Osteochondrosis is accompanied by various clinical signs, including the so-called tension symptoms. This is what they call complications from nerve tissue spinal cord, as a result of which the patient experiences regular pain.
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When doctors use the term “tension syndrome in osteochondrosis,” they mean the appearance pain symptoms which occur during passive movements of the arms and legs. The cause of these sensations is too much tension on the nerve roots that are located in the spinal cord. Tension also refers to spasms (sharp contractions) of muscle fibers.
Reasons similar symptoms are pathogenic processes of destruction of vertebral bone tissue. As a result, they gradually shift and change location. Therefore, the bones begin to compress the intervertebral discs, which is why they also collapse and have a mechanical effect on nerve fibers as well as muscle tissue. As a result, they become very stretched and cause significant pain to the patient. This syndrome is a neurological manifestation of osteochondrosis, so first of all you should contact a neurologist.
Symptoms of tension intensify if, along with osteochondrosis, a person suffers from other chronic pathologies– , pinching sciatic nerve, hernias and disc protrusions.
Neurological symptoms of osteochondrosis are always accompanied by pain. Their clinical manifestations are different, therefore medical practice A classification of signs accompanying osteochondrosis has been developed. Each group of symptoms is given its own name.
Emerging Lasegue symptom in osteochondrosis lumbar region accompanied by the following symptoms:
With sudden movements, the sensations become unbearable. Turning and bending the legs can cause nerve fibers to become damaged or even ruptured. Therefore, the patient is advised to undergo immediate diagnosis. First of all, the doctor determines the maximum angle at which a person can raise the lower limb without severe pain. Then set the angle of the maximum possible bend of the leg at knee joint. In accordance with this, the degree of development of osteochondrosis is determined.
Symptoms of tension in osteochondrosis of the lumbar region may be accompanied by lumboischialgia, when pain radiates to 1 or both lower limbs. If a person can sit without any extraneous sensations, then this pathology is absent.
This symptom of tension can be diagnosed if the following signs are observed:
Thus, the patient is looking for three points of support at once, which is why the symptom received a similar name.
To identify this sign, the patient is asked to lie down on a bed or couch, and then gradually change position - sit down. If the legs cannot be kept in a straight position (they bend at the knee joint), a landing symptom is determined.
To detect this symptom, the patient lies on his stomach, the doctor bends the leg at the knee joint until it causes pain. Discomfort is associated with tension on the femoral nerve, and the pain itself appears on the surface of the leg (femoral part, front side).
To identify Neri's symptom in osteochondrosis, a person lies on his back, with his arms and legs directed along the body. The doctor places his hand on the back of the head and tries to bend the neck with a sharp movement so that the head comes as close as possible to chest. When discomfort occurs, this symptom of tension is diagnosed. To understand the degree of development of the disease, the neurologist visually determines the maximum angle at which it is possible to bend the neck without extraneous sensations.
The appearance of such signs is caused by the formation of processes on the bones of the spine, which compress nerve fibers, muscle tissue and blood vessels. A hernia may also be the cause. intervertebral disc when his body pinches the nerve roots.
The symptom allows you to identify inflammation of the spinal roots (sciatica), as well as possible spasms of the lower back muscles. Associated symptoms are disturbances in sweating, complete or partial loss of sensitivity in the damaged area, surges in pulse and blood pressure.
Neurological manifestations of osteochondrosis of the cervical and other parts of the spine are accompanied by Dejerine syndrome. The patient himself can identify it. If, during sudden body movements when coughing or sneezing, noticeable pain occurs in the lumbosacral region, this indicates tension in the nerve roots.
But it should be borne in mind that such a test does not lead to unambiguous conclusions. A person should still go for diagnostics. The pain threshold for all people is not the same, so even if minor discomfort occurs, it is better to consult a neurologist.
Occurs as a result of damage to the sciatic nerve. It can appear in 2 ways:
Diagnosis begins with a visit to the doctor. The patient can contact his general practitioner or go straight to a neurologist. This must be done as quickly as possible, because it is extremely difficult to cure the symptoms of tension at home. To make a diagnosis, the doctor analyzes the patient’s complaints, as well as the medical history, conducts a visual examination and palpation (palpation) of the back muscles.
Additionally, they apply instrumental methods examinations:
If necessary, carry out general analysis blood and urine.
The course of therapy is aimed at solving several problems at once:
The most common disease occurs in the lower back, because it is where the main physical activity. Therefore, treatment of lumbar osteochondrosis with neurological manifestations is used most often. For this purpose, medications, physiotherapeutic procedures, massage, therapeutic exercises, and in some cases surgical intervention are used.
First of all, it is necessary to relieve pain. They can be stopped with special blockades with novocaine, painkillers, and anti-inflammatory non-steroidal drugs:
Among the physiotherapeutic procedures used are the following:
Additionally, the patient is prescribed massage sessions, manual therapy, in some cases, traction traction is performed spinal column in air (dry) or in water (underwater). Therapy is carried out using reflexology, as well as folk remedies. Their use is agreed with the doctor.
Treatment is always carried out comprehensively and involves mandatory correction of the patient’s lifestyle. It is unacceptable to eat food containing large number salt. There is a need to consume foods enriched with calcium and vitamin D, which promotes its absorption. The patient is also shown therapeutic exercises, which is first carried out under the supervision of a doctor, and then at home.
The operation is indicated in cases where conservative treatment does not give significant results for 2-3 months or more. Also to surgical intervention may be used if the patient experiences severe pain, and the disease has been developing for a long time (advanced cases).
Osteochondrosis causes complications in different systems organs. The disease leads to disruption of the functioning of the spinal nerve roots due to their mechanical compression and inflammatory processes. Depending on the area of damage, one or another symptom occurs, pain in a specific part of the body. If you consult a doctor in a timely manner, the prognosis for recovery is favorable.
Besides determining the location and properties of pain when questioning the patient, the suspected sources of pain are clarified using diagnostic provocation techniques: palpation and percussion identification of pain points and zones, examination of symptoms of tension in nerve trunks and roots, changes physical condition fabrics.
All these techniques combined with registration of protective muscle contractions, changes in pulse, sweating, pilomotor, pupil size; galvanic skin parameters, plethysmo-, pneumo-, rheovaso-, rheoencephalograms, etc. (B. S. Agte, 1966, 1972; E. N. Panchenko, 1974, etc.). Changes in the blood levels of catecholamines, acetylcholine, their inhibitors and other substances, asymmetries of regional leukocytosis, skin sensitivity to UV rays, tissue hydrophilicity and other tests indirectly confirm the presence of pain.
Pain points and areas are numerous, neurologists do not always know their exact location. Taking this into account, we present brief description localization of a number of pain points and zones. To avoid diagnostic errors, it is necessary to examine not only standard points and zones, but also surrounding tissues, identifying maximum pain.
Symptoms of tension. Diagnostic value have symptoms of Lasegue, Bekhterev, Matskevich, Dezheria, Neri. A number of research techniques have been proposed for their verification and objectification. Thus, Lasegue's symptom can be checked by distracting the patient with research pain sensitivity back surface legs from distal sections to the proximal (Rose maneuver), in a standing position, lying on the stomach. We sometimes check this symptom by examining the knee reflex 3-4 times in a position corresponding to the transition from the first to the second phase of Lasegue's symptom in a given patient.
At Lasègue's symptom palpation or a pneumatic sensor can determine the moment of involuntary contraction of the abdominal muscles (Vengerov's maneuver), gluteal (Verbow's maneuver) and lumbar (Ogienko's maneuver) muscles. Wasserman's and Matskevich's symptoms are checked by protective elevation of the pelvis (Seletsky's symptom). The symptom of Dejerine's cough impulse can be checked by taking Sicard - when standing on the sore leg, the pain persists, but on the healthy leg it disappears. We test it by observing the patient's coughing response during distractive auscultation of the lungs. When examining the symptoms of tension, it is necessary to clarify the localization of pain to distinguish it from pathology, the musculoskeletal system or internal organs.
Other techniques objectification of pain. In case cervical osteochondrosis the pain intensifies with rotation of the head tilted forward (Fenz symptom), pressure on the head tilted to the shoulder (Spurling-Scoville symptom), and decreases with passive extension of the head (Bertschi-Rocher unloading symptom). IN differential diagnosis omoperiarthritis use Lezhar's symptom: pain in the area shoulder joint when placing your hand behind your back with the back of your hand facing the opposite shoulder blade.
Carpal tunnel syndrome pain provoked using the following tests: flexor (flexion of the hand at a right angle for 45-60 s), extensor (extension), compression (finger compression of the carpal tunnel or shoulder area with a cuff for 1-2 minutes to the level of systolic pressure), elevator (raising hands up for 1 minute).
Pain with sacroiliitis occurs when the doctor lifts the hips and pelvis of a patient lying face down (swallow symptom), forced flexion of the hip (Gate's symptom), adduction and abduction of the hips of a patient lying on his back (Makarov's symptom), transverse compression of the pelvis of a patient lying on his side (Kushelevsky's symptom) and other methods of displacement of the pelvic bones.
At radicular-shell, including discogenic processes, sometimes pain or paresthesia corresponding to the affected root is detected by percussion of the spinous process of the vertebra (bell sign, Razdolsky's spinous process symptom), compression of the jugular veins (cerebrospinal fluid push symptom), axial load on the spinal column. In order to objectify and gradate pain, devices based on dosed pressure on painful points and areas have been proposed.
Neri's sign was studied by an Italian neurologist in 1882 when he discovered a relationship between low back pain and head flexion in patients with.
To perform the test, bend the head of the patient, who is in a supine position, towards the chest. At the same time, a person, if present, develops strong ones. Their appearance is due to additional irritation of the membranes of the spinal cord at the exit of the inflamed roots. spinal nerves.
Neri symptom test.
The Neri symptom appears in the following diseases:
Each person has their own threshold for pain sensitivity. It can be strong or weak, which does not allow the syndrome to be assessed according to general criteria. As a result, in each specific case the doctor must analyze the severity of the pathology individually.
, Neri) with osteochondrosis are formed due to:
The pathogenetic mechanism of Neri's symptom is infringement of the nerve roots in the L3-S1 segments (from 3 lumbar to 1 sacral vertebrae). Against the background of gradual displacement of the nucleus pulposus, progression of its destructive changes, and degenerative changes in soft tissues, ruptures of hyaline plates gradually occur, which protrude beyond the functional vertebral segment.
Nerve root compression often occurs with posterior intervertebral disc prolapse. In such a situation, the syndrome is characterized severe pain in the lower back.
Variants of pain syndrome in pathology of the lumbar spine:
Thus, Neri syndrome is an important prognostic sign that allows one to begin timely treatment spinal pathology. In combination with other tension syndromes (Lasègue, Wasserman), it can be used to assess the dynamics of disease therapy.
Lasègue's symptom occurs against the background of tension in the roots of the sciatic nerve, which occurs due to pinching of the nerve fiber in the spine or spasmodic contraction of the lumbar and gluteal muscles. This and some other symptoms make up a group of “tension symptoms” - pain that occurs when nerve fibers are stretched.
Pain in the projection of damaged nerve fibers occurs when lifting the leg up while the person is lying on his back. Pathogenetic mechanism The occurrence of the symptom is due to the fact that when the lower extremities move, the sciatic nerve has to stretch, but when it is pinched, the length of the nerve fiber decreases. Against this background, when the limbs are slowly lifted upward, the sciatic nerve is “overstretched,” which is why pain occurs.
Physiologically, the sciatic nerve is normally capable of stretching to a length of up to 15 mm. It goes through gluteal muscles and innervates the thigh and lower leg. Theoretically, its infringement can be localized throughout, but in practice compression is more common in the lumbosacral and gluteal region. Let's consider the mechanism of occurrence of Lasegue's symptom:
A false-positive Lasegue symptom is observed in people with reduced endurance of the muscle groups of the posterior thigh. If it is present, lifting the leg up leads to soreness of the femoral muscles. False-positive “triggering” is observed in older people. Its pathogenesis is not associated with compression of the sciatic nerve.
Neurologists, when assessing the condition of the sciatic nerve in patients with suspected vertebrogenic lumbargia, note not only the presence of pain. What to look for when assessing Lasegue's symptom:
The lower limbs should not be raised above the achieved level if the patient has any painful sensations. The sciatic nerve can withstand loads of up to 3 kg. This pressure comes on him when top position legs above the horizontal plane at an angle of 60-65 degrees. With excessive loads, there is a risk of nerve fiber rupture!
Important rules for checking with Lasegue:
The most common reason pathological symptom of sciatic nerve tension - intervertebral disc herniation in the lumbosacral spine, grade 2 and 3.
With severe prolapse of the disc into the spinal cord at the level of L5-S1, the patient experiences pain along the thigh and lower leg due to vertebrogenic lumbargia, so assessment of tension symptoms does not complement the clinical status important information. If such symptoms are present, an x-ray of the lumbar spine is required. If possible, an MRI of the lumbosacral spine is performed.
Other diseases in which tension of the sciatic nerve is observed:
When identifying pathological symptoms tension, the neurologist must refer the patient for additional examinations: radiography of the spine, magnetic resonance imaging (MRI) and computed tomography (CT). They are carried out to determine the cause of the disease and establish a reliable diagnosis.
In the video, checking Lasegue's symptom:
The Lasègue symptom in neurology was first described in the mid-19th century and was named after the researcher who discovered it. May appear when various diseases. There are several degrees of this manifestation.
This symptom is a painful sensation in the lumbar region of a person lifting an elongated lower limb, which disappears when the leg is bent. Occurs when:
Appears due to pinching nerve endings, excessive stretching or damage to nerve fibers. Because of this, lengthening the nerve becomes impossible. When lifting the lower limb, stretching begins, which causes discomfort. In this case, there is no pain at rest. If a person bends his leg, the muscles of the back surface of the limb contract, the nerve fiber stops stretching and the pain syndrome disappears.
The test is carried out if a person complains of pain in the lower back, buttocks, thighs and lower legs when performing movements. The lesion may occur on one side or be bilateral.
The study should be carried out by a specialist neurologist. It is not recommended to do this on your own: incorrect technique can cause harm and correct readings will not be obtained.
For testing, the patient should lie on their back. The surface on which the patient is located is straight and hard. A person should position himself as evenly as possible so that the sides of the body are symmetrical to each other. The back is completely relaxed, the damaged nerve is not tense, so there should be no discomfort.
The doctor slowly bends the patient's lower limb in hip joint. When this action is performed, the leg should be bent at the knee. This movement should also be painless.
At the next stage of the test, the doctor slowly and smoothly raises the straightened leg. In this case, no sudden movements should be made; The limb should be raised gradually. As soon as the patient feels pain, the test is stopped. You cannot endure pain; you must immediately inform your doctor about the appearance of unpleasant sensations.
If the patient is under the influence of anesthesia or pain medications, the test will have to be delayed. Such medications reduce sensitivity, which can distort test results. In addition, there is a risk of nerve fiber rupture, since pain will not appear with strong tension.
If the test results are positive, you will need to undergo additional examination.
The result is considered negative when a right angle is obtained when raising the leg. In addition, if bending the leg does not eliminate pain, the result is also considered negative. In such cases, pain is most often caused by pathologies localized in the limb itself:
Additional examinations will be required to find out the cause and eliminate it.
If pain occurs when lower limb raised at an angle of 60 degrees, the result is not positive. In this position, the nerve is stretched to its maximum length, which is impossible in the presence of pinching.
A pseudo-positive result is observed with weak muscles. In most cases, this variant is found in older people whose muscles experience age-related degenerative changes. To make a diagnosis, you should contact an orthopedic specialist.
The result is considered positive when the patient is unable to raise his leg more than 30 degrees. As you lift your leg, the intensity of the sensation gradually increases. If you bend the limb at the knee, the sensation will immediately disappear.
A doctor should evaluate the test results. You can independently determine it incorrectly, which is why the treatment will not correspond to the problem, and the patient’s condition will become worse.
This symptom is not an independent diagnosis. Whatever results are obtained, additional testing will be required. The doctor will tell you which specialist to contact, what and how to check in each individual case.
If pain occurs, you should not expect the pathology to go away on its own. You need to see a doctor as soon as possible to avoid unpleasant complications and worsening the patient’s condition. If therapy is started in a timely manner, it will be possible to get rid of the disease faster.
