The so-called symptoms of "tension" and "position" are based on myofixation (reflex, subconscious) of the affected motor segment due to irritation of the receptors of its deformed tissues and causing an increase in intradiscal pressure in a number of symptoms. When conducting experiments on animal corpses, it was proved that the nerves have a reserve of length and the ability to move in relation to the adjacent tissues in the fascial bed, as a result of which there is practically no tension on the nerve.
The main symptoms of position and tension are:
1. Symptom Fenz - the phenomenon of "oblique" rotation. If the head tilted forward is rotated in both directions and pain occurs, this indicates the presence of rubbing spondylotic growths of adjacent vertebrae. 2. Klein's symptom - with forced turns and throwing the head back, sensations of dizziness, nausea, noise in the head may occur. This indicates the interest of the vertebral artery in cervical osteochondrosis. 3. Spurling's symptom - the phenomenon of "intervertebral foramen". With a load on the head, tilted on the shoulder or tilted and turned to the painful side, paresthesias or pains occur, radiating to the innervation zone of the root, which undergoes compression in the intervertebral foramen. 4. Berchi's test - the patient sits on a chair, the doctor stands behind the patient and covers the lower jaw with his palms, presses his head to his chest, rises on toes, as a result, the cervical spine is stretched (compression of the roots is removed, blood flow through the vertebral arteries improves). If this changes the nature and intensity of noise and pain in the neck, head or ear, this indicates the interest of the cervical spine in the occurrence of cerebral symptoms. 5. Neri's symptom - with active and passive tilts of the head forward, pain occurs in the area of \u200b\u200bthe affected root. 6. Symptom of "axial load" - when pressure on the patient's head along the vertical axis increases pain and paresthesia in the area of \u200b\u200bthe affected root. 7. Lhermitte's symptom - with a sharp tilt of the head forward, pain occurs in the form of an electric current passing through the whole body along the spine. 8. The symptom of "raised and lowered arms" is a decrease in pain in the horizontal position of the arm and an increase with the addition of paresthesias at night with a lowered arm; allows you to differentiate the discogenic process from the infectious and toxic. 9. Symptom of "reins" - when the thoracic vertebrae are affected, the long back muscles below the level of the lesion are tense and when the patient bends they tense in the form of taut reins. Usually the symptom is sharply positive in secondary radiculalgia (tuberculosis, metastasis, Schmorl's hernia). 10. Bonnet's test - adduction of the hip is accompanied by tension of the piriformis muscle, and in the presence of neuroosteofibrosis and pain. 11. Lasegue symptom - there are three degrees of its severity:
I - mild: pain appears when raising the leg to an angle of 60 °, not intense, there is a moderate protective contraction of the muscles of the back, abdominal wall, pelvis;
II - moderately pronounced: pain appears when the leg is raised to an angle of 45 °, there is a sharp protective contraction of individual muscles, a moderate autonomic reaction;
III - pronounced: the angle of elevation of the leg is up to 30 °, there is a generalized protective muscle contraction and a sharp vegetative reaction. There are modifications of the Lasegue symptom that can be used in expert cases: a) the appearance of pain when lowering the leg from the edge of the couch while the patient is lying on his stomach; b) a study of the Lasegue symptom in the patient's standing position; c) Vengerov's reception: contraction of the abdominal muscles when examining the Lasegue symptom (you must first distract the patient's attention), etc. 12. Ankylosing spondylitis (Lasegue's cross symptom) - the onset of pain in a "sick" leg when examining the Lasegue symptom on the healthy side. 13. The symptom of "landing" - flexion of the sore leg or both legs when the patient tries to sit in bed with straightened legs. 14. Vaserman's symptom - the appearance of pain on the front of the thigh when lifting up a straightened leg in a patient lying on his stomach. 15. Symptom Matskevich - the appearance of pain on the front of the thigh when flexing the lower leg in a patient lying on his stomach. 16. Symptom Dejerine ("cough point") - the appearance of back pain when coughing, sneezing, straining. 17. Sicar's symptom - pain along the way sciatic nerve with strong plantar flexion of the foot in a lying patient. 18. Symptom Govers - Sikar - pain along the sciatic nerve with strong dorsiflexion of the foot. 19. The symptom of Turin is pain along the sciatic nerve with a strong dorsal extension of the thumb. 20. Razdolsky's symptom ("bell") - when pressing on the interspinous ligament, the spinous process, paravertebral points, the pain radiates to the radicular or sclerotomic zone of the diseased leg. 21. A symptom of a "locked back" - the appearance of a lumbago sensation in the patient after an attempt to lift a weight or at the moment of a sharp tilt, extension of the trunk in the form severe pain in the lower back or in the lumbosacral region, which fixes the body in a bent position; patients cannot move, since any movement causes sharp pain. 22. Symptom Amos - characterized by a kind of transition from a lying position to a sitting position: trying to sit down, the patient helps himself, resting his hands on the lumbar region. This symptom is noted with vertebrogenic lumbosacral pain syndrome. 23. Marching test Panov - Lobzin - Churilov - in a standing position the patient is asked to march in place, palpating at the same time the lumbar paravertebral muscles. On the pain side (homolateral side), a pronounced muscle tension is found.
Often in patients with vertebrogenic pathology, autonomic disorders also occur. So, trophic changes are manifested in the skin, subcutaneous tissue in the form of a violation of sweating (anhidrosis or hyperhidrosis), skin peeling, wrinkles, thinning, swelling; in the form of painful sensations at the points of attachment of muscles and tendons to the bone protrusions.
A number of vegetative pain points are also palpated.
1) A.M. Grinshtein's point (orbital) - at the inner corner of the orbit. 2) The point of the temporal artery - palpated by sliding palpation. 3) The point of the vertebral artery is located medial to the posterior edge of the sternocleidomastoid muscle, below the occipital points on the line connecting the apex of the mastoid process and the spinous process of the epistrophy at the border of the outer and middle third. 4) The point of the superior cervical sympathetic node is at the level of C2-C7 vertebrae medial to the Naderb points on the antero-lateral surface of the bodies. 5) The point of the stellate node - from the transverse process of the C7 vertebra to the head of the first rib. 6) Markelov - Birbrayir points - carotid artery, superior trigeminal, phrenic nerve (above the middle of the clavicle), shoulder girdle (in the middle third), midpoint of the shoulder, radial artery, thenar, intercostal, vertebral (D-3), solar plexus (on the middle of the distance between the navel and the pubis), Lapinsky (at the inner edge of the popliteal fold), the artery of the feet.
Vasomotor disorders are manifested by chilliness of the extremities, pronounced venous pattern; a decrease in the temperature of both or one foot, the back of the hand, forearm (Erben's symptom); a decrease in the pulsation of the arteries of one or both feet, more often on the side of more pronounced pain (Wartenberg symptom).
There is an asymmetry in the color of the skin of the feet and hands. So, if the limb is pale and cold to the touch, then the arterioles suffer; if cyanotic, cold, then arteries and venules; if it is cyanotic, warm - then venules.
The simplest test for detecting vegetative-vascular changes is Bogolepov's test. The patient stretches his arms forward - the color of the skin of the hands and blood circulation are determined. Then he raises one limb as high as possible, and lowers the other down. After 30 seconds, the patient raises his arms to the starting position. In healthy individuals, the color of the nails becomes uniform after 30 seconds.
Patients with irritation of the vertebral artery syndrome have sensations of fog before the eyes, headache, paracusis, intolerance to noise and bright light, dizziness, nausea, palpitations, pain in the heart (cervical migraine). The state of the tone of the intracerebral vessels is judged by the state of the retinal arteries, by the sensations that arise when turning and tilting the head and when stretching along Berchi.
Patients may develop a sensitivity disorder of sympathetic genesis, mild hypoalgesia in the form of a half-hood or half-jacket. There may be reflected visceral symptoms, especially from the urinary and gallbladder.
They also pay attention to the presence of a direct symptom of Claude - Barnard - Horner (constriction of the pupil, palpebral fissure and retraction of the eyeball) or the opposite. The reaction to UFO changes (less on the pain side), the indicators of galvanic test, blood pressure, pulse, rheovasography, and kymography change.
Neri's symptom was first described by a neurologist from Italy in 1882. It was he who discovered the relationship between pain in the lower back and head flexion. Moreover, this symptom, as a rule, manifests itself only in people suffering from lumbar osteochondrosis.
The test is fairly straightforward. To do this, you just need to ask the patient to lie on his back on a flat surface, and then bend his head to the chest. In this case, a patient with lumbosacral radiculitis develops pain in the lumbar region. The appearance of such sensations is explained by irritation of the already inflamed roots of the spinal cord.
When this happens
Neri's symptom in neurology is checked quite often. And here we are most often talking about certain diseases of the back or spine, among which it is worth noting:
- Myeloradiculopathy. Most often it develops in the lumbar region and leads to infringement of the roots in the L5-S1 region. Concomitant manifestations include loss of tendon reflexes, impaired sweating, loss of skin sensitivity, and beginning changes in the lower extremities. In a laboratory study of the cerebrospinal fluid, an increased content of erythrocytes and leukocytes can be found in it.
- Inflammation of the nerve roots, which is popularly called. This pathological condition occurs with osteochondrosis of the spine and is combined with intervertebral hernias, tumors, injuries.
- Muscle spasm of the muscles of the lower back. This condition is diagnosed with hypothermia and the process may involve not only muscle tissue, but also the spinal nerves that pass through them. In this situation, the Neri test turns out to be positive because the nerve fiber is compressed.
- Grades 2 - 4 is formed when there is a decrease in the height of the vertebrae by more than half.
When conducting the test, it should be remembered that each person has a different threshold for pain sensitivity, therefore, it is impossible to focus only on this symptom when making a diagnosis. Therefore, in each case, it should be understood that before making a diagnosis, it is necessary to listen to all the patient's complaints, conduct other examinations, and only on this basis make the correct diagnosis and begin treatment.
Pull Syndrome Symptoms
What are the symptoms of Neri syndrome and why do they form? All tension syndromes in the presence of osteochondrosis have their own causes. The most common of them are:
- Protrusion of the intervertebral disc.
- Fusion of the vertebrae.
- The presence of bone osteophytes.
- Inflammation of muscles and ligaments.
The mechanism of the development of Neri's symptom is primarily associated with the infringement of the nerve roots in the region of the third lumbar - the first sacral vertebrae. Against the background of changes in the nucleus of the vertebra, a protrusion occurs outside its functional zone. With pain in the lower back, one can suspect compression of the nerve root, which occurs against the background of prolapse of the intervertebral disc. The pain syndrome itself can have several variants.
With severe back pain that occurs with the slightest movement, Neri's symptom will always be positive. In this case, the main reason is the pinching of the nerve roots.
Pain that is less severe and lasts 3 weeks can form a false negative Neri test. Over time, pain in the legs may appear, which does not go away for a long time, but most often remains throughout the entire disease.
With the lateral direction of the intervertebral hernia, with its protrusion at a distance of no more than 10 mm, the Neri symptom in neurology may not be observed.
It turns out that this test allows you to determine the initial manifestations of a particular disease of the spine, and therefore - to start timely treatment that will not allow the disease to progress. As for other signs of tension, their identification is also mandatory for any patient complaints of pain in the lower back, sacrum or neck. Only a comprehensive examination will give an accurate idea of \u200b\u200bthe problem itself and will allow the doctor to prescribe adequate treatment, which, if strictly followed, can relieve not only pain, but also other pathological manifestations.
Lasegue symptom – is a rather informative diagnostic symptom that is often used in neurological practice. It is also called the symptom of tension.
This kind of research is indicated for patients with suspicion of various diseases of the spine, pathology of the sciatic nerve, nerve roots, etc., associated with osteochondrosis and not only.
The identification of the Lasegue symptom should be carried out exclusively by a specialist, a neuropathologist. Do not try to diagnose yourself at home. You can make mistakes, both in the very technique of performing the diagnostic procedure, and in evaluating the results of such a home "study".
In order to conduct research for a positive or negative Lasegue symptom, or a symptom of tension, the patient is asked to take a supine position.
This happens until the onset of pain along the sciatic nerve (along the back of the thigh). In this case, the study is stopped.
A positive Lasegue symptom is considered if pain occurs when the doctor lifts the patient's leg 30⁰ -40⁰ above the level of the surface on which the patient lies, and when the doctor gradually flexes the subject's leg in the hip and knee joints, the pain disappears.
This variant of a positive Lasegue symptom may be associated with damage (compression) of the 5 lumbar (lumbar) or 1 sacral (sacral) roots. The reason for this phenomenon can be, most often, osteochondrosis.
If pain occurs when the subject's straightened leg is lifted 70 на above the couch level, it is a non-root pain that can be caused by a pathology of the thigh muscles, paravertebral muscles, etc.
If the pain does not go away when bending the leg in the hip and knee joint, the Lasegue symptom is considered negative.
In this case, we are talking about the symptomatology of non-neurological genesis. Leg pain in this case may be associated with a pathology of the knee or hip joint. And a patient who has this kind of symptomatology needs additional research to identify the true cause of pain.
Quite often, leg pains can be psychogenic. Then, during the diagnostic procedure, there will be no relationship between the onset of symptoms and changes in the position of the subject's leg. More often this kind of pain occurs in women suffering from hysteria.
How does the Lasegue symptom arise?
It is not for nothing that practitioners often refer to this symptom as a symptom of tension. Its appearance is associated with the intense tension of the sciatic nerve fibers in this position.
In case it is damaged, inflamed, etc. - the patient will experience acute pain and raising the leg in a straightened state will be impossible further. Therefore, in this case, the Lasegue symptom is considered to be positive.
The sciatic nerve is a kind of continuation of the roots of the lumbar spinal cord, it consists of its fibers. This is the largest nerve of those that exist in the human body. This is why the pain when pulling it is so intense.
The fact that the sciatic nerve is a continuation of the fibers of the lumbar spinal cord is the reason that pain in it may indicate pathology, entrapment of the roots at the level of the 5th lumbar (5L) - 1st sacral (1S) roots. This is why the positive Lasegue symptom is of such high diagnostic value.
Why is a healthy person able to raise a straightened leg high enough, while a person with sciatic nerve pathology is not? The fact is that the sciatic nerve has a limited ability to stretch.
And if, for example, he also has to bend around the bulge of an intervertebral hernia - a symptom of tension appears, the nerve is initially in tension and this makes raising the leg higher than 30⁰-40⁰ above the couch level sharply painful. This symptom belongs to the category of lumbar compression symptoms.
It is important that with a lesion at the level of the lumbosacral region, pain appears precisely in the region of the lumbar region, and not the leg itself, or it radiates to this region.
In what diseases does the Lasegue symptom occur?
The most common cause of Lasegue's symptom is osteochondrosis of the lumbosacral disc at the S1 level. In the case of this disease, the patient is concerned about pain in the buttock region, which spreads along the back of the thigh, reaching the lower leg and outer surface of the foot.
This is due to the area of \u200b\u200binnervation of the S1 root. Often this kind of pain radiates to the little toe and heel of the same foot. In the same area, simultaneously with the Lasegue symptom in this pathology, hyposthesia is often determined, i.e. decrease in sensitivity in this area.
Radiculitis of the lumbosacral region is the second, but no less significant reason for the appearance of a positive Lasegue symptom and, alas, its no less common cause. In the case of lumbosacral sciatica, in addition to Lasegue's symptom, the patient also has Neri's symptom and Bekhterev-Fayerstein's symptom.
Neri's symptom is manifested in the fact that with intense bending of the patient's head in the direction chest there is a sharp pain in the lumbosacral position. It is important to note that at the time of research for the presence this symptom, the patient should be in the supine position.
Ankylosing spondylitis-Faystein's symptom, or, as it is also called, Lasegue's cross symptom, is characterized by the fact that when the leg is raised from the healthy side, pain in the sore leg is noted.
With myeloradiculitis, in addition to the symptoms described above, an increase in the severity of reflexes and even the appearance of pathological tendon reflexes may also be observed.
Lasegue's symptom can also be detected when infectious diseases spinal cord.
In any case, if a positive Lasegue symptom is found, the patient must be sent for an additional comprehensive examination, in order to clarify the cause of its appearance, to verify or deny the presence of one or another pathology in the patient.
Lasegue's symptom in neurology is observed when the fibers of the sciatic nerve are stretched. Stretching of the roots occurs when the sciatic nerve is pinched inside the spinal canal or when the muscles of the lower back or buttocks contract spasmodically.
Lasegue's symptom is one of the so-called tension symptoms. They are characterized by the appearance of pain in cases of stretching of nerve fibers. Painful sensations in the presence of the Lasegue sign appear in the areas of projection of nerve fibers when the lower extremities are raised up in the patient's supine position.
The reason for the appearance of the characteristic clinic is that normally - when the legs move - the sciatic nerve is stretched. But in a pinched nerve, the fibers are constantly shortened and their length is shorter than in a healthy nerve. As a result, a characteristic clinical picture is observed when the lower limbs move.
Normal condition of the sciatic nerve
In a normal physiological state, the nerve stretches up to 15 millimeters in length. The nerve runs deep in the gluteal muscles and provides the muscles of the thigh and lower leg.
According to the theory, it can be impaired along its entire length. Practice shows that most often the infringement is observed in the lumbosacral and gluteal zone. In a normal state of the nerve, a person does not experience pain when moving.
Find out: how to effectively treat, drug therapy.
All about: the development of the disease, symptoms of the disease, approaches to treatment.
How does a doctor determine the Lasegue pulling symptom?
To identify the symptom of Lasegue tension, the doctor needs to lay the subject on a flat and hard surface. From this position, the patient tries to lift the injured leg. All this time, the doctor closely monitors the person under study. When the patient does not move, pain or any other unpleasant sensations for the patient do not appear in the projection of the sciatic nerve and its fibers.
Attention! You should be aware that pain and other undesirable sensations do not occur if the examined person, lying on his back, raises his leg bent at the knee at an angle of 90 °. At this moment, there is no stretching of the fibers (roots) of the spinal and sciatic nerves.
If the patient feels pain only when raising the unbent (straightened) leg, we can confidently judge that the Lasegue symptom is positive.
Intensity pain gradually increases until the moment when the leg is raised less than 60 °. At this angle, the greatest stretching of the sciatic nerve is noted.
The results of many years of research have proven that the severity of the sciatic nerve stretching is in direct proportion to the height of the affected leg. It was found that with the intensification of pathological changes in the nervous tissue, the angle at which the patient feels pain decreases.
In a situation where soreness manifests itself at significant angles of elevation of the legs, it is more likely that there is a strong stretching of the muscles of the thigh or buttocks. This is often observed in those individuals whose musculoskeletal system is inflexible.
How to identify a Lasegue pulling symptom:
- lay the patient under study on a firm, flat surface in a supine position;
- ask the patient to smoothly raise the leg extended at the knee joint on his own;
- if you cannot raise your leg on your own, help to perform the movement (movements should be smooth);
- note the level at which the patient notes the occurrence of painful sensations.
Other signs of tension
Neurology is a young science. Particular activity in the study of problems of the nervous system was noted in the second half of the nineteenth century. It was then that the majority of the symptoms used by modern practical medicine were identified and described. These include signs of sprain, most of which are nominal: named after the doctor who described them.
Symptoms of tension include:
- sign of Lerrey (landing);
- tripod sign (spacers);
- bonnet sign;
- wasserman-Matskevich feature;
- sign of Neri;
- dejerine's sign;
- bekhterev-Faystein sign.
They try to determine these signs one after another, so as not to bother the patient once again, not to cause him pain. Often, some signs are test for others. For example, the symptoms of Neri and Lasegue complement each other, and in the absence of one, it will not be possible to determine the other.
What is the result of the diseases identified with the help of the Lasegue tension symptom?
The signs of tension directly indicate the presence of a number of diseases. Most frequent reasons their appearances are:
- the lumbosacral region at the S1 level;
- ankylosing spondylitis;
- sciatica;
- lumbosacral region.
By themselves, these diseases limit the daily activities of a person. Patients develop fatigue, pain in the affected areas, discomfort during movement, and aching joints. If the disease is not treated, symptoms will progress steadily. In advanced stages, many people become disabled. Therefore, in the treatment of such diseases, timely treatment plays an extremely important role for health.
Important! If you have any discomfort or pain during movement, you should contact for medical help... Do not postpone the visit to the doctor, since the prognosis of recovery depends on this.
What to do if Lasegue's symptom is positive?
Persons who have a positive Lasegue pulling symptom and have other signs of stretching should be treated by a neurologist (neurologist). The doctor will prescribe the appropriate treatment.
The therapy program will include pain relievers, drugs that improve the nutrition of the nervous tissue, drugs to improve the transmission of nerve impulses. From non-drug means are used:
- physiotherapy;
- acupuncture;
- manual therapy;
- massage;
- injection ozone therapy.
In cases where the pathological process has gone far, surgical treatment is recommended.
Conclusion
Lasegue's sign (along with other symptoms of tension) is widely used in practical medicine to determine the pinching of the sciatic nerve. In cases where the above signs are determined as positive, the doctor prescribes additional examinations to establish the cause of the nerve damage.
After establishing the cause of the pathological condition, a treatment appropriate to the severity of the disease is prescribed: therapeutic or surgical.
If there are positive signs of tension, the prescribed treatment must be followed, otherwise the disease will progress. This can lead to serious health problems, including disability. Don't resort to funds traditional medicine or to the help of persons without special education.
These include radicular and radicular-vascular syndromes. Radicular syndrome is discogenic lumbosacral radiculopathy (radiculitis). The defeat of the roots of this level is clinically manifested by sensitive (pain, paresthesia, anesthesia), motor (paresis of individual muscle groups) disorders, changes in tendon reflexes (first increase, and then decrease). There are also vegetative disorders. At the same time, vertebrogenic syndromes, manifested to varying degrees, are determined: muscle-tonic, vegetative-vascular and neurodystrophic.
The clinical manifestations of radicular syndrome depend on the localization of the herniated intervertebral discs. Most of them are observed at the level of LIV-LV and LV-SI intervertebral discs, which is associated with the greatest load on the human lower lumbar spine. Therefore, most often the L5 and S1 roots are squeezed, somewhat less often the L4 root. Depending on the number of affected roots, mono-, bi- and polyradicular syndromes are distinguished. The main clinical syndrome of L5 root lesion is pain in the upper part of the buttock, which radiates along the outer surface of the thigh, the front surface of the leg and foot into the big toe. The pain is often of a shooting character, sharply aggravated during body movements, changes in body position, sneezing, coughing. In the same areas, a feeling of numbness is observed. During the examination, weakness and hypotrophy of the muscles that extend the thumb, hypesthesia in the innervation area of \u200b\u200bthis root are noted. Knee and Achilles reflexes do not change.
S1 root lesion syndrome is characteristic of osteochondrosis of the lumbosacral disc. The most common complaint is pain in the gluteal region, which spreads along the back of the thigh, lower leg, outer surface of the foot, radiating to the heel, little toe. The muscle tone of the buttocks, back of the thigh and lower leg is reduced. Flexor weakness is also noted. thumb, sometimes feet. Frequent symptoms include a decrease or disappearance of the Achilles reflex. In the area of \u200b\u200binnervation of the S1 root, minor hypesthesia is determined.
Osteochondrosis of the LIII intervertebral disc is much less common. With its posterolateral hernia, signs of damage to the L4 root are revealed. The pain spreads along the front of the thigh and the inner surface of the lower leg. Weakness and atrophy of the quadriceps femoris muscle is noted. The knee reflex decreases or disappears. The sensitivity of the skin is disturbed according to the radicular type, hyperesthesia is determined, which is replaced by hypesthesia.
The defeat of the L5 and S1 roots is much more common. The main clinical symptom is pain in the lumbosacral region, often of a shooting character, with a feeling of numbness. The pain radiates to the back and outer surface of the thigh, lower leg and foot. Exercise, coughing, sneezing make it more acute. Painful scoliosis is often developed, which is directed by the bulge towards the healthy side. The place of straightening or strengthening of the lumbar lordosis is noted. The movements of the spine are sharply limited during bending. The pain can be so severe that the patient acquires a characteristic posture. Basically, he lies on his back with the lower limbs bent at the knee joints.
In the acute period during palpation, there is pain in the paravertebral points in the area of \u200b\u200bthe lumbar spine and spinous processes of the LIV, LV and SI vertebrae. Pain points are also determined in the projection zone of the sciatic nerve in places where it comes close to the skin: at the point where the nerve exits the pelvic cavity between the sciatic tubercle and the greater trochanter of the thigh, in the middle of the gluteal fold, in the popliteal fossa, posterior to the head of the fibula, behind medial malleolus (Vallee point).
In addition to pain points, the so-called symptoms of tension are also determined (Lasegue, Bekhtereva, Neri, Dejerine, Sicard, landing, etc.).
Lasegue's symptom is the appearance or intensification of pain in the lumbar region and along the sciatic nerve in a patient lying on his back, while bending the extended leg in the hip joint (phase I of Lasegue symptom). If you further bend it at the knee joint, the pain disappears or sharply decreases (phase II of Lasegue symptom).
Ankylosing spondylitis (Lasegue's cross symptom) the appearance of pain in the lumbar region during flexion of the healthy lower limb in the hip joint.
Neri's symptom is an increase in pain in the lumbar region with passive bending of the head (bringing the chin to the sternum) of a patient lying on his back with straightened lower limbs.
Dejerine's symptom is an increase in pain in the lumbar region when coughing, sneezing.
Symptom Sikar - - increased manifestations of lumboischialgia during the extension of the patient's foot, lying on his back with straightened legs.
A symptom of landing - if a patient lying on his back is offered to sit down, then the lower limb on the affected side during landing bends at the knee joint.
If the pathological process is localized in the vertebral segments L1 - L4 and is manifested by signs of lesion of the femoral nerve, symptoms of tension of Wasserman and Matskevich are observed.
Wasserman's symptom - the occurrence or intensification of pain in the innervation zone of the femoral nerve during extension of the leg in the hip joint in a patient lying on his stomach.
Matskevich's symptom is the occurrence of sharp pain in the innervation zone of the femoral nerve during a sharp flexion of the lower leg in a patient lying on his stomach.
The defeat of the roots of the lumbar and sacral segments of the spinal cord can be accompanied by autonomic disorders, which are manifested by a decrease in skin temperature, increased sweating in the area of \u200b\u200binnervation of the corresponding roots, and a weakening of the pulse in the corresponding arteries.
With compression of the cauda equina, which develops in the presence of a median hernia, extremely sharp pain occurs that extends to both limbs. Signs of peripheral paresis of the feet, perineal anesthesia, and urinary dysfunction are characteristic.
Radicular-vascular syndrome develops as a result of compression of the radicular or radicular-spinal arteries by herniated lumbar intervertebral discs or under the influence of other factors. As a rule, there is a clinical picture not of radiculopathy, but of radiculo-ischemia or radiculomyeloischemia. It can be manifested by syndromes of lesions of the epicone, cone, cauda equina, “paralytic sciatica”. The clinical picture is predominantly dominated by motor, sensory disorders in the presence of moderate or mild pain syndrome, and sometimes its absence.
Spinal compression syndrome is mostly due to median or paramedian hernia. Obviously, there are other factors: osteophytes, epiduritis, etc. Their development is acute, and the clinical picture is manifested by various neurological syndromes: epiconus, cone, cauditis. Patients have significant motor (lower paraparesis or paralysis) and sensitive (conductive or radicular type) lesions. Disorders of sensitivity in the perineal region may be noted. Such lesions are accompanied by impaired urination.
The course of lumbosacral radiculopathy (radiculitis) is characterized by periodic exacerbations and remissions. Exacerbations occur due to the influence of various factors (hypothermia, unsuccessful movement, lifting loads, etc.).
Diagnostics, differential diagnosis... The diagnosis of cervical reflex syndromes, cervical radiculopathy is established on the basis of clinical manifestations diseases and X-ray examination data.
As for the pain syndrome in the thoracic spine, it can be caused by various factors: tuberculous spondylitis, a tumor of the spinal cord, ankylosing spondylitis. Pain in the thoracic spine can be observed with a tumor of the mediastinum, esophagus, etc. Sometimes it is a consequence of duodenal ulcer or diseases of the pancreas, kidneys. Only after a comprehensive examination of patients, excluding these diseases, it is possible to establish a diagnosis of thoracic radiculopathy (radiculitis), which is a consequence of osteochondrosis of the spine.
In typical cases, the diagnosis of neurological manifestations of lumbar osteochondrosis, starting with non-root forms (lumbago, lumbodynia, lumbar ischialgia) and ending with radicular and radicular-vascular syndromes, is not difficult. However, pain in the lumbosacral region can be predetermined by various diseases that must be excluded. These are primarily tumors, inflammatory processes of the spine and pelvic cavity, spinal arachnoiditis, and tuberculous spondylitis. Therefore, the doctor should always remember about atypical lumbosacral pain and the possibility of serious pathology. For this it is necessary to examine each patient in detail. In particular, auxiliary examination methods are used: examination of cerebrospinal fluid, X-ray, CT, MRI of the spine.
Treatment. In an acute period, first of all, bed rest, rest and pain relievers are needed. The patient should be placed on a firm bed, for this a wooden shield is placed under a regular mattress. Local remedies are also used: a heating pad, a bag of hot sand, mustard plasters, banks. The local irritant is various pain relieving ointments that are rubbed into the painful areas of the skin.
Pain relievers are also used. Assign analgin - 3 ml of a 50% solution, reopirin - 5 ml or baralgin 2 ml intramuscularly. Apply an anesthetic mixture (solution of analgin 50% -2 ml, cyanocobalamin - 500 mcg, no-shpy - 2 ml, diphenhydramine 1% - 1 ml) intramuscularly in one syringe. Chlorine-ethyl irrigation of the paravertebral area is effective. You can also use quartz irradiation in an erythemal dose. Sometimes these activities are enough to relieve pain.
In cases where there is no effect, the scope of treatment should be expanded. It is advisable to carry out the treatment in a neurological hospital. Painkillers continue to be used: analgin, baralgin, sedalgin, trigan. Often the pain is caused by the defeat of sympathetic fibers, that is, it is sympathetic in nature. In this case, Finlepsin 200 mg is prescribed, Gangleron 1 ml of a 1.5% solution, sodium diclofenac 3 ml, Xefocam (8 mg) 2 ml intramuscularly. It is effective to use drugs that have anti-inflammatory and analgesic effects: Movalis 7.5 mg 2 times a day after meals for 5-7 days or 1.5 ml intramuscularly every other day (3-5 infusions); rophica (rofecoxib) 12.5-25 ml 2 times a day for 10-14 days, celebrex 1 capsule (100 mg) a day for 5-7 days.
To reduce the edema of the spinal nerve root, dehydration agents are prescribed: furosemide 40 mg, hypothiazide - 25 mg per day for 3-4 days, aminophylline 10 ml of a 2.4% solution intravenously in 10 ml of a 40% glucose solution. In the presence of reflex muscular-tonic syndromes, use mydocalm 50 mg, sirdalud - 2-4 mg 3 times a day. The appointment of chondroprotectors (traumeel, discus compositum intramuscularly) is effective. With prolonged pain syndrome, a good result is obtained by novocaine blockade (20-40 ml of a 0.5% solution) in combination with phlosterone - 1 ml, cyanocobalamin - 500-1000 mcg. In chronic recurrent course of the disease, B vitamins, biogenic stimulants (aloe extract, peloid distillate, plasmol, vitreous) are prescribed subcutaneously for 10-15 days.
Physiotherapeutic methods include electrophoresis of novocaine, calcium chloride, magnetotherapy, diadynamic therapy. Balneotherapy is carried out with coniferous, radon baths, as well as mud or paraffin-ozocerite applications. Massage and exercise therapy are also effective. When acute manifestations subside, orthopedic treatment is used to stretch the spine using a variety of traction devices and devices. Dosed underwater traction, as well as manual therapy, have a positive effect.
Experience shows that sometimes the pain subsides completely after conservative treatment for several months. In the chronic stage of the disease, spa treatment is recommended, in particular mud therapy (Odessa, Saki, Slavyansk, Holodnaya Balka), radon baths (Khmelnik, Mironovka), paraffin-ozokerite applications (Synyak).
With persistent pain syndrome use surgery... It is carried out only if there are indications such as continuous pain, severe movement disorders. Urgent indications for surgical treatment are prolapse of the intervertebral disc with compression of the radicular-spinal artery and the development of movement disorders in the form of flaccid paresis or paralysis, urinary disorders.
To prevent frequent relapses, the patient should be temporarily or permanently transferred to work that is not associated with significant spinal loads. In the absence of a positive effect in treatment for 4-5 months, it can be established III group disability. Sometimes the patient is recognized as disabled.
Prevention. Among /; preventive measures are the fight against hypokinesia, physical education and sports. It is necessary to avoid hypothermia, sudden movements during the performance of work associated with a significant load of the spine and tension of the roots of the spinal nerves.