondrosis. This symptomatology is accompanied, as a rule, by loss of appetite, which causes weight loss, deficiency of essential nutrients. In the later stages, the disease can provoke vomiting when turning the head, walking or bending over. This is due to the lack of blood flow to the middle ear, where the center of balance is located.

Neurological symptoms of cervical osteochondrosis

Some manifestations of the disease can not immediately be attributed to the characteristic signs. You should know what symptoms of cervical osteochondrosis should not be ignored, for example, lack of air. With the defeat of this department, the syndrome of irritation of the phrenic nerve can develop. The patient has difficulty breathing, there is a lack of oxygen, which provokes shortness of breath and even severe suffocation.

This manifestation of the pathology is often accompanied by snoring, it intensifies if you take an uncomfortable position during sleep. This leads to the fact that a person does not rest at night, wakes up with a feeling of general malaise, weakness, feels tired and overwhelmed. This condition, if left untreated, can lead to memory impairment, decreased concentration, and irreversible changes in brain tissue.

Vestibular signs

Another direction of how osteochondrosis of the cervical spine manifests itself is vestibular signs. The supply of the brain with all the necessary nutrients occurs through the vertebral arteries. If cervical chondrosis develops, in which the work of the inner ear is disrupted, the patient experiences tinnitus and ringing. In certain cases, hearing loss or impairment is added to these symptoms.

Lump in throat

In some cases, the disease manifests itself in only one symptom - pharyngeal. There is a feeling that a lump has formed in the throat with osteochondrosis of the cervical region, itching, itching, dryness are felt, swallowing is difficult. These manifestations are associated with impaired conduction of the neurovascular trunks emanating from the spinal cord. A lump in the throat is not a specific symptom of chondrosis, it may indicate a tumor or inflammatory process. If this symptom appears, you should definitely consult a doctor.

Visual signs of cervical osteochondrosis

Symptoms of chondrosis of the cervical spine can be different, but visual acuity disorders are among the most common. The visual analyzers are supplied through the carotid and vertebral arteries. If a decrease in blood circulation occurs due to compression of the latter, a decrease in vision begins, which does not improve when wearing glasses. Cervical osteochondrosis - symptoms:

• low pressure;
• "floating", flashing dots;
• atherosclerosis of the arteries in the brain;
• violation of focus on the subject;
• veil, fog before the eyes.

A characteristic sign that a decrease in vision is due to pinching of a blood vessel by a vertebra, circulatory disorders, will be the lack of improvement when wearing glasses, performing special exercises. Only timely treatment of the underlying disease (before the occurrence of irreversible tissue damage) will help to change the condition.

Arterial signs

The spine plays an important role in the human body, so any of its diseases affect many systems. There are certain arterial signs of cervical osteochondrosis that indicate this disease. These include sudden loss of consciousness. This is the most unpleasant, dangerous symptom that is inherent in this disease. This happens due to circulatory disorders, when blood temporarily stops flowing through the cerebral arteries.

A pronounced spasm of the arteries occurs due to the response of deformed bone processes to irritation of nerve endings. If your friend has osteochondrosis of the cervical region and he has lost consciousness, he must be laid down, his legs raised to a slight elevation in order to increase the outflow of blood from the limbs and increase the flow to the brain. After that, people, as a rule, quickly come to their senses.

Instability of blood pressure is another symptom of the disease from this group. Doctors can diagnose jumps in indicators if the blood supply is disturbed. This is not a specific symptom of chondrosis, but fits into the overall picture of the disease. Blood pressure can drop or rise sharply. A person feels a deterioration in his condition, so he needs to ensure peace.

Dizziness

It has previously been described that loss of consciousness sometimes occurs in this disease. This applies to cases where the flow of blood to the brain was severely hampered. More often, patients feel dizzy with cervical osteochondrosis. This is a common symptom that accompanies all patients with this disease. This phenomenon has a spontaneous manifestation. The cause of this condition is a reduction in the amount of oxygen supplied to the inner ear. It is located in the human brain, is responsible for the sense of balance. Dizziness occurs when:

• turning the head, neck;
• if you suddenly get out of bed.

Temperature in osteochondrosis

In some cases, pathological processes spread among the structures of the cervical segment of the spinal cord. This happens with disc protrusions, canal stenosis. The temperature in osteochondrosis is the body's response to these pathologies. The same reaction is possible with vertebral artery syndrome. This is a frequent occurrence in osteochondrosis in the last stages of the development of the disease. Therefore, fever refers to non-specific symptoms of the disease.

This sign will not necessarily be present, the thermoregulation of the body may be normal. If you feel constant pain in the back of the head, shoulders, neck, and when you turn or tilt your head, an aggravation occurs, you should contact a specialist and undergo an examination. Lack of treatment will inevitably lead to the fact that the condition will worsen, the level of comfort of life will decrease.

Discuss

Cervical osteochondrosis - symptoms, sensations

Osteochondrosis is a disease that is associated with irreversible changes in the vertebral discs. The neurology of osteochondrosis is manifested by pain with recoil to other parts of the body, muscle tension, numbness of the extremities. Symptoms are important to distinguish and comprehensive approach to therapy.

Neurological symptoms may occur with:

• sedentary lifestyle;
• increased load on the spine;
• flat feet, overweight;
• wearing high heels;
• spinal injury;
• hereditary factor.

Most complaints are based on neurological complications of osteochondrosis, which are divided into 4 stages.

1 stage. The appearance of protrusions of the intervertebral discs, increased pain. In medicine, pain syndromes of neurology in osteochondrosis are divided into:

• bouts of pain in the cervical region - cervical;
• pain in the sternum - thoracal;
• in the lumbar region was called - lumbago, frequent attacks, which are permanent in nature, were called - lumbalgia.

2 stage. Associated with prolapse of intervertebral discs in osteochondrosis, which increases the discomfort of neurology, pinched nerve endings - the appearance of radicular syndrome. With changes in the neurological nature, pain appears, which is called sciatica, it is divided into:

• cervical sciatica;
• cervicothoracic sciatica;
• lumbar;
• sciatica in the lumbosacral region;

3 stage. The manifestation of pathological changes in the vascular-radicular sections in osteochondrosis. As a result, the blood circulation of the spinal nerve and nerve endings at the roots is disturbed. Pathological processes develop in the motor apparatus, the sensitivity of some parts of the body disappears.

4 stage. The blood circulation in the spinal cord is disturbed, which leads to insufficiency of blood in the vessels and ischemic stroke.

When to consult a neurologist

Often, when neurology appears, the patient wonders what caused it and what provoked it. Often the cause of severe pain may not be osteochondrosis, but other diseases:

• intervertebral hernia or sciatica;
• displacement of the discs of the spine;
• loss of sensation in the limbs, discomfort when turning the neck;
• diseases of internal organs;
• metabolic disease.

Symptoms of such diseases are similar to osteochondrosis. It is necessary to pay attention and note the focus of pain, consider whether there is irradiation in the limb. If the following symptoms appear, you should consult a neurologist.

Chondrosis of the cervical region has the following neurological symptoms:

• the appearance of a migraine, which even strong painkillers cannot cope with;
• when turning the neck, severe dizziness may occur;
• pain can radiate to the arm, shoulder girdle;
• vision and hearing deteriorate, “flies” appear before the eyes;
• loss of sensation of the tongue is common.

Neurological manifestations of osteochondrosis of the thoracic region:

• itching and numbness of the legs;
• feeling of tightness of the chest, intercostal neuralgia;
• decreased sensitivity of the limbs;
• pain between the shoulder blades with sharp bends;
• when inhaling and exhaling, increased pain in the chest.

Some symptoms can be confused with angina pectoris. In case of severe pain, it is necessary to contact the surgeon or the attending physician to confirm the neurological manifestations of osteochondrosis in the spine.

With lumbosacral neurology, it manifests itself as follows:

• aching or worsening pain in the lumbar region in any position, without pressure;
• inability to make any turns or U-turns;
• the pain is aggravated by sneezing and coughing;
• pain passes from the sacrum to the pelvis or legs.

When contacting a specialist, the patient will be assigned an examination using the CT or MRI method. Diagnosis and justification is the initial stage of the fight against pathology. After the diagnosis and examination according to the criterion - neurological status in osteochondrosis, the patient will be prescribed appropriate treatment.

Ways to eliminate neurological manifestations

In the acute stage of osteochondrosis on nerves, the main goal for eliminating the pain syndrome is bed rest and taking drugs that relieve pain.

Well help to cope with neurology and inflammation of the adjacent factor physiotherapy courses, which are designed to relieve pain:

• ultrasound;
• a magnetic field;
• UV irradiation;
• manual therapy;
• the use of vasodilators.

When manifestations of neurology occur, osteochondrosis is considered a dangerous disease that can lead to disability. If delayed with conservative treatment, the later stages of this disease will not be cured.

Can emotional stress cause an exacerbation of osteochondrosis and how to eliminate it

The back is an organ that reacts sharply to the processes occurring in the body: anxiety, stress, guilt. The focus of the appearance of neurology can tell about the problems that served the development of pain.
The main reaction of neurology to a stressful situation is that the body wants to hide from it, the muscles go into a state of tension.

1. Neck. Problems in the cervical vertebrae may indicate internal and external flexibility. A person dreams of change, cannot get out of the routine. Often, with increased stress at work or at home, diseases of the cervical region worsen in a person.
2. Thoracic department. Responsible for the emotional state of the body. Often, neurology can occur with mental trauma or the loss of a loved one. The occurrence of the disease can provoke shyness, self-doubt.
3. Osteochondrosis of the lumbar. The main load is assigned to this part of the spine. With increasing loads, a person has a large number of problems and worries, there are fears for himself and his family.

Neurology in the sacrum - may be the cause of dissatisfaction in family or sexual relationships, incompatibility with a partner. A person loses a sense of freedom, thoughts of death arise.

To treat such aspects of neurology in osteochondrosis, sedatives should be taken. It can be industrial drugs, folk remedies. Which drugs will be most effective for treatment, only a competent specialist can decide.

What sedatives can be taken

Sedatives for osteochondrosis and emerging neurology have a beneficial effect on a person. With frequent and severe pain, the patient has nervousness, in order to drown it out, sedatives are required. In modern medicine, there are many antidepressant drugs. Doctors prescribe drugs:

1. Valerian tincture with osteochondrosis neurology has a mild sedative effect. Reception is required to be carried out by course methods.
2. Motherwort - the principle of action is similar to valerian tincture.
3. Elenium - contains chlordiazepoxide in its composition, has relaxing and calming properties in neurology.
4. Novopassit - this drug is of plant origin. Contains plant extracts. Helps with mental stress, anxiety, unreasonable fears. Available in syrup and tablet form. It should not be used for myasthenia gravis and allergies to plant extracts included in the preparation.
5. Nozepam - well calms and fights insomnia.
6. Gidazepam is a neurological sedative that has an anticonvulsant effect, has a mild muscle relaxation effect. It works well for neurosis, migraine, increased irritability, emotional instability.

The main task of taking antidepressants for osteochondrosis is the fight against increased nervousness. Such medications have their own characteristics:

• sleep improves, when interacting with agents that improve sleep, enhances their effect;
• the patient's activity decreases during the daytime;
• the reaction to stimuli from the outside world decreases.

When taking sedatives, doctors advise you to stop driving a car, it is advisable to take a vacation at work and devote time to your health.

Usually, all antidepressants are well tolerated by patients, do not contribute to addiction, the only negative is that drowsiness may appear.

Contraindications to taking antidepressants are:

• individual intolerance;
• allergy;
• pregnancy and lactation;
• diseases of the internal organs.

Osteochondrosis on a nervous basis is aggravated. Sedative drugs for neurology must be taken as prescribed by the attending physician. With an increase or an incorrectly selected dose of the drug, the following symptoms may occur:

• lethargy;
• inexplicable euphoria;
• violation of coordination of movement;
• pupil enlargement;
• decreased muscle tone;
• the appearance of pallor of the skin;
• the occurrence of apathy, lethargy.

With such symptoms, the patient should be immediately shown to a specialist.

Neurological manifestations of osteochondrosis of the spine are dangerous. In addition to medicines, it is necessary to apply massage courses, physical exercises, folk methods. With an incorrectly drawn up treatment regimen, the disease can go into a form in which it will cause a large number of complications.