skin tenderness
Introduction
Introduction Skin tenderness is one of the common symptoms of neuralgia. This kind of pain refers to the pain that is felt without external stimuli, also known as spontaneous pain. There are many types of spontaneous pain, and the lesions can be divided into peripheral neuropathic pain and central nervous pain. Neuralgia is a common disease in neurology. It is a subjective narrative. Detailed physical examination should be performed according to the patient's prompts. It is possible to confirm the diagnosis and differential diagnosis from physical examination. The pain of the spinal nerve should pay attention to whether the local muscle has atrophy, weakness, muscle tension, involuntary movement and mutual aid exercise, gait, deep and shallow feeling and compound feeling and local presence or absence of sensory disturbance.
Cause
Cause
First, peripheral neuropathic pain
1, trigeminal neuralgia: common in inflammatory infiltration, atherosclerotic compression and cerebellopontine angle tumor, nasopharyngeal carcinoma, trigeminal ganglion tumor, chordoma, multiple sclerosis.
2, sphenopalatine ganglion pain, pterygopalatine pain, genic ganglion pain: seen in sinusitis, sphenoid sinusitis, ethmoid sinusitis, nasal structural deformation, nasal septum bending due to mechanical compression of the middle turbinate, skull base fracture, metastasis Cancer, banding diagnosis of viral infections, etc.
3, occipital neuralgia: common in neuritis, upper respiratory tract infection, influenza, malaria, rheumatism, diabetes, thyroid disease, alcohol, lead poisoning, occipital, neck trauma, cervical spondylosis, rheumatoid spondylitis Or metastatic cancer, skull base recession, occipital foramen stenosis, sacral occipital fusion, atlantoaxial dislocation, upper cervical vertebral insufficiency, cerebellar tonsil sacral, intraspinal tumor, occipital macropore area tumor, adhesive spinal spider web Membrane inflammation, syringomyelia, ligament injury of the suboccipital joint, anterior and posterior arch fracture of the atlas, atlantoaxial subluxation, and cervical muscle injury.
4, intercostal neuralgia: common in infectious and toxic radiculitis, pleurisy, chronic pneumonia, aortic aneurysm, mitral stenosis, thoracic organ disease, thoracic tuberculosis, tumor, ankylosing spondylitis, myeloma, spinal cord Spinal lesions such as inflammation, rib tumors, rib fractures, osteophytes, and herpes zoster.
5, neck and shoulder arm neuralgia, brachial plexus neuritis: common in cervical osteoarthrosis, neck mass, tumor, herpes zoster, influenza, plaque diagnosis of cold and malaria infection, cold, inoculation of xenogeneic serum vaccine.
6, ulnar nerve pain, median nerve pain and lateral femoral neuralgia: seen in neuritis, trauma, local inflammation and oppressive lesions.
7, femoral neuralgia and sciatica: seen in nerve root lesions such as tumor compression, lumbar disc herniation, tumor, inflammation and other diseases.
8, tail bone pain: seen in trauma, fractures and so on.
9, burning neuralgia: seen in trauma such as knife cuts, crush injuries, heavy injuries, especially firearm injuries, chemical damage, infection and so on.
10, herpes zoster: the cause is caused by varicella-zoster virus.
Second, central pain
1, spinal pain
(1) Posterior horn pain is more common in trauma, tumor, syringomyelia and so on.
(2) Post-spinal pain is seen in multiple sclerosis and spinal cord spasm.
(3) Spinal thalamus pain is more common in syringomyelia.
2, thalamic pain
Thalamic pain is more common in cerebrovascular diseases and tumors.
3, pons, medullary pain
Found in cerebrovascular disease, tumors, multiple sclerosis, etc.
4, cerebral cortical pain
Cerebral cortical pain is rare, usually tumors, vascular diseases and so on.
Examine
an examination
Related inspection
Electromyography EEG examination Brain CT examination Low back pain Physical examination Prolactin (PRL)
Physical examination
Neuralgia is a common disease in neurology. It is a subjective narrative. Detailed physical examination should be performed according to the patient's prompts. It is possible to confirm the diagnosis and differential diagnosis from physical examination. Reasonable examination should be carried out according to the medical history. For example, peripheral nerve pain and head pain should be paid attention to such as fundus examination, head and ear, sinus, oral examination and presence or absence of signs of nervous system positioning. The pain of the spinal nerve should pay attention to whether the local muscle has atrophy, weakness, muscle tension, involuntary movement and mutual aid exercise, gait, deep and shallow feeling and compound feeling and local presence or absence of sensory disturbance. Various reflections such as deep and shallow reflections, pathological reflexes, meningeal irritation signs, and special pain relief postures in pain areas. For central pain, attention should be paid to examinations such as fundus examination, head examination and signs of nervous system localization.
Auxiliary inspection
1, peripheral nerve pain
(1) Head and face nerve pain: paranasal sinus plain film, brain CT or MRI, lumbar puncture examination.
(2) spinal nerve pain: flat radiograph, spinal CT or MRI, lumbar puncture examination, myelography, electromyography, etc.
2, central pain
Brain CT or MRI, EEG, etc. are generally used.
Diagnosis
Differential diagnosis
1. Skin pain: Skin pain is divided into two types: fast pain and slow pain. Quick pain is a kind of sharp and sharp tingling. Slow pain is a burning pain that is unclear and unbearable.
2, skin lightning pain: If there is "lightning pain" on the surface of the skin, and a similar situation occurs for several days, it may be suffering from asymptomatic herpes zoster.
