One of the most common causes of chest pain is intercostal neuralgia. This is a disease that occurs when the intercostal nerve is irritated or pinched, the main symptom of which is acute pain. As a rule, intercostal neuralgia affects elderly and senile people. This disease also occurs in young people (especially in people leading a sedentary lifestyle, as well as in swimmers) and even sometimes in children (mainly during periods of intensive growth). We will talk about why this pathology develops, what are the clinical manifestations, principles of diagnosis and treatment in our article.
What is the intercostal nerve
Less commonly, intercostal neuralgia can develop against the background of the following diseases:
- food poisoning (acute gastroenteritis);
- spondylopathies;
- rib diseases and deformities chest;
- allergic diseases;
- toxic (alcoholic) polyneuropathy;
- diabetes;
- diseases of the digestive tract that cause deficiency of B vitamins in the body ( chronic gastritis, colitis, hepatitis, peptic ulcer of the stomach and duodenum);
- thoracic aortic aneurysm.
Microtraumas caused by regular excessive physical activity, especially in combination with hypothermia, can also lead to intercostal neuralgia.
Clinical manifestations of intercostal neuralgia
The main symptom of this disease is pain along the intercostal space. The intensity of pain can vary: from sharp, acute, severe, shooting (more often) to constant, medium intensity. The pain intensifies when the patient moves, when coughing and sneezing, and even when breathing. Often a person takes a forced position: leans towards the affected side in order to minimize the range of movements in it. Some patients, when coughing, laughing or sneezing, press their palm firmly against the affected intercostal space for the same purpose: to reduce the range of movements in this area so that it hurts less.
Very often, the pain with intercostal neuralgia intensifies under the fingers of the doctor performing palpation: he easily probes the direction of the pain along the nerve. It is worth noting that patients can characterize their sensations not only as pain, but also as burning, tingling, and in the later stages of the disease - as numbness in the intercostal space.
When the intercostal nerve on the left is damaged, the pain often imitates the sensations of angina pectoris: patients evaluate the pain as burning, with irradiation (spread) in left hand, shoulder blade, spine. However, angina pain still does not depend on movements, coughing, laughter, etc., and, moreover, decreases after the patient takes nitroglycerin tablets or its analogues. However, in order not to miss such an important cardiac pathology, in doubtful cases the doctor prescribes an ECG for the patient. It is important not to confuse intercostal neuralgia with myocardial infarction, because the pain with it is also not reduced by nitroglycerin. Therefore, if pain suddenly arises in the heart area, you should not tempt fate, hoping for the best, but you need to play it safe: call an ambulance and undergo an electrocardiogram.
In some cases, when the nerves of the lower ribs are affected, the nature of the pain may resemble the sensations of renal colic (sudden sharp pain in the lumbar region of a cramping nature, radiating to the leg or groin). In such cases, you should also not delay, but it is important to immediately seek help from specialists. Remember that it is still better to be vigilant regarding your health.
Less commonly, intercostal neuralgia can copy the manifestations of diseases such as pleurisy, stenosis thoracic aorta, mediastinal tumors.
Diagnostics
The doctor will make a diagnosis of typical intercostal neuralgia without much difficulty based on the patient’s complaints, medical history and life history, as well as based on the results of an objective examination:
- upon examination, you will notice possible redness or paleness of the skin over the affected nerve;
- upon palpation, the patient will note pain along the affected intercostal space;
- examination of the heart (palpation, percussion, auscultation) will not show any pathological changes in this organ.
If a specialist has doubts about the nature of the patient’s pain syndrome, he will prescribe additional research methods that will help confirm or refute this or that diagnosis:
- plain radiography of the chest organs;
- Ultrasound of organs abdominal cavity and retroperitoneal space.
Treatment of intercostal neuralgia
Therapy for this pathology, as a rule, is carried out in 2 directions: alleviating the patient’s condition by reducing, or better yet, removing pain, and treatment of the disease against which neuralgia arose.
In the vast majority of cases, the patient is treated on an outpatient basis. For the first 3-7 days of the disease (depending on its severity), the patient is prescribed bed rest. Moreover, his bed should be flat, hard, with an orthopedic mattress or a shield placed under a regular mattress. Staying on a bed with a sagging net is strictly contraindicated: it can only worsen the patient’s condition.
General drug treatment
A patient with intercostal neuralgia may be prescribed drugs from the following groups:
Local treatment
First of all, in this section I would like to note dry heat to the affected area. However, it must be a source of indirect heat, such as a knitted item or woolen scarf. Applying hot objects to the affected area is not only unhelpful, but even harmful. With minor heating, local blood flow in the area is activated, but as it cools, the opposite effect will be noted: increased swelling and increased pain.
Ointments and gels containing non-steroidal anti-inflammatory drugs (NSAIDs) can also be used. These are drugs such as dolobene, DIP-relief, fastum-gel and others.
Other ointments or solutions that do not contain NSAIDs, but include anesthetics and reflex substances, also have analgesic effects. These are drugs such as menovazine, capsicam, finalgon - they can also be used to treat intercostal neuralgia.
A relatively new dosage form for the treatment of this pathology and other inflammatory diseases of the musculoskeletal system are transdermal patches. They are impregnated with one or more anti-inflammatory and analgesic substances, which, after being glued to the affected area, are slowly released and have a long-lasting effect directly on the affected nerve. One such drug is Voltaren. A patch with a special composition can also be used, which does not contain NSAIDs, hormones and other usual substances, but has a pronounced analgesic and anti-inflammatory effect - nanoplast forte.
Non-drug treatment
When the acute symptoms of intercostal neuralgia are eliminated, methods will help to quickly restore the functions of the affected areas non-drug treatment, namely:
- therapeutic massage (improves metabolic processes in the paravertebral muscles, tones them, reduces swelling, relieves pain);
- physical therapy (exercises to strengthen the muscular corset of the spinal column, prescribed by a doctor for a specific patient);
- manual therapy (it normalizes the connections between the vertebrae and eliminates pinched nerves);
- acupuncture;
- physiotherapy (magnetic therapy, laser therapy, electrophoresis, UHF).
Traditional medicine recipes
Methods will help alleviate the condition of a patient with intercostal neuralgia traditional medicine, but always in combination with traditional treatment by an appointed specialist.
- To reduce pain, you should lubricate the affected area with freshly squeezed radish or horseradish juice.
- You can also prepare a rue tincture for analgesic purposes (2 tablespoons of the raw material, pour 250 ml of boiling water and leave for 14 days). During intense pain, apply compresses to the affected area.
- Will remove pain syndrome and a lotion of steamed wormwood (steam the wormwood, then grind it into a paste, add sea buckthorn oil and apply to the painful area).
- If the patient has geranium growing at home, you can use it. Tear off a leaf and rub it on the affected area, wrap it warmly.
- A gauze compress moistened with flax seed infusion should be applied to the area of the affected nerve.
- You can prepare an ointment using Vaseline and aspen buds. Grind the buds, add Vaseline in a ratio of 1 part Vaseline to 4 parts buds. Rub into areas of greatest pain 2-4 times a day.
- The patient will feel better after a warm bath with sea salt and sage.
- You can take a healing decoction (chamomile flowers, lemon balm leaves, tincture of valerian officinalis, orange skins, honey) internally - it will strengthen the nervous system as a whole.
- Traditional medicine can also be purchased ready-made at a pharmacy. Such a remedy is pepper plaster. Before using it, you need to degrease the affected area with alcohol, dry it well, then apply a patch and wait for the effect. After some time, the skin under the patch will begin to burn. You cannot endure it forcefully; this way you can seriously burn your skin. If intense burning occurs, the patch should be removed.
Prognosis and prevention
With a timely diagnosis and adequate treatment of both the intercostal neuralgia itself and the underlying disease, complete recovery is noted.
It is easy to understand that, due to the many causes of the disease, methods specific prevention it does not exist. To reduce the likelihood of its occurrence, you should promptly treat diseases that may result in intercostal neuralgia, as well as avoid stress, avoid excessive physical exertion and hypothermia.
Most often, pain in the chest is mistaken for a heart attack, various diseases of the spine or organs gastrointestinal tract, although these may be manifestations of intercostal neuralgia. The pathology occurs due to pinching or irritation of the intercostal nerve and manifests itself in the form of acute pain. Intercostal neuralgia has strictly defined symptoms and treatment that every person needs to know about. In our article we will try to understand the causes of damage to the intercostal nerves, clinical manifestations, principles of diagnosis and treatment of an abnormal process.
To understand the cause of this pathology, you first need to know what intercostal neuralgia is, the symptoms and treatment of this condition.
Damage to the intercostal nerves serves as a definite warning of serious diseases of the body structures. Intercostal neuralgia is characterized by pinching, irritation or inflammation of peripheral nerves located in the narrow intercostal space. It is characterized by acute pain, which significantly worsens a person’s quality of life: performance decreases, irritability appears.
Pinched intercostal nerve is not a “terrible” diagnosis, but it has similarities with the symptoms of more serious diseases. Intercostal neuralgia can affect older people, as well as young people who tend to lead a sedentary lifestyle or engage in professional swimming.
This pathology in children is observed only in rare cases, for example, during periods of intensive growth.
Irritation of nerve tissue indicates that some pathological change is occurring in the body. There are many reasons for the development of this process. Therefore, consultations with a neurologist and diagnostics in this matter are extremely important in order to make an accurate diagnosis of the patient and begin treatment in a timely manner.
Most common reasons intercostal neuralgia are:
It is necessary to correctly identify the causes of intercostal neuralgia and fight not only its symptoms, but also eliminate the root cause of its development.
Main symptoms
The main symptom of intercostal neuralgia is pain. Moreover, there is always an immediate acute pain. Nerve inflammation can take you by surprise because it can appear suddenly. A person begins to experience severe discomfort, it becomes difficult for him to perform everyday duties.
The pain may intensify with emotional conversation, coughing, or turning the body. Even in a state of rest, a person does not feel better. High pain intensity may persist for 4-7 days.
The skin in the area where the irritated nerve is located usually loses sensitivity. But if you feel the affected area, the pain can sharply intensify.
Secondary symptoms of intercostal neuralgia may be:
- pallor skin or, conversely, redness;
- increased sweating;
- involuntary muscle contraction;
- loss of consciousness (possible with a low pain threshold in some people).
Most often, pain occurs in the chest and spreads along the ribs. Depending on the root cause of intercostal neuralgia, pain can spread beyond the chest, and this misleads the doctor in correct positioning diagnosis.
Inflammation of the nerve in the intercostal space provokes pain from all sides. In addition, the pain can spread beyond the affected area: to the lower back, back, shoulder blades.
You can independently distinguish the pain of a pinched intercostal nerve from cardiac pain. It is necessary to take one of the heart medications, according to the instructions: Validol, Nitroglycerin or Corvalol. If after some time there is no relief, it means intercostal neuralgia. In this case it is necessary diagnostic test in a specialized institution to determine the cause of the pathology.
It will not be difficult for a neurologist to establish a diagnosis of intercostal neuralgia. Judging by the patient’s symptoms, complaints and palpation (feeling), he will be able to determine treatment tactics.
To establish the primary source of pain, the following diagnostic methods are prescribed:
- X-ray of the chest organs (survey);
- MRI of the spine;
- Ultrasound of the abdominal organs.
Treatment methods
Treatment of intercostal neuralgia occurs in two directions:
- relief of the patient’s condition, reduction of pain;
- treatment of the underlying disease against which intercostal neuralgia occurred.
In most cases, intercostal neuralgia is treated on an outpatient basis. For the first few days, the patient must remain in bed. To do this, you need to properly arrange the bed: it must be firm. Also use an orthopedic mattress or place a backboard under a regular mattress.
The treatment regimen consists of the following points:
- drug therapy;
- physiotherapy and exercise therapy;
- acupuncture;
- manual massage;
- ethnoscience.
First of all, the specialist will help the patient reduce the pain of intercostal nerve entrapment and may prescribe the following medications.
- Non-steroidal anti-inflammatory drugs (Diclofenac, Meloxicam), they will relieve pain and have a direct effect on the inflammatory process in the body. These tools have several dosage forms: injection solutions, tablets, ointments, suppositories.
- Muscle relaxants (Sirdalur, Tolperil), which reduce the severity of spasm of muscle fibers.
- Sedatives based on herbal components (Sedasen, Persen, Novo-Passit).
- B vitamins (Neurobion, Neurorubin). Vitamin B restores damaged nerve structures and improves the passage of impulses through them.
- Painkillers. Ointments based on bee and snake venoms have a good effect: Apizartron, Viprosal.
Physiotherapy and exercise therapy
Electromagnetic and magnetic fields, UV rays, infrared radiation, ultrasound, electrophoresis and other physiotherapeutic methods.
Medicinal Physical Culture(physical therapy) is most effective when the nerve is pinched between the ribs. IN individually the specialist selects a set of activities for the patient, taking into account the severity of the pathology, the patient’s well-being and the symptoms of the disease.
Manual massage
To speed up recovery, the attending physician may advise the patient to undergo additional manual therapy. One of the most common methods of doing this is massage. Using his fingers, the specialist will influence the intercostal spaces, as well as the spine if neuralgia occurs due to diseases of the spine.
Manual therapy will help improve metabolic processes and blood flow in affected tissues, relax muscles and normalize the conduction of nerve impulses.
Acupuncture
Sometimes with intercostal neuralgia, acupuncture can significantly alleviate the patient's condition.
This method of treatment helps to quickly eliminate pain and relieve muscle imbalance.
Folk remedies
Most often as a first aid medical care use mustard plasters or pepper plaster. They warm up soft tissues well and have a beneficial effect on blood circulation.
You can also use special ointments, herbal infusions, and compresses that have an anti-inflammatory and analgesic effect at home.
- Glycerin and honey. The ingredients must be taken in equal quantities, mixed and applied to the affected areas. Use once every two days.
- Chamomile and peppermint. Fill hot water 1 tbsp each dry herbs mint and chamomile. Leave to infuse for approximately 1 hour. Strain the infusion and drink it throughout the day. The course of treatment lasts no longer than 5 days.
- Indoor geranium. Pluck several leaves of the plant, put them on a linen or cotton napkin and bandage them to the affected area, wrap them with a downy scarf on top. The compress must be kept for 40 minutes.
- Turpentine and Vaseline. Mix turpentine and petroleum jelly until smooth in a 1:2 ratio. Gently rub the resulting mixture into the area of intercostal neuralgia.
- Geranium and lemon balm. Pour boiling water over these ingredients and let it brew for a while. This decoction must be consumed regularly in the form of tea until the intercostal neuralgia completely disappears.
Please remember that self-medication may pose a potential threat to your health. Before using folk remedies for intercostal neuralgia, you should consult your doctor, as there is a possibility of intolerance to individual components. In addition, the manifestation of pain along the intercostal nerve may indicate more serious problems in organism.
If the diagnosis was made correctly and all the doctor’s instructions were followed, then the person’s complete recovery will follow. To reduce the likelihood of intercostal neuralgia, it is necessary to promptly treat the primary diseases that cause the pathology.
Preventive measures for intercostal neuralgia consist of following the well-known rules:
- monitor your diet, it should be rational;
- avoid hypothermia of various kinds, stress;
- take care of your health;
- treat internal diseases musculoskeletal system;
- ensure correct posture;
- exercise regularly;
- treat infectious diseases at the first manifestations.
Conclusion
Intercostal neuralgia is a fairly common pathological condition. A timely visit to a neurologist will help prevent serious complications and identify the root cause of inflammation/pinching of the intercostal nerve.
Intercostal neuralgia is a lesion of the intercostal nerves, accompanied by intense pain. The pathology itself does not pose a threat to life, however, the symptoms of intercostal neuralgia can mask serious diseases, which include, first of all, cardiovascular pathologies, in particular myocardial infarction. In some cases, intercostal neuralgia indicates the presence of other diseases, such as neoplasms spinal cord or chest organs, pleurisy.
Intercostal neuralgia is one of the most common diseases nervous system person
The intercostal nerves contain both sensory and motor fibers, as well as sympathetic fibers. In the human body, there are 12 pairs of nerves in the intercostal region, each of which passes below the edge of the corresponding rib in the intercostal space as part of the neurovascular bundle. Intercostal nerves innervate the skin and muscles of the peritoneum, costal and diaphragmatic parts of the pleura, anterior abdominal wall, mammary gland, chest. Neuralgia occurs when the roots of the intercostal nerves are compressed at their exit from the spine, usually as a result of muscle spasm.
Intercostal neuralgia occurs equally often in men and women. Susceptibility to the disease increases with age.
Synonyms: neuralgia of the intercostal nerves, thoracic radiculitis.
Causes of intercostal neuralgia and risk factors
Most common reasons Neuralgia of the intercostal nerves are:
- osteochondrosis, spondylitis, ankylosing spondylitis and other diseases of the thoracic spine;
- tumors of the thoracic spinal cord;
- sudden unsuccessful movement;
- chest injury;
- forced awkward body position;
- general hypothermia of the body, hypothermia of the chest and back;
- pathologies of the upper gastrointestinal tract;
In women, intercostal neuralgia can be caused by wearing tight underwear, as well as being underweight. In children and adolescents, intercostal neuralgia can occur during a period of intensive growth of the bone skeleton.
The contributing factors are:
- metabolic disorders (diabetes mellitus);
- age-related changes in blood vessels;
- diseases of the nervous system;
- infectious and inflammatory diseases;
- uncomfortable workplace.
Forms of the disease
There are two main forms of intercostal neuralgia:
- radicular - caused by irritation of the roots of the spinal cord and is accompanied by pain in the thoracic region, can masquerade as cardiac pathology;
- reflex – occurs due to muscle tension in the intercostal spaces.
Intercostal neuralgia occurs equally often in men and women. Susceptibility to the disease increases with age.
Depending on the location, intercostal neuralgia is classified into unilateral and bilateral. The latter often occurs against the background of immunodeficiency, radiation sickness, herpes infection and a number of other diseases.
Symptoms of intercostal neuralgia
The main symptom of intercostal neuralgia is paroxysmal piercing pain, which can be shooting, burning, stabbing, or resemble an electric shock. The pain intensifies when laughing, coughing, deep breathing, turning the body, getting up upper limbs. In addition, pain increases with palpation of the affected area and can become unbearable for the patient. The patient takes a forced body position (antalgic postures) to reduce or stop pain. The pain is long-lasting, often persisting day and night, although its intensity may vary.
The pain can have different localization. In women against the background of hormonal changes during menopause and/or fasting menopause pain is often noted in the area of the projection of the heart, pain can radiate to the mammary gland. In men, pain is more often localized at the level of the lower ribs, on the left side of the chest. Depending on the location of the lesion, the pain may radiate to the heart, scapula, and epigastrium. When pain is localized along one or two intercostal nerves, it can acquire a girdling character.
A characteristic sign of intercostal neuralgia is that pain does not decrease at night. In the early stages of the disease, pain in the chest may be less intense, manifesting itself in the form of tingling, but increase with the progression of the pathology. Pain with intercostal neuralgia can be either unilateral or bilateral. During the first few days from the onset of the pathological condition, attacks of intercostal neuralgia can lead to sleep disturbances (including insomnia) and worsening general condition patient.
In children, intercostal neuralgia manifests itself as severe pain in the affected area and is accompanied by convulsions, sleep disturbances, increased excitability, and speech disorders.
The clinical picture of the disease may include:
- muscle spasms in the affected area;
- numbness of the affected area;
- increased sweating (hyperhidrosis);
- pallor or redness of the skin;
- feeling of crawling sensations;
- shortness of breath (due to incomplete breathing during attacks of pain); etc.
Signs of intercostal neuralgia, which is caused by herpetic viral infection, are skin rashes and itchy skin, occurring even before the rash appears. Skin rashes represent pink spots, which transform into vesicles and dry out. The rash is localized on the skin of the intercostal space. Temporary hyperpigmentation of the skin is observed in place of the rash elements during convalescence.
Diagnosis of intercostal neuralgia
The primary diagnosis of intercostal neuralgia is carried out on the basis of complaints and anamnesis, as well as an objective examination of the patient. Often the data obtained is sufficient to diagnose the disease. In complex diagnostic cases, as well as for the purpose of differential diagnosis with other pathologies that have similar manifestations, additional examination, which, depending on the indications, includes:
- magnetic resonance and CT scan(to exclude neoplasms, hernia);
- X-ray examination of the chest and spine in direct, lateral and oblique projections;
- electroneurography (if the consequences of injuries are suspected);
- electrocardiography (to exclude diseases of the cardiovascular system);
- ultrasonography;
- contrasting discography;
- gastroscopy (to exclude pathologies of the gastrointestinal tract);
- general and biochemical blood test;
- serological blood test; etc.
The information content of computed tomography increases when performed together with an X-ray contrast examination of the spinal cord cerebrospinal fluid tracts (myelography).
In some cases, intercostal neuralgia indicates the presence of other diseases, for example, neoplasms of the spinal cord or chest organs, pleurisy.
It is possible to identify pathology at an early stage, as well as monitor the effectiveness of treatment using electrospondylography. The method allows you to assess the condition of the spine and determine the extent of damage.
Required differential diagnosis intercostal neuralgia with other diseases:
- cardiovascular pathologies (angina pectoris, coronary heart disease, myocardial infarction);
- intervertebral hernia;
- thoracic radiculitis;
- lung cancer and other chest tumors;
- diseases of the gastrointestinal tract (gastritis, acute pancreatitis, gastric ulcer);
- renal colic ; and etc.
Treatment of intercostal neuralgia
Patients with intercostal neuralgia are prescribed bed rest for a period of several days to several weeks.
Acute pain syndrome accompanying intercostal neuralgia is relieved by parenteral administration of analgesics. If this is not enough, they resort to novocaine blockade of the intercostal nerves. After the pain intensity decreases, the patient is transferred to parenteral painkillers.
Treatment of intercostal neuralgia is complex. For increased muscle tone, muscle relaxants are used central action. Swelling in the affected area is eliminated with the help of diuretics, as well as venotonics. In order to improve the functions of those involved in pathological process nerve, parenteral use of ascorbic acid and B vitamins is indicated. Non-steroidal anti-inflammatory drugs are used according to indications (patients with heartburn, gastritis or peptic ulcer their purpose is supplemented with drugs from the group of organotropic gastrointestinal drugs), sedatives, antidepressants, vitamin complexes.
In case of development of intercostal neuralgia against the background of a herpetic infection, it is prescribed antiviral drugs, antihistamines. Treatment is supplemented local application antiherpetic drugs in the form of ointment.
In women, intercostal neuralgia can be caused by wearing tight underwear, as well as being underweight. In children and adolescents, intercostal neuralgia can occur during a period of intensive growth of the bone skeleton.
As a complement to the main treatment of intercostal neuralgia in the area of pain localization, physiotherapy and manual therapy can be used after relief acute symptoms intercostal neuralgia
In case of intercostal neuralgia due to displacement of the vertebrae or osteochondrosis, gentle manual therapy or traction of the spinal column can be performed. For intercostal neuralgia that has developed against the background of spinal pathologies, it is recommended to supplement the main treatment physical therapy, including a set of rehabilitation exercises.
For intercostal neuralgia caused by a tumor, treatment is carried out in the oncology department.
Possible complications and consequences
In the absence of adequate treatment, intercostal neuralgia can have complications:
- circulatory disorders with subsequent development of pathologies of muscles and internal organs;
- chronic pain syndrome;
- exacerbation of chronic diseases of the digestive system;
- promotion blood pressure, hypertensive crisis ;
- transient ischemic attack, stroke;
- angina attack accompanied by intense pain; and etc.
Forecast
With timely treatment, the prognosis of the disease is favorable. In the case of intercostal neuralgia caused by herpetic infection, relapses are common.
Prevention
Specific prevention of neuralgia of the intercostal nerves has not been developed; general strengthening measures will help prevent the development of pathology. Recommended:
- a healthy lifestyle that includes regular moderate physical exercise and rational balanced nutrition;
- timely treatment of spinal diseases, chest injuries, pathologies of internal organs;
- measures to help prevent spinal curvature or treat an existing curvature;
- avoiding hypothermia;
- work in comfortable conditions, with prolonged forced body positions, take breaks for a short warm-up.
Video from YouTube on the topic of the article:
Intercostal neuralgia(synonym – “ thoracic radiculitis) is a neurological pathology that occurs as a result of damage or compression of the intercostal nerves, manifested in the form of pain.
The pain experienced by patients with intercostal neuralgia is one of the most severe. On the scale, it ranks third, along with acute kidney pain.
Intercostal neuralgia is often confused with other diseases, especially if the pain occurs on the left (simulates pathologies of the heart, stomach). Often even experienced doctors are misled.
Anatomical features
Thoracic vertebra consists of a massive anterior part (body) and a posterior part, an arch from which processes extend. At the junction of the body with the arch there are vertebral notches - superior and inferior. When the lower notches of the overlying vertebra are compared with the upper ones of the underlying vertebra, an intervertebral foramen is formed. The spinal nerves leave the spinal canal through it.Anatomy of intercostal nerves:
- From the anterior part of the thoracic spinal cord, nerve bundles emerge that perform motor function, and from the back - sensitive.
- Then, inside the spinal canal, the anterior and posterior bundles unite to form the thoracic nerves of the spinal cord. There are a total of 12 pairs of nerves in the thoracic region, corresponding to the number of segments of the spinal cord.
- The spinal nerve exits the spinal canal through the intervertebral foramen.
- Outside the spine, the thoracic nerve is divided into two bundles: anterior and posterior. The posterior one goes to the back muscles. Front bun, in fact, is the intercostal nerve. The first intercostal nerve runs along the edge of the rib. All the rest are located in the thickness of the intercostal muscles, filling the spaces between the ribs.
Irritation or compression at any of these levels can lead to intercostal neuralgia. Types of nerve fibers that make up the intercostal nerve:
- motor– innervate the intercostal muscles, the diaphragm, provide respiratory movements;
- sensitive– provide skin and other types of sensitivity;
- vegetative– control vascular functions, sweat glands etc.
Causes of intercostal neuralgia
main reason the occurrence of pain associated with intercostal neuralgia - compression of the thoracic spinal nerves at the point of exit from the spinal canal.Causes of intercostal neuralgia:
| Cause | Description |
| Sudden awkward movements. | A sudden movement may cause short-term compression of the intercostal nerve. This leads to pain. |
| Osteochondrosis of the thoracic spine. | A degenerative disease characterized by the destruction of intervertebral discs. Factors leading to the development of neuralgia:
|
| Injuries |  Types of injuries leading to intercostal neuralgia:
|
| Infectious diseases | Infections that most often lead to the development of intercostal neuralgia:
|
| Hypothermia | Cold causes irritation of the intercostal nerves, leading to attacks of intercostal neuralgia. |
| Increased physical activity | With excessive physical strain, microtraumas of the intercostal muscles occur. |
| Radiculopathy (radicular syndrome) |  Radiculopathy is compression of the spinal root. In this case, irritation and pain extend to the intercostal nerve. |
| Herniated disc |  A disease characterized by protrusion of the intervertebral disc beyond the vertebra. The prolapsed part of the disc compresses the nerve emerging from the intervertebral foramen. In the thoracic spine spina bifida are rare, since the vertebrae are connected to the ribs and take part in the formation of the chest, they are securely fixed. |
| Tumors of the spine, spinal cord, surrounding tissues |  Tumors in the area where the nerves pass through the spinal foramina, reaching a fairly large size, cause compression. |
| Spondylolisthesis |  Rarely found in the thoracic spine. It is characterized by the sliding of the overlying vertebra from the underlying one forward. As a result, both the spinal cord and the nerves extending from it are compressed. |
| Congenital defects development of vertebrae and ribs |
|
| Lead poisoning | Lead renders toxic effect on nervous tissue. |
| Alcohol abuse | Ethyl alcohol has a toxic effect on nerve tissue. |
| Osteoporosis |  A disease characterized by thinning and destruction of bone tissue. This leads to a decrease in the height of the vertebrae, their deformation, and increased fragility. |
| Hormonal disorders |
|
| Hypovitaminosis |
|
| Scoliosis and severe postural disorders |  With significant curvature of the spinal column, conditions arise for compression of the intervertebral nerves. |
| Ankylosing spondylitis (ankylosing spondylitis) |  Chronic illness intervertebral joints, leading to deformities of the spinal column. |
| Vertebral hemangioma |  A rare condition when a benign vascular tumor is located deep in the vertebral body - hemangioma. It makes the vertebra more fragile and susceptible to injury. |
Signs of intercostal neuralgia
| Symptom (group of symptoms) | Explanation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pain in the area of the affected nerve | The leading symptom of intercostal neuralgia. The pain is very intense and occupies the third position (severe pain) on the generally accepted scale. May be comparable to hepatic or renal colic. Duration of pain:
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Increased pain during movement and physical activity | Factors that can provoke intensification and occurrence of pain in intercostal neuralgia:
**Hereinafter when describing medications. Source: Mashkovsky M.D., “Medicines - edition 15, revised. and additional”, Moscow, LLC Publishing House “Novaya Volna”, 2005. What ointments are used in the treatment of intercostal neuralgia?
Vitamin preparations prescribed for intercostal neuralgiaWhen a nerve is compressed, its nutrition and functioning are disrupted. Therefore, for intercostal neuralgia, vitamin preparations are prescribed to help improve metabolic processes in the nervous tissue.
Physiotherapy for intercostal neuralgia
Is massage effective for intercostal neuralgia? Medical massage is effective for intercostal neuralgia, so it is almost always included in the overall treatment program.
Acupuncture for intercostal neuralgia Acupuncture (acupuncture) is a branch of traditional Chinese medicine that practices the insertion of thin metal needles into specific points on the body. Acupuncture effects:
Manual therapy for intercostal neuralgia In most cases, intercostal neuralgia is associated with compression of the nerve exiting through the intervertebral foramen. Thus, this pathological condition falls within the competence of the chiropractor. The effects that a chiropractor seeks to achieve in a patient with intercostal neuralgia:
Osteopathy for intercostal neuralgia Osteopathy is a branch of medicine that involves influencing the root cause. An osteopathic doctor, using light movements, pressure, etc., tries to eliminate factors that led to compression of the nerve in the intervertebral foramen:
Osteopathy is somewhat reminiscent of massage and manual therapy, but the effect is lighter and more accurate. Physical therapy for intercostal neuralgiaWith intercostal neuralgia, it is necessary to limit any physical activity. As the attacks subside, the patient begins to engage in physical therapy under the supervision of a specialist.Swimming is beneficial for patients with intercostal neuralgia. How to treat severe neuralgia? If, despite treatment, severe pain persists with intercostal neuralgia, then treatment is carried out in a hospital, stronger drugs are prescribed:
How to treat intercostal neuralgia at home?Neuralgia is a disease that is often accompanied by very severe pain and is treated for a long time and with great difficulty. Therefore, it is worth visiting a neurologist in any case. It is necessary to understand the causes and understand how serious the disease is.Can be used at home(after consulting with your doctor!):
Traditional methods of treating intercostal neuralgia
How is intercostal neuralgia treated during pregnancy? The treatment regimen for intercostal neuralgia in pregnant women is not much different from the standard one. Peculiarities:
|
Intercostal neuralgia is a condition of compression of the nerve endings located between the ribs. This problem occurs in middle-aged and elderly people, and very rarely in children. The essence of the disease is irritation, pinching or inflammation of the nerve endings in the space between the ribs, or pinching of the roots of the spinal thoracic nerves.
Intercostal neuralgia is a “tricky” disease, since its symptoms are very similar to the manifestation of pathological symptoms of the heart. However, the nature of such pain is fundamentally different, so the symptoms should be studied in detail.
Symptoms
Intercostal neuralgia manifests itself as acute, burning or dull pain along the nerves. Pain in the rib area has the following characteristics:
- Continues for some time with a stitching or sharp character;
- Increased pain when taking a deep breath, changing body position, sneezing or coughing;
- The presence of two pain points: in the chest area and near the spine;
- It lasts for a short time and goes away on its own, or it bothers you for a long time and does not go away even at night.
Often attacks are accompanied by sweating, muscle twitching, tingling in the chest area, as well as a red or pale tint to the skin. Manifestations may be of a “walking” nature, that is, located in the area of the collarbone, shoulder blades or lower back. The very place where the nerve endings are damaged becomes numb and therefore does not hurt.
The difference between the symptoms of neuralgia and cardiovascular diseases
Firstly, with neuralgia, pain in the chest area persists for a long time, both day and night. In case of heart disease, the pain goes away after five or ten minutes or is relieved with medications.
Secondly, the pain intensifies with changes in body position, palpation or sudden movements, which is not typical for cardiac vascular diseases. An electrocardiogram or radiography excludes cardiac pathology and differentiates intercostal neuralgia.
- Angina;
- Myocardial infarction;
- Ankylosing spondylitis;
- Lung diseases;
- Tumor diseases.
In men, this pathology manifests itself in the form of localized pain in the ribs, mainly in their lower part. Women feel the presence of this disease sharp pain on the left side, in the region of the heart.
The presence of intercostal neuralgia during pregnancy can significantly complicate the process of bearing a child, which is due to the presence severe pain. A woman in the “position” faces a recurrent course of the disease, which often stops only after childbirth.
Causes
The causes are very diverse: consequences of injury, osteochondrosis, draft, stress, chest injuries, impaired metabolism, etc. It also occurs as a result of muscle spasm or tone, which contributes to irritation of nerve tissue, leading to pain.
Nominated medications, used over a long period of time can cause its occurrence. Alcohol abuse can also lead to the development of pathology due to toxic effects on the body. A lack of vitamin B in the body and diabetes mellitus can also provoke neuralgia.
Diagnostics
Diagnosis begins with a routine examination by a neurologist. Based on the patient’s complaints, the specialist performs a typical differential examination chest, excluding heart and respiratory diseases.
If there is a left-sided focus of localized pain, an ECG is prescribed to exclude cardiac pathologies. X-rays of the spine, or rather its thoracic region, are also required.
If it is difficult to make a diagnosis, a neurologist may prescribe additional tests: electroneurography, computed tomography or MRI.
Treatment
The treatment method depends on the nature of the disease and the degree of its neglect. Also, the cause of the disease plays an important role in prescribing effective and efficient treatment.
At running forms the disease must be spent several months to eliminate it, which in most cases has a positive prognosis. The only way to cope with the disease is complex treatment, aimed at ridding the patient of the cause of neuralgia. An important factor for successful treatment is compliance with the pastel regime during the period of its exacerbation, which prevents its progression.
There are several basic rules for successfully getting rid of pathology:
- The patient's bed should be moderately hard, but in no case soft;
- During an attack, dry heat should be applied to the painful area, bandaging the painful area with a warm woolen scarf or applying pepper plaster or mustard plasters to the painful points in the paravertebral region;
- It is useful to rub painkillers and anti-inflammatory ointments on sore areas;
- If severe pain occurs, analgesics should be taken.
To successfully treat the pathology, the first step is to get rid of the pain by eliminating the irritating factor. When the nerve endings are pinched and compressed, the patient is prescribed pain medications. If upon examination an incorrect position of the thoracic vertebrae is detected, then treatment begins with returning them to their place using massage and physiotherapeutic procedures.
Manual therapy should only be carried out by a specialist, since inept actions can lead to unwanted effects and even disability. Using the osteopathic method, it is possible to restore the position of part of the thoracic spine from an anatomical point of view. The result of these procedures is the restoration of blood circulation and normalization of lymph flow.
Reflexology is effective method to eliminate the disease even in advanced stages, in addition to which therapeutic restorative exercises are prescribed. These classes are compiled individually for each patient, taking into account the complexity of the disease and its symptoms.
Recently, more and more often, specialists have resorted to laser therapy and ultraviolet irradiation, which provide faster results than other methods. positive result, of course, in combination with taking medications.
If the conservative method does not bring the desired result, then it is mandatory to prescribe surgery, aimed at eliminating the cause of diseases, such as disc herniation or osteochondrosis.
Forecast
The prognosis is favorable, due to its cure, which can last quite a while. long term. Most patients, following all the doctor’s instructions, soon stopped feeling the symptoms, and after a certain period they completely got rid of the disease, which did not return to them in the future.
The first thing that affects the treatment process is a timely visit to a specialist. This is explained by initial stages are more amenable to therapy and require much less time to completely eliminate the disease. Also, complications in mild stages of the disease are unlikely, which gives patients a chance for a full and healthy life.
Consequences
The consequences do not pose a threat to the health or life of the patient. But often this disease hides a number of serious pathologies of internal organs. There are also many diseases that are diagnosed as neuralgia: renal colic, cholecystitis, pleurisy and acute abdomen syndrome.
Thus, if you do not pay attention to the problem and do not treat the disease on time, you can cause serious and irreparable harm to your health.
Prevention
Prevention involves regular lung physical exercise, strengthening the immune system, taking multivitamins and a balanced, proper diet.
Every person should know that colds can also cause many serious illnesses, including intercostal neuralgia. That is why you should protect yourself from drafts. Also, correct posture prevents the occurrence of not only neuralgia, but also scoliosis. Improper lifting of weights (tension of the back muscles, instead of the leg muscles) can adversely affect health and cause a similar pathology, the treatment of which will require more than a month.
Thus, it should be remembered that it is better to prevent a disease than to waste time on eliminating it. If it is already progressing, then it is better to consult a specialist, but in no case self-medicate, as this technique can lead to an unfavorable outcome.
