long thoracic nerve entrapment
Introduction
Introduction to chest long nerve compression syndrome The thoracic nerve originates from the neck 5, neck 6, and neck 7 nerve roots, and occludes the anterior serratus muscle. This nerve compression is rarely noticed by physicians. In the study of the anatomy of the scapular dorsal nerve, the authors found that most of the scapular dorsal nerves began to co-exist with the cervical 5 nerves of the thoracic nerve at the initiation of the cervical 5 nerve, and the sacral origin and sputum of the middle part of the penis muscle. The fibrous annulus, so that the thoracic nerve originating from the neck 5 nerve may also be compressed together with the dorsal scapular nerve. The compression of the thoracic nerve will produce clinical symptoms, the neck, the back have obvious tender points, and the compression The tenderness point on the back can induce numbness inside the forearm and fingers. The patient complains of discomfort in the left chest, tingling, left chest wall and underarm discomfort, and there is a feeling from the back pain to the front of the heart. After the neck is partially closed, the patient is completely The symptoms disappear. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: angina
Cause
Causes of chest long nerve compression
Cause:
The compression of the thoracic nerve often occurs only in the thoracic nerve originating from the nerve root of the neck 5, that is, the neck 5 nerve root is subjected to compression.
(two) pathogenesis
The chest long nerve innervates the anterior serratus muscle. The role of the anterior serratus muscle is to abduct and rotate the scapula. During the forward motion, the anterior serratus pulls the scapula outwards away from the spine and makes it close to the chest wall. When the upper extremity abduction may be limited, the abduction should not exceed the head. The author's clinically diagnosed thoracic nerve compression does not have a limitation of upper extremity movement. This is because the chest nerve compression in these patients only originated in The thoracic nerve of the neck 5 nerve root originated from the neck 6, and the thoracic nerve of the neck 7 nerve root was not compressed, so there was no shoulder abduction dysfunction caused by the compression of the thoracic nerve. The thoracic nerves of the cervical 5 nerve roots are often dry at the beginning, so the two are often stuck together. The clinical feature of the two compressions is that the patient has a feeling of pain from the back to the chest, and sometimes it may merge. The neck 5 nerve root compression, if there is also shoulder discomfort, the diagnosis may be more clear.
Prevention
Thoracic nerve compression syndrome prevention
Chest long nerve compression syndrome is a kind of disease that is closely related to modern living and working conditions. It can be prevented completely, and the prevention method is also very simple. It is to avoid long-term position stalemate and avoid maintaining a posture for a long time. And working in a mechanical and frequent activity, working for a period of time, activities and activities, doing some relaxing exercises.
Complication
Thoracic nerve compression syndrome complications Complications
The main complication of this disease is that when the compression is severe and lasting, it can cause demyelination of nerve fibers, and even the distal axonal disintegration, Waller degeneration of myelin. During limb movement, nerve fibers in the stenotic channel undergo chronic inflammatory inflammation under mechanical stimulation and aggravate the vicious circle of edema-ischemia. This further causes damage, so patients with this disease should actively treat to prevent complications.
Symptom
Chest long nerve compression symptoms common symptoms chest pain back faint numbness discomfort pain angina
1. History and symptoms
(1) The patient may have a history of neck discomfort and "cervical spondylosis".
(2) chest wall, chest wall and armpit discomfort, pain, acupuncture-like pain, such as in the left chest wall, resembles angina.
(3) If the scapular nerve is compressed, the patient may complain of feeling from the back to the heart.
(4) Cardiac examination data does not support angina pectoris.
2. Signs
(1) The upper and lower tenderness of the posterior margin of the sternocleidomastoid muscle is significant.
(2) Sniping the chest may induce chest pain.
(3) There are signs of scapular dorsal nerve compression when the scapular nerve is compressed.
3. Special examination was performed on the midpoint of the posterior margin of the sternocleidomastoid muscle. The most obvious point was the upper and lower tenderness. It was partially closed with 0.25% bupivacaine 2~3ml, and all symptoms disappeared.
Examine
Examination of chest long nerve compression syndrome
Special examination: (1) The most obvious point of tenderness in the midpoint of the posterior margin of the sternocleidomastoid muscle was partially closed with 0.25% bupivacaine 2 to 3 ml, and all symptoms disappeared. (2) The patient has chest discomfort, tingling, and the disease of the heart is ruled out. When the symptoms of the neck pain point are partially closed, the possibility of chest nerve nerve compression is highly considered.
Laboratory examination: no positive findings were found on X-ray examination.
Diagnosis
Diagnosis and diagnosis of chest long nerve compression syndrome
The patient has chest discomfort, tingling, and the disease of the heart is ruled out. When the symptoms of the neck pain point are partially closed, the possibility of chest nerve nerve compression is highly considered.
Differential diagnosis
1. Angina: The pain in the left front chest must be differentiated from angina pectoris, and the heart should be examined. If necessary, please consult a cardiologist.
2. biliary colic: patients with right front chest discomfort and pain should think of gallbladder, biliary tract disease, pay attention to abdominal signs and history of biliary tract, it is not difficult to rule out.
