We can talk about pain in the arm (brachialgia) with glenohumeral periarthrosis and epicondylosis (dystrophic form of brachialgia), with the syndromes of the anterior scalene, pectoralis minor muscle and shoulder-hand syndrome (vascular-neural form of brachialgia), with compression-radicular syndromes (compressive-radicular form of brachialgia), irritation from the spinal motion segment (sclerotomy form of brachialgia). However, it is advisable to diagnose the syndrome itself, and not the form of brachialgia. This is both more specific and more informative for treatment. We should talk about brachialgia when there is pain and dystrophic disorders in the arm, but it is not possible to identify a defined syndrome. Thus, vertebrogenic reflex brachialgia syndrome is diagnosed in the absence of other specific compression or reflex symptom complexes of osteochondrosis.
Referred pain can spread from the cervical spine to the entire arm and to individual parts of it. The same reflected - reflex - can be not only pain phenomena, but also muscular-tonic, neurodystrophic and neurovascular changes in the arm area. Since all these changes are accompanied by pain, it is convenient to define them as brachialgia.
This term also emphasizes that we are not talking about radiculargia, not about neuralgia, but about a pain syndrome in the arm area, which cannot be associated with damage to any individual roots or nerves. We are talking about changes in the tissues of the hand themselves, accompanied by pain and soreness. although their initial source is the cervical region, that is, the vertebral focus. Many forms of brachialgia associated with the cervical dystrophic process of the spine can occur independently of it under the influence of local macro- and microtrauma.
General information
In the medical literature, shoulder-hand syndrome occurs under various names:
- Steinbrocker syndrome
- cervico-vertebral syndrome,
- glenohumeral arthritis,
- subacromial bursitis,
- cervicobrachial syndrome,
- cervical rib syndrome,
- scalenus syndrome,
- abduction syndrome,
- sympathetic trophoneurosis, etc.
In the development of the syndrome, great importance is attached to infection (influenza), intoxication, metabolic disorders, endocrine disorders, prolonged microtrauma, and physical stress. Probably, the development of this syndrome is based on neurovascular reflex mechanisms that arise as a result of the combined influence of various etiological factors.
The onset of the disease is acute or subacute. Pain in the shoulder joints occurs both during movement and at rest, especially at night. The pain radiates to the shoulder blade, neck, head, arm. Spontaneous pain often occurs at night. Swelling, pain, and limited movement appear in the joint area. Usually after 1-2 months the hand becomes involved in the pathological process. The local temperature rises periodically. Skin color is purple with a bluish tint. Movements are significantly limited. On palpation, fluctuation and pain are noted. The consequence of swelling is deformation of the fingers. In the area under the brachial plexus, in the supraclavicular fossa, in the upper edge of the scapula, where the suprascapular nerve passes, pain is detected. Due to severe pain in the shoulder joint, restriction of movements occurs (initially adduction and internal rotation).
Diagnostics
Pain, numbness, pins and needles and disturbances in arm movement can be caused not only by compression of the nerves in these bone canals. There are also diseases of the brachial plexus, spinal hernias, muscle tightness and other conditions that cause pain in the arms. Therefore, the most reasonable thing is to immediately contact a specialist, and not try to figure it out on your own.
Diagnosis of pain in the arm may take 2-3 days. First of all, this is an examination by a neurologist, as well as conventional clinical methods (tests, X-rays, MRI) and special techniques that allow you to accurately determine the extent of nerve damage - electromyography and electroneurography.
These methods examine the electrical activity of muscles and the speed of transmission of nerve impulses. By combining the results of both methods, one can understand whether the nerve has retained its function or has degenerated and been replaced by connective tissue. The treatment method depends on the results of the examination.
Causes
The syndrome does not arise just like that, but its appearance is just a reflex reaction of the body during myocardial infarction, traumatic damage to the shoulder and other joints of the arm, or spinal osteochondrosis. The main factor in the appearance is a violation of trophism or ischemia of certain areas of the spinal cord. Sometimes the syndrome can appear several years after injury or injury.
The disease begins to manifest itself after 50–60 years and very rarely occurs at a young age. It is especially common as one of the manifestations of osteochondrosis, so patients with this disease should be regularly examined in order to identify the first signs at the earliest stage.
Main types
There are primary (at the level of the outlet of the supraspinatus muscle) and secondary (at another level) impingement syndrome.
Primary impingement syndrome
Occurs when mechanical irritation of the supraspinatus muscle in a narrow space is associated with:
- congenital deformation of the acromion process;
- thickening of the muscle at the anterior edge of the acromion;
- the presence of osteophyte of the acromioclavicular joint;
- changes in bone shape after injury;
- acromio-clavicular arthrosis.
Secondary impingement.
It appears with a relative decrease in the subacromial space due to:
- chronic bursitis;
- an increase in the size of the rotator cuff due to spasm or inflammation;
- displacement of the greater tubercle of the humerus due to injury;
- ossification of the rotator cuff;
- so-called instability of the shoulder joint.
There are also three stages of damage to the rotator cuff muscles in subacromial syndrome, which determine the treatment tactics for their infringement:
- The first stage is characterized by swelling and hemorrhages in the tendons. At the same time, there is no violation of their integrity. It occurs in young athletes and responds well to treatment if treated in a timely manner.
- The second, in addition to tendon thickening, is characterized by signs of chronic inflammation, fibrosis, the presence of microtraumas, and tears. Depending on the reason, the issue of surgery is decided.
- The third demonstrates complete tendon ruptures, degenerative bone lesions - the acromion and the greater tubercle of the humerus; presence of osteophytes. Occurs in patients over 40 years of age. In this situation, surgical intervention is necessary.
Symptoms of shoulder-hand syndrome
Symptoms of shoulder-hand syndrome (Steinbrocker syndrome) are:
- severe, burning pain in the shoulder and hand, not relieved by analgesics,
- reflex contracture of the muscles of the shoulder and wrist joints with pronounced autonomic-trophic disorders, especially in the hand area.
- the skin on the hand is swollen, shiny, smooth, sometimes with erythema on the palm or acrocyanosis of the hand and fingers.
Over time, muscle atrophy, flexor contracture of the fingers, osteoporosis of the hand (Sudeck atrophy) develop, and partial ankylosis of the shoulder joint is formed.
What measures can be taken to correct the situation?
Treatment for such a disease will take quite a long time, and it will be prescribed by a doctor. The patient will have to regularly monitor the condition of the muscles and joints.
There is no specific treatment for shoulder-hand syndrome. The measures taken to normalize the patient’s condition are based on a blockade, carried out mainly with the help of novocaine. Ganglioblockers can be added to the drug.
Stages of the disease
The first stage lasts from 3 months to six months. It is characterized by the following symptoms:
- Shoulder pain.
- Pain in the hand.
- Severe and constant tension in the forearm muscles.
- Restricted mobility of the joints of the affected hand.
- Stiffness of the hand and fingers.
- Tendon reflexes on the hand are increased, well-defined swelling appears, and acrocyanosis may appear - a blue tint to the skin of the fingers.
The second stage can last up to 6 months. At the same time, pain and swelling become less significant, and sometimes disappear completely. However, trophic disorders begin to appear. The coolness of the hand is noteworthy. X-ray examination reveals signs of osteoporosis.
The third stage sometimes lasts for several years. Here the main symptom is contracture, which turns into stiffness of the shoulder and fingers, and this is an irreversible process. There is muscle atrophy, osteoporosis, and a strong decrease in the local temperature of the skin of the hand.
Henry Ford Disease, or Carpal Tunnel Syndrome
As Engels said, labor made a man out of a monkey. And monotonous work - the same one, the organization of which allowed Henry Ford with his assembly line to become a very rich man - led not only to an increase in production, but also to the emergence of specific diseases.
It is not at all surprising that builders often suffer from arthrosis of the shoulder joint, surgeons who spend many hours tensely at the operating table from varicose veins, and office workers from carpal tunnel syndrome, which is also known as carpal tunnel syndrome.
What is carpal tunnel syndrome?
Scientists claim that there is no special connection between using a mouse with a keyboard and the appearance of characteristic pain in the hand: they say, along with white-collar workers, pianists, seamstresses, and even sign language interpreters also suffer from carpal tunnel syndrome. Nevertheless, hammering on keys for many hours certainly does not improve your health.
Carpal (carpal) tunnel syndrome occurs when one of the three nerves responsible for the mobility and sensitivity of the hand - the median - becomes pinched in the wrist area, on the back of the hand. This occurs due to a combination of two factors - the genetically determined anatomical narrowness of the carpal tunnel and the long stay of the hand in an unnatural position.
"De-energized" hand
We all know the problem of a broken phone or laptop charging cable: one fine day you notice that due to constant kinks at the base of the cord, the braiding has burst, which means it’s time to go to the store for a new one or, armed with electrical tape, try to temporarily postpone the purchase .
Approximately the same situation occurs when you methodically compress the median nerve during work year after year: the first symptom, as a rule, is discomfort in the pads of the thumb, index and middle fingers. It can be aching pain, tingling, numbness, or even a kind of “shooting” - as if the hand is being shocked. Some patients note that it is as if a tight bracelet is locked around the wrist, which limits the mobility of the hand.
During periods of exacerbation, a person experiences problems with usual actions - he cannot comfortably pick up a spoon while eating, transfers his mobile phone to the other hand while talking, refuses to sew because he cannot thread the needle. Shaking the limb brings temporary relief, but after a few minutes or hours the discomfort returns, sometimes even preventing sleep.
In severe cases, tunnel syndrome can lead to atrophy of the thumb muscles, making it impossible to even hold an object in the affected hand. In this case, the disease usually affects the dominant hand - the right hand in right-handed people and the left hand in left-handed people.
Diagnosis is a delicate matter
Even if you find yourself with symptoms characteristic of carpal tunnel syndrome, do not rush to label yourself as “disabled office worker” and go on an Internet search for quick treatment. If your hands become numb or you experience discomfort, this may be caused by other diseases that have nothing to do with compression of the median nerve. For example, inflammation of the wrist joint or tumor. Therefore, if pain and problems with hand mobility and sensitivity occur, it is important to make an appointment with a neurologist as soon as possible.
And here we are faced with a popular problem in domestic medicine: you will be diagnosed without problems (although you will most likely have to pay for electroneuromyography and MRI of the joint yourself), but the prospects for treatment will be vague.
And it’s not that neurologists haven’t learned how to treat carpal tunnel syndrome—it’s just that few patients decide to make a radical change in activity, even if only for the sake of their own health. And since this pathology has not yet been classified as an occupational hazard, you should not count on an official transfer to another position while maintaining the same salary.
Therapeutic measures: radical and not so radical
If you are not ready to take a time-out of several months or retrain as an ambidexter, then you need to approach treatment responsibly. First, deal with unpleasant symptoms: drugs from the group of non-steroidal anti-inflammatory drugs will help for this. They will relieve inflammatory swelling of the nerve and numb the problem area. But don’t get carried away with ibuprofen and the like: this is only a temporary measure of help.
The most important thing is to eliminate the cause of the “break” of the nerve. To do this, it is necessary that the hand and forearm be in the same plane while working. That is, either pick up a flat computer mouse, or make it a rule to place a cushion under your arm to level the position of the limb.
By the way, a good move would be to buy an orthosis that fixes the wrist in one position. There is no need to wear it around the clock - only during work that caused carpal tunnel syndrome. Physiotherapy and massage will also ease the symptoms of carpal tunnel syndrome, but remember that warming up the wrist should only be done with the approval of a doctor and without exacerbation of the disease.
To restore nerve fibers, your doctor may prescribe you injections of a drug containing vitamin B6 - do not ignore this recommendation, because the process of restoring the median nerve will take more than one month. Of course, there is a lot of this compound in cereals, walnuts, bananas and seafood, but it is unlikely that diet correction will help on its own, although in combination with other approaches it will certainly be useful.
The last resort in the treatment of carpal tunnel syndrome is surgery - during the operation, the doctor cuts the tissue of the wrist at the base of the palm, and then the transverse carpal ligament, which allows the nerve to be freed from its anatomical “captivity”.
Despite the apparent simplicity of this solution, you need to be prepared for a long recovery period and possible side effects: sometimes after surgery on the hand, patients complain of chronic weakness in the hand, which prevents them from performing usual actions with the same dexterity.
***
Finally, a few words about prevention. The idea of limiting time spent at the computer seems blasphemous to almost every modern person, so it is more appropriate to solve the issue of strengthening the ligaments and tendons of the hands. Pull-ups on the horizontal bar, jumping rope and the now so popular plank exercise will help you avoid the unpleasant consequences of carpal tunnel syndrome. And for fun, you can try using a graphics tablet instead of a mouse - after all, scientists have long proven the beneficial effects of handwriting on brain function!
Olga Kashubina
Photo thinkstockphotos.com
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What can a doctor do?
There is no specific treatment for Steinbrocker syndrome. It is based on novocaine blockades of the anterior scalene muscle and stellate ganglion. Sometimes ganglion blockers are added to Novocaine - gangleron, pentamin, benzohexonium.
At the initial stage, phonophoresis with hydrocortisone, which must be alternated with electrophoresis with nicotinic acid, helps to relieve symptoms. Finlepsin is prescribed, or intramuscular administration of B vitamins. Proserin is prescribed according to a specific and long-developed scheme. Sometimes additional antihistamines and decongestants are required. Some patients benefit from acupuncture.
Treatment options
In case of acute pain, you can try to provide the patient with first aid. To relieve tension in the arm and spine, the arm is fixed with a scarf, bending at the elbow. Painkillers you can take are analgin and amidopyrine.
During exacerbations, it is recommended to provide the patient with a state of rest. Pain is relieved with the help of medications, sometimes massage and gymnastics, physiotherapy, which includes electrophoresis and the use of ultrasound, help.
If all measures taken in the form of conservative treatment have no effect, surgical operations are prescribed. During surgery, muscle dissection, removal of intervertebral hernia, and so on can be performed.
Clinical picture
The disease begins to develop gradually and most often is one of the manifestations of glenohumeral perarithrosis. The shoulder joint is primarily affected - patients complain of its stiffness. After this, the pathological process is diagnosed in the hand area. It also happens the other way around - the hand is affected first, then the shoulder. And finally, in very rare cases they are affected at the same time.
The main symptom is severe pain that does not go away even after taking strong analgesics. The second equally important symptom is contracture of the muscles of the shoulder and wrist joints, and sometimes the hand.