Cervical plexus is a lesion of the cervical nerve plexus of infectious, traumatic, compression-ischemic, toxic, dysmetabolic genesis. The clinical picture includes pain syndrome, sensory disorders, hiccups, difficulty trying to cough or speak loudly, shallow and rapid breathing. Diagnostics is carried out using radiography, ultrasound, tomography, electrophysiological studies. The main objective of treatment is to eliminate the causal factor of plexus development and conduct restorative neuroprotective and vascular therapy.
ICD 10
G54.2 Lesions of the cervical roots, not classified elsewhere
General information
Cervical plexus is much rarer than brachial plexus and lumbosacral plexus. There are bilateral, right- and left-sided cervical plexus. In most cases, cervical plexus is secondary and requires a search for the causal pathology that caused it. The issues of diagnosis and treatment of cervical plexus lesions are the responsibility of specialists in the field of neurology, traumatology and orthopedics.
The cervical plexus is located in the thickness of the neck muscles on the side of the transverse processes of the vertebrae and is covered in front by the sternocleidomastoid muscle. It is formed by the anterior branches of the CI-CIV — upper cervical spinal nerves. The motor branches of the cervical plexus innervate the muscles of the head and neck, the muscle lifting the scapula, and partially the trapezoid muscle. The sensitive branches are responsible for sensory perception of the skin of the occiput, the auricle, the antero-lateral surface of the neck and the anterior surface of the upper chest. A mixed diaphragmatic nerve originates in the cervical plexus, innervating the diaphragm, pericardium, pleura and partially the peritoneum.
Causes
Cervical plexus due to hypothermia is quite rare. More often it has an infectious-allergic, compression-ischemic, metabolic cataract or post-traumatic character. Leading causes:
- Infections. It occurs against the background of an infectious disease (tuberculosis, brucellosis, syphilis, flu, sore throat, etc.) or as a post-vaccination complication.
- Compression. The cause is compression of the branches of the cervical plexus by a tumor process, a cervical rib or enlarged lymph nodes in cervical lymphadenitis.
- Toxic and metabolic factors. The lesion of the cervical plexus can be observed in dysmetabolic diseases (diabetes mellitus, gout) and intoxication.
- Injuries. Cervical plexus can occur with subluxations of the cervical vertebrae, fractures, bruises and other spinal injuries in the cervical region. In newborns, plexus of the cervical plexus is possible as a result of birth trauma, accompanied by stretching or compression of the branches of the plexus. Traumatic plexus can be iatrogenic in nature and occur as a result of surgical interventions on the neck.
- Degenerative diseases. Pathological changes that occur with osteochondrosis of the spine affecting the cervical region can provoke cervical plexus.
Symptoms
The main manifestations are pain syndrome and sensitivity disorders. Their localization depends on which branches of the cervical plexus are affected. Pain occurs in the antero-lateral part of the neck, supraclavicular region, occiput, auricle. When the diaphragmatic nerve is affected, they spread to the chest. Sensory disorders include paresthesia (transient tingling, a feeling of goosebumps crawling on the skin) and numbness (decreased sensitivity). If cervical plexus has arisen as a result of hypothermia, its acute manifestation with a pronounced pain syndrome is noted. With plexus of compression genesis, as a rule, there is a gradual development of symptoms.
Motor disorders are less likely to accompany cervical plexus than sensitive ones. Most often, patients complain of difficulties when trying to speak loudly or cough. With a unilateral lesion of the plexus, a muscular torticollis may be observed. The defeat of the diaphragmatic nerve is manifested by hiccups. If the lesion is bilateral, then the diaphragm turns off from the act of breathing, which provokes the appearance of rapid and more shallow breathing, shortness of breath. Intense pain syndrome, in turn, restricts the respiratory excursion of the chest and aggravates shortness of breath.
Diagnostics
Cervical plexus is diagnosed by a neurologist according to anamnesis, complaints and objective examination. In the diagnosis, an important place is given to the recognition of the cause of plexus. If there was an injury, the patient should be examined by a traumatologist. If plexus is suspected due to a tumor process, an oncologist’s consultation is required. Directions of diagnostic search:
- Diagnosis of vertebrogenic pathological processes. It is carried out using radiography of the spine in the cervical region, CT or MRI of the spine. It is possible to conduct an ultrasound of the neck.
- Exclusion of pathology of visceral organs. In case of chest pain, radiography of the thoracic cavity, CT of the mediastinum, ultrasound of the heart is prescribed.
- Neurological EPI. In order to clarify the topic of the lesion of the nervous system, electromyography of the neck muscles and electroneurography can be performed.
It is necessary to differentiate cervical plexus from the manifestations of cervical osteochondrosis, spondyloarthrosis, radicular syndrome, cervical spondylosis, neuritis, cervical myositis, cervical myelopathy.
Treatment
Therapy has two main directions: the relief of the primary disease that is the cause of plexus, and the restoration of the function of the nerve fibers of the plexus.
- Etiotropic therapy. In the infectious process, antibacterial therapy is prescribed, in case of injury — immobilization, in case of toxic plexus, detoxification is carried out, correction of metabolic disorders is carried out. In order to relieve pain and inflammation, NSAIDs (ketorolac, diclofenac, nimesulide, ibuprofen), blockade of the stair muscle are indicated. Plexus of compression-ischemic genesis may require surgical treatment with the removal of the compression factor (tumor, lymph node, hematoma, cervical rib). The operation may also be required if the branches of the plexus are completely interrupted. In such cases, according to the indications, a nerve suture or its plastic is performed.
- Pathogenetic treatment. Functional restoration of the plexus is carried out with the help of neurometabolic pharmaceuticals (vitamins B6, B and B12, galantamine) and drugs that improve blood circulation of the affected plexus (nicotinic acid, xanthinol nicotinate, pentoxifylline).
- Physical therapy. Along with pharmacotherapy, the reparative processes in the nervous tissue are promoted by physiotherapy treatment. Amplipulstherapy, diadynamic currents, UHF, hydrocortisone phonophoresis, electrophoresis on the plexus area, ozokerite applications, electromyostimulation are used. To reduce the pain syndrome, iontophoresis with novocaine, acupuncture, electroacupuncture are used.
- Rehabilitation therapy. Massage and physical therapy begin approximately 14-21 days later, after the subsiding of the island-inflammatory processes. In the late recovery period, mud treatment and hydrotherapy with hydrogen sulfide, coniferous, radon baths are shown.
Prognosis and prevention
The outcome depends mainly on the etiology of plexus and the degree of lesion of the plexus. With proper and timely treatment, the prognosis is more often favorable. The absence of such over time can lead to the formation of a muscular torticollis, complications from the respiratory system due to paresis of the diaphragm.
Prevention is aimed at preventing neck and spine injuries, especially in sports; effective therapy of infectious diseases; correction of disorders arising from dysmetabolic pathology; timely recognition and treatment of neoplasms. Prevention of birth injuries of the plexus consists in adequate obstetric care, the correct choice of the method of delivery.
