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Exercises to restore sensitivity in the little finger. Numb hands: causes of impaired tactile sense

This time an experienced neurologist Kirill Aleksandrovich Shlyapnikov will answer a question from regular reader Sergei. He, like me, had ischemic stroke. And subsequent paralysis with loss of sensation in the arm and leg. True, it happened to him a little later, at the beginning of 2015. Since then, Sergei has been very persistent in his recovery from the stroke. We correspond almost daily. I have great respect for him. For his perseverance and optimism. He has serious consequences of a stroke. But he never whines or gets discouraged. Such a real and strong man.

This is what the Doctor answered to his question:

V.Sh. Another question. After the stroke, sensation was lost. And from above. The skin felt like it wasn’t mine. And inside, the body itself, the muscles. How can this restore both skin and muscles, sensitivity?

K.Sh. There are different transmission channels. Even different fibers. Some fibers transmit superficial sensitivity - tactile, pain. And deep types of sensitivity go along other neural pathways. These are joint-muscular feelings, for example, or feelings of pressure and mass. And if we are talking about a defect at the level of the brain, then naturally we must improve blood circulation, neuroprotectors give and time.

If we are talking about joint-muscular feelings. The more signals we send to the brain from the joint-muscular receptors, the more they pave the way for themselves. These are movements.

As for tactile sensitivity. It's difficult with her, of course. How to stimulate her? Painful sensations or what? This is sadism))). But still, the brain has the ability to perform the functions that we ask of it. We talked about this last time. If we don’t ask, it won’t be returned. Please, he will return it. Therefore, there are all sorts of methods that I remember were in the Soviet Union. In the offices rehabilitation treatment there were plywood boards on which the telephone was screwed, some taps, handles))). And all this had to be done after the stroke. The more we try to make subtle movements, the more they will come to us. We don’t try at all - they won’t come at all.

V.Sh. That is, if you want your skin to feel good, you need to lightly massage it? Or what?

K.Sh. Massage. Trying to catch temperature sensations. Try to develop develop fine motor skills . Trying to do something with your fingers. For example, peel an egg yourself. Well, a needle and thread is already absolutely aerobatics))). Do something around the house. Cut some food. At first, since there is no sensitivity, this has to be done under visual control. That is, another traffic control system is activated.

V.Sh. Well, yes, because you can do it without looking))).

K.Sh. Yes, you can hit your finger if it doesn’t feel it))).

V.Sh. It's possible, but not necessary.

K.Sh. And from the beginning it’s wildly inconvenient. Annoys. Nothing works. But it won’t work for a month. Maybe three. Maybe it won’t work out for half a year. Half a year. And then maybe it will be. Not a guarantee.

V.Sh. Need to try.

K.Sh. But how can we do without this?! If this happened.

Very impressive in communication with Doctor Shlyapnikov that he always has in his stash a way to solve the difficulties that you encounter while recovering from a stroke. He doesn’t talk about how difficult and insoluble it is. It’s simply clear and explains what to do. The most important! It always works. Tested on me several times))).

upper limb , in particular the hands, can occur due to the action of sharp and blunt objects. As a rule, they are accompanied by soft tissue damage, bone fractures, bruises or suppurative processes. Postoperative injuries to the nerves of the hand are also common.
Incisions made through the eminence of the thumb are especially dangerous for motor branch of the median nerve, and incisions in the distal third of the palm are for the palmar branches of the nerves of the fingers.

Damage to the soft tissues of the fingers accompanied by a violation of the integrity of the own digital nerves.

Seddan, based on pathological, anatomical, clinical and prognostic data, distinguishes the following three types of nerve damage: 1. neuropraxia, 2. axonotmesis, 3. neurotmesis.

1. Neuropraxia refers to benign nerve damage caused by temporary changes. Pathologically, in such cases we are talking about localized fragmentation of myelin. Clinically, neuropraxia is characterized by paralysis, while sensitivity is preserved or slightly impaired. Cure occurs spontaneously in most cases within a few weeks or months.
An example of such damage is the so-called sleep paralysis(“paralysie du lundi”, “paralysie des amants”, “Saturday-night paralysis”).

2. In the presence of axonotmesis, the integrity of the nerve is not completely disrupted. Its connective tissue elements are preserved, only the axial cylinders are affected. The consequence of such an injury is a complete loss of motor, sensory and sympathetic function. If denervation is prolonged, muscle atrophy and irreversible fibrotic changes occur.

Thanks to the preserved connective tissue elements, there are sufficient conditions for regeneration and axons can grow towards the periphery. Examples of axonotmesis are observed in humeral fractures or therapeutic destruction of the phrenic nerve.

3. Neurotmesis refers to such nerve damage, in which the nerve is cut along its entire diameter, so the possibility of spontaneous regeneration is completely excluded. Both axons and connective tissue bundles were cut pathologically. The symptoms of neurotmesis are the same as those of axonotmesis, so in the early stages it is not possible to differentiate between them.

If the palm is damaged in the indicated places, one should remember the possibility of nerve damage (as directed by Meson)

Reliable diagnosis installed only during surgery. If signs of regeneration do not appear before a certain period, then the damage is neurotmesis. It can occur when open fractures, gunshot wounds and due to severe bruises. The connection of a nerve after neurotmesis by surgery never leads to complete cure, since perfect matching of nerve fibers is not possible.

In addition to those listed three main types of nerve damage, differ: partial neurotmesis, nerve ischemia and combined injuries. With partial neurotmesis, the changes do not extend to the entire area of innervation of a given nerve.

At axonotmese sensitivity is restored to approximately 100%. After applying a suture to the nerves, restoration of sensitivity to the same extent does not occur. With true regeneration, sensitivity is not restored concentrically, but from the proximal to the distal direction.

The first clinical a sign of nerve fiber regeneration is that when the nerve stump is percussed along its course, parasthesia phenomena occur. If percussion is performed along the course of the nerve, from the distal to the proximal direction, then a point is reached, during percussion of which the patient experiences a crawling sensation and a feeling of current action. This feeling radiates in the direction corresponding to the course of the distal end of the nerve.

Should be measured periodically distal edge distance a gradually increasing area of restoration of sensitivity from any bony elevation of the arm, taken as the starting point for comparison. This symptom of regeneration in German literature is called the Tinel sign or Hoffmann-Tinel sign.

If there is regeneration, then percussion of the peripheral end of the nerve causes a feeling of current action, since the regenerated non-pulp nerve fibers are sensitive to mechanical irritation. If a moderate crawling sensation occurs only upon percussion of the injury site and the feeling of the current does not appear in the periphery, then regeneration has not occurred and a nerve suture is indicated.

Tinel's sign is not an absolute sign of regeneration, since the nerve elements leading to paresthesia may not function clinically. Therefore, many doubt the reliability of the Tinel sign.

Finally, we present the estimation method regeneration of sensory and motor fibers according to Nigst:
A) Sensitivity assessment:
(0) there are no signs of sensitivity in the area of innervation of the nerve,
(1) restoration of deep pain sensitivity,
(2) restoration of tactile sensitivity and superficial pain sensitivity to a certain extent,
(3) restoration of cutaneous pain and tactile sensitivity in the entire autonomous region of the nerve,
(4) the previous type of restoration of sensitivity, but with the restoration of the ability to distinguish between two points.

B) Assessment of movement disorders:
(0) no contraction observed,
(1) restoration of contractility in the proximal muscle group,
(2) restoration of contractility in both proximal and distal muscle groups,
(3) the condition of the muscles (2), but in addition all the most important muscles are capable of acting against resistance,
(4) condition (3), but with restoration of the ability to perform synergistic and isolated movements,
(5) complete restoration of function.

For example, in case median nerve damage grades B-2 and A-2 surgical intervention is indicated. However, we can speak about the success of the intervention only if the recovery reaches grades B-5 and A-3. In the area of innervation of the ulnar nerve, for complete success it is necessary to restore the motor function of the interosseous muscles, otherwise fine movements of the hand are impossible.

However, recovery sensory function of the ulnar nerve may be even more important than motor, taking into account the supporting role ring finger and little finger. Restoring the motor function of the radial nerve is more important than restoring its sensory function.

Spinal injuries are one of the most severe types of injuries. IN Lately prevalence and severity of injuries spinal column is growing, which is associated with an increase in the number of vehicles, speed traffic, the spread of high-rise construction and other factors modern way and the rhythm of life.

Patients with spinal injuries make up 18% of all patients in trauma hospitals. These are mostly young people ( average age is 17-35 years old). Therefore, the treatment of spinal injuries is not only a responsible medical and social problem, but also an economic one, because the risk of developing permanent disability after spinal injury is very high.

Causes of spinal injuries

Among the causes of spinal column injuries and spinal cord, which is inside, should be called:

Road traffic accidents. In such cases, a person can be injured both as a pedestrian and while inside a vehicle. Particular importance is given to whiplash injury, which occurs when the neck is sharply bent and then straightened with the same force, throwing the head back. Such circumstances arise during a collision 2 Vehicle, during sudden braking at high speed. It is to prevent this type of injury to the cervical spine that there are head restraints in cars.
Falling from height. Such incidents are almost always accompanied by spinal fractures and spinal cord damage. Particularly dangerous is the case when the victim lands on his feet - most of the spinal column is injured.
Diver's injury. It develops when a person dives from a height into the water head down. In this case, the victim hits his head against obstacles in the pond and strong flexion or extension occurs. cervical spine with its subsequent traumatization.
Also, the cause of damage to the spine and spinal cord can be knife, gunshot, or explosive injuries when the traumatic factor hits the spinal area.

Classification of spinal injuries

Injury to the spine and spinal cord has a clear classification, which directly affects therapeutic tactics and forecast. All injuries can be divided into open (with violation of the integrity of the skin) and closed (without them).
Depending on the nature of damage to the anatomical structures of the spine, there are:

Injuries to the ligamentous apparatus of the spinal column (ruptures and sprains of ligamentous structures). Refers to mild degree.
Vertebral body fractures. This includes compression injury, when the vertebral body is compressed and a compression fracture occurs (people with osteoporosis are especially susceptible to this mechanism). Also, fractures of the vertebral bodies can be comminuted, marginal, vertical, horizontal and explosive.
Damage to the intervertebral discs (rupture of the fibrous ring with prolapse of the inner part of the disc, acute hernia Schmorl).
Fractures of the processes (spinous, transverse, articular) and vertebral arches.
Dislocations and subluxations of the vertebrae, fracture-dislocations.
Traumatic spondylolisthesis.

All fractures are divided into 2 groups:

with displacement, when the normal axis of the spine is disrupted and high risk spinal cord compression;
without displacement.

It is also important to divide spinal injuries into stable and unstable. Stable fractures occur when only the anterior part of the spine (vertebral bodies) is damaged. Moreover, if at the time of the blow the spinal cord was not damaged due to displacement of the vertebra, then in the future this risk is minimal.

An unstable fracture occurs when both the anterior and posterior parts of the spine (arches and processes) are damaged simultaneously. Moreover, if compression of the spinal cord did not occur at the time of injury, then the high risk of this complication remains in the future, since any movement can lead to such consequences.

Types of spinal cord injuries:

concussion (this is a reversible functional impairment);
bruise or contusion (organic damage to nerve tissue);
compression, which can be caused by vertebral fragments, damaged disc, hematoma, edema, etc.;
partial and complete rupture is the most severe damage, the consequences of which depend on the level of violation.

Symptoms of spinal injuries

The clinical symptoms of spinal injury primarily depend on whether the spinal cord is damaged, as well as on the location of the injury, its type and mechanism.

Signs of stable injuries

Stable spinal column injuries include:

soft tissue bruises;
ligament damage;
stable fractures of the vertebrae (body, spinous, transverse processes without displacement).

Characteristic clinical symptoms:

diffuse pain at the site of injury;
swelling, bruising, hematomas in the area of injury;
movements may be limited slightly or severely, depending on the degree pain syndrome;
when the spinous processes are fractured, local pain occurs, sometimes you can feel their pathological mobility;
in some cases, signs of radiculitis appear;
with fractures of the transverse processes there is pain in the paravertebral areas;
There are no neurological symptoms, except in cases of secondary radiculitis.

Cervical spine injury

Damage to the upper segments of the cervical spinal cord is life-threatening. The function of the cardiovascular and respiratory centers suffers, and this can lead to immediate death. If there is an injury at the level of the 3-4 segment of the spinal cord, the patient experiences tetraplegia (paralysis of the arms and legs), all types of sensitivity below the site of injury are lost. They also suffer respiratory muscles and the diaphragm, which is dangerous due to respiratory arrest.

When the 4-5 segment of the spinal cord is compressed, tetraplegia occurs, but without respiratory disorders. If 5-8 segments of the spinal cord are damaged, paralysis of various arm muscles develops and lower paraparesis is observed; dysfunction may be present pelvic organs.

Damage to the thoracic and lumbar spine

Damage to the thoracic spinal cord due to spinal injuries is accompanied by weakness in the legs and dysfunction of the genital and pelvic organs. Paralysis of the muscles of the anterior abdominal wall may occur. Respiratory disturbances may occur due to paralysis of the intercostal muscles.

Damage at the lumbar level leads to paralysis of various muscle groups lower limbs(feet, legs or thighs). Sensitivity below the location of the injury also suffers, and the function of the pelvic organs and reproductive system is impaired.

Diagnosis of injuries to the spine and spinal cord consists of interviewing the patient, clarifying complaints, the mechanism of injury, examination data of the person, and determining the presence neurological symptoms spinal cord injuries, as well as data additional methods examinations (radiography, MRI, CT, myelography, etc.).

Natal injuries

Birth injuries are a whole group of mechanical damage to fetal tissue that occurs during childbirth. One of the most serious types of birth trauma is spinal injury. Recently, the number of such injuries has decreased significantly as the number of deliveries by caesarean section has increased.

Factors that can lead to birth injury to the spine:

obstetric care during childbirth;
application of obstetric forceps;
breech and other types of pathological presentation of the fetus;
postmaturity;
large fruit;
rapid or prolonged labor;
deep prematurity;
abnormalities of fetal development.

Most often, the cervical spine and the adjacent brachial plexus are affected. Symptoms depend on the level of damage. As a rule, such an injury is accompanied by pain (the child is restless, constantly changes his position, testing physiological reflexes is painful). Torticollis, shortened or elongated neck may be observed. If the upper cervical segments of the spinal cord are damaged, a picture of spinal shock, various respiratory disorders, the “frog” position, and urinary retention or incontinence can be observed.

If the brachial plexus is damaged, the child may develop Cofferat syndrome (paresis of the phrenic nerve), Duchenne-Erb, Dejerine-Klumpke, and Kehrer palsy. All these syndromes have their own distinctive features and consequences.

Damage to the thoracic region is manifested by respiratory disorders resulting from paresis of the intercostal muscles, as well as lower paraparesis of the legs of a spastic nature, “flat belly” syndrome.

Trauma to the lumbar and sacral regions in infants is accompanied by flaccid paraparesis of the legs and dysfunction of the pelvic organs.

Recovery from a spinal injury in a newborn is long. In some cases, due to the high plasticity and degree of regeneration in infants, it is possible to completely get rid of the symptoms and consequences of injury, but in some cases persistent disability develops throughout subsequent life.

First aid for spinal injury

It is necessary to note 2 main points of care for spinal injury:

reliable and correct fixation of the injured area;
If possible, administer anesthesia.

It is necessary to lay the victim on a hard surface with his back, and he is not allowed to sit down or stand up. Regardless of the damaged area, the cervical spine must be securely fixed. There are special collars for this. If you don’t have such a device at hand, you can roll up a thick roll of clothing and secure it around your neck.

Several people should carry the victim to keep the body at the same level and minimize movements in the spine. Such transportation will help avoid secondary spinal cord injury.

In this case, it is necessary to monitor the person’s pulse and breathing. In case of violations, resuscitation assistance must be provided according to the general rules. Under no circumstances leave the victim alone and do not move him from place to place unless absolutely necessary. It is imperative to call an ambulance.

Principles of treatment and rehabilitation after spinal injury

The consequences of spinal injuries directly depend on the timeliness and correctness of first aid, on the type and mechanism of injury, and on concomitant damage to the spinal cord.

Treatment can be conservative or surgical. For mild injuries, treatment is only conservative. Prescribe symptomatic medications(analgesics, hemostatic, restorative, anti-inflammatory), strict bed rest, massage, exercise therapy, physiotherapy.

In more severe cases conservative treatment can be supplemented by closed reposition (simultaneous reduction of dislocations, fractures, traction) followed by immobilization of damaged segments of the spine (collars for the cervical spine, corsets for the thoracic or lumbar).

Surgical treatment is used in cases of spinal cord injury or high risk of injury due to spinal instability. Surgery may also be prescribed if it is ineffective. conservative therapy. After surgery, strict immobilization or traction is used.

Recovery from a spinal injury is a rather long and labor-intensive process. For injuries without compression of the spinal cord, exercise therapy is indicated from the first days of rehabilitation. They start with breathing exercises and gradually perform exercises for the limbs and spine. The classes must be supervised by a rehabilitation specialist. Massage and physiotherapy are also prescribed.

For spinal cord injuries, recovery is complemented drug treatment, which is aimed at the regeneration of nervous tissue, electrical pulse therapy, acupuncture.

Unfortunately, it is not always possible to restore functions lost due to spinal injury. But the desire to get well, as well as competent treatment and a rehabilitation program sometimes work wonders.

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Hip replacement surgery: rehabilitation after replacement surgery at home, reviews of recovery

Rehabilitation in the period after endoprosthetics hip joint is needed to restore the activity of the joint, relieve pain, prevent complications, prepare the leg for stress and improve the general well-being of the patient.

A successful rehabilitation process after hip replacement is associated with many features. Restorative procedures begin the very next day after implementation surgical intervention, in which the prosthesis is replaced, and they can last from 2 to 3 weeks.

Sometimes, for example, if a person has weak immunity, the recovery period begins in the preoperative time. This is necessary so that the hip joints can be maximally prepared for replacement of the prosthesis and avoid disability.

Restorative procedures are based on the following principles:

the strictest consistency;
continuity of course;
systematic classes with a doctor and independently;
individual approach.

Rehabilitation: what is it for?

Some recovery measures after endoprosthetics should be carried out at home, however, absolute self-medication can be hazardous to health.

After all, the psychological peculiarity of a person is such that unpleasant painful sensations (a natural phenomenon in the postoperative period) will push him to instinctively save his leg.

As is known, inadequate exercise leads to muscle wasting and incorrect tone redistribution. As a result, the likelihood of contractures increases, which can lead to deformation of the pelvic and hip bones, complications when walking, and compensatory scoliosis.

Restorative measures after hip replacement are carried out under the supervision of doctors in a special health resort. In such centers, doctors will control the load so that muscle and joint tissues are developed correctly, muscle tone is restored and pain goes away.

Initial preoperative recovery period

The zero rehabilitation phase consists of special exercises. They must be done before surgery at home or in the clinic. Such training helps:

improving blood circulation;
prevent stagnant formations;
activate tissue trophism;
improve the finishing of the cardiovascular and respiratory systems;
develop hip joints;
eliminate pain syndrome;
remove discomfort.

Note! The basic principle of the zero stage of rehabilitation is that each exercise should be done slowly and carefully.

Using your lower legs (not your knees), you need to do 5 circular movements counterclockwise and clockwise.

You need to forcefully press the previously straightened limb into the floor. The tension must be maintained for at least 7 seconds. The exercise is repeated about 10 times.

Without removing the heel from the floor, you need to bring it with the knee bent to the thigh. Then the leg should be returned to a straight position by slowly moving the heel in the direction from the hip. The exercise is repeated 7 to 10 times.

The buttocks should be contracted and held tense for about 8 seconds. You must do at least 10 repetitions.

The straightened limbs are smoothly spread to the sides, without being torn off from the surface. The exercise is repeated 10 times.

The straightened leg should be raised above the floor level a few centimeters, after which it should be slowly placed on the surface. You need to repeat the exercise no more than 10 times.

To achieve greater effectiveness of rehabilitation together with exercise therapy, before the start of hip replacement surgery, it is advisable to carry out several procedures of electrical stimulation of the femoral and gluteal muscular system, and massage of the lower extremities.

1-4 and 4-8 days

On the first day after the operation, the patient should remain in bed, so he is transported using a gurney. On the second day, you can gradually load the new joint with your own body weight using a walker or crutches. Sometimes the doctor prescribes partial load.

The main tasks during the rehabilitation period are as follows:

doing exercises;
getting out of bed independently;
walking with crutches or a walker;
independent use of the toilet;
The patient must sit down and get up from the chair himself.

To avoid the risk of complications in the first phase of recovery after surgery, it is not recommended to wear shoes without a spoon, cross your legs, squat and lie on the side on which the operation was performed. Also, do not take a hot bath before the patient plans to go to bed, raise the leg more than 90 degrees, and constantly keep a bolster under the knee joint.

In the first two days after hip replacement, the doctor prescribes magnetic therapy or UHF, which involves therapeutic effect temperature and radiation to the area where the seam was made.

Such procedures have an analgesic and anti-inflammatory effect. Moreover, they can be performed without removing the bandage in the ward. If there are any contraindications to such procedures, UV irradiation of the wound is performed during the dressing process.

For preventive purposes to avoid stagnation in the lungs and prevent the development of pneumonia, initial recovery includes breathing exercises and vibration chest massage.

Also, at the beginning of recovery, the patient undergoes massage, exercise therapy and does exercises for the joints. At the same time, he learns to do isometric exercises, which consist of tensing the muscles of the buttocks, lower legs and thighs.

Therapeutic gymnastics after endoprosthetics is done every day for 15 minutes (from 3 to 5 sessions). In this way, it is possible to enhance metabolic and trophic processes in the muscles and mobilize the central nervous system. This type of gymnastic exercise is effective in cases of bilateral damage to the hip joints.

After 4 days after hip replacement, you should begin to climb stairs, placing your hand on the railing, taking no more than one step at a time.

To shorten the recovery period after joint replacement, the doctor prescribes massage and a course of exercise therapy.

So, climbing the stairs should be done as follows:

place a healthy limb on the top step;
raise the leg with the prosthesis one step higher;
place the cane or crutch on the step below;
place the operated limb one step lower;
reposition a healthy limb.

Climbing the steps of a house during the postoperative period should always begin with the leg that is healthy, and you should go down leaning on the operated limb. The fourth or fifth day is often called the phase of “deceptive possibilities”, because weakness and acute pain disappear on the 5th day of rehabilitation. Consequently, a person wants to restore sensation in the leg after prosthetics.

Important! At this stage, you cannot ignore the recommendations and load the limb. Otherwise, everything may end in a dislocation of the hip joint.

2-8 week

Rehabilitation during the period after hip replacement at 2-3 weeks, when the sutures have already been removed, includes a painless massage of the joint, in which light massage movements are used. Patients are also prescribed a special therapeutic and physical training complex of exercises:

for small joints of the legs;
sitting down on the bed using your hands;
for chest and diaphragmatic breathing.

WITH special attention care should be taken when positioning and securing the leg with special bolsters after surgery to replace the prosthesis. Rollers are placed under the knee joint on the outside to prevent external rotation of the femur.

During this period, the load on the muscles should increase. The operated leg should be exercised to restore strength and restore motor balance. After which the patient will be able to switch from crutches to a cane.

Recovery for 4-6 weeks in a sanatorium or at home must necessarily include a set of exercises aimed at developing the muscular system of the leg, in particular the hip joint.

The first recommended exercise is resistance (using an elastic band). You need to do it 2 times a day in 3 approaches. The ankle is wrapped with one end of the tape, the remaining part is attached to the leg of a chair or table.

The next exercise is resistance hip flexion. To do this, you need to lean against the wall on which the elastic band is attached and put your leg to the side. The limb should be understood forward and the knee should be straightened. Next you need to return to the starting position.

The third exercise is done in a standing position; it involves moving the limb to the side. You need to stand with the healthy side of your leg against the attached tape, and then move your prosthetic leg to the side and return to the starting position.

In the sanatorium, during the rehabilitation period after surgery to replace a prosthesis, it includes training on special simulators. And you need to walk using a cane until your balance is completely restored. You need to move every day for at least 10 minutes, three times a day, each time increasing the walking time, so that the artificial hip joint takes root normally.

After hip replacement, training should be easier. In order for the exercises to be beneficial and not harmful, you need to consult a trainer or watch a special video.

The best option after surgery would be to exercise on an exercise bike, which will help restore muscle tone and restore mobility of the hip joint.

Initially, the pedals can only be turned backwards, and then forwards. In this case, the knees should not be raised high. After a month, the load can be increased. Also, before starting classes, the machine needs to be adjusted to suit your height.

Late stage

The main rehabilitation after endoprosthetics surgery is to undergo a course of treatment in a sanatorium or health center, where there is special equipment.

The doctor selects the method of rehabilitation therapy individually, taking into account the stage and form of the disease of each patient. To return life to a healthy direction, the sanatorium uses various restorative procedures, for example, therapeutic massage.

Actions of a specialist manual therapy are aimed at restoring the muscular and ligamentous apparatus, relieving pain, activating blood circulation and eliminating pain.

Also, after an operation during which total endoprosthetics was performed, for speedy recovery The doctor prescribes acupuncture to the patient. This procedure allows you to reduce pain by eliminating vascular spasm and improving the nutrition of tissue cells.

Physiotherapy is a procedure in which temperature, electric current, laser and ultrasound are applied to the recovery area. During mud therapy, metabolism is activated, resulting in improved tissue nutrition thanks to medicinal properties dirt.

Hydrotherapy is also very helpful in the post-operative period. To quickly return to your normal life, you need to do water aerobics, take pine and salt baths and not forget about the Charcot shower.

Total hip replacement is a rather difficult operation, since the main category of patients who need it are elderly people. Therefore, it is necessary to replace a weak load with a heavier one no earlier than after 2-3 months. If such recommendations are not followed, then complications may arise.

therapeutic exercises;
special food;
massage;
drug therapy.

And don’t forget that you need to sleep and rest more.

A compression fracture of the spine, the consequences of which we will consider, is one of the most serious and dangerous forms of spinal injury. With such an injury, “compression” of the vertebrae occurs (one or several at once), which leads to a decrease in the height of the spinal column, which is why the consequences can be extremely severe.

If the vertebral body itself is “pressed” into the spinal canal, then destruction of the intervertebral disc and compression of the spinal cord is very likely, which is the cause of the development of paresis and paralysis of the limbs.

The most dangerous in this regard is considered to be a fracture of the cervical vertebrae, the consequences of which can be the most serious, including death. So, in the summer the most common option is fracture 4, 5 or 6 cervical vertebra, the consequences of which we will describe below.

We call this type of injury a “diver’s injury,” since it is often suffered by those who like to dive from heights. It is usually caused by hitting the head on the bottom, often resulting in instant death.

By the way, abroad this injury is often called the “Russian injury”, since only our compatriots tend to “take it to the chest” and then dive from a decent height in an unknown place.

About compression fractures in general

In general, this is a fairly common injury that occurs during sudden simultaneous compression and flexion of the spine. This specific load leads to a sharp increase in pressure on the discs and vertebral bodies, as a result of which the anterior part of the vertebra “flattens” and takes on a wedge shape. The result is a decrease in the height of the spinal column, which can cause part of the vertebral body to begin to press on the spinal cord.

The most common compression fractures are the first and second lumbar vertebrae, as well as the 11th and 12th thoracic vertebrae. In this case, either one of these vertebrae or several at once can be damaged. Very often, the cause of such injury is car accidents or falls from a height.

Separately, we can mention the prevalence of this type of injury in older people, which most often occurs as a result of the development of osteoporosis, in which bones weaken and become brittle. In this situation, a compression fracture can act as a complication of the underlying disease, although its danger does not decrease at all.

IN general case Spinal fractures in which there is no damage to the spinal cord are divided into 3 degrees. With the first degree, the height of the vertebra decreases by less than half, with the second - by about half. With the third degree, the decrease is the most significant - more than 50%. At the time of the fracture, the patient feels quite severe pain.

It is noteworthy that in cases where a fracture occurs in vertebrae weakened by other diseases with relatively minor injuries, the pain is insignificant and is often simply ignored.

In addition, it should be taken into account that the characteristic manifestation of the lesion is nerve structures with a fracture, it is not the pain itself, but the appearance of neurological symptoms. For example, it could be numbness in the legs or arms, or simply muscle weakness.

About the consequences of compression fractures

As we have already said, a compression fracture itself can be very dangerous. Thus, one of the most dangerous is a fracture of the fifth cervical vertebra. The whole problem is that in the cervical spine there is a lot of blood vessels and nerve canals, so injury to this department often leads to very serious consequences.

Thus, unlucky “divers” at a minimum risk “earning” pathological segmental instability, which occurs due to a significant decrease in the height of the injured vertebra. There is no point in describing what will happen in the worst case, but the best scenario in this situation is quite dangerous.

Fractures in the thoracic region are very rare, since they are almost always the result of direct trauma. For example, a fracture of the 7th thoracic vertebra usually manifests itself as quite severe but tolerable pain (if there has been no spinal cord injury). As a result, a person often decides to “be patient, it will go away on its own.” Of course, it doesn’t go away on its own, but it adds a number of complications that are more difficult to cure.

Fractures in the lumbar region are quite complex, since it is this section that bears the maximum load.

A fracture of the 12th thoracic vertebra, or 1-2 lumbar vertebrae (fractures of the 3rd and 4th lumbar vertebrae practically do not occur) are not too dangerous if treatment was started on time and the spinal cord was not injured.

But a decrease in the size of one of the vertebrae in a given part of the spine almost always leads to rapid degenerative changes and injury to nerve endings, which results in chronic pain syndromes.

About the treatment of spinal fractures

Compression fractures of the vertebral bodies are an extremely unpleasant phenomenon, but they do not always require surgical intervention. Usually, the matter is limited to strict and prolonged bed rest, which can last several weeks, as well as taking analgesics that can get rid of pain.

Over time, of course, the vertebra will “grow together,” but the patient still has to deal with the consequences of the fracture. First of all, because the shape of the vertebra has changed and now it can shift under heavy loads. Moreover, sometimes a slight displacement can be observed immediately after the removal of the cast and the first attempts to move. This happens because the back muscles have seriously weakened during treatment and are not yet able to support the spine.

It should be understood that if a spinal fracture occurs, then treatment is not only a long stay without movement, but also hard work to rehabilitate the body.

Yes, the basis rehabilitation period usually becomes physiotherapy and massage, which allow you to restore your condition muscle corset backs. Physiotherapeutic procedures will also be useful to help restore normal metabolism in the area of injury, and this is a good preventive measure. possible development degenerative processes.

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Particularly difficult problems in hand nerve surgery include plastic surgery of nerves in a scar-modified tissue bed, as well as irreparable lesions of the central and/or peripheral ends of the nerve. Depending on the characteristics of the damage and the condition of the tissues in the defect area, two main situations can be distinguished: 1) when nerve repair is possible and 2) when the problem of restoring sensitivity in the fingers should be solved in other ways (Diagram 27.3.1).

Scheme 27.3.1. The choice of method for restoring the sensitivity of the skin of the finger, depending on the condition of the ends of the nerves and tissues of the hand.

Nerve grafting is possible. If previous nerve surgery did not lead to recovery skin sensitivity on the fingers, then in most cases the surgeon chooses one of four options for nerve plastic surgery: 1) repeated conventional plastic surgery; 2) plastic surgery of the nerve with non-blood-supplied neural grafts with their placement outside the scarred tissue area; 3) plastic surgery with blood-supplied neural grafts and 4) placement of non-blood-supplied neural grafts in a flap specially transplanted into the defect area, which plays the role of a full-fledged biological environment.

Repeated nerve repair is performed when the condition of the soft tissues is satisfactory, there are no significant scars in the area of the tissue defect and a relatively small amount of diastasis between its ends. The chances of good results are maximized if the extent of the damage allows excision of scarred tissue in the area of the nerve defect.

Nerve plastic surgery with transposition of neural grafts. With a significant size of the nerve defect (several centimeters) and pronounced scar tissue changes, the real danger becomes blockage of axon growth through the grafts by the resulting scars. If the scar cuff around the area of nerve damage cannot be excised, then the chances of success increase significantly when longer neural grafts are used for repair of the nerve, laid to bypass the scarred area.

Transplantation of blood-supplied neural grafts is indicated in cases where simple options plastics are not applicable due to the high probability of cicatricial blockade of grafts. Most often, this situation occurs with defects of the median nerve at the level of the carpal tunnel and proximal hand.

Operation technique. Radiation is used as a blood-supplied neural graft. vascular bundle from the contralateral forearm, if necessary including a muscle fragment and/or skin area.

The graft is transferred to the defect area and placed so that the length of the intermediate sections of the donor nerve corresponds to the size of the diastasis between the refreshed ends of the median nerve (Fig. 27.3.16, b). Then the neural graft is divided into sections, keeping the adjacent vessels intact (Fig. 27.3.16, c). After connecting the ends of the neural grafts with the ends of the median nerve, the artery and one of the veins of the transplanted tissue complex are connected to the corresponding elements of the vessels of the receptive bed (radial or ulnar vascular bundle - Fig. 27.3.16, d).

Rice. 27.3.16. Scheme of plastic surgery of a median nerve (MN) defect using a blood-supplied neural graft from the radial neurovascular bundle.
a — location of the ends of the median nerve before surgery; b, c — laying and formation of fragments of the neural part of the graft; d - after surgery. A, V - artery and vein; N - nerve (explanation in the text).

Creation of a complete biological environment around neural grafts. With widespread scar tissue changes in the area of the nerve defect, the surgeon often has to solve the problem of not only nerve plastic surgery, but also restoration of damaged tendons and skin. A radical solution to this set of problems can be transplantation of a complex of tissues into the defect and the placement of both neural grafts (non-blood-supplied) and tendon grafts.

When the defect is located in the area of the carpal canal and base of the hand, radial or ulnar flaps (muscle or musculocutaneous) can be used as a donor source. However, the least complicated and traumatic is the transplantation of a muscle flap from the flexor carpi ulnaris on a peripheral pedicle.

Operation technique. A flexor carpi ulnaris flap is formed from the center to the periphery, separating the muscle tissue from the tendon so as to preserve the anatomically constant and fairly large branches of the ulnar vascular bundle entering the peripheral part of the muscle (Fig. 27.3.17, a). The length of the flap is determined taking into account the size of the defect between the refreshed ends of the nerve and the arc of rotation of the tissue complex.

The muscle flap is moved into the carpal tunnel and sutured to the surrounding tissues. Neural grafts are passed through the transplanted muscle, and their ends are anastomosed with the ends of the median nerve (Fig. 27.3.17, b).

Rice. 27.3.17. Scheme of plastic surgery of the median nerve using a flexor carpi ulnaris flap on a peripheral pedicle as a complete biological medium.
CH - median nerve; LSK - flexor carpi ulnaris; L — muscle flap from the flexor carpi ulnaris; Tr - neural grafts carried out through a mixed muscle flap; LA - ulnar vascular bundle (explanation in the text).

Use of sensory branches of intact nerves for plastic surgery. In rare cases, as a result of injury, the central end of the nerve trunk is affected over a significant extent. Most often, the median nerve at the level of the forearm is affected by ischemic necrosis of the tissues of the anterior surface of the segment. In this case, the peripheral part of the nerve can be used for reinnervation, and the dorsal cutaneous branch of the ulnar nerve or superficial branch radial nerve.

Nerve plastic surgery is not possible. Implant plastic surgery of nerves. A special situation arises in cases where the peripheral ends of the median and/or ulnar nerves are excised. This may be the result of an improperly performed operation for Dupuytren's contracture, a consequence of injury, or the result of transplantation of a denervated flap with a significant thickness of tissue onto the hand.

If the condition of the skin of the finger is satisfactory, then reinnervation of the working surfaces of the hand can be achieved by implantation nerve plasty.

Operation technique. The central end of the median (ulnar) nerve is isolated and refreshed. A neural graft (usually the sural nerve) is passed under the skin in the direction of the denervated zone so that the end of the donor nerve comes out into the smallest incision in the functionally significant area of the finger (hand) (Fig. 27.3.18, a). The central end of the neural graft is then sutured to the central end of the main nerve, and distal end divided into separate bundles (Fig. 27.3.18, b). Each bundle is brought out using a thin thread and a needle to a separate point, and after removing the excess bundle with scissors, its end is immersed with microtweezers at the subdermal level (Fig. 27.3.18, c). This method allows you to obtain a fairly high level of reinnervation of complex flaps transplanted onto the fingers.

Rice. 27.3.18. Scheme of the stages of implantation plastic surgery of the palmar digital nerve (SPN) for reinnervation of the palmar surface distal phalanx.
a — neural graft (Tr) is brought into the wound of the distal phalanx; b — the end of the graft is divided into separate bundles; c — implantation with a neural graft bundle is completed (explanation in the text).
Sensitive flap transplantation. Transplantation of sensitive flaps onto the denervated surface of the fingers is possible in various variations and in many cases is an alternative to complex options for plastic surgery of nerves and tissue defects. The following methods of transferring sensitivity to the hand can be used.

S-shaped plastic surgery with opposing flaps. Indicated for moving sensitive skin from the secondary to the dominant surface of the finger in elderly patients or after unsuccessful plastic surgery nerves.

Operation technique. The operation is performed in two stages (Fig. 27.3.19). During the first stage, two flaps are formed on the proximal pedicle (sensitive) and on the distal pedicle (denervated - Fig. 27.3.19, b, c). The flaps are swapped and sutured to the edges of the defect (Fig. 27.3.19, d). In this case, excess skin occurs and both flaps protrude somewhat. After 6-8 weeks, the swelling subsides and the flaps take root.

During the second stage of the operation, the superficial layer of skin along approximately two-thirds of the insensitive flap is excised. When determining the size of the excised area, it is advisable to first remove about half of the skin of the flap, then try to move the distal edge of the proximal flap and, only after assessing this distance, finally determine the boundaries of the excision. In this case, the contours of the distal phalanx change only slightly (Fig. 27.3.19, e, f). This method allows one to obtain close to normal sensitivity of the distal phalanx, despite a 2-month period of flap hyperesthesia.

Rice. 27.3.19. Stages of reconstruction of the soft tissues of the distal phalanx of the finger to improve the sensitivity of its denervated surface (according to I. Niechajev, 1987).
a - d - 1st operation; d - f - 2nd operation. Points - denervated half of the finger; dark shading - sensitive half of the finger (explanation in the text).

Transfer of an island flap from the non-dominant surface of the finger. This operation is possible in two ways. In the first option, a flap is cut out on broad base, which includes the neurovascular bundle (Fig. 27.3.20, a). After transposition of the flap onto the dominant surface of the finger, the donor defect is covered with a skin graft. The method was proposed by J.Littler in 1964.

In the second option, proposed by BJoshi in 1974, a flap from the non-dominant surface of the finger is isolated and transplanted onto the denervated surface of the finger as an island flap (Fig. 27.3.20, b).

Rice. 27.3.20. The use of flaps to restore the sensitivity of the working surface of the finger at the expense of the skin of the sensitive non-dominant surface.
1 — transposition of the flap from the opposite surface of the finger (according to JXittler, 1964); 2 - island flap transplantation (according to BJoshi. 1974) (explanation in the text).

Transplantation of a flap from the dorsal radial surface of the second finger of the hand is advisable for tissue defects of the first finger. The broad-based flap includes the terminal branches of the 1st dorsal carpal artery, as well as the superficial branch of the radial nerve (Fig. 27.3.21). The donor defect is covered with a dermatotomy flap.

Rice. 27.3.21. Scheme of transplanting a flap from the dorsal radial surface of the second finger to the palmar surface of the first finger: before (a) and after (b) surgery.

Transfer of an island flap from the fourth finger to the first finger. Irreversible damage to the branches of the median nerve with impaired sensitivity of the palmar surface of the first finger became the basis for the development of an operation to transfer sensitive skin from the zone of innervation of the ulnar nerve.

Operation technique. An island flap is cut out on the ulnar surface of the fourth finger of the hand and isolated on the palmar digital neurovascular bundle in the proximal direction to the level of the departure of the common palmar digital artery from the superficial palmar arch (Fig. 27.3.22, a, b). The vascular pedicle is isolated with a layer of loose fatty tissue, preserving the thin veins accompanying the arteries. If necessary, the radial portion of the palmar arch can be divided and mobilized. The common palmar digital nerve is divided to the point of flap rotation using a microsurgical technique. The flap is carried out in the subcutaneous canal, making additional access if necessary, and sutured into the tissue defect of the first finger (27.3.22, c). For the success of the operation, it is important to prevent torsion and compression of the vascular pedicle.

Rice. 27.3.22. Stages of transplantation (a, b, c) of an island flap from the ulnar surface of the fourth finger to the palmar surface of the first finger (explanation in the text).

Engraftment of the flap leads to the restoration of sensitivity on the working surface of the first finger. At the same time, many authors note hyperesthesia of the transplanted tissues, sometimes reaching hyperpathy, which reduces the value of this method.

Sensitive islet radial cuta transplantation. A radial fasciocutaneous flap on a peripheral vascular pedicle can be transplanted to the area of the eminence of the first finger and reinnervated (Fig. 27.3.23).

Rice. 27.3.23. Scheme of transplantation of a radial flap on a peripheral vascular pedicle and its reinnervation through the palmar cutaneous branch of the median nerve.
LuA - radial artery; LoA - ulnar artery; LCN—lateral cutaneous nerve of the forearm; LVSN - palmar branch of the median nerve; KT - skin graft covering the donor defect, a - before surgery; b - after surgery.

Free transplantation of tissue complexes. To restore the full sensitive skin of the hand, various donor sources can be used, most often the basin of the first dorsal metatarsal artery. The advantages of flaps taken from the area of the first interdigital space of the foot include the possibility of transplanting flaps of various shapes and relatively large ones, which can be placed on the working surface of the hand. Reinnervation of the transplanted tissues can be achieved through the deep branch of the peroneal nerve (flap nerve), which is sutured to one of the sensory nerves of the bone (Fig. 27.3.24).

Rice. 27.3.24. Scheme of isolation and transplantation of a flap, including tissues of the first interdigital space of the foot (a), onto the denervated surface of the stump of the fingers (b).
Ta - dorsal artery of the foot; B - accompanying arteries and veins; N - deep branch of the peroneal nerve; T - graft, NA - zone of neural anastomosis; SA - zone of vascular anastomosis.

IN AND. Arkhangelsky, V.F. Kirillov

Good day, forum members and dear doctors.
Prehistory. At the end of October 2017, my lower back began to hurt. At first there was moderate pain, then it grew into a sharp, intolerable one. I also caught a cold, and when I sneezed and coughed, I tried to hang on a chair or table so that my back wouldn’t hurt so much. I live in Germany, so I first went to a therapist, he prescribed me Ibuprofen, which I choked on for 2 months, with absolutely no results. I took a referral and went to an orthopedist, he took an x-ray, prescribed Ibuprofen again, made a blockade, assured me that there was nothing wrong and gave me a referral for exercise therapy. Within 2 weeks the pain persists and begins to radiate right leg. I limp back to the therapist, she prescribes me the muscle relaxant Orthoton, along with Ibuprofen. After a few days, the pain becomes unbearable, it seemed to flow into the leg, I could neither stand nor walk, I could only lie on the floor without moving. They took me to the doctor, gave me another injection, again Ibuprofen, which I was already gnawing on by the handful. By that time, my leg was numb and I couldn’t stand on my toes. I was also terribly sick. And then came the first session of exercise therapy, I went to class, at least just to explain that I couldn’t exercise. And oh miracle! An adequate person, a masseuse, when I told about my problem, suggested that Ibuprofen simply did not work on me, and recommended asking a therapist to prescribe Diclofenac for me. I immediately sent my husband to the pharmacy, and was only able to buy Voltaren, a small dosage of Diclofenac, the rest only by prescription. It's strict here. And that same evening the long-awaited relief came. The leg began to gradually release. Within a few days of taking diclofenac, the pain completely disappeared. But numbness, paresis and lameness remained.
With these symptoms I go back to the orthopedist, he immediately sends me to a neurosurgeon. On the same day I get an appointment and receive an appointment for an MRI and Cortisone for 3 days. A week later re-appointment With the results of the MRI, cortisone did not bring relief. And I am scheduled for surgery. They gave me time to think until the next morning, since it was before Christmas. In short, I refused and decided to look for other solutions. I called, searched, found out. I found a massage therapist who specializes in hernias. After a week of sessions, I began to notice that I was walking better. After the massage course, I went back to the neurosurgeon; she, seeing that the paresis had almost gone, said that there was now no indication for surgery.
Reality. There are no indications for surgery, but what to do with sensitivity? She's gone too! One buttock is smaller, the calf muscle is narrower, along the back of the leg, from the thigh to the toes, I don’t feel anything.
I am working on the paresis, but there is still a slight weakness. I can stand up on my toe and even jump.
Dear doctors, I’ve been reading the forum since November and saw that Neuromidin and Trental are prescribed to restore paresis. Please tell me, can these drugs help in my case?
The neurosurgeon prescribed only exercise therapy.
I don’t download MRI, I think since it has become much easier, it doesn’t make sense.
Thank you in advance for your help and advice!!!