Osteochondrosis is a dystrophic degenerative vertebral disease, the base of which is damage to intervertebral discs.The development of a degenerative column disease is facilitated by prolonged microtraumation, excessive static and dynamic load, hereditary predisposition, advanced age.The most common location of the lesion is the cervical and lumbar column.This is due to their greatest mobility and loading.
General concept of osteochondrosis
The intervertebral disc over time loses its liquid and loses its absorbing function.It becomes less resistant to physical effort.The fibrous ring, which is located on the outskirts of the disc, is gradually thinner, the cracks are formed.The pulp nucleus moves along the periphery in the cracks and formed formsProtub(Local protection, 1 degree).Due to intensive physical activity, the projection can increase and move spasmodically in the light of the vertebral canal.In this case, they speak of the hernia of the disc (2 degrees).Sometimes free fragments of the nucleus can form -Sequestration.
In the early stages of the disease, pain can be explained by overexciting the fibrous ring and irritation of the posterior longitudinal ligament.Pain can be located locally in the back or neck, as well as in distant areas.With cervical osteochondosis, the pain can be reflected at the back of the head, the blade and the interspace zone, the spam and the hand.
Pain is accompanied by a reflex spasm of segmental muscles.This phenomenon has a protective nature and stabilizes the defined part of the spine.Over time, muscle contraction becomes an independent source of pain.By moving towards the intervertebral hole, the hernia clashes the neighboring nerve roots.Radicular pain has a character of shooting and permeating, clearly located when innervation of the nerve.It is accompanied by appropriate neurological manifestations:
- decrease in sensitivity;
- failure of reflexes;
- muscle weakness.
The degeneration of the disc violates the normal anatomical ratio between the components of the spine: discs, vertebrae, joints and ligaments.The gradual decrease in the height of the intervertebral disc leads to a change in joint links and the formation of subluxation and dislocations of the vertebrae.This fact indicates the instability of the spine and reduces resistance to injury, which can lead to an exacerbation of osteochondrosis.
With age, the stability of the spine is restored due to the formation of osteophytes, hypertrophy of joint processes, disc fibrosis, thickening of ligaments and joint capsules.The final stage of the pathological process is called spondylosis.Pain at that time calmed down.
The main symptoms of cervical osteochondosis
In terms of cervical segments, nerve roots and their arteries, spinal cord and its vessels and vertebral arteries can be subjected to compression.Compression of the spinal cord is possible due to the posterior intervertebral hernia or rear osteophytes.People with a narrow vertebral canal are particularly predisposed to this.With hernia, the signs of compression of cervical osteochondosis are developing fairly quickly and the symptoms of the cerebrospinal fluvine current block are softer.
It is very difficult to distinguish clinically the compression of the spinal cord with a tumor and a hernia.Osteochondrosis of the cervical column manifests itself by spastic paresis of the legs, conduction disorders of sensitivity, pain and weakness in the hands.In some cases, the signs of compression are combined with signs of ischemia of the spinal cord substance which occurred due to the compression of the vertebral artery and the radicular vessels.
Symptoms of damage to anterior horns and ventral departments can suddenly develop with the involvement of pyramidal paths (blood supply to the anterior vertebral artery).Anterior spine syndrome occurs: slow paresis of the arms, spastic paresis of the legs, a function of altered sphincter.Sometimes the symptoms of the blatant violation of deep sensitivity in the hands are developing.After 2 to 3 weeks, the signs of a stroke of the spine begin to regress.In terms of the volume of pathological orientation, we can say about the severity of residual phenomena.
Cervical myelopathy
Myelopathy is chronic ischemia for cervical osteochondosis.A large role in the development of this syndrome is played by compression of blood vessels.The most characteristic is the defeat of the ventral parts of the side pillars and the front horns.It manifests itself by a spasticatrophic paresis of the arms, a spastic paresis of the legs, a violation of the deep sensitivity of the legs (classic triad).
In a certain number of patients, the Lermitta symptom appears: a feeling of passing the electrical discharge along the whole spine with an irradiation of the pain in the hands and legs during the direction.It is possible to develop lateral amyotrophic sclerosis in which there are no bulbar symptoms.
An important role in confirmation of myalopathy is played by MRI and CT, which reveal the compression of the shell bag with osteophytes and a thickened yellow group.
Radicular compression signs
Since the underlying discs wear out more quickly, spondylrosis develops in the corresponding segments.The osteophytes shrink the intervertebral holes and press the roots (at the lumbar level more often a compression of the hernia of the disc in the epidural space).When moving the growth head, the spine is injured, which causes edema formation, which more narrows the intervertebral hole.Develop reactive inflammatory reactions.
Clinical manifestations:
- C3 -Koreshok (below 2 cervical vertebrae, occurs quite rarely) - pain in the corresponding half of the neck, a feeling of swelling of the tongue, a feeling of a coma in the throat;
- C4 -koreshok - Pain in the appropriate shoulder flow, collarbone, atrophy of the trapezoid muscle, a decrease in the tone of the neck muscles (irritation of the cervical roots 3 and 4 increases the tone of the diaphragm, which leads to a change in the liver and the appearance of paparcal pain);
- C5 -decor - Pain in the neck and exterior surface of the shoulder, hypotrophy of the deltoid muscle;
- C6 -koreshok (one of the most common locations) -pain in the neck, blades, shoulder, radial surface of the forearm spreads to 1 finger, parepezesie in the hands, weakness of the biceps of the muscle with two doors;
- C7-Koreshok-Pain spreads to 2-3 fingers, accompanied by paresthesia, weakness of the three-headed muscle;
- C8 -Koreshok -The pain extends on the surface of the forearm elbow to the 5th finger, accompanied by paresthesia.
Cervical reflex syndromes
Vertebral syndrome manifests itself in acute cervical pain (bastards, cervical), less often chronic or subabid.The main sources of pain syndrome are a fibrous ring, the rear longitudinal ligament, the joint capsule, the tense muscles.Krivosheya is not as pronounced as the curvature of the spine at the lumbar level.
The pain is painful, radiate at the back of the head.Intensify when driving or extended stay in a single position.On palpation, the pain of thorny processes and articulations on the painful side (along the posterior surface of the neck of 3 to 4 cm is lateral that spicy processes) is determined.The involvement in the process not only of the back, but also of the before the spine (anterior staircase, etc.) is characteristic.
Previous staircase syndrome
The muscle tension of the staircase occurs very often with cervical osteochondosis.The muscle is determined by the side of the muscle in the shape of a sternum in the form of stressful quality, dense and increased size compared to the healthy side.Due to the tension, the compression of the supravichic vessels occurs, which is accompanied by pain and swelling in the hand, altered sensitivity and motor activity (along the nerve of the elbow).Pain is intensifying in a horizontal position.
Small chest muscle syndrome
The development mechanism is similar to the previous one.The compression of the gold vascular beam occurs between the muscle and the shoulder bone (or the corave process) under increased removal conditions of the hand.It is accompanied by pain in the chest, shoulder blade, hand.
Existing characteristics are often considered pain in the heart with VSD (there are no acute attacks, the effect of taking nitroglycerin or sedatives is not, increased symptoms during movement and palpation of pain points).
Rear syndrome
The distrophic vasomotor disorders that occur as a result of the irritation of the sympathetic plexus of the vertebral artery are characteristic.The branches of the plexus are located in the tissues of the brain and the skull.It manifests itself clinically by dizzy, ringing in the ears, spectacular disorders, anxiety.
The compression of the vertebral arteries with osteophytes emanating from the joints of the spine, in combination with atherosclerotic damage to these vessels, is an important pathogenetic factor in the development of the insufficiency of the arteries of the brain and the spinal cord.
Conclusion
In most cases, pain in the hands and neck is associated with cervical osteochondosis.In some patients, pain is caused by an intervertebral disc hernia, in others - osteophytes and arthritis of the spine joints.Each of these options can cause local or thoughtful pain, radicular syndrome and myelopathy.When examining patients with pain in the neck, it is necessary to exclude pathologies such as:
- tumors of the spine;
- epidural abscess;
- spondylarthritis;
- subarachnoid hemorrhage;
- meningitis;
- Abscess of the room;
- stratification of the carotid artery;
- Cervical vertebrae fracture.