Neck-shoulder syndrome

Neck-shoulder syndrome - a set of symptoms, developing at defeat cervical roots and brachial plexus and characterized by pain of varying intensity, by paresthesia, muscle weakness, a change of color of the skin (pallor, cyanosis) in the area of the upper arm, hand.
The origin of the neck-shoulder syndrome can be caused by degenerative-dystrophic changes in the cervical spine, tumors of the vertebrae or neck injuries (broken collarbone and first of ribs with the displacement of bone fragments and other pathological factors.
The progressive development of osteochondrosis of the cervical spine is most common after the age of 40 and is accompanied by deformation of vertebral bodies and formation of bone growths (osteophytes) and intervertebral hernias. Pain syndrome in the form of an unquenchable sharp, aching, boring, pulling pain occurs when physical overloads of the cervical spine after a previous infection and other Pain of the cervical spine iradionet in the girdle, the forearm and hand. Palpation paravertebral points of the cervical spine painful. On radiographs are defined by different severity of the signs of osteochondrosis, spondylosis.
To congenital factors, causing compression of the brachial plexus, is cervical incremental edge or fibrous degeneration with a shift toward the front from the insertion middle scalenus. Clinically this anomaly is manifested by pain on the inner surface of the shoulder, in the whole hand. Pain can be firing dull, burning. They appear and grow by the end of the working day. Pain depend on the pose. Lifting and supporting the elbow, the tilt of the head, the affected side lead to pain. Pain combined with hyperesthesia, paresthesia or anesthesias in hand (see Sensitivity). Marked decrease of power in his hand, atrophy of the muscles of the hand and forearm, vegetative disorders.
The cause of occurrences neck-shoulder syndrome can be benign or malignant tumors. Benign tumors of the trunks of the brachial plexus, as a rule, are neuromas. Dimensions neurinomas brachial plexus can be from a few millimeters to 5-10 see
When localizations them above the clavicle they are usually small. If placed below the clavicle neurinomas reach large sizes and are easily accessible palpation.
Malignant tumors that appear next to the brachial plexus, you can proceed on its tissues, causing an unquenchable pain along the nerve trunks and loss of motor and sensory functions of the hands.
Patients with neck-shoulder syndrome should be addressed as a medical assistant in neurological hospital for examination.
Treatment. For acute pain is necessary to provide first aid, namely: to reduce the tension of the roots of the cervical spinal cord hand in the bent elbow joint is fixed on the headscarf, prescribe painkillers (analgin, amidopyrine). In conditions of neurological hospital in spinal osteochondrosis sometimes spend traction, physiotherapy. In case of compression of the brachial plexus and vessels in case of the failure of the conservative treatment shown surgery (removal of intervertebral hernias, incremental, ribs, cut hypertrophied scalenus, elimination of shift fragments collarbone, ribs, removal of the tumor).

Neck-shoulder syndrome - a group of syndromes characterized by pain varying degrees, extending from the neck or shoulder girdle in the upper limb. Pain in the neck and shoulder region occur in about 10% of patients with diseases of peripheral nerves.
The most common cause of pain in the neck and shoulder region is involving in pathological process of nervous structures of the neck as the result of degenerative changes in the cervical spine. Much less similar symptoms may be accompanied by tumors of the cervical spinal cord or spinal root, tumors or neck vertebrae, as well as some of the anomalies of the cervical area.
In degenerative-dystrophic lesions of the spine compression of the roots occurs because the change of standard correlation between the vertebrae, decreases the diameter of intervertebral holes can be formed back hernia of intervertebral disks; the latter at the side and mid-side localization lead to compression of the roots in the spinal canal. Progressive course of degenerative disc disease is accompanied by deformation of vertebral bodies and formation of bone growths - osteophytes that can grow ventral lateral, in a lumen of an intervertebral holes and dorsal into the spinal canal.
Along with the changes of intervertebral disc and bone machine develop degenerative and reactive changes in ligaments and soft tissues of the spine - fibrosis occurs yellow ligament and sheaths roots, seal epidural fat, venous stasis, impaired circulation of cerebrospinal fluid and lymph, there are changes in the membranes of the spinal cord.
Changes of the spine are the cause of irritation or compression not only of spinal roots, but also the vertebral artery and nerve border cervical sympathetic trunk and the spinal cord itself. Most often affected the most mobile niinesalu the spine (C,V-CVII).
The disease usually develops after the age of 40 years; persons who have undergone the trauma of the cervical spine, or operating in unfavourable conditions, can develop at an earlier age. Disease can contribute to overload the cervical spine, awkward movements of the head and neck, sharp fluctuations of temperature. Women get sick more often than men. The first symptoms of the disease in women is often coincides with the menstrual cycle.
Pain syndrome in the form of hard, aching, boring, pulling pain of varying intensity occurs after exercise, after a previous infection, and sometimes for no apparent external causes. Pain localized in nigricana spine, iradionet in shoulder girdle, shoulder, forearm and wrist. They may be accompanied by pain in the neck, interscapular region, in the chest; with left-sided localization syndrome sometimes, the pain in the heart area, reminiscent of angina.
The head of the patient and cervical spine are usually fixed. His head was slightly tilted forward, and sometimes to the side. Tilt the head back painful. Movement in the neck can be accompanied by a crunch. Painful to palpation spinous processes and egotistic gaps in the cervical spine. Pain is usually spread in a top-down type - from the neck to the periphery. Typical are the so-called dorsolateral painful field, exciting back-the outer surface of the upper arm and shoulder. Typical point, pressure which causes pain: between the transverse processes of the CIII-ThI on the leading edge of the trapezius muscle, subclavian hole at the level of the coracoid process, between acromial process and a large bump shoulder. The load on the axis of the spine at an inclination of the head towards the defeat of the causes of pain in his hand. In severe cases of the disease, associated with a sharp physical overexertion, one can observe a strong contractions of the muscles of the neck and shoulder area.
From the area of the upper arm and shoulder pain in approximately half of patients apply to the forearm and hand. Here, more Than in the proximal observed paresthesias. In case of dissemination of radicular disorders on the distal limbs clinically quite possible to clearly establish the level of destruction and struck root.
When a disc herniation or osteophytes at the level of CIV-CV affected spine CV. This pain from neck and shoulder area spread on the outer surface of the Forearm on the rear I finger. Also in this area can be identified and discomfort. Defeat CV spine accompanied decline or loss of reflex with biceps muscle shoulder, reduced power flexor tendons of the forearm.
In pathology at the level of intervertebral disk C,V-CVI suffers mainly spine CVI. Pain spread on the dorsal surface of the forearm and move on to the rear of the II, III and IV fingers, reduced power triceps shoulder, reduced or falls reflex with her.
Root CVII affected with involvement in the degenerative process of the intervertebral disk CVI-CVII. Pain and discomfort are localized on ulnar surface of a brush and V finger. Discomfort in the affected areas roots are not rude, often identified areas gipestesia with areas of hyperpathia. Motor disorders develop later sensitive and rarely reach the degree of paralysis.
Monoarticular picture of neurological disorders are found only in 1/3 of the patients. The remaining patients revealed the defeat of two or even three roots at the same time. Meet and bilateral forms of lesions with radicular pain.
Neck-shoulder syndrome can occur acutely, to wear remitting nature, compounded after exposure to various pathogenic factors, or to take a chronic form of flow. The intensity of pain syndrome can be different. The character of the pain is largely determined by the degree of participation of the vegetative nervous system. When their involvement in pain take a particularly painful character, an area that is becoming more common.
Along with compression radicular disorders Ya. Yu. Popeljanskij offers a select group reflex neurodystrophic neck-shoulder syndrome, to which he refers humeroscapular periarthritis, syndrome front scalenus, epikondilit, neck "lumbago".
Humeroscapular periarthritis characterized by an acute pain in the shoulder joint, sharp restriction of movement in it. In the area of innervation cutaneous branches axillary nerve detected hyperesthesia. Pain can irrationality in the neck, elbow, fingers. In the process usually involves the periarticular tissue: swell wall mucous bags, tendons, they are deposited salts lime.
Developing with cervical osteochondrosis reflex spasm front scalenus (scalenus syndrome, the syndrome of Naffziger) leads to the compression of the neurovascular bundle, which is manifested by pain in the forearm and elbow of the hand. Brush becomes cold, cyanotic. The role of the extension of edges in the appearance of scalenus syndrome most authors rejected, as it occurs with equal frequency in the absence them.
With scalenus syndrome similar mechanism syndrome Wright. It is characterized by pain in the chest muscles with preferred radiation of pain in the shoulder, blanching of the brush. When allocating a shoulder you can watch the disappearance of the pulse at the radial artery. The mechanism of this syndrome is described as an independent disease, is the compression of the neurovascular bundle small pectoral muscle; as you remove shoulder he pressed to the coracoid process of the scapula. The syndrome occurs when conducive to the development of the variants of the structure of subclavian region. Occurs after a dramatic and unusual movements of the shoulder joint.
Only rarely pain in the hand are caused by an abnormality of large vessels supplying blood to the upper limb syndrome Pejeta - Strattera). There may be a picture of arterial insufficiency with a pale hand and the weakening of the pulse on a radial artery or more often venous insufficiency accompanied by swelling of the hands.
Almost most often have to meet with neck and shoulder pain caused cervical osteochondrosis. In these cases, the diagnosis is based on medical history, the typical character of the pain syndrome, data neurological examination and x-ray of the cervical spine. Radiography is usually revealed varying degrees of osteochondrosis, spondylosis amid the disruption of statics. X-rays produced in the back, side and oblique (3/4) projections, can detect the straightening of cervical lordosis or kyphosis some segment, reducing the height of the disk, the violation of the configuration of the vertebral bodies, the narrowing of intervertebral holes, rear osteophytes of the vertebral bodies. The severity of clinical symptoms are not always corresponds to the degree x-ray changes of the spine.
In most cases, the diagnosis typical neck-shoulder syndrome is straightforward.


Treatment, especially for acute pain, is best done in a hospital.
When neck-shoulder syndrome caused cervical osteochondrosis, in the complex of therapeutic measures include the unloading of the cervical spine, which is achieved by imposing a cardboard-cotton-gauze (type Trench) bandages, special plastic retainers or neck corsets. It is recommended that careful traction of the cervical spine, which can be performed manually or using a loop Glisson with a cargo of 2 to 6 kg 2 times a day for 10-15 minutes
In acute radicular pain effectively introduce the novocaine in front staircase muscle (1% solution - 5-10 ml). Vegetative component of pain, especially when humeroscapular periarthritis, significantly decreases or stops after procaine blockades starry host Yes the affected side.
To reduce the tension roots hand, it is expedient to focus on the headscarf. When all pain syndromes shows the use of analgesics (amidopirina, analgin and others), with a sharp pain in a few days is permissible to use drugs in combination with desencibilizirutee drugs (diphenhydramine, bellaid, the b-complex vitamins).
When neck-shoulder syndrome (with the exception is caused by tumors) designate physiotherapy - diadynamic therapy, ultrasound on the cervical area, electrophoresis with novocaine, dikain, chlorine. The use of thermal procedures on the neck with osteochondrosis leads to the exacerbation of pain.
Conservative complex treatment in most cases is effectively. But pain and limitation of ability to work can sometimes last for 2-3 months. When low efficiency of conservative treatment of a course of therapy (analgesic dose) on the cervical spine with front and outer rear-external fields.
The complete failure of conservative treatment with continued persistent pain radicular-vegetative syndrome in the result of those cervical osteochondrosis gives reason to turn to surgical treatment.
Patients with neck-shoulder syndrome, perform the following operations: foraminotomy decompression with roots, remove the disc after hemilaminectomy or a laminectomy, anterior cervical fusion of the affected segment of the spine, or combine some of these interventions.