Intercostal nerves are located in the intercostal spaces between the external and internal intercostal muscles. Each of them first passes under the lower edge of the corresponding rib, falling into 1 furrow with an artery and vein, deployed under them.
The upper 6 intercostal nerves reach the sternum, here they are called the front skin branches and end in the skin of the anterior chest wall. The 5 lower following and the sixth, which is called the hypochondrium, continue into the front wall of the abdomen, penetrate between the internal oblique and transverse muscles, perforate the rectus abdominis muscle and end in the skin of the anterior abdominal wall. They innervate these same muscles.
The front skin branches of the upper 6 nerves innervate the following muscles: intercostal external and internal, hypochondrium and lifting muscles, transverse muscle of the chest and abdomen, named muscles of the abdomen, square muscle of the lower back and pyramidal muscle of the abdomen.
In space to the costal angle, the intercostal nerves are covered by a parietal pleura and intrathoracic fascia. Thus, thoracic nerves innervate all the muscles and skin of the chest and abdomen in front and side, the parietal pleura and peritoneum, as well as the mammary glands.
What is part of the nerve
All intercostal nerves are mixed, because they contain motor, sensory and sympathetic fibers.
- Motor - innervate intercostal muscles, diaphragm, provide respiratory movements. This allows a person not to suffocate from suffocation. Together with the diaphragm, a person can arbitrarily take a deep breath.
- Sensitive - provide and carry skin, pain, tactile, temperature and other sensitivity in the spinal cord. They form a pain (primary) reaction in neuralgia.
- Vegetative - they control the functioning of blood vessels, sweat glands, etc. They are responsible for increasing skin temperature, vasodilation, the appearance of "goose" skin, sweating from the skin of the chest; all these reactions occur on an unconscious level.
Path of pain
In neuralgia, the primary pain analyzer is the thoracic segments of the spinal cord, their gelatinous substance. It is in the form of a group of neurons located in the gray matter of the posterior horns of the spinal cord. These groups are interconnected along the entire vertical spine. Further, the sensitive bundles in the composition of the spinal thalamic tract intersect, pass into the thalamus and then into the cerebral cortex, where the pain is emotionally colored. At the same time, vegetative manifestations in the form of hyperemia of the skin, burning sensations are also characteristic.
And the proximity of the conducting bundles of sensation of tactile touch and temperature can give pains of a different nature: excruciating, burning.
Intercostal neuralgia
Intercostal neuralgia or thoracic sciatica is a neurogenic pain syndrome in which compression or irritation of the nerve roots occurs due to inflammatory and degenerative changes in the spine.
The etiology can be any - hypothermia, intoxication, infringement, infection, etc. the patient's age can be any, for children the diagnosis is uncharacteristic.
Intercostal neuralgia or thoracalgia is not life-threatening, but it often occurs against the background of more serious pathologies and is complicated. Pain with neuralgia on a scale are in 3rd place after renal colic.
Causes
The most common cause of neuralgia is osteochondrosis of the thoracic spine with radicular syndrome or intervertebral hernia and protrusion. Then they say that it pinched the intercostal nerve.
Neuralgia can be triggered by herpes zoster (the herpes virus likes to sit on nerve trunks). Often this can be a manifestation of diseases of the internal organs - pleurisy, tumors of the spinal cord, chest and mediastinum.
Also among the reasons:
- back and chest injuries;
- any curvature of the spine;
- intervertebral hernia;
- spondylosis, multiple sclerosis, ankylosing spondylitis.
Inflammation of the intercostal nerve can occur for the following reasons:
- infections (TB, syphilis, flu);
- pathologies of the nervous, endocrine, digestive systems: ulcers, gastritis, diabetes;
- hypertension, atherosclerosis, thyrotoxicosis.
In the elderly, neuralgia can provoke a careless sharp movement, in which there is muscle spasm, hypothermia, age-related changes. Contributing factors - alcoholization, chronic fatigue, hypovitaminosis gr. B, decreased immunity.
Symptoms of intercostal neuralgia
Symptoms and treatment of intercostal nerves have the closest relationship. The main symptom is a sharp sudden unilateral piercing acute pain in the chest (thoracalgia), which runs along the rib in the form of a girdle from the spine to the sternum. Patients compare it with an electric shock and call it backache.
The pain may not be so severe at first, but it quickly gains strength and becomes unbearable. She can give back, scapula, heart, epigastrium. Concomitant symptoms: pallor or redness of the skin, local sweating. This occurs due to irritation of the sympathetic fibers in the nerve.
Symptoms of pinching of the intercostal nerve give characteristic repetitive seizures that last from a few seconds to 2-3 minutes. At the same time, the patient freezes on inhalation, trying not to move, because it intensifies the pain. Any movements, even ordinary breathing, coughing, laughing, talking, all lead to increased pain.
In the period between pain attacks, symptoms of an intercostal nerve appear, such as paresthesia along the nerves - a feeling of tickling, creeping creeps.
With a herpetic infection, intercostal neuralgia is supplemented first with itching, then with skin rashes on the intercostal space, occurring on the 2-4th day of neuralgia. First, these are pink spots, they turn into bubbles, burst and then dry out with the formation of crusts.
They supplement thoracology with their pain. In place of the crusts, temporary hyperpigmentation remains.
Treatment of intercostal neuralgia
Treatment of intercostal nerves should be carried out comprehensively. It is etiotropic, i.e. aimed at eliminating the cause of the disease in the first place.
Then the pain is eliminated and the affected nerve is restored. To do this, apply anti-inflammatory, analgesic treatment, antispasmodics, sedatives, neurotropes, muscle relaxants, as well as alternative medicine: physiotherapy, massage, osteopathy, IRT, alternative methods.
Alternative methods can help at home only with mild to moderate neuralgia. In severe cases, it is necessary to carry out blockades stationary.
In anti-inflammatory therapy, NSAIDs predominate first, in severe cases - corticosteroids.
Anti-inflammatory nonsteroids - Piroxicam, Ibuprofen, Diclofenac, Nimesulide. Their application is general and local.
An auxiliary tool in the treatment of pinching of the intercostal nerve for the relief of pain is the appointment of sedatives, which will help reduce the increased excitability of the nervous system. Local treatment - creams, ointments, patches and gels with anti-inflammatory, relaxing, analgesic and warming effects.
It is good to apply ointments containing poisons of bees and snakes. They have all of these features. These include Viprosal, Apizartron, etc. Viprosal, in addition to snake venom, also contains camphor and fir, which gives an analgesic effect.
Muscle relaxants are used in the presence of a muscle-tonic syndrome: "Tizanidine", "Tolperisone hydrochloride."
In the treatment of pinching of the intercostal nerve at the exit of the intervertebral opening due to osteochondrosis, accompanied by displacement of the vertebrae, manual therapy and spinal traction help. This will remove compression. If neuralgia is a consequence of a tumor, the treatment is surgical.
Neurotorps - will improve the recovery of the affected nerve: these are, first of all, vitamins of group B - B1, B6, pantothenic acid (B5), Pentovit.
Antispasmodics are prescribed for spasm, i.e. increased muscle tone surrounding the nerve fibers with their injuries. As long as there is muscle spasm, the pain does not go away. Assign "Halidor", "Besalol", "Papazol", "Drotaverin" and others. They can be used in tablet or ampoule form.
Of the analgesics shown, "Analgin", "Baralgin", "Spazdolzin", "Tempalgin", "Ketorol" and others.
Physiotherapeutic methods - ultraphonophoresis, laser therapy, magnetotherapy, electrophoresis, UHF, Darsonval. All of them activate protective mechanisms and relieve inflammation, reduce pain.
Local treatment
For treatment, ointments and gels are used:
- "Fastum-gel" - relieves swelling, has an analgesic effect.
- "Capsicam" - effective as a warming agent. Ointment enhances blood flow and helps restore tissue trophism.
- "Finalgon" is also a warming ointment. Expands blood vessels due to heating, increases oxygen supply to tissues, improves trophism.
- "Indomethacin", "Ortofen", "Naklofen", "Ibuprofen" - ointments with anti-inflammatory, decongestant and analgesic effect.
- Menovazin is an anesthetic ointment. The effect comes from local cooling of the skin.
- "Chondroxil" - considered a chondroprotector, improves spinal mobility.
With local treatment, it is preferable to use ointments, because their penetrating ability is higher. With sharp pains, warming ointments are usually not prescribed, because they enhance stimulation and can lead to ischemic crisis, heart attack due to increased outflow of blood from the heart vessels.
Massage for neuralgia
What is its use? It improves blood flow in the capillaries and small arteries, enhances metabolic processes, accelerates the elimination of toxins and substances that contribute to the development of inflammation, anesthetizes and improves the conduction of nerve impulses.
Acupuncture with intercostal neuralgia
Acupuncture (acupuncture or IRT) - refers to TCM (traditional Chinese medicine). With this treatment method, special very thin needles are introduced into the active points of the desired meridians.
The effects of acupuncture: relieve inflammation, pain, have a sedative effect, increase immunity by enhancing metabolism and improving blood flow.
Manual therapy for intercostal neuralgia
Since neuralgia in most cases is caused by a pinched nerve when it leaves the spinal canal, the actions of the chiropractor eliminate this compression. At the same time, the posture is straightened and the work of the entire vertebral column improves.
Osteopathy with neuralgia
Osteopathy is a type of etiotropic treatment. It is similar to massage and manual therapy, but the doctor’s movements are lighter, neater and more pressing. An osteopath should be an excellent manual. The art of osteopathy has been studied for many years.
The doctor here uses the sensitivity of his hands, not strength. The goal is to eliminate nerve infringement. Manual therapy is the combination of the doctor’s hands on the musculoskeletal system. Osteopathy acts on various organs, bringing the body to the "right wave". It aims to eliminate the cause of the disease as a whole. Totally painless.
Physiotherapy exercises for intercostal neuralgia
It is shown only when the acute manifestations of the disease subside. It is carried out and selected under the supervision of a medical instructor. With neuralgia of the intercostal nerves, swimming is recognized as very useful.
How to treat severe neuralgia?
In severe neuralgia, treatment is only inpatient. Here it is possible to apply more powerful tools:
- blockage of the intercostal nerves - chipping of the nerve region with solutions of anesthetics (novocaine, lidocaine, etc.);
- tranquilizers - to improve and relax anxiety, nervous tension and indirectly, improve mood;
- sedatives of various groups.
Indications for surgical treatment of intercostal neuralgia
Surgery is used for hernias of the intervertebral discs, pronounced changes in the vertebral column with osteochondrosis. Also, surgery is necessary for tumors of the spinal cord and surrounding tissues.
How to treat intercostal neuralgia at home?
Home treatment should be under the supervision of a physician. By its permission, certain ointments can be used, which will be most effective - anti-inflammatory and warming.
In many families, it is possible to use home physiotherapeutic devices and methods:
- "Darsonval" - a device for magnetotherapy;
- You can call a masseur or manual for procedures;
- use hand massagers.
With the permission of the doctor, you can prepare homemade ointments according to folk recipes.
Prediction and prevention of intercostal neuralgia
Neuralgia is perfectly treated. Prevention will be timely treatment of vertebral diseases, prevention of scoliosis and kyphosis, therapy of chest injuries. It is necessary to exclude hypothermia. High immunity, which provides a healthy lifestyle and hardening, will protect against infections.