Decreased sense of position and vibration
Introduction
Introduction The sense of position and loss of vibration means that the body's sensory system does not produce normal position and vibration response to external stimuli. It is one of the symptoms of objective sensory disturbance and can also be manifested in the clinical symptoms of polyneuritis. Objective sensory impairment is a sensory-induced disorder, which means that the body's sensory system does not produce a normal feeling of external stimuli. Various damages to the nervous system can cause sensory-induced disorders when it involves receptors, conduction pathways, and sensory centers. The most common influencing factors are the nervous system and surrounding tissue tumors, trauma, infection, poisoning, degeneration, neurotrophic disorders, and Cerebrovascular disease, etc.
Cause
Cause
Reasons for positional awareness and loss of vibration:
Various damages to the nervous system can cause sensory-induced disorders when it involves receptors, conduction pathways, and sensory centers. The most common influencing factors are the nervous system and surrounding tissue tumors, trauma, infection, poisoning, degeneration, neurotrophic disorders, and Cerebrovascular disease, etc.
Sensory induction disorders vary depending on the nature of the lesion. When the lesion causes damage to the nervous system, the sensation diminishes or disappears, and when the nerve system is stimulated, it may cause hyperesthesia, over-sensation, or feeling inversion. Sensory decline is caused by increased stimulation threshold (inhibition) and decreased reactivity; hypersensitivity is caused by increased reactivity or decreased sensory threshold, mainly pain and tactile sensitivity; hypersensory is caused by increased sensory threshold and prolonged reaction.
Examine
an examination
Related inspection
Electroencephalogram examination
Diagnosis of positional awareness and loss of vibration:
1. Position sense:
1 The patient closes his eyes and passively examines the patient's limbs, such as the fingers and toes. The patient can correctly tell the movement, direction and position of these parts.
2 Thumb test: The patient closes his eyes, and stretches his forearm and thumb to make the wrist flexion and flexion 2 to 3 times. Then he uses the opposite thumb or finger to touch the thumb on the side. Touched.
3 palm test: the patient closed his eyes, rubbing his hands together, and the two hands could interact with each other as normal.
2. Vibration: Use a 128HZ tuning fork to place the protruding bone, ask for vibration, and make double-sided and up-and-down contrast.
Diagnosis
Differential diagnosis
Differential diagnosis of positional awareness and loss of vibration:
First, gloves (socks) type sensory disorder (glove anesthesia)
(1) The etiology of acute infectious polyneuritis is not known. It often occurs after various acute febrile diseases. It is characterized by damage to most peripheral nerves, showing a symmetric distribution, and the proximal end is heavier than the distal end. Rapid development from the bottom and the top, severe cases of dysphagia and difficulty breathing. Sensory dysfunction is lighter than dyskinesia, often with gloves, socks-like sensation, muscle tenderness, and some patients have spontaneous pain and paresthesia at the distal end of the limb.
(B) terminal neuritis (terminal neuritis) caused by various factors of multiple peripheral nerve damage, although the cause is different, but there are common clinical manifestations: distal symmetry of the limbs, motor and autonomic disorders. The distal part of the limb is paralyzed or sputum, the muscle tension is low, the tendon reflex is weakened or disappeared, the muscle is atrophied, or there is a wrist and a foot. The affected limb first appears paresthesia, with ants walking, acupuncture, burning or stinging, and at the same time or later, the symmetry of the distal part of the limb is reduced or disappeared. A long or short glove or sock distribution.
(C) Diabetic peripheral neuritis (polyneuritis in diabetes) sensory disorder with shallow sensation diminished or disappeared, can also be expressed as hyperesthesia, often accompanied by a variety of paresthesia such as acupuncture pain, burning pain or cold pain, ants Walk and numbness.
(4) Vitamin B1 deficiency peripheral neuritis (polyneuritis in vitamine B1 deficency) may be caused by insufficient long-term intake, malabsorption and metabolism, manifested as pain, temperature, tactile decline or disappearance, occasionally hypersensitivity, Gloves and socks are distributed or regionally distributed, and limbs often have numbness, burning, ants, and nighttime. Muscles and nerve trunks have tenderness and can be associated with nerve damage. The symptoms are severe and long lasting.
Second, strip, block feeling sensation (streak sensory disturbance)
(a) Trigeminal lesion Trigeminal peripheral paralysis. Limited to facial skin, conjunctiva, cornea, mouth, tongue and nasal mucosa, the corneal reflex disappears. If only the nose, eyes, forehead and anterior scalp are feeling impaired, it is the damage of the first branch of the trigeminal nerve (eye branch); the sensory disturbance at the front of the lips, cheeks and ankle is the second branch of the trigeminal nerve. (Maxillary branch) damage; sensory disturbance of the lower jaw, lower cheek and ankle is the third branch of the trigeminal nerve (mandibular branch). Often accompanied by chewing muscles, diaphragmatic atrophy, mandibular deviation to the disease side when opening mouth. Common diseases are: nasopharyngeal carcinoma, middle cranial fossa meningioma, semilunar tumor, aneurysm, acoustic neuroma, meningitis, rock tip inflammation, etc.
(2) Single spianl nerve injury
1. Mononeuritis: A localized sensory disorder occurs in a certain innervation area. Since two adjacent nerves are overlapped, the sensory area is often smaller than the nerve area.
2. Most mononeuritis multiplex: usually begins with pain, paresthesia, and dyskinesia with peripheral nerve damage, progresses within hours to days, and other nerves are also affected. Lower limbs are more common than upper limbs. Common in nodular polyarteritis, rheumatoid arrhythmia and leprosy.
3. Radial nerve palsies: the upper arm, the forearm's ankle, the thumb, and the back of the first and second metacarpal spaces feel reduced or lost. With the wrist, it is usually a high position injury; when the tibia is less than one third of the injury, the sensory disturbance is limited to the thumb and the very small part of the dorsal side of the first and second metacarpal spaces; Obstacle and hanging wrist. Mainly caused by trauma, lead poisoning and compression of the phrenic nerve.
4. Median nerve palsies: The temporal side of the palmar, three-finger and ring fingers are reduced or absent, with acupuncture-like pain or numbness. When the median nerve is damaged in the upper arm, complete paralysis occurs, the big fish muscle atrophy, the hand is "handcuffed", common in scalpel wound and humeral fracture; the wrist lesion damages the median nerve, the lateral three-finger dysfunction and thumb movement Obstacles, common diseases are chronic wrist strain, carpal sheath cyst in carpal tunnel, carpal fracture, arthritis, acromegaly, mucous edema and wrist pus infection.
5. Ulnar nerve palsies: The ulnar side of the palm and the back of the hand, the entire little finger and the ring finger feel reduced or lost, especially the little finger, often a "claw-shaped hand." Common causes are trauma, oppression and leprosy.
6. Palsies of nervus peroneus communis: sensation of the anterior lateral and instep of the lower leg, with loss of foot and sag and cross-threshold gait.
