A pinched nerve in the shoulder joint is a common problem. Many people confuse it with the inflammatory process, although these are two different neurological diseases that have similar symptoms. At the same time, experts note that if treatment is not timely, pinching can lead to the development of an inflammatory process. To avoid such a complication, you need to pay attention to the first symptoms and seek qualified help from a specialist.
The nerve can become pinched when bone spurs begin to appear around the spinal disc. The discs act as some kind of “shock absorbers” between the vertebrae in the spinal column. Bone spurs are new bone formations. They begin to grow when the discs weaken significantly and wear out over time. As we age, the vertebrae become compressed and the discs become thinner. Bone spurs grow around the discs to strengthen them. However, this bone growth can put negative pressure on the nerve root in the spinal column.
Kinds
Idiopathic brachial neuritis
Idiopathic brachial neuritis is a disorder of unknown etiology with an asymmetrical arrangement of the brachial plexus. It occurs in all age groups, but is more common between the third and seventh decades. Men are more often affected than women. Intervening events occurring days or weeks before the onset were noted in 28-83% of cases in various ways. Respiratory infections, influenza-like illnesses, immunizations, surgery, and emotional stress were common symptoms, with no triggers found in half of the cases. Idiopathic brachial neuritis is more common in men who engage in vigorous athletic activities such as wrestling, weight lifting, and gymnastics.
The pathophysiology of idiopathic brachial neuritis is not fully understood, and the disease is considered an immune-mediated disorder.
Idiopathic hypertrophic brachial neuritis
This disease is uncommon and tends to gradually affect the brachial plexus. The disease continues for several months or even years, and gradually progressive weakness and wasting of the segments affected by this disease is a key, but at the same time, often ignored symptom.
This disease differs from the above-described idiopathic brachial neuritis in its painless course, although some patients may have minor pain and weakness.
Hereditary neuralgic amyotrophy
Hereditary neuralgic amyotrophy is an autosomal dominant disorder characterized by repeated episodes of paralysis and sensory impairment of the affected limb, preceded by severe pain. Hereditary neuralgic amyotrophy is genetically linked to chromosome 17q25, where mutations in the septin-9 gene have been found. Hereditary neuralgic amyotrophy is a rare disease and its worldwide prevalence is unknown.
Onset of hereditary neuralgic amyotrophy occurs at birth or later in childhood, with a good prognosis for cure. However, individuals with hereditary neuralgic amyotrophy may have permanent residual neurological deficits after repeated attacks.
Neurogenic thoracic outlet syndrome
Neurogenic thoracic outlet syndrome is characterized by pain, paresthesia, and weakness of the upper extremities, which may be aggravated by raising the arms or frequent movements of the head and neck. This is usually seen in women.
Cancer-associated brachial plexiopathy
Brachial plexus involvement is a well-known complication of cancer. Pectoral plexopathy in such cases may be caused by metastatic spread or a consequence of radiation therapy for cancer.
Traumatic form of brachial plexopathy
Trauma is one of the most common causes of brachial plexopathy. These injuries usually result from a motorcycle or high-speed traffic accident, a fall from a significant height, or an impact. This can occur with penetrating trauma and gunshot wounds. This may be the result of iatrogenic trauma. In injured patients, the consequences should be carefully assessed. Determine the extent of head, neck and shoulder injuries. With open injuries, there may be damage to large blood vessels and lungs, in which case urgent surgical intervention is necessary.
Symptoms of the most common neuritis
Facial neuritis is characterized by facial pain, loss of control over the muscles of the mouth and eyes, disturbances in facial expressions, and distortion of facial features. The patient may shed tears or suffer from dry eyes. Often, facial neuritis occurs against the background of viral infections and hypothermia.
Trigeminal neuritis is accompanied by severe paroxysmal pain at the exit points of the nerve. The sensation may intensify when washing with cool water.
Acoustic neuritis is manifested by hearing impairment and tinnitus. If the nerve connecting the brain and the vestibular apparatus is damaged, symptoms such as nausea, dizziness, and unsteady gait may appear.
1 ENMG
2 Reflexology
3 Massage
Optic neuritis (or retrobulbar neuritis ) is expressed by pain when moving the eyeball, narrowing of the field of vision, partial loss of visual acuity, disturbances in color and light perception and other disorders of visual function.
Solar plexus neuritis (or solaritis ) is characterized by severe, burning abdominal pain, tachycardia, nausea, vomiting, flatulence and loose stools, accompanied by chills and cramps. Symptoms are relieved with potent drugs (conventional anti-inflammatory drugs do not help).
Ulnar nerve neuritis is characterized by pain in the affected area and impaired motor function, which is manifested by the inability to clench all the fingers on the hand into a fist, especially the little finger. Sometimes a person has problems bending his arm.
Radial neuritis is manifested by a decrease in the ability to flex and extend the forearm and wrist, difficulty deviating the thumb, and loss of sensation in the back of the hand.
Neuritis of the sciatic nerve is manifested by weakening of the flexors and extensors of the foot, pain covering the back surfaces of the thigh and lower leg, numbness of the gluteal muscles, and decreased sensitivity in the limb. The main cause of the disease is considered to be pinched sciatic nerve.
Neuritis of the femoral nerve is characterized by difficulties with flexing the hip and straightening the leg at the knee joint, decreased sensitivity and muscle strength of the anterior surface of the thigh, etc.
1 Laboratory diagnosis of neuritis
2 X-ray
3 MRI
Causes
These nerves can be damaged by stretching, pressure, or cutting. A strain can occur when the head and neck are forced away from the shoulder, such as during a fall from a motorcycle or sometimes a car accident. In more severe cases, the nerves may become torn from the spinal cord. Pressure can occur when the brachial plexus between the collarbone and the first rib is damaged, which can occur during a fracture or dislocation. Swelling in the area from excessive bleeding or damaged soft tissue can also lead to injury.
Diagnostics
Many adult injuries will not recover on their own, and early evaluation by physicians who are experienced in treating these problems is important. Some injuries can heal over time or with quality therapy. Recovery time may be weeks or months. When the situation is unlikely to improve, several surgical techniques can be used to improve recovery.
To decide which injuries are most likely to resolve on their own, your doctor will rely on several exams of your arm and shoulder to check muscle strength and feeling in different areas. Additional tests such as MRI scans or CT/myelography may be used. A nerve conduction study/electromyogram, a test that measures electrical activity transmitted by nerves and muscles, may also be performed.
In some cases where nerve repair does not occur, tendon transfer surgery may be performed.
Physical therapy
In addition to drug therapy, patients may be prescribed physical therapy. During physical therapy, providers should focus on patient education, increasing upper extremity range of motion, strengthening exercises to maintain scapular motion, and techniques to help reduce pain. Physical therapy plays a large role in the treatment of SPT. Techniques such as TENS (transcutaneous electrical nerve stimulation) can help reduce pain.
The duration and intensity of strength exercises depend on the degree of muscle denervation, muscle weakness and the level of biomechanical impairment. The patient's premorbid functional activity level is also important. Exercises to increase range of motion play a large role in therapy and should be selected taking into account which muscles are affected. These exercises may require assistance from a physical or occupational therapist.
For obvious reasons, strength exercises are not indicated when muscles are completely denervated. Due to the lack of innervation, voluntary movements are impossible, so it is impossible to perform exercises with resistance. If denervation is only partial, your doctor may prescribe exercises to strengthen the rotator cuff, scapular stabilizers, and other muscles of the upper extremity. The choice of exercises depends on which nerve or part of the brachial plexus is affected. Resistance exercises should be tailored to the muscle's ability to work and level of pain.
The role of electrical stimulation is still controversial, but it should definitely be included in therapy for prolonged denervation, i.e. when it has lasted for more than four months. Electrical stimulation can help maintain and restore normal properties of denervated muscles (if the appropriate stimulation mode is chosen). The optimal time to start electrical stimulation is immediately after a muscle nerve injury: the longer the period between injury and treatment, the lower the degree of recovery. Electrical stimulation will not interfere with axon regeneration or muscle reinnervation. It can also indicate an increase in muscle mass and report on its quality.
Treatment
In most cases, treatment takes place on an outpatient basis, in severe situations - in a hospital. For plexopathy, anti-inflammatory therapy is carried out, painkillers, dehydrating drugs are used, and physiotherapeutic procedures are also prescribed. After the pain subsides, special exercises, massage, and a complex of vitamins are prescribed.
In more severe situations, surgical treatment is prescribed to eliminate the compression and restore the functionality of the plexus branches.
Treatment process at the Innovation Center
Our Innovative Clinic has created excellent conditions for the diagnosis and treatment of pain in the shoulder joints of various types and origins. After finding out the causes of the pathology, the doctor will select tactics and methods of treatment. We practice using the following techniques:
- Acupuncture.
- Manual therapy.
- Kinesitherapy.
- Osteopathy.
- Massotherapy.
- Physiotherapy.
We achieve excellent results using shock wave therapy and Hiwamat therapy. The course of treatment is carried out under the supervision of a doctor, whose efforts are aimed not only at relieving unpleasant symptoms, but also at eliminating the cause of discomfort. The professionalism of our specialists and an individual approach will help you completely get rid of the problem, and if this is not possible, then avoid complications and achieve stable remission. This is confirmed by a large number of reviews about the work of our center and doctors both on our website in the Reviews section and on other sites on the Internet.