Neuropathies and neuralgia
Neuropathy is a persistent lesion of a peripheral nerve or several nerves - polyneuropathy, with motor, sensory and autonomic changes in the innervation zone of this nerve or a group of nerves.
The most common types of neuropathies, polyneuropathies and neuralgia:
- Alcoholic polyneuropathy
- Diabetic polyneuropathy
- Intercostal neuralgia ("shingles" in the herpes virus)
- Trigeminal neuralgia
- Facial nerve neuritis (Bell's palsy, post-traumatic neuropathy)
- Trigeminal neuritis
- Optic neuritis
- Radial nerve neuropathy
- Median nerve neuropathy
- Ulnar nerve neuropathy
- Sciatic nerve neuropathy
- Tibial nerve neuropathy
- Fibular (peroneal) nerve neuropathy
- Traumatic neuropathy (post-injection, after fractures)
Diagnosis of neuropathy and neuralgia
Depending on the type of damage in neuritis (neuropathy) and polinverite (polyneuropathy), a variety of symptoms will manifest:
- movement disorders (paresis, paralysis) in a particular muscle or muscle group
- changes in sensitivity, both in the direction of their strengthening and weakening (numbness) or perversion
- trophic disorders (muscle wasting and atrophy, cyanosis of the skin, poor healing of the skin with injuries, trophic ulcers)
Depending on the anatomical level of nerve damage in neuritis (neuropathy) and polyneuropathy (polyneuropathy), sensitivity disorders (numbness, tingling, "chills") in the patient will be at different levels.
Classical electrodiagnostic (ENG) for neuritis (neuropathy) and polyneuritis (polyneuropathy) is of great importance in the system of a comprehensive study in the period from 2 weeks and later after nerve damage, helping to separate degenerative from non-degenerative disorders. Thus, to a certain extent, the prognosis of the course of neuritis and polyneuritis is determined, since closed damage to the nerve trunks, in particular the brachial plexus, accompanied by degeneration, is always doubtful regarding the completeness and quality of restoration of lost movements, especially in the distal parts of the limb.
Restoration of movements in neuropathy and polyneuropathy up to a force of 4–5 points is observed only in those muscles in which, during classical electrodiagnostic (electroneurography - ENG), reduced electroexcitability or a reaction of partial degeneration is revealed.
With the reaction of complete degeneration of the nerve, restoration of movement in the muscles is not observed.
In very late periods after injury, the identification of the loss of electrical excitability of the paralyzed muscles gives another reason in favor of refusing to operate on the nerves.
Earlier than in other areas, the electrical excitability of the muscles of the dorsum of the forearm disappears. Contrary to conventional wisdom, the small muscles of the hand often turn out to be more stable in terms of their ability to respond to stimulation by the current.
Electromyography is a very promising research method for closed injuries of the brachial plexus, which makes it possible to record the dynamics of changes in the neuromuscular apparatus during the recovery process in neuritis. The corresponding electromyographic curve with the appearance of previously absent action potentials allows us to expect the restoration of movement long before the first clinical signs of this restoration.
Treatment of neuropathy and neuralgia
Treatment is selected individually for each patient in each specific case of the disease. It is important to consider the cause of neuritis to properly treat it.
Treatment of neuropathy should include a set of conservative procedures, the main task of which is to stimulate the restoration of the nerve sheath and its conduction for the nerve impulse:
- neurolysis of the nerve trunk (in the case of a scar on the nerve, etc.)
- nerve stimulation
- muscle stimulation
- vitamins of group "B", "C" and "E"
- antiviral drugs
- homeopathic remedies, etc.
The duration of treatment and its frequency is dictated in the future by the functional state of the nerve itself, muscles, and the restored lost sensitivity.