home Audience 5 Polyneuropathy of the upper extremities: symptoms, treatment and consequences of pathology. Polyneuropathy of the upper extremities: symptoms, diagnosis, treatment methods, reviews Neuropathy of the right hand

Polyneuropathy of the upper extremities: symptoms, treatment and consequences of pathology. Polyneuropathy of the upper extremities: symptoms, diagnosis, treatment methods, reviews Neuropathy of the right hand

Neuropathy is a disease that is accompanied by degenerative or dystrophic damage to the nerves. Refers to fairly common diseases of the nervous system and has many factors that can cause it.

The onset of the disease can be indicated by the appearance of pain, numbness, a burning sensation in certain areas of the skin. Then muscle paresis develops with loss of reflexes.

In peripheral neuropathy, the symptoms depend on which nerve is affected. When the motor nerves are damaged, the work of muscle fibers is disrupted. There is muscle weakness followed by muscle atrophy. A change in sensory fibers leads to numbness of the extremities, paresthesia, and the appearance of pain. If the nerve of the autonomic nervous system is affected, then patients complain of the appearance of dry skin, the frequent development of inflammatory processes, hair loss, and discoloration of the skin.

Causes of neuropathy

There are many causes of the disease, the most common include:

Intoxication - poisoning of the body with salts of heavy metals, arsenic, mercury, side effects of certain drugs, with chronic alcoholism.
Neuropathy in diabetes mellitus - with this disease, this pathology occurs most often. In advanced cases, diabetic foot develops.
Due to trauma, hypothermia.
Lack of minerals and vitamins, metabolic disorders.
Infectious diseases, including HIV.
Multiple sclerosis is a disease in which the nerve sheath is destroyed.

Types of neuropathies

In his medical practice, the doctor often encounters peripheral neuropathy. In this form, the nerves of the arms and legs are affected. Usually the diagnosis is not difficult. With autonomic neuropathy, internal organs suffer, its symptoms are not so specific. The patient seeks medical help from a therapist and not always the disease can be associated with nerve damage.

Post-traumatic neuropathy can also be distinguished. The main cause is trauma to the nerve trunk, damage to the spinal cord. This also includes tunnel neuropathy, which occurs as a result of compression of the nerve by muscle fibers and ligaments.

Diagnosis of the disease

Diagnosis of neuropathy based on complaints, questioning and examination of the patient. The level and extent of nerve damage can be determined using electroneuromyography. This method allows you to find out the presence of an inflammatory process, the degree of disturbance in the conduction of a nerve impulse, what exactly is affected - a muscle or a nerve, is there a tunnel syndrome.

The radial and ulnar nerves are most commonly affected. If the radial nerve suffers, then the patient complains of a change in the sensitivity of the skin and movement disorders. Complaints and signs depend on the degree and level of the lesion.

If the nerve is damaged in the upper parts of the patient, the extensor muscles of the hand, phalanges of the fingers, and forearm do not work. When you try to raise your hand, the hand hangs, the sensitivity of the first, second and some part of the third fingers is impaired. With neuropathy of the radial nerve in the lower sections, the ability to straighten the forearm and hand remains, skin sensitivity is preserved on the shoulder while maintaining the above signs of neuropathy. To determine the level of damage to the radial nerve, there are special diagnostic tests, they are used by neuropathologists.

When the doctor, when contacting the patient, will pay attention to paresthesia and numbness of 4-5 fingers and along the nerve. As the disease progresses without treatment, the brush begins to resemble a "clawed paw" in appearance. Diagnosis is usually straightforward and diagnostic tests are used. Of the neuropathies of the upper extremities, these two nerve trunks are affected more often.

Symptoms of neuropathy of the lower extremities

Tibial nerve neuropathy has the following symptoms:

Sensitivity disorder - paresthesia and numbness of the skin on the sole, back of the leg. Intense pain may also occur.
Damage to the motor roots - paresis of the muscles that turn the foot inward, the flexors of the fingers and foot. The Achilles reflex is lost. In the future, atrophy of the posterior muscles of the lower leg develops. The foot is constantly in an extended state, which makes it difficult to walk.

Diagnosis can be made based on simple tests:

Walking with an emphasis on socks is impossible.
The patient is unable to turn the foot inward and flex the toes and foot towards the sole.

Neuropathy of the peroneal nerve is quite common. He is one of the branches. With its defeat, motor and sensory disturbances are observed. But here you can see that the opposite muscle group suffers than with damage to the tibial nerve.

What will a specialist see with neuropathy of the peroneal nerve?

There is no way to walk and stand on your heels.
The foot hangs down, turned slightly inward, the toes are half bent.
A characteristic gait - peroneal, cock-like, stepage - a person, in order not to touch the floor with his fingers, tries to raise his leg high. Then he puts the sock on the floor, then the edge of the foot and the sole.
Atrophy of the muscles that are on the anterior surface of the lower leg.
The patient cannot straighten and turn the foot outward.
Decreased range of motion in the ankle joint.

With neuropathy of both the tibial and peroneal nerve, the treatment will differ little from the generally accepted one.

The basis of therapy is the elimination of the causes that caused the disease. In addition, painkillers and agents are prescribed to restore the activity of the affected nerve fiber. In the initial stages of neuropathy, detoxification therapy, vitamins, non-steroidal anti-inflammatory drugs, vascular drugs, hormones, and antioxidants are used for treatment. If the cause is an infectious or viral disease, then antibacterial, antiviral agents are prescribed.

With a decrease in acute manifestations, physiotherapy, massage, physiotherapy exercises, reflexology can be added to the prescribed medications.

It is important to pay attention to the lower extremities, because late therapy will lead to complications and, possibly, disability. The same can be said about neuropathy of the upper extremities. Depending on the severity of the disease, treatment is carried out on an outpatient basis in a polyclinic or in a hospital. The recovery period usually takes place in a sanatorium.

The innervation of the hand is carried out by a whole system of peripheral, that is, located outside the brain and spinal cord, nerves. Their diseases of non-inflammatory origin (caused by various degenerative and dystrophic processes) are called neuropathy. It is not a separate disease, but is part of the symptom complex of various pathological conditions, therefore, to determine the treatment tactics, it is not enough to establish the presence of a pathology, but it is also necessary to identify the cause of its development. Neuropathy of the upper extremities is not as common as that of the lower extremities, since the legs are innervated by the longest, and therefore the most vulnerable, nerve fibers. Degenerative-dystrophic changes in the peripheral nerves often begin with the lower extremities, later the nerves of the arms, torso, and face are involved, although sometimes the nerves of a specific part of the body, in our case, the arms, are immediately affected.

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Epidemiology

Statistics show that neuropathies of the upper extremities are not so rare. The most common type is the carpal tunnel syndrome, which affects people who, often, by the nature of their activities, are forced to make flexion movements with the hand. Of all the tunnel syndromes, 2/3 of complaints are precisely on this localization. And earlier, many professions led to the development of this pathology, now the widespread use of a computer has been added to them - both in professional activities and in everyday life. As a result, from 1 to 3.8% of the adult inhabitants of the planet annually complain of its symptoms. There are three to ten women per man. The peak of manifestation is at the age of 40-60 years.

Another vulnerable area of the median nerve is located in the upper third of the forearm, degenerative-dystrophic changes in this part are called pronator teres syndrome. In addition to the reasons described above, the presence of a rare anomaly, the process of the humerus (Struser's ligament), can cause the development of this syndrome.

Quite often, the function of the ulnar nerve is disturbed. This is also facilitated by compression lesions in everyday life, sports and at work.

Causes of upper limb neuropathy

The vast majority of isolated degenerative and dystrophic changes in the nerve fibers of the hand occur as a result of banal squeezing of one (mononeuropathy) or several nerves (polyneuropathy) innervating the upper limb. There are five such nerves: musculocutaneous and axillary, which regulate the work of the shoulder and partly of the forearm, its upper and lower parts, respectively; median, ulnar and radial, controlling the work of the hand from the shoulder to the fingers.

Different parts of the nerves, located both shallow under the skin and in the center of the arm, can be pinched. There can be many reasons for such an event - about two hundred.

Perhaps, most often, neuropathies of one of these nerves or multiple ones arise due to an uncomfortable position in which the working hand stays for a long time, monotonous movements performed by one or two hands. And if the working hand of a person engaged in monotonous and hard physical labor used to suffer, then with the advent of the era of computers, office workers joined the risk group. The compression nature of neuropathies in half of the cases of its occurrence is associated with professional activities. One of the most common pathologies is carpal tunnel syndrome (associated with compression of the median nerve at the point of its transition to the hand), which affects people who spend a lot of time at the computer every day, tailors, musicians, dentists and other specialists or athletes who perform multiple monotonous flexion hand movements.

Also, median nerve neuropathy is often caused by unusually high loads on the wrist, dislocations of the carpal joint, and damage to the forearm.

Often associated with monotonous flexion movements in the elbow and compression of the ulnar nerve, cubital tunnel syndrome occurs. The reason for this is the habit of constantly resting the elbow on a hard surface, including in everyday life, for example, talking on the phone, or bending in weight, for example, putting the elbow out the window, while driving a car or hanging from the edge of the table, which again applies to office workers.

Ulnar nerve neuropathy is manifested by Guyon's canal syndrome - in this regard, professions associated with vibration are dangerous; cycling, motorcycle racing; constant reliance on a cane (innervation of the palmar muscles suffers).

Radial neuropathy can occur due to improper position of the hand during prolonged sleep (“sleep paralysis”), in conductors, runners and representatives of activities in which you often have to make monotonous movements in the elbow bend, with fractures of the collarbone and shoulder joint, habit carry a heavy bag on the elbow.

The axillary or radial nerve is damaged by prolonged movement with crutches and so on.

In addition, hand injuries can lead to neuropathies of the upper extremities - fractures, dislocations, leading to direct damage to nerve fibers, adjacent muscle or bone tissue, blood vessels (lack of nutrition due to circulatory disorders, compression between swollen tissues, injury on the sharp edges of broken bones).

Operations involving the nerve in the formation of scar tissue, the development of ischemia, edema; prolonged intravenous infusions; inflammatory diseases - arthritis, bursitis, lymphadenitis and others; cervical osteochondrosis; tumors both directly in the nervous tissue, such as an interdigital neuroma, and localized near the nerve, often cause compressive or ischemic neuropathy.

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Risk factors

Risk factors for its development include: frequent hypothermia, physical overstrain, contact with toxic substances, inflammatory complications of infectious diseases, systemic pathologies - endocrine, autoimmune, liver diseases, kidney failure, deficiency of B vitamins due to alimentary causes or diseases of the gastrointestinal tract , vaccination, heredity, alcoholism, hormonal fluctuations.

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Pathogenesis

The pathogenesis of lesions of peripheral nerves is diverse, it is always based on a degenerative-dystrophic process caused by compression, metabolic, ischemic disorders, or as a result of direct trauma (bruise, rupture, incision, puncture) of nerve fibers. The structure of peripheral nerves is similar to an electrical wire - nerve cells (axons, neurites) are enclosed in a myelin sheath, resembling an insulating one. According to the pathogenesis, neuropathy is divided into axonal, when the axons themselves (nerve cells) are destroyed, and demyelinating, when the shell undergoes destruction.

With infringements, stretching, squeezing, ruptures, the axon is usually damaged. With slight compression, the anatomical structure of the nerve is preserved, and it recovers quite quickly and completely. In severe injuries, complete regeneration of the nerve may not be possible even if the myelin sheath is preserved.

In the second case, the myelin sheath is broken, which acts as an insulator and conductor. In the pathogenesis of demyelinating neuropathy, a genetic predisposition, rheumatoid arthritis, various forms of diabetes, impaired liver and kidney function, and hypothyroidism are considered. Isolated lesions of the nerves of the upper extremities in such pathologies are rare, however, this cannot be completely excluded. The defeat of a single nerve can cause tuberculosis, polyarthritis, poisoning with toxic substances, including alcohol and medicines.

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Symptoms of upper limb neuropathy

Peripheral nerve fibers are divided into motor (motor), sensory (sensitive) and autonomic. Depending on which ones are predominantly affected by pathological changes, such symptoms will prevail in the clinical picture, although isolated damage to any one type of fiber is practically not found, therefore, various variants of the symptom complex are possible.

Motor neuropathy is manifested by muscle weakness, lethargy, trembling even with slight physical exertion, convulsions, over time, muscle mass decreases, visually the limb becomes thinner. It is often difficult for the patient to raise his arms up, especially through the sides, his coordination of movements is disturbed, it is impossible to hold objects with his fingers.

The first signs of sensory symptoms are tingling in the fingertips, numbness rising higher; there is a feeling that a tight glove is put on the hand; pain syndrome from mild discomfort to acute and burning pain (causalgia); loss of sensitivity in the direction from the periphery to the center (first - the fingers, then the hand and above).

Vegetative symptoms - pallor of the skin, pigmentation, marbled skin; cold fingertips even in hot weather; hyper- or hypohidrosis; loss of hairs on the skin, thinning of the skin in places with impaired innervation; thickening and stratification of nails; skin ulceration.

Symptoms increase depending on the stage of the disease. Therefore, if any pain, numbness, loss of sensation and limitation of motor functions appear, even if there were no injuries, you should consult a doctor.

Damage to one nerve is called mononeuropathy. Types of damage to the nerves of the upper limb are manifested by the following symptoms:

the musculocutaneous nerve controls the work of the anterior part of the arm above the elbow bend; if it is damaged, the functions of the shoulder and elbow joints are disturbed;
damage to the axillary nerve affects the innervation of the dorsum of the limb, impaired shoulder abduction and extension of the shoulder joint;
when the median nerve is damaged, motor skills and sensitivity are disturbed along the entire length of the arm, but more often - the hand, thumb, index and middle fingers;
neuropathy of the ulnar nerve is manifested by impaired movements of the hand, ring and middle fingers;
neuropathy of the radial nerve manifests itself as a loss of sensitivity of the back surface of the hand, impaired finger motility, as well as flexion in the elbow and carpal joints.

The first signs of the most common mononeuropathy of the median nerve - carpal tunnel syndrome - are numbness and tingling in the tips of the thumb, index and middle fingers of the working hand in the morning, which disappears after a couple of hours and no longer reminds of itself during the day. Already in the presence of such symptoms, you need to seek medical help, because later the hands will begin to go numb at night, and then in the daytime, it will become problematic to hold objects with a sick hand, it will increasingly lose function.

Pain sensations at first are in the nature of tingling or burning, appear during a night's rest or in the morning. The patient has to wake up and lower the sore hand down (the pain from this disappears). First, one or two fingers hurt, then the whole palm is gradually involved in the process, and even the arm up to the elbow.

The motor skills of the hand are disturbed, the fingers, and over time, the hand itself weakens, it becomes difficult to hold objects, especially small and thin ones.

In the advanced stages of the disease, sensitivity decreases, the diseased limb is constantly numb, later it ceases to feel touch and even pricks with a sharp object. Atrophic processes occur in muscles and skin.

Symptoms of neuropathy of the ulnar nerve also begin with numbness and tingling, localized in the cubital fossa, along the back edge of the forearm and hand, capturing the ring finger and little finger. Pain sensations of the same localization and motor disorders increase, then loss of sensitivity and muscle hypotrophy - in this sequence, the cubital canal syndrome develops.

With Guyon's canal syndrome, sensations are localized and grow from the side of the palmar surface.

With mild degrees of neuropathy, there are no serious motor and sensory disorders yet, so the likelihood of recovery depends on timely seeking help.

Complications and consequences

As already mentioned, in the initial stages, the sensations in neuropathies are quite tolerable and, if you do not pay attention to them, the condition begins to worsen. Muscles hypertrophy, the hand works worse and worse.

Without treatment, the process can end in irreversible atrophy of muscle tissue. Visually, the limb decreases in volume, the hand is deformed and becomes similar to the palm of a primate - flat, with the thumb pressed against it.

Sometimes with partial damage to the median, even less often - the ulnar nerve, a causalgic syndrome develops. This is how injuries become more complicated when, at the time of wound scarring, irritation of the afferent receptors of nerve cells occurs, which leads to intense, simply unbearable pain. Of course, in such a state it is impossible not to ask for help. Causalgia appears approximately on the fifth day after the injury, and sometimes a little later, for example, after two weeks.

Axonal neuropathy is characterized by slow development and a long course. Without treatment, the process ends with complete atrophy of muscles devoid of innervation and loss of limb mobility (the hand “dries out”).

Demyelinating neuropathy is characterized by a fairly rapid development of the disease, with impaired sensitivity and loss of motor functions.

Diagnosis of neuropathy of the upper extremities

At the first symptoms of discomfort - tingling, numbness, burning, soreness, limited motor skills, muscle weakness, you should contact a medical facility.

When interviewing a patient, not only disturbing symptoms are considered, but also occupational risks, the presence of bad habits, previous injuries and the possibility of intoxication. The presence of chronic diseases, past infections, genetic predisposition is taken into account.

Clinical blood and urine tests, a blood test for glucose, thyroid hormones, protein content, B vitamins are prescribed. A blood and urine test for the content of toxic substances may be prescribed.

Nerve trunks are directly palpated, a biopsy of nerve fibers is performed and the depth of their damage is determined. A study of cerebrospinal fluid, testing of nerve reflexes and reactions may be prescribed.

Instrumental diagnostics is carried out: electroneuromyography, radiography, ultrasound examination of the state of internal organs.

Consultations with doctors of other specialties, additional tests and studies may be prescribed.

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Differential Diagnosis

Differential diagnosis is carried out according to the results of the examination, the results of laboratory and instrumental studies.

Often, with a long course of the disease, neuropathy can even be determined visually by the violation of symmetry and motor skills of the upper limbs. Laboratory diagnostics helps to understand the cause of nerve damage, to establish the presence of metabolic disorders, an autoimmune process, inflammation and infections. Specific tests allow you to identify characteristic antibodies and antigens, the content of vitamins and proteins in blood plasma.

Instrumental studies show a decrease in the speed of the nerve impulse or its absence (atrophy), a decrease in the activity of muscle fibers.

Special diagnostic tests can reveal which nerve has been damaged. So, for example, with motor neuropathy of the ulnar nerve, the patient cannot clench the affected hand into a fist due to the fact that the ring finger and little finger do not bend. He also fails to spread his fingers like a fan and then bring them together, press his hand to the surface of the table and scratch it with his little finger. Sensory reflexes partially or completely disappear on the ring finger and little finger, on the forearm and hand from the side of the elbow.

Sensory polyneuropathy is systemic disease of the nervous tissue unclear etiology. It manifests itself as a disorder of motor activity and a violation of sensitivity. In advanced cases, a strong pain syndrome is connected.

The success of the treatment is completely depends on the cause that gave rise to this pathology, as well as from the timeliness of contacting a specialist.

Causes of the disease

There is no consensus among experts that would fully reveal the cause of the onset of sensory-type polyneuropathy. But there are the most common diseases and factors that, according to medical observations, can cause the development of the disease:

Autoimmune processes- when, due to disturbances in the functioning of the immune system, the body's own nerve cells begin to be perceived as foreign and are attacked by macrophages ("devouring" immunity cells). Otherwise, we can say that the reaction of self-destruction of the nervous tissue is triggered, and as a result, polyneuropathy is formed.
Toxin poisoning- they can be found both in poisons and in food products: low-quality alcohol and preservatives. This also includes heavy metal poisoning, which instantly provoke the onset of symptoms of neuropathy.
Diabetes- with an increase in the level of glucose in the blood, the permeability of capillaries and the blood supply to peripheral tissues are disturbed. This leads to a lack of proper nutrition and the natural death of the cells of the nervous system.
Avitaminosis- this is the most "harmless" and easily corrected cause of the development of polyneuropathy. It is necessary to correct the intake of vitamins B1 and B12, which are responsible to a greater extent for the active conduction of nerve signals to the muscles.
Oncology- cancerous tumors, in some cases growing to large volumes, compress the nerve fibers and partially block the conduction of the nerve impulse to the peripheral regions. Symptomatic polyneuropathy occurs and cannot be cured until the tumor is removed.
hereditary factor- recognized as the most dangerous. If the cause of the development of symptoms of polyneuropathy is associated with it, then the treatment will be mostly ineffective, because there is no way to eliminate the root cause of the development of the pathology - genetic disorders in this area have not yet been studied

In the case of toxic polyneuropathy, the cause of the poisoning must first be clarified - that is, the substance, as a result of which pathological changes occurred in the body.

Ask your question to a neurologist for free

Irina Martynova. Graduated from the Voronezh State Medical University. N.N. Burdenko. Clinical intern and neurologist of BUZ VO \"Moscow Polyclinic\".

Treatment without its preliminary neutralization will be ineffective.

Pathogenesis

Sensorimotor polyneuropathy is a disorder in which structural damage to nerve cells.

These cells are usually responsible for motor (motor) activity. When their structure is disturbed, then along with it, the conduction of a nerve impulse is also disturbed. As a result, motor activity is disturbed, and there may be a partial or complete disappearance of skin sensitivity.

Damage to nerve cells can be of a dual nature: myelin sheaths (membrane through which nerve impulses are conducted) and axons, the nuclei of nerve cells, can be damaged.

Recovery of the nuclei is much slower, and long-term treatment is required to achieve even minimal results.

Symptoms

In this disease, the symptoms will appear gradually(the condition can sharply worsen only with an acute toxic form - more on that below). Sensory polyneuropathy begins to manifest itself with burning and tingling (local symptoms of a violation of the conduction of a nerve impulse and blood circulation), and subsequently it can reach the development of paralysis and paresis, which is already much more difficult to treat.

All these manifestations are due to damage to muscle innervation, that is, the absence of an impulse from the nerves to the muscles, and a violation of their motor activity.

And in the absence of contraction and movement, the blood flow instantly stops, stagnation occurs, and the vessels are deprived of nutrition and oxygen.

So, with sensory polyneuropathy the following symptoms develop:

Itching, burning, tingling in the muscles;
Numbness of muscles or limbs (with damage to peripheral nerve fibers);
Loss of skin sensitivity (syndrome of "gloves" and "socks");
Loss of muscle strength (syndrome of "cotton legs" - when, when walking, the muscles cannot cope with the physical load to which they are exposed, and the legs give way), which manifests itself most often with additional load: walking uphill, climbing stairs, etc .;
Cutting pains in the muscles that occur during spontaneous contraction;
Vegetative-vascular manifestations: peeling and dryness of the skin, the formation of ulcers and weeping wounds, etc.

These symptoms can also appear with a sedentary lifestyle and lack of movement.

Normalization of lifestyle and the inclusion of daily adequate loads will help to completely get rid of negative symptoms and return to good condition.

Forms

This disease is classified based on many factors: the nature and localization of damage, the intensity of the development of symptoms, etc. Let us consider in more detail each variant of the classification of sensory polyneuropathy.

Depending on the depth of damage to the nervous tissue, polyneuropathy is classified into:

Demyelinating(mostly the membranes of nerve cells are damaged - their myelin sheaths);
axonal(the central core of the nerve cell - the axon) is damaged.

The demyelinating form is much easier to treat, and therapy takes less time.

According to the intensity of the development of symptoms, polyneuropathy is divided into:

acute(symptoms develop progressively over 2-3 days, and reach their maximum on the fourth day);
Subacute(the period of development of productive symptoms lasts several weeks);
Chronic(sluggish with a slowly progressive course - easily treatable).

The acute nature of the development of the disease most often occurs with a toxic form of the disease - poisoning with heavy metals or alcohol of inadequate quality. A subacute picture is typical for patients with diabetes mellitus. It develops with a sharp jump in blood sugar. Symptoms may return to their original state when hypoglycemic drugs are prescribed.

Chronic polyneuropathy often manifests itself in people with hereditary pathology. It lasts all life, moderately manifesting itself. The disease can be activated with the active influence of adverse factors from the outside.

Another classification of sensory polyneuropathy is based on the nature of the symptoms present:

Hyperalgesic- manifested by pain syndrome, sharp pain at the slightest touch, decreased sensitivity, numbness in the muscles, etc .;
Atactic- manifested by muscle weakness, lack of coordination of movements, numbness and inability to keep balance;
mixed- is characterized by the manifestation of various symptoms.

Depending on the nature of the manifestation of the disease and the cause that gave rise to it, an individual treatment regimen will be prescribed that is right for you.

Diagnostics

Sensory polyneuropathy of the upper and lower extremities is diagnosed in various ways, depending on the nature and location of the damage. Consider the most commonly used diagnostic methods.

Clinical Methods

Clinical diagnosis of sensory neuropathy is to determine the level of skin sensitivity in the patient. Improvised means can be used:

pins;
Medical "skewers";
Needles etc.

The doctor gently presses on the skin with the tip of the needle and waits for the patient's reaction.

A characteristic sign of the development of sensory polyneuropathy will be the lack of sensitivity. The patient simply does not feel that he was pricked and passed through the skin with a needle.

In addition, clinical diagnostic methods include the collection of an anamnesis of the disease from the patient. Data on working conditions (its harmfulness), diet, predominant foods in the diet, addiction to alcohol, smoking and many other factors that could provoke the development of this pathology are being clarified.

Clarifying tests are always prescribed for the alleged patient: a general blood test, a blood test for glucose levels, an immunogram - if necessary. The more information about a person in the hands of a specialist, the more objectively he will be able to assess the disturbing manifestations of the disease and make the correct diagnosis.

Study of pain sensitivity

When conducting this study, the doctors of the clinic first of all want to find out the level of damage to the so-called C-fibers (unmyelinated type). Unlike the general clinical diagnosis of the level of sensitivity, there is a certain technique here that allows you to identify the nature of the damage to a certain segment of the nervous system.

To begin with, the doctor finds out by questioning whether the patient is worried about pain at the site of the alleged lesion. If yes, then the patient is asked to describe the nature of the pain: dull, sharp, cutting, etc. After clarifying this circumstance, they proceed to the procedure itself. Two objects are taken from the same material: blunt and sharp. Alternately, without a definite sequence, one or another object leans against the patient's skin. In this case, the patient is asked to determine when the blunt leans against, and when the sharp one leans.

Punctures with a sharp object should not be sharp, strong and deep. A light pressure and a small puncture are enough to make the sensations barely perceptible. Otherwise, it will be difficult to determine the damage to the surface ability to feel.

To obtain accurate and reliable data, skin exposures are carried out not only on the “sick” part of the body, but also on a healthy one.

Most often, they begin to explore the sensitivity of the skin in the damaged area, gradually moving to a healthy one and noting the difference in the nature of the sensations.

Temperature sensitivity

Determination of temperature sensitivity is intended for diagnosing damage to thin weakly myelinated fibers of the peripheral nervous system. They are responsible for the pain threshold and are well defined by the diagnosis of temperature sensitivity.

For the procedure, medical test tubes are most often used. They contain water of different temperatures: +5С and +25С.

Alternately, the leg (or other affected area) of the patient is touched different test tubes, offering him to determine what touched: cold or hot?

Tactile sensitivity

The determination of tactile sensitivity is carried out using the Frey apparatus and horse hairs of different thicknesses. Myelinated thick A-fibers are responsible for the sensitivity of the skin to light touch. It is their condition that is determined during this procedure.

Deep Sensitivity

The work of deep thick myelinated fibers is evaluated. There are several diagnostic methods:

Vibration sensitivity assessment- carried out with the help of special medical tuning forks. They are calibrated for a certain frequency and duration of vibration. The device is installed on the surface of the patient's bone notch (depending on the location of the bone damage, different ones can be used), and the patient is asked to determine the moment the vibration starts and its end. Usually the vibration lasts about 9-12 seconds. It is considered normal if the patient noted at least a third of the entire time the vibration continued.
EMG- electromyography is the main tool for diagnosing the state of the segments of the nervous system responsible for muscle contraction. It is carried out using an electromyograph - a special device that notes the level of activation of muscle-tendon reflexes. The object of EMG research is the motor unit (MU). It represents the entire complex of neuromuscular conduction: motor neurons of the anterior segments of the spinal cord, the nerve impulse conduction system (axons and fibers), as well as the muscle itself, which is innervated by the above fragments of the nervous system. EMG assesses the state of the muscle, the intensity of its contraction, and if a pathology is detected, the device also determines the level and localization of MU damage.

EMG needle

With the help of needle EMG, the spontaneous motor activity of muscle fibers during the period of rest (lack of load) is examined. If such an effect occurs, then this indicates a deep disturbance of nerve conduction.

Most often, this method is used for sensory polyneuropathy of the lower extremities.

Consider the main indicators that appear in this study, and the levels of damage to the nerve fiber, which they indicate.

Positive sharp waves (POS) are spontaneous, sharp muscle contractions that occur involuntarily. This indicator indicates irreversible damage to the nerve fiber or group of fibers (with an enlarged SOV value).
Fibrillation potentials (PF) is an indicator for a single muscle fiber. One MU and the place of damage are evaluated in case of deviations.
Fasciculation potentials (PFc) - a sharp unreasonable reduction in the entire DE, the appearance of its spontaneous activity. Occurs with central disorders of the nervous system, requires additional diagnostic measures.
M-answer - the state of a single muscle fiber is assessed, and if there are deviations, the entire MU is further examined and the site of damage is located.

The method is very popular and allows the diagnosis to accurately determine the degree of damage to the nerve fiber and its localization.

Late neurographic phenomena: F-wave and H-reflex

By studying the F-wave, it is possible to determine the intensity of the work of motor neurons of the central horns of the spinal cord, that is, the initial localization of the motor unit (MU). This wave is marked on the device and means the impulse sent from the neurons of the spinal cord to the peripheral muscle fibers. If the intensity and activation time of the wave coincides with the boundaries of the norm, then this means that the problem, if any, is not in the initial links of the DU, but is located lower - in the axons or myelin sheaths. The F-wave is not a reflex.

H-reflex is monosynaptic reflex, in an adult, it is caused by contraction of the calf muscle. This indicator (in comparison with the M-response) can reveal the localization of the lesion in the reflex arc. The reflex arc is a mechanism for conducting a nerve impulse, the result of which will be a contraction of the calf muscle. It begins with stimulation of the tibial nerve fiber, which is subsequently transmitted to the posterior horns of the spinal cord, through them to the anterior ones, and along the course of the nerve fiber, the impulse enters the muscle. When the impulse passes up to the posterior horns of the spinal cord, it goes through the sensitive nerve tissues, and down through the motor tissues.

The calculated ratio between the H-reflex and the M-response will provide information about the location of the damage to the reflex arc - the sensitive or motor department.

Nerve action potential study

This diagnostic method reveals structural lesions of sensory fibers. They are diagnosed using a parameter called somatosensory evoked potentials (SSEPs). It is determined by intense pain and temperature effects. Upon receipt of the data, they are compared with the norm indicators, and the specialist makes a conclusion regarding the condition of the sensory fibers in the patient.

Diagnosis can be difficult due to concomitant therapy with painkillers.

Biopsy

The biopsy is taking microscopic doses of tissue material, which is mainly used to diagnose structural lesions. With the help of a biopsy, it is possible to assess the depth of damage to the nerve fibers, as well as to determine which particular structural part of them is damaged - the axon or the myelin sheath.

It is not uncommon to diagnose superficial sensory neuropathy of the skin when a sample is taken for examination.

Confocal microscopy

Confocal microscopy is one of the modern methods for diagnosing structural damage to C-fibers without outside intervention. The method is absolutely painless, and thanks to it, in addition to damage to the nervous tissue, it is also possible to diagnose the state of conduction in the cornea. The method has no analogues in the study of defects in the outer thin nerve fiber in diabetics.

Treatment

Treatment of sensory type polyneuropathy of various localizations is always multi-stage scheme, which consists of the following areas:

drug therapy;
Physiotherapeutic methods;
Surgical intervention (for neuropathy caused by a tumor).

They should be carried out in a complex and for a long time, in order to avoid unpleasant consequences of the disease.

Which doctors treat?

The treatment of polyneuropathy is mainly handled by a neurologist, but the patient will still have to visit other doctors. And which ones - will depend on which group of diseases caused this symptom.

If polyneuropathy is caused by diabetes mellitus, then the supervision of an endocrinologist will be required, who will conduct the main treatment of the underlying disease. With polyradiculoneuropathy, when disorders are localized in the neurons of the spinal cord, and polyradiculoneuropathy, in which the transmission of a nerve impulse along the nerves of the reflex arc suffers, the surgeon will observe the patient.

In any case, you will have to visit several specialists at once and treat the disease with all possible methods, otherwise there is a risk of complications.

Medical preparations

Medical treatment is currently main body of therapy polyneuropathy. Several groups of drugs are used at once, we list the most commonly prescribed:

Corticosteroids are hormone therapy. If autoimmune diseases have become the cause of the development of polyneuropathy, then in this case steroid hormones are prescribed that suppress the immune system. In addition, they have a powerful anti-inflammatory effect, which is necessary in the treatment of inflammation of the nervous tissue. The following drugs are most often prescribed:

Prednisolone- a substance completely analogous to the steroid hormones of the human body. Contraindications: hemophilia and other diseases of the blood coagulation system, fractures in the joints, osteoporosis, age under 2 years. The cost is about 100 rubles.

Tamoxifen- inhibits intracellular biochemical reactions in tumors associated with folic acid. The cell stops receiving food and dies. The cost is about 100 rubles. Side effects: digestive disorders, depression, migraine, retinopathy, cataracts, embolism, fluid metabolism disorders, etc.

Immunoglobulins are natural human antibodies obtained artificially and placed in a solution. They are powerful stimulants of their own immunity and help in the fight against antigens (foreign inclusions). In polyneuropathy, they are effective during an exacerbation, but the mechanism of action is still not clear. Gamma immunoglobulins are used for the demyelinating form of sensory polyneuropathy, as well as for polyneuropathy caused by diphtheria bacillus. In this case, antidiphtheria immunoglobulin is used.

Physiotherapy

Physiotherapeutic methods enhance the effect of medication and are always prescribed as an additional treatment. Among them the most popular are:

Physiotherapy exercises - helps to restore muscle activity and the very structure of nerve cells by increasing blood flow and nutrition.
Massage - is prescribed at the first stages of therapy for polyneuropathy of the vegetative-vascular form, in which tissue trophism is disturbed, and non-healing ulcers and wounds appear on the skin. Due to the increased blood flow during massage, the blood supply to the small vessels of the skin increases, and it is restored.
Magnetic therapy - acts selectively on nerve fibers, contributing to their self-healing.
Electrophoresis - stimulation of a nerve impulse and blood supply with a low power current.

Plasmapheresis

This is a modern method of blood purification from foreign impurities and toxins. It is carried out with the help of special expensive equipment. Effective against sensory type polyneuropathy caused by autoimmune and infectious processes.

The method is used only as a last resort strictly for the purpose of a specialist.

Folk remedies

Alternative methods of treatment for polyneuropathy should be used only after consultation with a specialist, because this is an additional, and not the main method of treatment. Here are the most commonly used ones:

Olive oil and raw yolk are beaten together, and to this mixture is added carrot juice and 2 tsp. honey. The solution is mixed until a homogeneous mass is formed and drunk inside twice a day 20 minutes before meals.
The bay leaf is ground into powder, 1 tsp is taken. of this powder and mixed with 3 tbsp. l. dry fenugreek powder. The mixture is transferred to a thermos and poured with one liter of hot water. After 2 hours have passed, it can be taken orally. Drink in small quantities throughout the day.
Brine. To half a bucket of warm water add a glass of salt and 2/3 cup of vinegar. Soar legs for 20 minutes every day for a month (for diseases of the limbs).

Treatment prognosis

The main factors that determine the result of the treatment of this disease are:

Immediate contact with the doctor when the first symptoms appear;
Completed and disciplined treatment.

In any case, sensory polyneuropathy requires long-term therapy, and most often a positive result is a temporary remission.

A full return of the original sensitivity is possible only at the beginning of treatment at the earliest stages of the disease, and the restoration of vegetative-vascular functions will be successful only with prolonged exercise therapy and massage.

Complications and consequences

The most common complications of sensory polyneuropathy will be paralysis and paresis, which develop as a result of a complete loss of innervation of the muscle fiber. Two factors - the lack of a nerve impulse and motor activity - cause the muscles to atrophy and "shrink", in some cases the changes are irreversible.

All these processes are the result of an untimely visit to the doctor. Timely initiated therapy is guaranteed to protect a person from such consequences.

In sensory-type diabetic polyneuropathy, the most common complication is tissue necrosis, ulcers, gangrene, and sepsis. The skin of a diabetic and the tissues adjacent to it are prone to the development of vegetative-vascular disorders.

There are ulcers, wounds of a non-healing type, and this is dangerous due to the penetration of bacterial and other types of infections.

Further prevention

To completely eliminate the likelihood of a relapse of the disease, you need to follow a few rules:

To bring the started therapy with medicines to the end;
Complete a course of physiotherapy;
Engage in physical therapy and self-massage on an ongoing basis;
Take B vitamins constantly (in an adequate daily dose).

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Conclusion

Sensory polyneuropathy is a dangerous disease that can result in severe complications. The only way to prevent them is to seek help from a specialist in time and complete the course of treatment.

Treatment of neuropathy of the lower extremities in the "Workshop of Health" relieves pain, restores nerve fibers, improves tissue nutrition and metabolism. Procedures accelerate blood circulation, restore muscle strength. The patient normalizes blood pressure and strengthens the immune system.

We care about the full recovery of patients. They can get a free consultation from our doctor within a year after the end of the course of treatment.

Causes of polyneuritis of the lower extremities

Neuropathy of the lower extremities may occur after surgery or leg injury. The work of the nerves is disturbed due to diabetes, lack of B vitamins and folic acid, physical overload. Polyneuropathy of the lower extremities is caused by a metabolic disorder: due to an imbalance in the body, the impulse does not normally pass through the nerve.

Polyneuritis of the lower extremities can appear in a person if he is cold, poisoned by mercury, acetone or alcohol. Chronic compression of the nerve appears due to intervertebral hernia, inflammation. Polyneuropathy of the lower extremities can be the result of infection: influenza, malaria, herpes, diphtheria, tuberculosis.

Types of neuritis

Disease	Manifestations
Neuritis of the axillary nerve	The patient cannot raise his arm to the side, does not feel well the upper part of the shoulder, the deltoid muscle atrophies. The disease occurs after injury, injury, dislocation of the shoulder.
Radial neuritis	The hand hangs when the arm is raised, the arm bends with difficulty. The person feels numbness and "goosebumps" in the fingers.
Neuritis of the ulnar nerve	The fingers become numb and weaken, the small muscles of the hand atrophy, pain in the elbow appears. The disease develops after a fracture of the arm, long support on the elbows.
median nerve neuritis	There is pain in the fingers, on the inside of the forearm. A person with difficulty bends his palm, fingers. The muscles of the fingers atrophy, the palm becomes numb. Causes of the disease: hand injuries, overexertion of the hand.
Lumbar and sacral plexus lesions	Weakness of the muscles of the pelvis and legs, numbness in the legs. Pain can be given to the lower back, buttock, hip joint, legs. Causes include birth trauma, tumors, hemorrhages, trauma.
Neuritis of the tibial and peroneal nerves	It is difficult for a person to bend the feet and fingers, the foot sags. Neuritis of the peroneal and tibial nerves appears after trauma, fracture, infections, metabolic disorders, beriberi.
Neuritis of the femoral nerve	The leg hurts, the person cannot bend it at the knee and straighten it, sit down from a lying position, does not feel touching the leg.
Neuritis of the sciatic nerve	The sensitivity of the legs decreases, the foot sags, movements in the hip, knee, and sometimes in the ankle joints are disturbed. Paresis and paralysis of muscles appear.
Polyneuritis - damage or inflammation of several nerves	The hands, feet and fingers suffer the most. Accompanied by pain along the affected nerves, weight loss, weakness in the legs. It is difficult for a person to walk, he may experience paralysis.

Prevention

To prevent neuropathy, do not drink alcohol, take protective drugs when working with toxic substances. Eat fresh products, when buying, check the expiration date and date of manufacture so as not to get poisoned. Observe the dosage of medicines, do not drink them unnecessarily. Treat influenza, sinusitis, sinusitis and other infections in time, do not carry them on your feet.

Do swimming, running, dancing, fitness: playing sports improves blood microcirculation. Avoid injuries and burns, do foot baths for 15 minutes. Walk in comfortable shoes, do not wear heels higher than 5 cm.

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Polyneuropathy is a rather dangerous disease, which is a lesion of the peripheral nervous system, which is based on trophic disorders, sensitivity disorders, vegetative-vascular dysfunctions, flaccid paralysis, observed primarily in the distal segments of the limbs. This disease is usually classified according to the etiological factor, pathomorphology of the pathological focus and the nature of the course.

Polyneuropathy of the extremities is considered a fairly common pathology, usually affecting the distal parts with gradual involvement of the proximal areas.

Symptoms of polyneuropathy

The disease under consideration, polyneuropathy of the upper and lower extremities, begins with muscle weakness, and first of all, in the distal parts of the legs and arms. This is due to damage to the nerve fibers. With this disease, first of all, the distal parts of the limbs are affected due to the lack of sufficient protection of segments of the peripheral system (for example, the blood-brain barrier located in the brain).

Manifestations of the described pathology debut in the area of the foot and spread gradually up the limb. Depending on the typology of nerve fibers that are more susceptible to destruction, all types of polyneuropathy are conventionally divided into four subgroups.

Due to the defeat, mainly, of the afferent long processes of neurons, patients have positive or negative symptoms. The first is characterized by a lack of function or its decrease, positive symptoms are those manifestations that have not been observed before.

In the first place, in patients, the disease in question is manifested by various kinds of paresthesias, such as burning, tingling, crawling, numbness. Then the clinical picture is complicated by algia of varying intensity, the susceptibility of pain stimuli increases. As symptoms increase, patients become overly sensitive to simple touch. Later, they have manifestations of sensitive ataxia, expressed in unsteadiness of gait, especially with closed eyes, and impaired coordination of movement. The negative symptoms of polyneuropathy include a decrease in sensitivity at the sites of damage to nerve fibers.

When the axons of movement neurons are damaged, polyneuropathy of the upper and lower extremities is manifested, first of all, by muscle atrophy and is found in the weakness of the legs and arms. The described symptomatology progresses to the occurrence of paralysis and paresis. Less commonly, there may be a condition manifested by unpleasant sensations in the legs, appearing mainly at rest and forcing people to make movements of a relieving nature (syndrome of "restless lower extremities"). In addition, fasciculations and convulsions may occur.

Vegetative dysfunctions are divided into trophic disorders and vascular disorders. The former include the appearance of pigmentation and peeling of the skin, the appearance of cracks and ulcers on the limbs. Vascular disorders include a feeling of cold in the damaged segments, fading of the skin (the so-called "marble pallor").

Vegetative-trophic symptoms also include changes in the structure of derivatives of the dermis (hair and nails). Due to the fact that the lower limbs can withstand more load, polyneuropathy of the legs is diagnosed much more often than the hands.

Polyneuropathy of the lower extremities

The disease under consideration, polyneuropathy of the extremities, is a degenerative destruction of nerve cells, causing a malfunction in the functioning of the peripheral nervous system. This ailment is manifested by a decrease in motor ability, a decrease in sensitivity, depending on the location of the pathological focus, any part of the limbs, muscle pain. With the disease under consideration, the patient's nerve fibers that feed the feet are damaged. As a result of structural damage to the nerve fibers, the sensitivity of the legs is lost, which affects the ability of the individual to move independently.

Treatment of polyneuropathy of the lower extremities, as a rule, is quite laborious and lengthy, since more often, this ailment is progressive in nature and develops into a chronic course.

To determine the causes provoking the development of the described disease, in the first turn, it is necessary to deal with the structure of the nervous system, in particular its separate area - the peripheral system. It is based on long processes of nerve fibers, the task of which is to transmit signals, which ensures the reproduction of motor and sensory functions. The bodies of these neurons inhabit the nuclei of the brain and spinal cord, thus forming a close connection. From a practical point of view, the peripheral segment of the nervous system combines the so-called "conductors" that connect nerve centers with receptors and functional organs.

When polyneuropathy occurs, a separate part of the peripheral nerve fibers is affected. Therefore, the manifestations of the disease are observed in certain areas. The considered pathology on the limbs manifests itself symmetrically.

It should be noted that the analyzed pathology has several varieties, which are classified depending on the functions of the damaged nerves. So, for example, if the neurons responsible for movement are affected, then the ability to move may be lost or difficult. Such polyneuropathy is called motor.

In the sensory form of the disorder in question, nerve fibers are affected, which cause sensitivity, which suffers greatly when this category of neurons is damaged.

Insufficiency of autonomic regulatory functions occurs when autonomic nerve fibers are damaged (hypothermia, atony).

Thus, the following significant factors provoking the development of this disease are distinguished: metabolic (associated with metabolic disorders), autoimmune, hereditary, alimentary (caused by eating disorders), toxic and infectious-toxic.

There are two forms of the described pathology, depending on the location of the lesion: demyelinating and axonal. In the first case, myelin is affected - the substance that forms the sheath of the nerves, with the axonal form, the axial cylinder is damaged.

The axonal form of polyneuropathy of the legs is observed in all types of the disease. The difference lies in the prevalence of the type of violation, for example, there may be a disorder of motor function or a decrease in sensitivity. This form appears as a result of serious metabolic disorders, intoxication with various organophosphorus compounds, lead, mercury salts, arsenic, as well as alcoholism.

There are four forms, depending on the tendency of the course: chronic and recurrent form of the course, acute and subacute.

The acute form of axonal polyneuropathy often develops in 2-4 days. More often it is provoked by severe poisoning of a suicidal or criminal nature, general intoxication due to exposure to arsenic, carbon monoxide, lead, mercury salts, methyl alcohol. The acute form can last more than ten days.

Symptoms of a subacute form of polyneuropathy increase within a couple of weeks. This form often occurs with metabolic disorders or due to toxicosis. Recovery is usually slow and can take months.

The chronic form often progresses for an extended period of time of six months or more. The disease usually appears on the background of alcoholism, diabetes mellitus, lymphoma, blood diseases, vitamin deficiency of thiamine (B1) or cyanocobalamin (B12).

Among axonal polyneuropathies, alcoholic polyneuropathy is more often diagnosed, generated by a long time and exorbitant abuse of alcohol-containing liquids. A significant role for the occurrence of the pathology under consideration is played not only by the number of “absorbed liters” of alcohol, but also by the quality of the consumed product itself, since many alcoholic beverages contain many substances that are toxic to the body.

The main factor provoking alcoholic polyneuropathy is the negative impact of toxins, which alcohol is rich in, on the nerve processes, which leads to metabolic disorders. In most cases, the pathology under consideration is characterized by a subacute course. Initially, there are sensations of numbness in the distal segments of the lower extremities, and severe pain in the calf muscles. With an increase in pressure, algia in the muscles noticeably intensifies.

At the next stage of the development of the disease, dysfunction is observed mainly in the lower extremities, which is expressed by weakness, often even paralysis. Most of all, the nerves that cause flexion-extension of the foot are damaged. In addition, the sensitivity of the surface layers of the dermis in the area of \u200b\u200bthe brushes of the “glove” type and the feet of the “sock” type are disturbed.

In some cases, this disease can have an acute course. Basically, this is due to excessive hypothermia.

In addition to the above clinical symptoms, other pathological manifestations may also be present, such as a significant change in the color range of the skin of the legs and the temperature of the extremities, swelling of the distal parts of the legs (less often of the hands), and increased sweating. The disease in question can sometimes affect the cranial nerves, namely the oculomotor and optic nerves.

The described violations are usually detected and grow over several weeks / months. This disease can last for several years. With the cessation of the use of alcoholic beverages, the disease can be overcome.

The demyelinating form of polyneuropathy is considered a serious disease, accompanied by inflammation of the nerve roots and a gradual lesion of their myelin sheath.

The considered form of the disease is relatively rare. More often this disease affects the adult male population, although it can also occur in the weaker half and children. Demyelinating polyneuropathy is usually manifested by weakness of the muscles of the distal and proximal areas of the extremities, due to damage to the nerve roots.

The mechanism of development and the etiological factor of the considered form of the disease today, unfortunately, are not known for certain, however, numerous studies have shown the autoimmune nature of demyelinating polyneuropathy. For a number of reasons, the immune system begins to consider its own cells as foreign, as a result of which it is accepted to produce specific antibodies. With this form of pathology, antigens attack the cells of the nerve roots, causing the destruction of their sheath (myelin), thereby provoking an inflammatory process. As a result of such attacks, the nerve endings lose their fundamental functions, which causes a breakdown in the innervation of organs and muscles.

Since it is generally accepted that the origin of any autoimmune disease is related to heredity, a genetic factor in the occurrence of demyelinating polyneuropathy cannot be excluded. In addition, there are conditions that can change the functioning of the immune system. Such conditions or factors include metabolic and hormonal disorders, heavy physical exertion, infection of the body, emotional overstrain, vaccination, trauma, stress, severe illness, and surgery.

Thus, the treatment of polyneuropathy of the lower extremities is represented by a number of features that must be taken into account, because the violation in question does not occur on its own. Therefore, when the first manifestations and signs of the disease are detected, it is necessary to immediately establish the etiological factor, since the treatment, for example, of diabetic polyneuropathy differs from the treatment of the pathology generated by alcohol abuse.

Upper limb polyneuropathy

This violation occurs due to damage to the nervous system and leads to paralysis of the upper limbs. With this disease, symmetrical damage to the nerve fibers of the distal regions of the extremities is usually noted.

Signs of polyneuropathy of the hands are almost always the same. In patients, there is an increase in sweating, a violation of pain sensitivity, thermoregulation, skin nutrition, a change in tactile sensitivity, paresthesias appear in the form of "goosebumps". This pathology is characterized by three types of course, namely chronic, acute and subacute.

Polyneuropathy of the upper extremities is manifested, first of all, by weakness of the hands, various algias, which in their content are burning or bursting, swelling, and occasionally tingling can be felt. With this pathology, vibration sensitivity is impaired, as a result of which patients often experience difficulties in performing elementary manipulations. Sometimes in people suffering from polyneuropathy, there is a decrease in sensitivity in the hands.

Cause polyneuropathy of the hands, most often, various intoxications, for example, due to the use of alcohol, chemicals, spoiled foods. Also, the occurrence of the disease in question can be provoked by: vitamin deficiency, infectious processes (viral or bacterial etiology), collagenoses, dysfunction of the liver, kidneys, tumor or autoimmune processes, pathologies of the pancreas and endocrine glands. Often this disease appears as a consequence of diabetes.

The described disease can proceed in each patient in different ways.

According to the pathogenesis, polyneuropathy of the upper extremities can be divided into axonal and demyelinating, according to clinical manifestations into: vegetative, sensory and motor. In its pure form, it is rather difficult to meet the listed varieties of this disease, more often the disease combines the symptoms of several variations.

Treatment of polyneuropathy

Today, the methods of therapy for this disease are rather scarce. Therefore, to this day, the treatment of polyneuropathies of various forms remains a serious problem. The level of knowledge of modern physicians in the field of the pathogenetic aspect and the etiological factor of this category of diseases determined the expediency of distinguishing two areas of therapeutic action, namely, undifferentiated methods and differentiated ones.

Differentiated methods of therapeutic correction suggest treatment of the underlying disease (for example, nephropathy, diabetes) in case of endogenous intoxications; in case of pathologies of the digestive system caused by malabsorption, they require the appointment of large doses of vitamins B1 (thiamine) and B12 (cyanocobalamin).

So, for example, diabetic polyneuropathy treatment drugs and their choice is due to the maintenance of a certain glycemic level. Therapy of polyneuropathy against the background of diabetes should be phased. At the first stage, body weight and diet should be adjusted, a set of special physical exercises should be developed, and blood pressure should be monitored for compliance with the norm. Pathogenetic methods of therapy involve the use of neurotropic vitamins and the injection of alpha-lipoic acid in large doses.

Undifferentiated methods of therapeutic action are represented by glucocorticoids, immunosuppressive drugs and plasmapheresis.

Polyneuropathy treatment drugs should be administered in combination. The specificity of the choice of therapeutic measures for the pathology under consideration always depends on the etiological factor that provoked the disease and determined its course. So, for example, the symptoms of polyneuropathy, generated by an excessive content of pyridoxine (vitamin B6), disappear without a trace after normalization of its level.

Polyneuropathy caused by a cancerous process is treated by surgical intervention - the removal of a neoplasm that put pressure on the nerve endings. If the disease occurs against the background of hypothyroidism, then hormone therapy is used.

Treatment of toxic polyneuropathy, in the first place, involves detoxification measures, after which medications are prescribed to correct the disease itself.

If it is impossible to identify or eliminate the cause that provoked the development of the described disease, the main goal of treatment involves the removal of pain and the elimination of muscle weakness.

In these cases, standard physiotherapeutic methods and the appointment of a number of drugs aimed at relieving or alleviating pain caused by damage to nerve fibers are used. In addition, physiotherapy methods are actively used at all stages of rehabilitation treatment.

With the help of analgesics or non-steroidal anti-inflammatory drugs, it is quite difficult to defeat algia. Therefore, the appointment of local anesthetics, anticonvulsants and antidepressants for the relief of pain attacks is more often practiced.

The effectiveness of antidepressants lies in their ability to cause activation of the noradrenergic system. The choice of drugs in this group is set individually, since antidepressants often cause mental dependence.

The use of anticonvulsants is justified by their ability to inhibit nerve impulses emanating from the affected nerves.

Doctor of the Medical and Psychological Center "PsychoMed"

The information provided in this article is for informational purposes only and cannot replace professional advice and qualified medical assistance. At the slightest suspicion of the presence of polyneuropathy of this disease, be sure to consult a doctor!