home Calculators Treatment of de Quervain's syndrome. Who is susceptible to the disease? Why does de Quervain syndrome occur?

Treatment of de Quervain's syndrome. Who is susceptible to the disease? Why does de Quervain syndrome occur?

Your hand hurts in your wrist, you don’t know what to do, but you continue to live as you lived. It would be more logical to think about the situation, find the causes of pain and try to eliminate them. Perhaps you got a syndrome with a not very well-known name.

Among various diseases that affect bones and connective tissues, de Quervain's syndrome is especially distinguished. This is a disease that affects the tendons, or rather a tissue sac - a vagina, in which the muscles of the thumb are “wrapped”. Group similar diseases called tenosynovitis, but it was Fritz de Quervain who first described the symptoms of pain in the finger area, who gave the name to this syndrome.

Painful sensations arise due to the fact that the walls of the tendon sheath become thicker, thicken, and the tubule within which the tendons slide becomes less passable. With any movement thumb the patient feels acute pain. De Quervain's disease is getting younger every year, and today it often affects people in their early 30s. Women are affected almost 10 times more often than men.

The most common cause of stenosing tenosynovitis is occupational diseases associated with constant stress and microtrauma of muscles and tendons. Thus, de Quervain's disease, the causes of which are related specifically to work, can occur in pianists, programmers, and athletes who load or often injure their thumb or hand.

The syndrome may also be a consequence of any infectious disease, including sexually transmitted diseases, tuberculosis and others. Often de Quervain's syndrome is observed in patients with rheumatic diseases.

Symptoms

First signs, according to which one can assume the development of this disease, - the appearance of night pain in the wrist area and in the area of the base of the main phalanx and the first metacarpal bone thumb The pain may also radiate to the elbow.

If de Quervain's disease is likely, symptoms may include:

Symptoms of de Quervain's syndrome

Swelling in the area of the radial fossa (also called the “anatomical snuffbox”), just above the trapezium bone.
Any movement of the thumb, as well as pressure on the radial fossa or the area of the first metacarpal bone, causes severe pain.
When you move and bend your finger, you can hear a characteristic tendon creaking, sometimes a clicking sound on the back of the hand - crepitus.
Gradually, Curwen's disease leads to limited movement of the thumb.

If all or some of these symptoms appear, this is a reason to immediately consult a doctor.

If the disease is not brought to an advanced state - the patient comes in a maximum of a month to a month and a half after the onset of night pain, then it is quite possible to get by therapeutic methods treatment.

Diagnostics

A preliminary diagnosis can be made by a surgeon or traumatologist according to the listed symptoms. However, stenosing tenosynovitis can be easily confused with some other tissue lesions:

arthrosis;
styloiditis of the radial process;
migrating polyneuritis.

If de Quervain's disease is suspected, the hands are x-rayed. The image will show the deposition of calcium salts in the area wrist joint.

Two more ways to identify de Quervain syndrome:

Mucard test. The fingers are straightened, joined together, the thumb is also straightened, pressed against the rest of the palm. The brush needs to be bent away from you, trying to achieve an angle of almost 90°. If the disease is present, the patient feels sharp pain in the area of the hand, just above the styloid process of the radius. The pain may also radiate to the thumb, elbow, or forearm.
Finkelstein test. The thumb is hidden in a clenched fist. The hand in the hand is bent in the direction from the thumb. Pain should be felt in the area from the base of the first metacarpal bone to the styloid process of the radius. Crepitation may occur.

The doctor says simply and clearly:

Therapeutic treatments

If de Quervain's disease is noticed in time, treatment will be relatively quick and painless.

First, the patient is prescribed joint immobilization - the splint will need to be worn for about a month to stop the development of the disease. In addition, it will be necessary to exclude any serious stress on the arm, especially at first, until the inflammation subsides.

To remove swelling and loosen painful sensations, it is recommended to apply an ice compress to the hand and thumb.

In the first few days, anti-inflammatory drugs are prescribed, for example, ibuprofen or diclofenac- it's cheap and affordable medicines. At severe pain injections of hormonal drugs may be prescribed to quickly reduce inflammation and swelling.

Important! The use of hormonal drugs may change hormonal background followed by sudden weight gain.

The fastest possible results with therapeutic treatment provide physiotherapy:

manual or hardware massage,
hydromassage,
micropulse electrotherapy (TENS),
phonophoresis (ultrasound administration of medications) with anti-inflammatory drugs.

Laser therapy using the HILT method provides excellent treatment speed.

Surgery

If the patient already has advanced de Quervain's disease, surgery is the only way to get rid of pain and restore mobility to the hand and thumb. It is done under local anesthesia, so that the patient is conscious and can be discharged home on the same day.

To bring ligaments and tendons into working condition, they are dissected through a small, several centimeters, incision. At the end of the operation, sutures are placed, which will need to be removed after 7-14 days, depending on the threads, technique and healing speed. During rehabilitation, the patient is shown exercises to restore mobility of the hand and fingers.

Folk remedies for de Quervain's disease

When you have been clearly diagnosed with de Quervain's disease, treatment folk remedies better to use as an auxiliary. After all conservative methods that your doctor prescribes is not painful, uncomfortable, or indirectly harmful to your health. Immobilization, cold compresses and anti-inflammatory drugs are all that is required from the patient.

To speed up the healing process, it is worth using natural diuretics - they will help reduce swelling faster. You can use ready-made pharmacy fees, you can prepare your own based on elecampane, mint, string, rose hips, and dill seeds.

However Don't overdo it with diuretics, since it can harm the kidneys or upset the balance of electrolytes in the body.

Patients who have de Quervain's syndrome in mild form, can use ointments based on Vaseline or baby cream with the addition of calendula, medical or bear bile. Wormwood helps well in the proportion of 30 grams of dry herb per 100 grams of ointment base. But it’s better not to experiment, but to immediately contact your therapist or a traumatologist directly.

On a note

De Quervain's disease advanced stages can cause a lot of discomfort. Besides, patients with this disease will be severely limited in work and home life. On initial stage The cure takes a minimum of time and is painless and almost without medications. In running states the operation is shown, which is routine and mass, can be performed in less than an hour, and the patient is sent home the same day.

De Quervain's disease is the technical name for inflammation of the thumb ligament. Normally, the tendons pass through the canal, but with this disease, its lumen narrows and an inflammatory process develops. Other names for this pathology are tenosynovitis, stenosing tendovaginitis, ligamentitis. The main symptom of the disease is pain that occurs near the thumb and spreads to the forearm area. It is impossible to make a diagnosis based on this symptom alone, but there are specific diagnostic tests that will help identify pathology. Treatment of de Quervain's disease of the hand is prescribed individually, depending on its stage. In the first stages, it is enough to use external anti-inflammatory drugs, and in advanced cases surgery may be required.

Causes of pathology

The main reason that can trigger the appearance of this disease is constant monotonous hand movements. The pathology is classified as occupational, since it often develops in athletes, seamstresses, and office workers who perform a large number of time behind the monitor, as well as among representatives of other similar professions.

The syndrome is often associated with for the following reasons:

injuries in the hand area;
inflammatory processes in joints;
long-term monotonous load on the wrist.

The muscles of the forearm, contracting and relaxing, move the fingers. Their tendons are located in a special channel, the lumen of which allows them to move freely. The position of the tendons is controlled by the ligaments of the hands, which become inflamed under prolonged stress. As a result, the lumen of the canal narrows, and finger movements become difficult. The thumb performs heavy load, than others, therefore such pathology most often develops in his area. For this reason, de Quervain's disease is distinguished from tenosynovitis and tenosynovitis of other fingers, and also because anatomical features and location of the thumb.

Symptoms of the disease

The disease can be recognized by its characteristic symptoms. In most cases it develops gradually, acute onset This is typical only for those patients whose disease arose after injury. In the first stages painful sensations occur only with sudden movements in the wrist and thumb, and then the symptoms progress:

pain spreads to the forearm area, can radiate to the shoulder or neck;
sensations may intensify during movement or be present even at rest;
swelling appears around the thumb, the skin over the damaged joint may turn red;
pressing on the thumb tendon is painless, most sharp pain occurs when palpated.

When examining a patient, it is important to compare the condition of both hands. Visually, the damaged joint may not be changed, but seen minor symptoms simpler in comparison. For staging accurate diagnosis There are specific tests, and x-rays may also be needed. According to statistics, this disease most often occurs in elderly patients (over 50 years old), as well as in females. On right hand characteristic symptoms appear more often, which is associated with a greater degree of its activity in Everyday life.

On initial examination Filkenstein test and other functional tests are performed

Diagnostic methods

A final diagnosis can be made even at the initial examination. To detect this disease, developed special methods, based on the characteristics of the muscles and tendons of the thumb.

The Filkenstein test is the first diagnostic test. The thumb must be clenched into the fist of the same hand, and then the hand must be tilted to the sides. If during these movements acute pain appears in the area of the wrist joint on the side of the first finger, the test is considered positive.
The tense abduction test is another way to diagnose de Quervain's disease. The thumb is pressed with outside, trying to move him towards the others. Normally, it will resist pressure, but with such a pathology, its strength decreases, and you can easily move it towards the hand.
The ability to hold various objects with the thumb is tested on both hands. Identical objects are sandwiched between the large and index fingers symmetrically with both hands, and the assistant tries to reach them. With a positive test, it is clearly noticeable how the damaged finger becomes much weaker than the healthy one and cannot hold an object for a long time.

According to the results functional tests The doctor orders an x-ray. The images will make it possible to determine at what stage of development the disease is, which structures are damaged, and whether it is possible to cure the pathology using conservative methods. For de Quervain's disease soft fabrics will be significantly compacted and thickened, the lumen of the canal will narrow. In advanced cases, you can observe the appearance bone growths on the periosteum or bones of the wrist joint.

Treatment methods

The treatment regimen may vary depending on the stage of the disease and the degree of tissue damage. If the patient applies on time, pain and inflammation can be eliminated using medicinal methods. In advanced cases, surgery is performed, but it is considered simple and safe, proceeds without complications and side effects.

In addition, the first requirement during treatment is to reduce the load on the wrist joint. The patient can use elastic bandages that will prevent careless movements. In some cases, a plaster cast or a durable plastic splint is applied to the damaged limb, which can be replaced with an elastic bandage only after a month and a half.

Conservative techniques

The cast should be applied in such a way that the thumb is limited in movement. The bandage starts on the hand and reaches the middle of the forearm. Some doctors prefer elastic pressure bandages instead of a cast, but this is not always justified. The fact is that it is almost impossible to apply it in such a way that the thumb is not involved in daily work. In addition, it may spontaneously weaken during the day. Is gypsum or plastic The best decision for the treatment of de Quervain's disease.

The first condition of treatment is complete immobilization of the limb for some time.

In addition to immobilizing the limb, it is necessary to use medications. The simplest method that will be effective in the first stages of the disease is non-steroidal anti-inflammatory drugs. They are produced in the form of creams or ointments for external use, as well as in the form of tablets and injections. These agents are used alone or in combination with local anesthetics. Thus, to relieve the symptoms of de Quervain's disease, novocaine blockades with the addition of anti-inflammatory components are often used.

Hormonal drugs prescribed for acute inflammatory process and expressed pain syndrome. Most often they are used in the form of injections. After the injection, the pain goes away within a short period of time, but the method has contraindications. Steroid anti-inflammatory drugs are not prescribed for pathologies of the liver or kidneys, metabolic disorders, during pregnancy and breastfeeding. In addition, they can be addictive, and over time it becomes impossible to relieve pain without their use.

Surgical intervention

The operation prescribed for de Quervain's disease is performed as planned. During the intervention, the surgeon administers drugs to local anesthesia, and then cuts the skin to gain access to the inflamed ligament. Next, it is cut open and the wound is sutured, making sure that movement in the joint no longer causes difficulty. The only complication that may arise after surgery is the formation of adhesions, but the process can be prevented by regular exercise.

The sutures are removed on day 10, after which the thumb becomes fully mobile. The patient’s task is to prevent recurrence of the disease, including on the second limb. If you do not reduce the level of physical activity on your wrist joints after surgery, treatment may not be effective. At home and at work, you can use special bandages that will protect your limbs from the recurrence of the disease.

De Quervain's disease is an occupational pathology. It develops with increased load on the thumb, constant monotonous movements in the wrist joint, and also due to injuries. Treatment will be individual in each case, but its success depends directly on the patient.

To begin with, the limb is immobilized in order to eliminate the main cause of the pathology, while using various drugs to relieve pain and inflammation. If conservative methods do not bring results, it is possible to carry out planned surgery for excision of the damaged ligament. After it, you need to restore the brush and develop it simple exercises. It is also recommended to change your field of activity and pay more attention to the health of the musculoskeletal system.

De Quervain's disease is a pathology characterized by inflammation of the tendons on thumb hands. The disease manifests itself gradually and has a rather slow development. Sometimes it takes several weeks or even months before seeing a doctor.

Description of the disease

De Quervain's disease (chronic tenosynovitis or is a pathology that is characterized by a gradual narrowing of the channel where the tendons of the thumb pass. The disease is accompanied by inflammation of the so-called tendon sheaths. The disease occurs due to constant stress on the hand, often in connection with the performance professional activity. Due to pain, patients are reduced in their ability to perform certain movements involving the entire hand.

Periodic contraction of the forearm muscles makes flexion/extension of the fingers possible. The tendons of the flexor muscles (approach the fingers through the palmar surface) and extensor muscles (pass through the back of the hand) are responsible for these movements. Transverse ligaments ensure that the tendons are held in the required position. The dorsal ligament is localized on the same side of the hand. Each group of tendons in the latter is located in a separate channel. actively involved in a person's daily life. Its tendons take the greatest load. De Quervain's disease provokes their consistent thickening and swelling. As a result, the canal becomes excessively small, symptoms of the disease arise, and the functioning of the entire hand occurs.

What causes the development of pathology?

Exact reasons for the appearance of this disease remain unexplored until the end. It has been suggested that constant, repetitive hand activity (golfing, gardening, childcare) may aggravate this condition. This is why the disease is sometimes called “mother’s wrist.”

Experts also identify a number of factors contributing to the development of pathology, namely:

Who is at risk?

The highest risk of developing this pathology is in people between the ages of 30 and approximately 50 years. De Quervain's disease is more often diagnosed in women during pregnancy and caring for a newborn.

What signs accompany the pathology?

The main symptom of this disease is pain in the area on the side of the thumb. When turning the brush discomfort may intensify. The pain often radiates to the forearm and neck area.

The hallmark of the disease is Finkelstein's symptom. A man clenches his hand into a fist and places his thumb inside. If the next attempt to move the arm to the side is accompanied by sharp pain, de Quervain (disease) can be confirmed.

When palpating the joint, slight swelling and pain are noted on the affected side.

The main mistake many patients make is not seeking help. qualified help, but ordinary immobilization of the hand. For these purposes, tight bandages and special wristbands are used. In this case, the onset of the disease is the cause of disability. Patients cannot perform even the most common household chores (peel potatoes, do laundry, unfasten buttons, etc.).

Establishing diagnosis

De Quervain's disease should not be ignored. Symptoms of pathology that appear for several days in a row should alert you and become a reason for immediate appeal to the doctor.

During the consultation, the specialist performs a physical examination of the affected area and may ask a number of clarifying questions (when did the pain appear, possible reasons). To confirm the diagnosis, the doctor performs several tests.

Conservative therapy

First of all, patients are recommended to stop previous activities with mandatory immobilization of the affected area. Immobilization of the hand should be done in such a way that the thumb is constantly in a bent position in relation to the index and middle fingers. For these purposes, the optimal solution is to use plaster cast, which is applied to the middle of the forearm. Such immobilization only prevents the joint from possible injury. Additionally, appropriate conservative therapy should be carried out.

Inflammatory changes in the ligaments underlie a pathology such as de Quervain's disease. Treatment involves the use of physiotherapeutic procedures (paraffin, ultrasound with hydrocortisone). In addition, anti-inflammatory drugs (Ibuprofen, Naproxen) and steroid injections (Hydrocortisone) are prescribed.

When is surgery required?

The operation is carried out in inpatient conditions using local anesthesia. Before starting direct anesthesia, the doctor marks the most painful area. Then novocaine is injected, and a transverse incision is made over the area of the so-called styloid process, which passes through this point. With a blunt hook, it is very carefully moved to the side subcutaneous tissue together with the veins, the dorsal ligament is exposed. The doctor cuts it open and partially removes it. Often, with a long course of the disease, fusion of the tendon with the tendon sheath occurs. In this case, all existing adhesions are excised. The wound is sutured and applied. The stitches are removed after approximately 10 days, and the ability to work is finally restored on the 15th day.

It must be taken into account that de Quervain's disease (disease) is usually caused by a pathological process in the area of the annular ligament. If after immediate surgical intervention the patient continues to overload the arm, the likelihood of a relapse increases several times. That is why patients are advised to reduce activity, and sometimes even change their type of professional activity.

Possible complications

What happens if de Quervain's disease is not treated? Over time, the hands become increasingly involved in the pathological process, and the person loses his usual ability to work. This is why it is so important when primary symptoms indicating an illness, seek qualified help from an appropriate specialist. When surgical intervention There is still a small chance of complications such as painful scar formation and impaired thumb movement.

Preventive measures

How to prevent the development of the disease? First of all, doctors recommend that all those who are at risk reduce physical activity associated with grasping movements of the hand. In addition, joint diseases of an inflammatory nature should not be started. In case of injury or mechanical damage brushes, it is important to seek help from a doctor and undergo a course of therapy. Only by following all the recommendations described above can the development of pathology be prevented.

Conclusion

In this article we described what symptoms are accompanied by de Quervain's disease. Surgery for this pathology is recommended in 80% of cases. However, timely start conservative treatment can eliminate the disease and minimize the development of complications.

We hope that all the information presented will be truly useful to you. Be healthy!

De Quervain's tenosynovitis is an inflammation of the tendons of the thumb. This condition causes pain in the finger when moving. Tenosynovitis is named after the Swiss surgeon Fritz de Quervain, who first identified it in 1895.

Photo: Wikipedia

Causes of de Quervain's tenosynovitis

golf;
piano playing;
printing;
carpentry;
carrying a child.

De Quervain's tenosynovitis is more common in women than men and often develops after pregnancy. Other causes include scar tissue formation after injury or inflammatory arthritis.

De Quervain's tenosynovitis of the thumb - symptoms

The main symptom of de Quervain's tenosynovitis is swelling and pain at the base of the big toe. The disease leads to inflammation of the synovial membranes that surround the two muscle tendons (extensor digitorum brevis and abductor pollicis longus).

finger) passing between the wrist and thumb. Tendons attach muscles to bones. In the thumb they are involved in movement. As the synovial membranes swell and thicken, it becomes painful for a person to move their thumb. Stretching or repetitive motion of the thumb during work or sports usually causes swelling and increases pain.

The main symptoms are pain and swelling at the base of the big toe. Pain occurs when moving the thumb or wrist, or when clenching the fingers into a fist. Swelling on the side of the wrist may occur.

De Quervain's tenosynovitis - diagnosis

Finkelstein test

For diagnostics de Quervain's tenosynovitis used Finkelstein test. At the same time, the person clenches his palm into a fist. Then bends the wrist towards the little finger. The test for de Quervain's tenosynovitis is considered positive if the pain worsens.

If symptoms do not improve after treatment, your doctor may recommend an ultrasound to determine if there is another cause for the pain.

De Quervain's tenosynovitis - treatment

Photo: Wikipedia

The person is usually referred to an orthopedist for treatment. Treatment includes exercise, anti-inflammatory pain medications, and wearing a splint. If the pain persists, steroid injections are used to reduce swelling.

Place the brush on a flat surface, such as a table, palm down. Carefully lift your thumb up and then slowly and smoothly return it to its place. This movement should be repeated 5-10 times.
Place your palm sideways on a flat surface. The thumb is removed from the fingers and then returned. The movement is repeated 5 to 10 times.
Place your palm on the table. The thumb moves to the side as far as is comfortable and then returns. The exercise is repeated 5-10 times.
Place your hand on the table, palm up, with your thumb touching your little finger. Hold for 6 seconds, repeat 10 times.
Squeeze the soft rubber ball and hold for 5 seconds. Repeat 15 times.

These exercises should be used for rehabilitation and only done after the pain has subsided.

If exercise worsens the pain or the pain does not go away after 4-6 weeks, you should see a doctor.

De Quervain's disease - inflammatory disease tendons of the thumb. The following synonyms are often found in the literature: stenosing tenosynovitis, carpal tunnel syndrome.

Why does the disease develop?

The tendon of the first finger of the hand, to which the extensor muscle is attached, runs in a separate narrow osteo-fibrous canal along with blood vessels and nerves. Due to the fact that the thumb performs many different tasks (minor operations, grasping, fixing objects), its ligaments and tendons experience constant stress. As a result, microdamage, inflammation and swelling of these structures develop. The already narrow channel becomes small for the movements of thickened ligaments. Compression of the neurovascular bundle occurs and the entire function of the hand is disrupted.

The disease was described at the beginning of the twentieth century by surgeon Franz de Quervain, but still does not lose its relevance. This is a fairly common disease that traumatologists and orthopedists classify as professional. It is found among professions that are forced to perform constant and similar work with the hands:

dressmakers, ironers;
painters and finishers;
surgeons;
musicians;

Often de Quervain's disease affects women who do housework, carry children in their arms, and do gardening. Currently, the disease is also observed in office workers who work with a computer mouse.

Development pathological process experts associate with hormonal changes in women, with a hand injury, with rheumatoid arthritis.

Symptoms

De Quervain's disease is chronic nature and develops gradually. First, swelling and pain appear in the thumb, then it spreads to the wrist joint and forearm. Symptoms intensify with extension and abduction of the first finger, with pressure on its base. During movement, friction and squeaking may be felt in the hand. The range of movements is sharply limited, the ability to hold objects between the first and second fingers is impaired.

During the examination, the doctor compares both hands. And notes insignificant local edema, smoothness or swelling in the area of the anatomical snuffbox. And when the hands deviate towards the little finger, there is restriction on one side and severe pain.

The patient feels acute pain during the Filkinshtein test. The hand is clenched into a fist with the thumb inward and tilted towards the elbow. Sharp pain indicates tension in the inflamed tendons, characteristic of stenosing tenosynovitis.

Diagnosis is based on complaints and examination data. Usually not required for diagnosis additional research. Sometimes, to distinguish de Quervain's disease from arthrosis of the wrist joint or inflammation of the styloid process, an X-ray examination is performed, which determines swelling and thickening of the soft tissue in the area of the osteofibrous canal.

How to treat the disease?

Treatment of the disease can be conservative and surgical.

Conservative treatment is carried out in a clinic and helps only at the onset of the disease. Complex therapy is carried out:

Ensuring complete rest of the hand, for which they apply a splint of plaster or plastic for up to 2 months, and then switch to wearing an orthosis - a special bandage, thanks to which the hand takes the correct position.
Elimination of activities that provoke the pathological process.
Anti-inflammatory drugs () relieve pain and reduce swelling. But the use of drugs in this group is possible short course and under the supervision of a physician, since the development of such serious side effects as a stomach ulcer with gastrointestinal bleeding is possible.
Blockades with corticosteroid hormones (kenalog) provide a long-lasting anti-inflammatory effect.
Physiotherapeutic treatment (ozokerite,).

If the process is prolonged or there is no improvement from drug therapy resort to surgery. Under local anesthesia An orthopedic traumatologist cuts the fibrous canal ligament and eliminates compression of the tendons. Already two weeks after surgery, the patient’s ability to work is restored.

Therapy for tendovaginitis is well complemented by treatment with folk remedies. But before using this or that recipe, you should consult a specialist. Traditional healers offer infusions and decoctions for the treatment of de Carvin's disease medicinal herbs, ointments from natural ingredients and compresses:

Ointment with calendula has a good anti-inflammatory effect. It is necessary to mix dry crushed flowers with baby cream or Vaseline and apply under the bandage at night.
Medical bile is taken as a compress, applied to a linen napkin and bandaged on the sore arm overnight. Bile has a resolving and anti-inflammatory effect.

To treat stenosing tenosynovitis, a decoction of wormwood is used, which is prepared from two tablespoons of the herb, poured a glass of boiling water and brewed in a water bath. The product is taken orally in a tablespoon 3 times a day before meals. The decoction can also be used topically, in the form of compresses.

By the way, you may also be interested in the following FREE materials:

Free books: "TOP 7 harmful exercises for morning exercises that you should avoid" | “6 Rules for Effective and Safe Stretching”
Rehabilitation of knee and hip joints for arthrosis- free video recording of the webinar conducted by a physical therapy and sports medicine doctor - Alexandra Bonina
Free lessons on treating low back pain from a certified physical therapy doctor. This doctor has developed a unique system for restoring all parts of the spine and has already helped more than 2000 clients With various problems with your back and neck!
Do you want to know how to treat pinching? sciatic nerve? Then carefully watch the video at this link.
10 Essential Nutrition Components for healthy spine - in this report you will find out what your daily diet should be so that you and your spine are always in good health. healthy body and spirit. Very useful information!
Do you have osteochondrosis? Then we recommend studying effective methods treatment of lumbar, cervical and thoracic osteochondrosis without drugs.