Osteochondrosis is accompanied by various clinical signs, including the so-called tension symptoms. This is the name for complications of nervous tissue spinal cord, as a result of which the patient experiences regular pain.
Collapse
What it is?
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.
The causes of such 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 the 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.
Kinds
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.
Symptoms of Lasègue
The emerging Lasegue symptom in osteochondrosis of the lumbar region is accompanied by the following symptoms:
- increased pain when raising the leg (while lying down);
- throbbing sensations in one or both legs.
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.
Tripod symptom
This symptom of tension can be diagnosed if the following signs are observed:
- The patient can sit up in bed only if he leans on both hands, placing them behind his back. Without support, a person will not be able to sit due to pain.
- When changing position (getting out of bed), a person tries not to strain his back muscles, as this causes him severe discomfort.
- While sitting on a chair, the patient places his hands on its surface (behind the chair) and tries to tilt his back back.
Thus, the patient is looking for three points of support at once, which is why the symptom received a similar name.
Symptoms of landing
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.
Wasserman-Matskevich symptom
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).
Neri's symptom
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. The cause may also be a herniated disc, when its 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.
Dejerine syndrome
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 movements of the body 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.
Bonnet reaction
Occurs as a result of damage to the sciatic nerve. It can appear in 2 ways:
- A person lies down on a flat surface, his leg is bent at the knee and hip joint, take her aside. Determine the maximum angles at which movement is possible without pain.
- During a visual examination, the doctor draws attention to the fact that the gluteal fold is poorly expressed or practically invisible. This is explained by a decrease muscle tone muscles of the buttocks, which also indicates the presence of the Bonnet reaction.
Diagnostics
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:
- CT scan;
- radiography.
If necessary, carry out general analysis blood and urine.
Treatment
The course of therapy is aimed at solving several problems at once:
- pain relief;
- elimination of swelling;
- cessation of inflammatory processes;
- recovery bone tissue, bone nutrition.
The most common disease occurs in the lower back, because it bears the main physical load. Therefore, treatment of lumbar osteochondrosis with neurological manifestations is most often used. For this purpose, medications, physiotherapeutic procedures, massage, therapeutic exercises, and in some cases surgical intervention are used.
First of all, you need to remove painful sensations. They can be stopped with special blockades with novocaine, painkillers, and anti-inflammatory non-steroidal drugs:
- "Diclofenac";
- "Ibuprofen";
- "Nimesulide";
- "Aceclofenac";
- "Naproxn";
- "Ketorolac" and many others.
Among the physiotherapeutic procedures used are the following:
- ultrasound therapy;
- magnetic therapy;
- exposure to ultraviolet radiation.
Additionally, the patient is prescribed massage sessions, manual therapy, and 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 amounts of salt. There is a need to consume foods enriched with calcium and vitamin D, which promotes its absorption. The patient is also shown physiotherapy, 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 produce 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).
Conclusion
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.
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For the first time, the symptom of pain in the lower back and sciatic nerve during bending of the straight leg in the area of the hip joint was described by the French doctor Lasegue.
The syndrome was then named after this physician.
To understand the essence of the syndrome, you should pay attention to the largest human nerve - the sciatic, which is formed by the roots of the spinal cord nerves.
If a traumatic effect or excessive tension on this nerve causes a sharp sensation in a person lying on his back when they try to lift or bend the limb, then Lasegue tension syndrome manifests itself.
Neurological assessment of the syndrome
This is a test that is used in this field when a doctor suspects a patient has a disease nervous system or parts of the spine.
To make a correct diagnosis, it is necessary to identify areas with pathology in the spine, in which the body, trying to put up protection, forms blocks and pinches the nerve roots.
They try to find such an area by testing the patient for this symptom.
Important rules when performing an inspection are:
- smooth raising of the lower extremities;
- stopping manipulations with the leg even at a small angle of leg elevation, if pain syndrome;
- the test is carried out without prior anesthesia so that the test results are not distorted.
In medicine there are concepts of positive and negative symptom Lasega. 
The exact presence of a tension symptom can be determined if the patient takes a supine position. The doctor carefully lifts the patient's leg until the patient feels pain in the sciatic nerve.
Lasègue syndrome can be:
- Positive the symptom is recognized if, when raised patient's legs at 30° a sensation of pain occurs in the limb. It occurs with gradual flexion of the lower limb at the knee and hip joint. This symptom may indicate compression of the lumbar and sacral roots, which most often occurs with.
- If the pain does not disappear when bending the leg in the hip or knee area, Lasegue's symptom is called negative, and pain can be caused by pathology of these parts of the limb. A patient with such a clinical picture during examination should be further diagnosed to identify the real cause of the pain syndrome.
- Pain in the lower extremity is often psychogenic in nature. They are often observed in hysterical women. During diagnosis, there is usually no connection between changes in leg position and the patient’s symptoms. Pseudo-positive the symptom may also be diagnosed in a person with weak muscles back of the thigh. Typically, such signs are observed in older people.
Practice shows that the appearance of pain when raising the leg by 70° indicates the presence of pathology in the joint. A consultation with an orthopedist is required to determine the pathology of the femoral muscles.
Causes and risk factors
The cause of tension syndrome may be the occurrence or.
The fibers of the sciatic nerve have a certain size, so they cannot lengthen indefinitely. And the development of these diseases causes the fibers to overstretch when they bend around the formed bulges, which leads to pain from the pathology.
To the very common reason manifestations of the symptom include a herniated disc in the lumbar region.
If prolapse occurs, pain is felt in the thigh and lower leg.
It is necessary to supplement the examination with MRI and X-rays.
The risks from tension of the sciatic nerve are associated with the fact that when it is pinched or shortened due to intervertebral hernia possible destruction of nerve connections.
This can lead to the development of paralysis.
Degrees of development
The study for this syndrome is carried out with the patient positioned on his back with passive movement of his leg in 3 phases:
- raising the leg at an angle of 60°;
- bending it at the knee joint by 45°;
- straightening the knee joint (angle 30°).
The severity of tension syndrome is determined by 3 degrees:
Identifying a symptom
The clinical picture of tension syndrome manifests itself as a consequence of impaired functioning of the nerve endings of the sacral plexus or spinal cord roots.
Symptoms, depending on the degree, appear as follows.
The symptom is considered positive if, in the first phase of pointing the straight leg upward at an angle, intense pain appears in the outer or back part of the leg or thigh, in the next phase the pain disappears or decreases, and then the sensation of pain appears again.
A special feature is the disappearance of pain when the knee or hip joint bends. This happens due to the relaxation of certain roots.
Doctors stand out following symptoms, indicating that the patient has Lasegue syndrome:
- painful sensations when raising the lower limb;
- when bending the knee and hip joints, the pain stops;
- when the healthy limb is raised, pain is felt in the affected leg (cross symptom);
- go numb during the test skin the front of the thigh.
Diagnostic approach
Doctors never make a diagnosis based on a test alone because people have different thresholds for pain sensitivity. To obtain more reliable information, this test is combined with the Bekhterev-Fayerstein symptom.
When are they determined pathological signs tension of the sciatic nerve identified after tests, the neurologist refers the patient to additional examination using hardware diagnostic methods.
Examinations using computed tomography and magnetic resonance imaging are prescribed or carried out x-ray examination spine. Thanks to this, the diagnosis is established most reliably.
Diseases that provoke the appearance of the syndrome
Diseases when the sciatic nerve becomes tense include:
Treatment of diseases that are accompanied by Lasegue's symptom consists of: drug therapy with the use of painkillers, physiotherapeutic procedures, acupuncture, and the use of orthopedic corrective agents.
Therapeutic blockades with anesthetics help relieve pain, and after the patient’s condition is alleviated, they are used manual therapy, only on the recommendation of a doctor.
Revealed positive result is the initial link comprehensive assessment of the patient's condition. It allows you to pay attention to the appearance of pathological processes in the body, determine the source of the lesion and begin its treatment.
These include radicular and radicular-vascular syndromes. Radicular syndrome is a discogenic lumbosacral radiculopathy (radiculitis). Damage to the roots of this level is clinically manifested by sensory (pain, paresthesia, anesthesia), motor (paresis of individual muscle groups) disorders, changes in tendon reflexes (first increase, and then decrease). There are also autonomic disorders. At the same time determine in varying degrees manifested vertebrogenic syndromes: muscular-tonic, vegetative-vascular and neurodystrophic.
Clinical manifestations of radicular syndrome depend on the location of 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 lower lumbar spine of a person. Therefore, the L5 and S1 roots are most often compressed, and the L4 root is somewhat less common. Depending on the number of affected roots, mono-, bi- and polyradicular syndromes are distinguished. Main clinical syndrome L5 root lesions are pain in the upper buttock that radiates down outer surface thigh, front surface of the leg and foot into the big toe. The pain is often shooting in nature, sharply aggravated during body movements, changes in body position, sneezing, coughing. There is a feeling of numbness in these same areas. During the examination, weakness and hypotrophy of the muscles that extend the thumb and hypoesthesia in the area of innervation of this 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 and little toe. The muscle tone of the buttock, back of the thigh and lower leg is reduced. Flexor weakness is also noted thumb, sometimes feet. Common symptoms include a decrease or disappearance of the Achilles reflex. In the area of innervation of the S1 root, slight hypoesthesia 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 are noted. Decreases or disappears knee reflex. The sensitivity of the skin is disturbed according to the radicular type, hyperesthesia is determined, which is replaced by hypoesthesia.
Damage to the L5 and S1 roots is much more common. Basic clinical symptom- pain in the lumbosacral area, often shooting in nature, with a feeling of numbness. The pain radiates along the back and outer surface of the thigh, lower leg and foot. Exercise stress, coughing, sneezing make it more acute. Painful scoliosis often develops, with its convexity directed towards the healthy side. The place of straightening or strengthening is marked lumbar lordosis. The movements of the spine are sharply limited during bending. The pain can be so severe that the patient takes on a characteristic posture. Basically, he lies on his back with his lower limbs bent at the knee joints.
IN acute period During palpation, pain is observed in the paravertebral points in the lumbar region and the spinous processes of the LIV, LV and SI vertebrae. Pain points in the projection area of the sciatic nerve are also determined in places where it comes close to the skin: at the point where the nerve exits the pelvic cavity between the ischial tuberosity and the greater trochanter of the femur, in the middle of the gluteal fold, in the popliteal fossa, posterior to the head fibula, behind the medial malleolus (Vallée's point).
Except pain points The so-called tension symptoms are also determined (Lasega, Bekhterev, Neri, Dejerine, Sicara, landing, etc.).
Lasègue'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 outstretched leg at the hip joint (Phase I of Lasègue's symptom). If you further bend it at the knee joint, the pain disappears or sharply decreases (phase II of Lasegue's symptom).
Ankylosing spondylitis symptom (crossed Lasegue symptom) is the appearance of pain in the lumbar region during flexion of the healthy lower limb at 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 the patient lying on his back with straightened lower limbs.
Dejerine's symptom is increased pain in the lumbar region when coughing or sneezing.
Sicard's symptom - - increased manifestations of lumboischialgia during extension of the patient's foot, lying on his back with straightened legs.
Symptom of landing - if a patient lying on his back is asked to sit down, then the lower limb on the affected side bends at the knee joint during landing.
If pathological process is localized in the vertebral segments L1 - L4 and manifests itself with signs of damage to the femoral nerve, symptoms of Wasserman and Matskevich tension are observed.
Wasserman's symptom is the occurrence or intensification of pain in the area of innervation 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 area of innervation of the femoral nerve during sharp flexion of the lower leg in a patient lying on his stomach.
Damage to the roots of the lumbar and sacral segments of the spinal cord may be accompanied by autonomic disorders, which are manifested by a decrease in skin temperature, increased sweating in the area of innervation of the corresponding roots, and a weakening of the pulse in the corresponding arteries.
When compression of the cauda equina develops in the presence of a median hernia, extremely acute pain occurs that spreads to both limbs. Characteristic signs are peripheral paresis stop, perineal anesthesia, urinary dysfunction.
Radicular-vascular syndrome develops as a result of compression of the radicular or radicular-spinal arteries by lumbar hernias intervertebral discs or under the influence of other factors. As a rule, it occurs clinical picture not radiculopathy, but radiculo-ischemia or radiculomyeloischemia. It can manifest itself as syndromes affecting the epiconus, conus, cauda equina, and “paralytic sciatica.” The clinical picture is mostly dominated by motor and sensory disorders in the presence of moderate or mild pain, and sometimes its absence.
Spinal compression syndrome is mostly caused by a 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, conus, cauditis. Patients experience significant motor (lower paraparesis or paralysis) and sensory (conductor or radicular type) lesions. There may be sensitivity disorders in the perineal area. Such lesions are accompanied by urination problems.
The course of lumbosacral radiculopathy (radiculitis) is characterized by periodic exacerbations and remissions. Exacerbations occur due to the influence various factors(hypothermia, unsuccessful movement, lifting loads, etc.).
Diagnostics, differential diagnosis. The diagnosis of cervical reflex syndromes, cervical radiculopathy is established on the basis clinical manifestations disease and X-ray data.
As for pain in the thoracic spine, it can be caused by various factors: tuberculous spondylitis, spinal cord tumor, ankylosing spondylitis. Pain in the thoracic spine can be observed with a tumor of the mediastinum, esophagus, etc. Sometimes it is a consequence peptic ulcer duodenum or diseases of the pancreas, kidneys. Only after a comprehensive examination of patients and exclusion of these diseases can a diagnosis of thoracic radiculopathy (radiculitis), which is a consequence of spinal osteochondrosis, be established.
In typical cases, diagnosing the neurological manifestations of lumbar osteochondrosis, starting with non-radicular forms (lumbago, lumbodynia, lumboischialgia) and ending with radicular and radicular-vascular syndromes, is not difficult. However, pain in the lumbosacral area may be predetermined by various diseases that need to be excluded. These are primarily tumors, inflammatory processes of the spine and pelvic cavity, spinal arachnoiditis, tuberculous spondylitis. Therefore, the doctor should always remember both atypical lumbosacral pain and the possibility of serious pathology. To do this, it is necessary to examine each patient in detail. Most often, they use helper methods examinations: cerebrospinal fluid examination, radiography, CT, MRI of the spine.
Treatment. In the acute period, bed rest, rest and painkillers are first of all necessary. The patient should be placed on a hard bed; for this, a wooden shield is placed under a regular mattress. Also used local remedies: heating pad, bag of hot sand, mustard plasters, jars. Local irritants are various anesthetic ointments that are rubbed into painful areas of the skin.
Painkillers are also used medicinal products. Analgin is prescribed - 3 ml of a 50% solution, reopirin - 5 ml or baralgin 2 ml intramuscularly. Apply an anesthetic mixture (analgin solution 50% - 2 ml, cyanocobalamin - 500 mcg, no-shpa - 2 ml, diphenhydramine 1% - 1 ml) intramuscularly in one syringe. Irrigation of the paravertebral region with ethyl chlorine 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 volume therapeutic measures needs to be expanded. It is advisable to carry out treatment in a neurological hospital. They continue to use painkillers: analgin, baralgin, sedalgin, trigan. Often the pain is caused by damage to the sympathetic fibers, i.e. it is sympathalgic in nature. In this case, finlepsin 200 mg, gangleron 1 ml of 1.5% solution, diclofenac sodium 3 ml, xefocam (8 mg) 2 ml intramuscularly are prescribed. The use of drugs that have anti-inflammatory and analgesic effects is effective: 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); Rofica (rofecoxib) 12.5-25 ml 2 times a day for 10-14 days, Celebrex 1 capsule (100 mg) per day for 5-7 days.
To reduce swelling 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 administration of chondroprotectors (traumeel, discus compositum intramuscularly) is effective. With prolonged pain syndrome gives a good result novocaine blockade(20-40 ml of 0.5% solution) in combination with flosteron - 1 ml, cyanocobalamin - 500-1000 mcg. In case of chronic recurrent course of the disease, B vitamins, biogenic stimulants (aloe extract, peloid distillate, plasmol, vitreous) subcutaneously for 10-15 days.
Physiotherapeutic methods include electrophoresis of novocaine, calcium chloride, magnetic therapy, and diadynamic therapy. Balneotherapy is carried out using coniferous, radon baths, as well as mud or paraffin-ozokerite applications. Massage and exercise therapy are also effective. When they subside acute manifestations, orthopedic treatment is used: spinal traction with the help of 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 it is recommended Spa treatment, in particular mud therapy (Odessa, Saki, Slavyansk, Kholodnaya Balka), radon baths (Khmilnik, Mironovka), paraffin-ozokerite applications (Sinyak).
For 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 movement disorders in the form of flaccid paresis or paralysis, urination disorders.
To prevent frequent relapses, the patient should be temporarily or permanently transferred to work that does not involve significant stress on the spine. If there is no positive effect in treatment for 4-5 months, it can be established III group disability. Sometimes the patient is declared incapacitated.
Prevention. Among the preventive measures, the fight against hypokinesia, physical education and sports are important. It is necessary to avoid hypothermia and sudden movements while performing work associated with significant load on the spine and tension on the roots of the spinal nerves.
Pain - This unpleasant feeling or emotional experience, occurring with the actual or potential threat of tissue damage or the term depicted by such damage (International Association for the Study of Pain, 1994). Pain is divided into acute and chronic.
· Acute pain– this is a sensory reaction with the subsequent inclusion of emotional, motivational, vegetative and other factors that arise when the integrity of the body is violated. Duration acute pain determined by the recovery time of damaged tissue or impaired smooth muscle function. The main afferent highway is the neospinothalamic tract.
· Chronic pain– pain that continues beyond normal healing, lasts for at least 3 months, is characterized by qualitatively different neurophysiological, psychophysiological and clinical relationships. Its formation depends to a large extent on a complex of psychophysiological factors and is often combined with depression.
Pain syndrome in the back and neck in various somatoneuro-orthopedic (vertebroneurological) diseases is the leading criterion for determining the severity of the patient’s condition, choosing therapeutic measures and carrying out expert assessment and labor forecast. There are 4 degrees of pain in the back and neck:
Severe pain syndrome – pain at rest, forced antalgic position, the patient cannot move, cannot sleep without taking sleeping pills and analgesics;
Severe pain syndrome – pain at rest, but less, moves with difficulty within the room, an antalgic posture occurs when walking;
Moderate pain syndrome – pain occurs only when moving;
Mild pain syndrome – pain occurs only during heavy physical activity.
Objectification and assessment of the quantitative, qualitative and spatial characteristics of the pain phenomenon is carried out using special questionnaires.
Symptoms of tension are associated with the occurrence of myofacial pain syndrome in the back and limbs in patients with degenerative-dystrophic diseases of the spine (Popelyansky Ya.Yu., 2003).
Previously accepted hypotheses about tension of the roots through herniated intervertebral discs during joint movement, liquorodynamic push, tension of the spinal cord and roots during neck flexion, etc. in patients with spinal osteochondrosis are currently only of historical interest, but the name of the symptoms remains the same.
1. Neri's symptom– forced tilt of the head of a patient lying on his back leads to pain in the lumbar region spine.
2. Symptom Lacera – flexion of the leg at the hip joint in a patient lying on his back,leads to pain along the back of the thigh or in the lumbosacral region (phase 1). When the leg is bent at the knee joint, the pain disappears (phase II).
3. Sequart's sign- flexion or extension of the foot of a patient lying on his back leads to pain in the popliteal fossa.
4. Bonnet's sign- bringing the affected leg of the patient lying on his back causes pain in the lower back or along the back of the thigh.
5. Matskevich's symptom - bending the leg at the knee joint in a patient lying on his stomach is characterized by the appearance of pain along the anterior surface of the thigh or in the groin fold.
6. Wasserman's sign - raising the outstretched leg of a patient lying on his stomach causes pain in the lumbar region
Questions for self-control
1. Define comorbidity in neurology.
2. What does somatoneurology, neurosomatology, somatoneuroorthopedics study?
3. Give examples of somatoneurological comorbid disorders.
4. List standard trigger points for vertebroneurological diseases. Name the viscero-cutaneous projections.
5. Describe the normal range of motion in the spine.
6. Define acute and chronic pain.
7. Describe the severity of the pain syndrome.
8. Describe the methodology for studying Lasegue’s symptom.
9. Describe the method of studying the symptoms of Wasserman and Matskevich.
10. The patient has a positive Bonnet sign on the right; make a topical diagnosis.
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 flexion of the head. Moreover, this symptom, as a rule, appears only in people suffering from lumbar osteochondrosis.
The test is quite simple. 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 his chest. In this case, a patient with lumbosacral radiculitis experiences 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
The Neri symptom is checked quite often in neurology. 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 pinched roots in the L5-S1 area. Associated manifestations include loss of tendon reflexes, impaired sweating, loss of skin sensitivity, the changes that have begun in lower limbs. At laboratory research cerebrospinal fluid an increased content of red blood cells and white blood cells may be detected 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 lower back muscles. This condition is diagnosed with hypothermia and the process may involve not only muscle tissue, but also spinal nerves that pass through them. In this situation, the Neri test is positive because compression of the nerve fiber occurs.
- Grades 2–4 are formed when the height of the vertebrae is reduced by more than half.
When conducting the test, you should remember that each person has their own pain sensitivity threshold, so you cannot 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 the basis of this make the correct diagnosis and begin treatment.
Symptoms of tension syndrome
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.
- Vertebral fusion.
- Presence of bone osteophytes.
- Inflammation of muscles and ligaments.
The mechanism of development of the Neri symptom is associated primarily with pinched nerve roots in the area of the third lumbar - first sacral vertebrae. Against the background of changes in the vertebral core, protrusion occurs beyond 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 pain in the lower back, which occurs with the slightest movement, the Neri symptom will always be positive. In this case, the main reason is pinched nerve roots.
Pain that is not so severe and lasts for 3 weeks can form a false negative Neri test. Over time, pain in the legs may appear that does not go away. long time, and most often remain throughout the entire disease.
In the case of a lateral intervertebral hernia, when it protrudes to a distance of no more than 10 mm, the Neri symptom may not be observed in neurology.
It turns out that this test allows you to determine the initial manifestations of a particular spinal disease, which means you can begin timely treatment, which 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 comprehensive examination will give an accurate idea of the problem itself and allow the doctor to prescribe adequate treatment, which, if strictly followed, can relieve not only pain, but also other pathological manifestations.
