Plexitis of the shoulder joint: symptoms, treatment, diagnosis

Plexitis, or plexopathy, is an inflammation of a bundle of spinal nerves caused by a number of reasons. Brachial plexitis is an inflammatory disease of the brachial plexus, sometimes affecting the cervical plexus due to its proximity. Plexitis of the shoulder joint is diagnosed in patients of all age groups. If left untreated, it can lead to complete immobilization of the shoulder joint and the entire arm.

What is brachial plexus plexitis?

According to localization, plexopathy can be right- or left-sided, and bilateral plexitis is also common.

Plexite owes its appearance to the influence of internal and external factors, depending on which it is divided into the following types:

1. Traumatic, caused by damage to the brachial neurovascular bundle during fractures, dislocations, and sprains of the shoulder joint. This same form includes plexitis received by a newborn during a complicated passage through the birth canal during a pathological birth. Plexitis resulting from exposure to occupational provoking factors is also considered traumatic.
2. Infectious, when the nerve fiber is affected by toxins of infections - tuberculosis, herpes viruses, influenza, cytomegaloviruses.
3. Infectious-allergic, appearing as a result of a reaction to the administered vaccine.
4. Toxic. This type of brachial plexus pathology occurs due to poisoning with alcohol substitutes, mercury salts and heavy metals.
5. Dysmetabolic, accompanying endocrine disorders - diabetes, gout, thyroid diseases.
6. Compression-ischemic, the mechanism of which is compression of the neurovascular bundle due to the shoulder being in a long non-physiological position - with illiterate immobilization of the injured arm, in a narcotic state after surgical treatment, with the use of incorrectly selected crutches. Nerves can also be compressed by tumors of the joint and periarticular area, enlarged lymph nodes, or hematoma after injury. Poor posture can also be a cause of this form of brachial plexitis.

In addition to the above, plexitis of the shoulder joint can also be caused by osteochondrosis of the cervical and thoracic segments of the spine, when deformed vertebral bodies compress the roots of the spinal nerves; aneurysms of arteries in the shoulder area, frequent and prolonged hypothermia, costoclavicular syndrome (when additional cervical ribs are formed), hyperabduction syndrome (when the shoulder joint is sharply abducted, the nerve bundle is pinched).

NEUROPATHY OF THE OPTURATIVE NERVE (n. obturatorius)

The first signs of compression of the obturator nerve are usually pain that occurs in the groin area and along the inner surface of the thigh, in the hip joint.

Usually the pain intensifies with coughing, tension of the abdominal muscles, that is, with any conditions that increase intra-abdominal pressure. In addition, hip extension, abduction, and inward rotation contribute to increased pain.

There may be a feeling of numbness and “crawling” in the middle and lower part of the inner thigh. Later, a zone of reduced sensitivity (hypesthesia) appears in these same areas.

Motor disorders are manifested by weakness of the adductor muscles of the thigh: weakness when bringing the hips together, difficulty in fulfilling the request to put one leg on the other.

How does brachial plexus plexitis occur?

The flow of plexite falls into two stages:

1. Neuralgic, when symptoms include pain in the skin and muscles, aggravated by movement.
2. Paralytic, when the pain is replaced by muscle weakness, swelling, and tissue atrophy. This stage usually occurs when the initial symptoms are not treated.

The clinical picture of shoulder plexitis includes the following symptoms:

• severe pain in the shoulder joint at rest and with movement, even small ones. The pain can be paroxysmal, radiating to the upper limb and clavicle area;
• tissue atrophy is expressed in swelling and pallor of the skin, the skin around the joint becomes cold, bluish, shiny, nails are brittle, and increased sweating of the palms is observed.
• reduction in the sensitivity of the outer surface of the hand with Erb-Duchenne palsy and the external surface - Klumpke-Dejerine syndrome;

• the muscles of the upper limb are weakened, to the point of the inability to normally raise the arm or move it, and there is also a violation of the motor skills of the hand, which makes it difficult to perform ordinary household tasks;
• Among the symptoms, at first glance, not associated with the shoulder joint, the following are noted: difficulty breathing and severe hiccups, if the phrenic nerve is affected, and occasionally, a constricted pupil and a sunken eyeball on the affected side.

Based on the location of pain, plexitis of the shoulder joint is divided into:

1. Upper, when pain is felt in the supraclavicular region.
2. Lower, with pain in the elbow joint, forearm and hand.
3. Total – covering the entire area of ​​the shoulder and arm.

If the signs of plexopathy are bilateral, this causes practical helplessness for patients and their dependence on loved ones. If left untreated, plexitis of the shoulder joint goes into a recovery stage, lasting about a year, while the functions of the nerve fiber may not be fully restored, which ultimately becomes the cause of persistent paresis, contractures, and muscle atrophy.

NEUROPATHY OF THE PUDENTAL NERVE (nervus (n) pudendus) - pudendoneuropathy

The nerve provides sensitivity in the anus and perineum, is responsible for the work (innervates) the muscles of the perineum, bladder (located in the bladder) and urethral (in the urethra) sphincters (muscles responsible for holding urine).

Neuropathy is manifested by: unilateral pain in the perineal area, sometimes in its anterior parts: in women - in the vaginal area, in men - in the scrotum; sometimes in the posterior regions - in the area of ​​the anus and rectum (anorectal), in the coccyx and buttocks.

In addition to pain, unpleasant sensations of numbness, tingling, and burning may occur in these same areas. Pain and discomfort increase when sitting and decrease when standing.

There may be short delays in urination.

Upon examination, no changes in the perineal area are detected.

Diagnosis of brachial plexus plexitis

Diagnosis of the disease is quite complex, and therefore involves the use of a list of methods:

• questioning and visual examination at a medical consultation;
• neuromyography and electromyography;
• MRI and computed tomography;
• Ultrasound and radiography of joints;
• blood analysis.

The diagnosis and subsequent treatment of shoulder plexitis is carried out by a neurologist. To differentiate brachial plexitis from its other types and similar manifestations of other diseases, a traumatologist, gynecologist, urologist may be involved in the diagnosis, and radiography of the spine and ultrasound of internal organs may also be performed.

Elena Malysheva tells more about shoulder inflammation, as well as how to identify plexitis in yourself:

Preparing to visit the doctor

Many patients are confused in expressing their thoughts, feelings and sensations. Before visiting a doctor, it’s good if you write down your thoughts on paper so that you don’t miss a single important point during the appointment. And, if you couldn’t formulate it on a piece of paper and realized that you can complement the thought orally, feel free to complement it. You also need to have with you a medical card and all kinds of documents (tests, studies, recommendations from other doctors) regarding the current illness in order to eliminate it.

Diagnostics using equipment

Equipment may be required to diagnose shoulder plexopathy. Therefore, after an external examination and questioning, the doctor gives directions to the necessary procedures and diagnostic rooms, including:

• MRI examination;
• X-ray examination;
• electroneurographic examination, etc.

Treatment of brachial plexus plexitis

Treatment of this disease is usually carried out using conservative methods. First of all, it is recommended to fix the sore shoulder with a plaster splint or bandage in order to ensure its immobility.

It is necessary to treat plexopathy with medication, when the patient is prescribed a number of drugs to eliminate the symptoms of nerve inflammation:

• painkillers. Among them are Analgin, Oxadol, Aspizol, novocaine blockades;
• non-steroidal anti-inflammatory drugs based on diclofenac, indomethacin, nimesulide and others. They can be used both in the form of tablets and injections, and ointments for local impact on the source of pain;
• vitamins of group B, A, C, E in the form of Neurovitan, Milgamma, Aevit and others;
• anticholinesterase substances to improve neuromuscular transmission. Among them are Kalimin, Prozerin, Invalin;

• agents that relieve swelling - urea, Manit;
• drugs that improve tissue nutrition - Nicotinic acid, Lidaza, Nerobol, Potassium Orotate;
• medications to stimulate blood microcirculation - Complamin and Trental.

After the acute phenomena subside and during the rehabilitation period, the patient is prescribed a course of rehabilitation treatment, including physiotherapeutic methods and manual techniques:

1. Reflexology, most often acupuncture.
2. Electrophoresis, phonophoresis, UHF, cryotherapy, magnetic therapy, dynamic currents, ozokerite, balneotherapy and other treatment methods.
3. Hirudotherapy.
4. Massage and therapeutic exercises.

The chief physician, a doctor with extensive experience, Nikonov N.B. and his patient talk about emendic massage for plexitis:

Therapeutic gymnastics, when used correctly and in a timely manner, can give a good effect and speed up recovery. The exercises are performed sitting or standing and include approximately the following movements:

• abduction and dilation of the shoulder blades with straightened shoulders;
• raising and slowly lowering the shoulders;
• circular rotations in the shoulder joint with elbows bent and arms spread to the sides;
• lateral bending of the body with circular rotations in the joint forward and backward;
• flexion and extension of the arms at the elbows with the body tilted forward;
• turning the palms up and down with straight arms.

The exercises are performed slowly, 8-12 times, with a gradual increase in repetitions up to 20-25 times. It is recommended to coordinate the course of gymnastics with your doctor.

Treatment can also be surgical, by plastic surgery of the nerve, if indicated - tumors, hematomas; post-traumatic plexitis can also be treated with surgery, taking into account the presence of bone fragments in fractures, severe contractures in advanced disease.

Folk remedies

Plexitis can be treated with folk remedies together with a complex of medications and physiotherapeutic methods of treatment. Typically, recipes for rubs and ointments are used to relieve pain and swelling:

• Vaseline (¼ cup) is mixed with crushed herbs: St. John's wort, hops and clover. Rub the sore spot with this mixture 3-4 times a day;
• 0.5 cup honey is mixed with crushed aloe leaves, horseradish root, marshmallow and Adam's root. The composition is filled with 0.5 liters of vodka and infused for three days. The infusion is rubbed into the area of ​​the sore joint 3 times a day;
• Grind the angelica root and pour boiling water over it, leave the mixture for 2 hours. Rub several times a day;

• pork fat is mixed with propolis, in a ratio of 50-100 g per 3-6 g, rub the mixture on the sore hand;
• turpentine, ammonia and eggs are mixed in a ratio of 30 ml per 30 ml per 2 pcs. (pre-beat the eggs into foam), rub the affected area with this mixture before going to bed;
• crushed willow bark is poured with boiling water for 2 hours and filtered. This infusion is used for warm compresses on the joint area;
• An alcoholic infusion of mumiyo can be used as a rubbing solution.

Herbal baths and decoctions for oral administration are also considered effective folk remedies for treating plexitis at home. The list of useful herbs, in addition to those listed, includes mint, chamomile, oregano, oak bark, and currant leaves.

Plexitis caused by birth trauma must be prevented even before its manifestations. Children are prescribed exercise therapy, means to strengthen the immune system, and attention is paid to diet.

Rheumatologist, academician Evdokimenko tells how to cure shoulder pain through gymnastics and simple exercises:

Prevention

There are methods for preventing plexopathy - this is an activity with sufficient physical activity, on an ongoing basis. Exercise therapy will include exercises: raising and lowering the shoulders, rotational movements of the arms, spreading the shoulder blades. With the help of physical exercise, it is important to normalize metabolism (eat nourishingly and densely to restore the strength and growth of new cells), so the risk of disorders in the nervous system will be minimal.

But it’s better to make an appointment with a specialist to prescribe an exact course of treatment just for you.

Risk factors:

• hypothermia;
• enlarged lymph nodes or tumor formation near nerve clusters;
• scoliosis (pathological curvature of the spine);
• congenital pathologies of the spine;
• metabolic disorders (for example, diabetes);
• autoimmune diseases;
• infectious diseases.

In rare cases, lumbosacral plexitis occurs as a result of venous thrombophlebitis or inflammatory diseases of the pelvic organs, such as prostatitis, cystitis, adnexitis, etc.