Plexitis of the shoulder joint: symptoms, treatment

General information

Plexitis is a pathological condition of the branches of the nerve plexus, which has a nonspecific inflammatory nature. The disease can affect different nerve plexuses, depending on which plexitis of the cervical, brachial, and lumbosacral plexuses is diagnosed. In addition, plexitis includes solaritis - damage to the solar plexus.
The code for MBK-10 is G54 (damage to the nerve roots and plexuses G54). Unilateral lesions develop more often; bilateral lesions are less common. The bilateral form is more difficult to treat, since longer rehabilitation is required and the patient feels worse, suffering from weakness and severe pain. The disease most often affects people of working age – from 20 to 60 years. This disease is often confused with neuralgia . However, the main difference is that with plexitis, the nerve plexus and its parts become inflamed, and with neuralgia, the tissues surrounding the nerve become inflamed.

As a rule, brachial plexopathy is a secondary or concomitant pathology. How exactly the disease manifests itself, why it develops and how to treat it will be discussed in this article.

Hereditary and idiopathic polyneuropathy (code G60)

Hereditary polyneuropathy is an autosomal dominant disease with systemic damage to the nervous system and varied symptoms. At the onset of the disease, patients experience fasciculations (visible contractions of one or more muscles) and spasms in the muscles of the legs. Next, atrophy and weakness develop in the muscles of the feet and legs, a “hollow” foot and peroneal muscular atrophy are formed, the legs resemble the limbs of a stork.”

Later, movement disorders in the upper extremities develop and increase, and difficulties arise in performing small and routine movements. Achilles reflexes are lost. The preservation of other groups of reflexes varies. Vibration, tactile, pain and muscle-joint sensitivity decreases. In some patients, neurologists determine thickening of individual peripheral nerves.

The following types of hereditary neuropathies are distinguished:

sensory radiculopathy with disorders of the functions of peripheral nerves and spinal ganglia;
atactic chronic polyneuropathy - Refsum's disease.
Bassen-Kornzweig disease is a hereditary acanthocytotic polyneuropathy caused by a genetic defect in lipoprotein metabolism;
Guillain–Barré syndrome – unites a group of acute autoimmune polyradiculoneuropathies;
Lhermitte syndrome, or serum polyneuropathy, develops as a complication of serum administration.

Neuropathologists also diagnose other inflammatory polyneuropathies that develop from insect bites, after administration of anti-rabies serum, rheumatism, systemic lupus erythematosus, periarteritis nodosa, as well as neuroallergic and collagenoses.

Pathogenesis

When plexitis develops, the patient experiences partial or complete damage to the nerve plexus. If the damage is partial, individual trunks, bundles and branches of nerves are injured. Complete damage to nerve tissue is rare.

The mechanism of origin of the disease may be different. Nerve elements can become damaged if they are compressed by a tumor or damaged vertebra. This is also possible with tumor growth, sometimes with disc displacement, as well as with epidural and intradural processes.

With the development of plexitis, toxic, vascular and metabolic changes are noted. Depending on the location of the lesion, the functions of different muscle groups may be impaired.

If the C5 and C6 roots are damaged, Erb's syndrome , manifested by paralysis of the deltoid muscle. In this state, a person is unable to move his hand away. There is also paralysis of the biceps brachii and supinator muscles, as a result of which the forearm does not bend. Paralysis of the supraspinatus and infraspinatus muscles also occurs.
If the roots C8 and D1 are damaged, Dejerine-Klumpke syndrome , which is characterized by paralysis of the hand.
If the roots are separated from the spinal cord, Horner's syndrome .
In case of large-scale damage to the plexus of nerves, paralysis of the muscles of half the shoulder and arm occurs. As a result, these areas lose sensitivity.
Also, a variant of the development of brachial plexopathy may be neuralgic amyotrophy with severe pain in the shoulder. Over time, it progresses to severe paralysis of the proximal parts of the arm of the atrophic type. This disease is believed to be of autoimmune origin.

The disease develops in stages:

At the first stage (neurological), spontaneous pain develops, as well as pain that intensifies with pressure and movement.
At the second stage (paralytic), flaccid paralysis and paresis . Vegetative-trophic disorders are also noted in the area that is innervated by the affected part of the plexus.

Consequences of plexitis

Even with proper treatment, incomplete recovery is possible. Sometimes irreversible persistent paresis, joint contractures, and muscle atrophy remain.

Without treatment, the prognosis is poor; plexopathy can cause serious complications:

thinning of muscle fibers and a decrease in their total volume;
loss of sensitivity in the affected part of the body;
paresis in the limbs.

There are known cases of paralysis of the affected part of the body, which leads to disability of the patient.

Classification

Brachial plexus plexopathy is classified into different types based on different characteristics.

Taking into account the localization of the affected nerve plexus, the following forms of the disease are distinguished:

Cervical plexitis - with this pathology, the patient is bothered by pain in the back of the head. If the disease develops, in its later stages paresis or paralysis of the cervical muscles is possible. Hiccups may develop due to irritation of the phrenic nerve.
Shoulder – pain in the collarbone area is bothersome. The pain radiates to the arm, and there is a violation of skin sensitivity. The muscle strength of the arm and shoulder girdle decreases, and reflexes also decrease. The hand on the affected side turns blue, and the palms often sweat.
Lumbosacral - with this form of the disease, all of the listed symptoms develop in the lower extremities. Over time, paresis and paralysis of individual muscle groups and trophic disorders are observed.

According to the prevalence of the process, they are distinguished:

Total – the entire plexus is affected, including branches and nodes.
Partial - individual trunks or branches are affected.

Also distinguished:

Unilateral lesion (right-sided or left-sided).
Bilateral defeat.

There are several types of plexitis depending on the factors that provoke the disease:

Traumatic - manifests itself as a result of injuries received from sprains, fractures, dislocations. This type also includes plexitis, which manifests itself in a newborn due to difficult passage through the birth canal during pathological childbirth. This type of disease can also develop after exposure to provoking occupational factors.
Infectious - develops as a result of exposure to infections on the nerve fiber - herpes , influenza , tuberculosis , cytomegaloviruses .
Toxic – a consequence of poisoning with low-quality alcohol, heavy metals, mercury salts.
Infectious-allergic – is a reaction to vaccination.
Dysmetabolic – develops with endocrine disorders ( diabetes mellitus , gout , thyroid diseases).
Compression-ischemic – a consequence of compression of the neurovascular bundle, when the shoulder remains in a non-physiological position for a long time. This is possible if the hand is improperly immobilized after an injury, in a state of anesthesia after surgery, etc. In addition, the nerves can be compressed by a tumor of the joint and periarticular area, hematoma , enlarged lymph nodes. This type of plexitis can also develop in people with poor posture.

How does plexopathy manifest itself in symptoms in adults?

There are several types of plexopathy due to the nature of the lesion in a certain area of the nerve plexuses. Let's consider the types of disease:

traumatic;
compression due to neoplasms: tumors, hernias, protrusions, etc.

Examples:

Plexopathy in the sacrum and lumbar region often occurs against the background of decreased function processes in the intervertebral discs due to hernias or protrusions.
Neck plexopathy affects the nerve plexuses near the back of the skull that control a group of muscles.
Brachial plexus plexopathy is common due to the position of the nerve ganglion - which is located in a place where there is a high risk of injury. In patients who consult a doctor, brachial plexopathy is diagnosed as post-traumatic.

Causes

Plexopathy has a neurological origin. Its development is determined by the following factors:

Mechanical injuries, wounds, sudden pulling out of an arm or leg. Post-traumatic destruction of nerve fibers is the most common cause of plexitis. Neuronal clusters can be damaged by a fracture of the clavicle bone, sprain, dislocation of the joint area, a strong blow to the shoulder, rupture of ligaments, or penetrating wounds. Pathology can also develop with constant minor injuries - for example, with constant use of crutches or working with certain tools.
Birth injuries.
Compression by neoplasms - tumors, hematomas, aneurysms , etc. In bedridden patients, the cause of the disease may be a prolonged stay of the limb in an uncomfortable position.
Poisoning with various toxins .
The influence of infection in the development of infectious diseases ( herpes , tuberculosis , syphilis ).
Metabolic disorders due to diabetes and other endocrine disorders.
Autoimmune disorders.
Diseases of the cervical spine. Due to protrusion , displacement of the vertebrae or intervertebral herniation of the cervical discs, compression of the roots and an inflammatory reaction occur. Osteochondrosis can also lead to plexitis .
Hypothermia, too much physical exertion.
Hyperabduction syndrome is a pinched nerve bundle during sudden abduction of the shoulder joint.
Costoclavicular syndrome is the formation of additional cervical ribs.

Basic principles of therapy

In case of acute polyneuropathy, patients are hospitalized in a neurology clinic, where the necessary conditions for their treatment have been created. For subacute and chronic forms, long-term outpatient treatment is carried out. Prescribe drugs to treat the underlying disease, eliminate the causative factor in case of intoxication and drug-induced polyneuropathies. In case of demyelination and axonopathy, preference is given to vitamin therapy, antioxidants and vasoactive drugs.

Rehabilitation specialists provide hardware and non-hardware physiotherapy using modern techniques. Patients are advised to avoid exposure to extreme temperatures, heavy physical activity, and contact with chemical and industrial poisons. If you have signs of polyneuropathy of the lower extremities, you can consult a neurologist by making an appointment by calling the Yusupov Hospital.

Symptoms of shoulder plexitis

Initially, plexitis of the shoulder joint manifests itself as severe pain in the affected area. Pain is transmitted from the center of the plexus to the peripheral zones. It arises spontaneously, its character is shooting, cutting. Sometimes the pain is so severe that a person cannot find a place to rest. There may also be pain in the affected limb. With strength loads, the pain intensifies. It also becomes stronger when the patient tries to turn, lift the arm or bend it at the joints.

Shoulder plexitis

This condition is characterized by muscle weakness. As the disease progresses, the person may have difficulty with gross motor skills (lifting heavy objects) as well as fine motor skills. Partial or complete paralysis of the limb may develop.

As the disease progresses, trophic manifestations are noted:

The skin in the affected area becomes discolored.
The epidermis becomes discolored, a vascular network appears on the surface of the skin, and its elasticity decreases.
Sweating increases or sweat disappears completely.
Brittle nails or hardening of the nail plates.
Since the skin loses its elasticity, it becomes injured very easily, and injuries take a long time to heal.

Symptoms of the disease largely depend on the cause that provoked the disease, as well as on the stage of the disease.

At the neurological stage, spontaneously occurring pain, lethargy or muscle tension in the affected areas are disturbing.

At the paralytic stage, paresis and paralysis develop in the area that is innervated by the branches of the affected plexus.

Symptoms of solarium

With solarium, the nerve endings in the solar plexus are damaged. The main symptom of this pathology is pain. Solaritis, which occurs as a result of injuries and infectious diseases, causes pain in the abdominal area. Pain appears between the navel and the xiphoid process. They are cramping and are not associated with food intake.

With solarium, other symptoms appear, which depend on the type of disease.

If irritation , cramps in the intestines, bloating , tachycardia , constipation , and increased blood pressure are observed.
If inflammation , pain, vomiting, nausea, diarrhea , decreased blood pressure are noted, and the amount of urine decreases.

Plexitis disease: treatment

Treatment methods depend on the stage and nature of the disease.

If plexopathy occurs after an injury, surgical intervention is required, the purpose of which is to eliminate the cause of compression of the nerve trunks. If the disease is infectious, the use of antibiotics is required.

For any type of plexitis, drug treatment is carried out to improve neuromuscular transmission and metabolic processes in muscle tissue and neuromuscular synapses. For this purpose, Neostigmine, Galantamine, angiotensin-converting enzyme are used. B vitamins are recommended for patients because they have neurometabolic effects.

To eliminate inflammation and pain, anti-inflammatory drugs are prescribed (Diclofenac, Ketorolac, Meloxicam, Ibuprofen). In cases of severe pain, therapeutic blockades are performed.

To improve microcirculation in the affected muscles and plexus tissues, vascular drugs are used, for example, xanthinol nicotinate or pentoxifylline.

Physiotherapeutic procedures have a good effect: massages, phonophoresis, electrophoresis, UHF, acupuncture, radon and hydrogen sulfide baths, ozokerite therapy, mud therapy, amplipulse therapy, etc.

Tests and diagnostics

To confirm the diagnosis, the specialist initially studies the patient’s medical history, conducts an examination and interview. In the diagnostic process, it is important to distinguish plexitis from similar diseases, in particular neuralgia .

During diagnostics, the following studies may be carried out:

Ultrasound examination of the affected area.
Electroneurography - to evaluate the impulse that passes along the nerve fibers.
X-ray of limbs, lungs.
Laboratory blood test.
CT and MRI - allow you to get the most accurate results.

Treatment with folk remedies

Folk remedies for the treatment of brachial plexitis can be used as auxiliaries in the process of main treatment. However, they should never replace drug therapy. Before using any of the methods, you should initially check with your doctor.

As a rule, traditional medicine suggests using ointments, compresses and rubbing.

Vodka-based infusion . 100 g of honey should be mixed with crushed horseradish root, aloe leaf, 20 g of marshmallow and Adam's root. Mix everything, pour in 500 ml of vodka and leave for three days. Rub the resulting infusion into the affected area three times a day.
Angelica root . It must be crushed and poured with a small amount of boiling water. Leave for 2 hours. Rub the resulting product into the affected area several times a day.
Willow bark . It must be crushed, pour boiling water and stand for 2 hours. After straining, use the infusion warm for warming compresses.
Propolis with fat . Mix 3 g of propolis and 50 g of pork fat, mix and use to rub the affected areas.
Alcohol infusion of mumiyo . It is used for rubbing.
Herbal baths . To prepare them, use a decoction of mint, chamomile, oak bark, oregano, etc.
Herbal teas . They are useful as general strengthening agents. They are prepared from chamomile, lemon balm, mint, rose hips, viburnum, etc.

Methods complementary to drug treatment

After the acute inflammatory process has passed, you can use massage, in combination with physiotherapy: electrophoresis, ultrasound, ozokerite, magnetic therapy. Constant therapeutic exercises will help consolidate the results. Balneotherapy, reflexology, laser therapy, cryotherapy will help stimulate nervous activity and relax muscles where necessary.

If pharmacological drugs in combination with additional treatment measures do not produce the desired results, surgical treatment methods will have to be used. In such cases, a neurosurgical operation will be performed, which helps restore the integrity of the nerve chain or relieve pressure on the nervous system.

Home remedies

For example, the use of traditional methods of treatment is allowed for shoulder plexopathy, but after consultation with the doctor and as an additional measure to the main therapy. The following are considered effective means at hand:

Ointments using propolis. You need to melt 15 g of animal fat in a water bath, then add 1 g of propolis. Stir until smooth and leave to cool. Use for external use with massage in the sore area 2-3 times a day; Bath with mint. Pour 1 liter into a kettle, then add 5-7 tablespoons of mint leaves, leave for 3 minutes, then pour into a warm bath. Take a bath for up to 30 minutes.

Prevention

To prevent the development of plexopathy, you should adhere to the following preventive measures:

It is important to avoid situations that could potentially lead to injury.
Proper management of patients during childbirth is necessary to avoid injury to the baby. In this context, it is important for doctors to make the right decision about the mode of delivery.
It is important to promptly treat all infectious diseases, as well as chronic diseases.
It is necessary to prevent disruption of metabolic processes.
At the first unpleasant manifestations, you should consult a doctor without self-medicating.
It is recommended to exercise regularly, especially swimming.
Equally important is a balanced diet with sufficient vitamins and minerals.
Prevention measures are special for those people who constantly use crutches. The brachial plexus suffers from loading the upper part of the crutch on the axillary region. Therefore, it is very important to choose the right crutches and use them in such a way as to prevent too strong and prolonged load.

In children

According to statistics, birth plexitis is diagnosed in an average of two children per thousand newborns. The reason for the development of this pathology is problems during childbirth . They are often associated with abnormal fetal position. Injury occurs due to excessive stretching of the nerves, their pressing against bone formations. If the brachial plexus is stretched too much, small vessels rupture and hematomas form within the nerve sheaths. Hematoma and the subsequent formation of adhesions and scars lead to compression of the nerve. The result may be paralysis of the upper limb.

It is very important that such pathology is identified in a timely manner, since delayed treatment can lead to the development of severe disorders. In newborns, brachial plexus injury is determined by the passive position of the arm. During the treatment, bandages and a plastic splint are used to properly fix the arm. Other treatment methods are also used.

If conservative methods do not give the desired results, surgical intervention is performed at an older age of the baby.

List of sources

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Wayne A.M. Diseases of the autonomic nervous system: a guide for doctors. - M.: Medicine, 1991. - 432 p.
Karlov V. A. Therapy of nervous diseases. M., 1996.
Plexit. Brief medical encyclopedia / Ch. editor B.V. Petrovsky. - M.: Soviet Encyclopedia, 1989.