Neuritis is an inflammatory disease of the peripheral nerve (intercostal, occipital, facial or limb nerves), manifested by pain along the nerve, impaired sensitivity and muscle weakness in the area innervated by it. The lesion of several nerves is called polyneuritis.The diagnosis of neuritis is carried out by a neurologist during the examination and carrying out specific functional tests. Additionally, electromyography, electroneurography and VP examination are carried out. Treatment of neuritis includes etiotropic therapy (antibiotics, antiviral, vascular drugs), the use of anti-inflammatory and decongestants, neostigmine therapy, physiotherapy, massage and exercise therapy.
Causes
Neuritis can occur as a result of hypothermia, infections (measles, herpes, influenza, diphtheria, malaria, brucellosis), injuries, vascular disorders, hypovitaminosis. Exogenous (arsenic, lead, mercury, alcohol) and endogenous (thyrotoxicosis, diabetes mellitus) intoxication can also lead to the development of neuritis. Most often, peripheral nerves are affected in the musculoskeletal channels and the anatomical narrowness of such a channel can predispose to the occurrence of neuritis and the development of tunnel syndrome. Quite often, neuritis occurs as a result of compression of the trunk of the peripheral nerve. This can happen in a dream, when working in an uncomfortable position, during surgery, etc. So people who move for a long time with the help of crutches may have neuritis of the axillary nerve, squatting for a long time – fibular nerve neuritis, constantly flexing and unbending the hand (pianists, cellists) — neuritis of the median nerve. Compression of the peripheral nerve root may occur at the site of its exit from the spine, which is observed with herniated intervertebral discs, osteochondrosis.
Symptoms
The clinical picture of neuritis is determined by the functions of the nerve, the degree of its damage and the area of innervation. Most peripheral nerves consist of nerve fibers of different types: sensory, motor and vegetative. The defeat of fibers of each type gives the following symptoms characteristic of any neuritis:
- sensitivity disorders — numbness, paresthesia (tingling sensation, “crawling goosebumps”), decreased or loss of sensitivity in the innervation zone;
- violation of active movements — complete (paralysis) or partial (paresis) reduction of strength in innervated muscles, development of their atrophy, reduction or loss of tendon reflexes;
- vegetative and trophic disorders — swelling, cyanosis of the skin, local hair loss and depigmentation, sweating, thinning and dry skin, brittle nails, the appearance of trophic ulcers, etc.
As a rule, the first manifestations of nerve damage are pain and numbness. In the clinical picture of some neuritis, there may be specific manifestations associated with the area innervated by this nerve.
Neuritis of the axillary nerve is manifested by the inability to raise the arm to the side, a decrease in sensitivity in the upper 1/3 of the shoulder, atrophy of the deltoid muscle of the shoulder and increased mobility of the shoulder joint.
Neuritis of the radial nerve can have different symptoms, depending on the location of the lesion. Thus, the process at the level of the upper 1/3 of the shoulder or in the axillary fossa is characterized by the impossibility of extending the hand and forearm and withdrawing the thumb, difficulty in bending the arm at the elbow joint, paresthesia and a decrease in skin sensitivity of the I, II and partially III fingers. With the arms extended forward on the side of the lesion, the hand hangs down, the thumb is brought to the index finger and the patient cannot turn this hand palm up. Neurological examination reveals the absence of the extensor elbow reflex and a decrease in the carporadial. When the inflammation is localized in the middle 1/3 of the shoulder, the extension of the forearm and the extensor elbow reflex are not violated. If neuritis develops in the lower 1/3 of the shoulder or upper part of the forearm, it is impossible to extend the hand and fingers, sensitivity suffers only on the back of the hand.
Neuritis of the ulnar nerve is manifested by paresthesia and decreased sensitivity on the palmar surface of the hand in the area of half of the IV and fully V fingers, on the back of the hand — in the area of half of the III and completely IV-V fingers. Muscle weakness is characteristic in the adductor and abductor muscles of the IV-V fingers, hypotrophy and atrophy of the muscles of the elevation of the little finger and thumb, interosseous and worm-like muscles of the hand. Due to muscular atrophy, the palm looks flattened. The hand with ulnar neuritis is similar to a “clawed paw”: the middle phalanges of the fingers are bent, and the main ones are unbent. There are several anatomical sites of the ulnar nerve in which neuritis may develop according to the type of tunnel syndrome (compression or ischemia of the nerve in the musculoskeletal canal).
Neuritis of the median nerve begins with intense pain on the inner surface of the forearm and in the fingers of the hand. Sensitivity is impaired on the half of the palm corresponding to the I-III fingers, on the palmar surface of the I-III and half of the IV fingers, on the back surface of the terminal phalanges of the II-IV fingers. The patient cannot turn the hand palm down, bend the wrist in the wrist joint, bend the I-III fingers. With neuritis of the median nerve, muscular atrophy of the elevation of the thumb is pronounced, the finger itself becomes in the same plane with the rest of the fingers of the hand and the hand becomes like a “monkey paw”.
Carpal tunnel syndrome is compression of the median nerve in the carpal canal and the development of neuritis by the type of tunnel syndrome. The disease begins with periodic numbness of the I-III fingers, then paresthesia appears and the numbness takes on a permanent character. Patients note pain in the I-III fingers and the corresponding part of the palm, passing after movements with the brush. The pain occurs more often at night, it can spread to the forearm and reach the elbow joint. The temperature and pain sensitivity of the I-III fingers is moderately reduced, atrophy of the elevation of the thumb is not always observed. There is a weakness in the opposition of the thumb and the occurrence of paresthesia when tapping in the carpal canal area. A characteristic sign of Phalaena is an increase in paresthesia with a two-minute flexion of the hand.
Lumbosacral plexopathy (plexitis) is manifested by weakness of the pelvic and lower extremity muscles, decreased sensitivity of the legs and loss of tendon reflexes on the legs (knee, Achilles). Characterized by pain in the legs, hip joints and lower back. When the lumbar plexus is affected to a greater extent, neuritis of the femoral and occlusive nerves comes to the fore, as well as damage to the lateral cutaneous nerve of the thigh. Pathology of the sacral plexus is manifested by neuritis of the sciatic nerve.
Sciatic nerve neuritis is characterized by dull or shooting pains in the buttock, spreading along the posterior surface of the thigh and lower leg. The sensitivity of the foot and lower leg is reduced, there is hypotension of the gluteal and calf muscles, a decrease in the Achilles reflex. Sciatic nerve neuritis is characterized by symptoms of nerve tension: the occurrence or intensification of pain when stretching the nerve while lifting a straight leg in a supine position (Lasega symptom) or when squatting. There is soreness at the exit point of the sciatic nerve on the buttock.
Neuritis of the femoral nerve is manifested by difficulty in extending the leg in the knee joint and hip flexion, decreased sensitivity in the lower 2/3 of the anterior surface of the thigh and throughout the anterior-inner surface of the lower leg, atrophy of the muscles of the anterior surface of the thigh and loss of the knee reflex. It is characterized by soreness when pressing under the inguinal ligament at the point of nerve exit to the thigh.
Complications
As a result of neuritis, persistent movement disorders may develop in the form of paresis or paralysis. Violations of muscle innervation in neuritis can lead to their atrophy and the appearance of contractures as a result of the replacement of muscle tissue with connective tissue.
Diagnostics
If neuritis is suspected during the examination, the neurologist conducts functional tests aimed at identifying motor disorders.
Tests confirming neuritis of the radial nerve:
- the patient’s hands lie with their palms on the table and he cannot put his third finger on the neighboring ones;
- the patient’s hands are lying back on the table and he can’t take his thumb away;
- attempts to separate the fingers of the hands pressed against each other lead to the fact that on the side of the neuritis there is a flexion of the fingers and they slide along the palm of the healthy hand;
- the patient stands with his arms lowered along the trunk, in this position he cannot turn the affected hand palm forward and pull the thumb away.
Tests confirming ulnar nerve neuritis:
- the brush is pressed with the palm surface to the table and the patient cannot make scratching movements with the little finger on the table;
- the patient’s hands lie with their palms on the table and he cannot separate his fingers, especially IV and V;
- the affected hand does not clench into a fist completely, especially the flexion of the IV and V fingers is difficult;
- the patient cannot hold a strip of paper between the thumb and index finger, as the terminal phalanx of the thumb bends.
Tests confirming neuritis of the median nerve:
- the brush is pressed by the palm surface to the table and the patient is unable to make scratching movements with the second finger on the table;
- the hand on the affected side does not clench into a fist completely due to the difficult flexion of the I, II and partially III fingers;
- the patient is unable to contrast the thumb and little finger.
Electrophysiological research methods (electroneurography, electromyography, evoked potentials) are used to determine the level and degree of nerve damage and its recovery during treatment.
Treatment
Neuritis therapy is primarily aimed at the cause that caused it. In infectious neuritis, antibacterial therapy (sulfonamides, antibiotics), antiviral drugs (interferon derivatives, gamma globulin) are prescribed. With neuritis resulting from ischemia, vasodilators (papaverine, euphyllin, xanthinol nicotinate) are used, with traumatic neuritis, immobilization of the limb is performed. Anti-inflammatory drugs (indomethacin, ibuprofen, diclofenac), analgesics, B vitamins are used and decongestant therapy (furosemide, acetazolamide) is performed. At the end of the second week, anticholinesterase drugs (neostigmine) and biogenic stimulants (aloe, hyaluronidase) are connected to treatment.
Physiotherapy procedures begin at the end of the first week of neuritis. Ultraphonophoresis with hydrocortisone, UHF, pulse currents, electrophoresis of novocaine, neostigmine, hyaluronidase are used. Massage and special physical therapy aimed at restoring the affected muscle groups are shown. If necessary, electrical stimulation of the affected muscles is performed.
In the treatment of tunnel syndrome, local administration of drugs (hydrocortisone, novocaine) is performed directly into the affected canal.
Surgical treatment of neuritis refers to peripheral neurosurgery and is performed by a neurosurgeon. In the acute period of neuritis with pronounced compression of the nerve, surgery is necessary for its decompression. In the absence of signs of nerve repair or the appearance of signs of its degeneration, surgical treatment is also indicated, which consists in suturing the nerve, in some cases nerve plastic surgery may be required.
Prognosis and prevention
Neuritis in young people with a high ability of tissues to regenerate lends itself well to therapy. In elderly patients with concomitant diseases (for example, diabetes mellitus), in the absence of adequate treatment of neuritis, it is possible to develop paralysis of the affected muscles and the formation of contractures.
Neuritis can be prevented by avoiding injury, infection and hypothermia.