Neuralgic amyotrophy is presumably an autoimmune disease that affects the nerves of the brachial plexus. Every year on 2 new cases per 100 thousand population.
There are two opinions about what may be the cause of development of this syndrome. In the first case suggests about the beginning of the process of demyelination, that is, the nerves lose their upper shell, called the myelin, and can’t perform the function.
The second version – the acute ischemia, i.e., poor blood circulation, which happens in the arteries of the neck. As a result the muscles do not receive the right amount of oxygen and other nutrition and begin to strain, which leads to compression of the nerve endings.
In the development of pathology are of great importance and predisposing factors. These include:
- Infections of the upper respiratory tract.
- Vaccinations against tetanus and pertussis.
- Operations in the shoulder area.
- Birth injuries.
- Heroin drug addiction.
However, the cause is not always possible.
Neuralgic amyotrophy, the second title of which — syndrome Parsonage – Turner, this pathology has pronounced symptoms, so diagnosis is usually to deliver is not difficult.
Most often the disease begins in the absence of reasons. The first symptoms appear suddenly, against the background of complete health of the patient. Most often affects men and women of pathology are detected much less frequently.
A few days before the beginning of the nerve plexus may feel slight pain, but almost no one pays attention, blaming fatigue. Slowly begins to develop atrophy, which reaches its peak in a few weeks.
The first symptoms appear suddenly in the night. It’s a sharp pain in scapula and shoulder girdle which can give a whole hand. Because of this, very limited movement in the joint.
The pain gradually decreases, but begins to grow muscle weakness, which is especially clearly expressed at 4 weeks of the disease. Flaccid paresis of the muscle, it is much thinner, and the hand looks withered.
Sometimes this applies not only to the muscles of the shoulder, but the forearm and even wrist. Disorders of sensitivity is not observed, and the reflexes are preserved.
Usually affects one arm, but gradually the process affects the second one, though this happens not immediately, but after a few weeks of onset. Another important symptom of neuralgic amyotrophy – wing-shaped blade, which appears due to the fact that muscles can’t hold it in normal position.
Diagnosis of the disease is relatively simple. The presence of the “wing” of the blade, dangling hand with its turning inside, the inability to bend the elbow or lift the arm and take the shoulder out of the way.
Changes in the blood or CSF no. If EMG revealed signs of neurological damage. When needle EMG revealed signs of lack of innervation in muscles that were affected in the pathological process.
Another study – ENMG is useful to understand how is the nerve impulse.
Other diagnostic methods, e.g., radiography, CT or MRI, allow to distinguish neuralgic amyotrophy from the other lesions of the shoulder, which are of secondary nature.
Differential diagnosis of
To correct diagnosis should be undertaken getdiagnostic, which will allow to distinguish this disease from others with similar symptoms. Primarily, this variety of paralysis and stroke.
It is necessary to distinguish traumatic lesions and autoimmune, and that is in the described condition. Treatment in the first and second case will be different.
Similar manifestation is typical for tick-borne encephalitis and polyneuropathy of Landry — Guillain — Barre. And finally, a blood test will help differentiate pathology from diabetes.
How to get rid of
Treatment begins with the application of anesthetic drugs, but use them only on prescription. Sometimes, it can only help narcotic analgesics, and corticosteroids in a dose of 60 – 80mg per day.
This treatment does not eliminate the paralysis and slows its development, but significantly reduces the level of pain. In the acute period of required immobilization of the limb, which helps to reduce the pain and will not allow the affected hand to perform usual work.
After removal of acute pain syndrome should only be done after a course of physiotherapy and physiotherapy.
Neuralgic amyotrophy of Parsonage – Turner – a disease that with proper and timely treatment takes place in 90% of patients. Therefore, disability of this pathology are not entitled to.