Intercostal shoulder girdle pain
Introduction
Introduction Disc herniation can squeeze the spinal nerve roots at the exit of the root canal nerve causing pain in the intercostal shoulder strap. Intercostal scapular pain is a clinical manifestation of thoracic disc herniation. The statistics of previous thoracic disc lesions rely on the diagnosis of iodophenyl myelin. With the emergence of safer, non-invasive, more advanced diagnostic techniques, MRI, CT, the understanding of thoracic disc herniation has changed. Awwad and colleagues observed 68 patients with asymptomatic thoracic disc herniation after observing CT scans (CTM) after choledochoscopy in 433 patients. Wood and colleagues reported that MRI imaging of adults with no chest pain below 40 years of age found that 55% of patients with thoracic disc degeneration, 37% of asymptomatic patients with acute thoracic disc herniation, of which 40% of those with disc herniation were Multiple disc herniations above one segment. In addition, in the autopsy of 368 unselected corpses, it was found that there were 15.2% of thoracic disc herniation. It can be seen that many people have no clinical manifestations of thoracic disc herniation, which is mainly due to the large sagittal diameter of the thoracic spinal canal in these patients, so that the prominent nucleus pulposus tissue is not enough to achieve the degree of compression of the spinal cord.
Cause
Cause
(1) Causes of the disease Chronic strain of the spine, injury and posture are not correct, forced position, can cause the disease; thoracic vertebral degeneration is also one of the causes of this disease.
(two) pathogenesis
Chronic strain or injury
Most of the disease is caused by chronic strain or spinal injury. In addition to the posture, the forced position and the excessive bending and excessive bending, various injuries, such as falling from a height, falling, repeated spine Sprains, etc., can cause the disease. The short course of the disease is mostly elastic and soft nucleus pulposus tissue, and in the long course of disease, the prominent nucleus pulposus is mostly hardened with the wrapping and contraction of fibroblasts, and may also be calcified or ossified induration. It is adhered to the posterior longitudinal ligament and fixed to the posterior margin of the vertebral ganglia. This is often one of the causes of extensive spinal segmental damage caused by this disease.
2. Thoracic degenerative changes
Although thoracic degeneration is related to age, and more common in middle age, the incidence of this disease is not proportional to age, so the degeneration of the vertebral segment is one of the causes of the disease. When the intervertebral disc is degenerated, the nucleus pulposus swells backwards and even ruptures and forms calcification in the later stage. In addition to its own characteristics, thoracic disc herniation also has a similar pathogenesis to cervical spondylosis or lumbar spondylosis. Spinal intervertebral disc is one of the earliest degenerative changes in human organs. Its degenerative changes manifest as disc degeneration, narrowing of the gap, unstable segments, ligament relaxation, nucleus pulposus or prolapse, bone hyperplasia and surrounding. A series of pathological processes such as soft tissue calcification. In this case, if you have another trauma, even a minor trauma can induce the disease. Therefore, this disease can sometimes occur in patients who are younger and whose disc degeneration is not very obvious. As for the occurrence of thoracic disc rupture and nucleus pulposus caused by obvious trauma, it is also related to its own degeneration. According to statistics, the incidence of thoracic disc herniation in the lower thoracic vertebrae is the highest, which also indicates the role of vertebral degeneration.
3. Changes in spine posture
Statistics show that in the case of congenital or acquired hunchback, the nucleus pulposus at the apex of the kyphosis is easy to protrude. Of course, abnormal posture is one of the causes of vertebral degeneration.
Examine
an examination
Related inspection
Chest plain chest wall examination
Clinically, the diagnosis of this disease is mainly based on the following three points:
1. The medical history can be acutely affected, or it can occur slowly, and the symptoms are different. It should be fully understood, including previous examinations and treatment overview.
2. Clinical manifestations Because the individual sagittal diameter of the patient's spinal canal is different, the difference in symptoms is also large, from general local pain to complete paralysis of the lower limbs. Therefore, such patients should pay attention to careful examination for early detection. .
3. Imaging examination
(1) X-ray examination: the conventional positive and lateral X-ray plain film of the thoracic vertebra is the first choice; it is reported that 20% to 50% of patients with thoracic disc herniation have calcified intervertebral disc in the spinal canal.
(2) Myelography: CT scan with a large dose of water-soluble contrast agent for myelography is a more accurate and accurate diagnostic method. If you do not have myelography first, but directly with CT, you will mistake the exact segment of the damaged spinal cord. However, most scholars currently believe that this kind of injury examination should be replaced by MRI, because the latter is also a method of longitudinal observation to estimate the entire thoracic spinal canal.
(3) CT and MRI examination: All suspected patients with this disease should have an early MRI examination. The authors found that MRI is the most effective measure for early diagnosis and timely treatment of this disease. In addition, myelography and CT examinations are helpful for the diagnosis of this disease, but because the diagnosis rate is not as good as MRI, it should not be used as the first choice item. It has been used less or only as a reference.
4. Other inspections
Including EMG and somatosensory evoked potentials, it is not helpful for the diagnosis of thoracic disc herniation.
Diagnosis
Differential diagnosis
1, intercostal neuralgia: also known as intercostal neuritis, is a group of symptoms, refers to the thoracic nerve root (ie intercostal nerve) due to different causes of damage, such as: thoracic degeneration, thoracic tuberculosis, thoracic spine injury, thoracic spine Membrane inflammation, tumor, ankylosing spondylitis and other diseases or ribs, mediastinum, pleural lesions, intercostal nerves are subjected to the above-mentioned diseases, oppression, stimulation, inflammatory reaction, and the emergence of chest intercostal or abdominal banded pain Sign.
2, the intercostal space may have tenderness is the clinical manifestation of intercostal neuralgia. Physical examination of patients with intercostal neuralgia found that there was significant tenderness in the paraspinal and intercostal space of the thoracic spine; typical patients with intercostal intercostal neuralgia had a positive neck test; the distribution of affected nerves often showed neurological impairment such as hyperesthesia or hypoesthesia. .
3, rib pain: the ribs corresponding to the back of the thoracic vertebrae have a slight shift, causing the rib nerve to be stuck or stuck, it will be painful. There is muscle damage at the point of pain that produces a sterile inflammation station that stimulates the rib nerve to cause pain.
4, the right rib pain syndrome is more common with young women, occurs in 2-4 thoracic joints. Can be single or multiple. The cause is not very clear, it is related to trauma, so it is common in manual workers and gymnasts.
