Bernhardt-Roth disease is a fairly common pathology that affects equally both men and women. Mostly older and middle-aged people suffer. In young patients, the disease occurs in most cases with sedentary work, a sedentary lifestyle, and increased body weight. The lack of regular physical exertion on the muscles of the lower extremities causes the development of tunnel syndrome, in which the lesion covers the femoral median nerve.
The causes of the disease
Before considering the causes of Bernhardt-Roth meralgia, it should be noted that the disease is a very painful tunnel syndrome. In the area of the ilium is the median branch of the femoral nerve. When the position of the inguinal ligament changes, its compression occurs. This nerve fiber is a continuation of the radicular nerve, which departs from the lumbar region of the spinal cord. The median femoral nerve is responsible for the innervation of the lateral zones of the lower limb. Pain is localized on the external femoral surface. Pain rarely passes to the shin, exclusively in the case of a compression disorder of the tibial nerve.
Potential causes
If we talk about the potential causes of the development of paresthetic meralgia, three main zones of the occurrence of tunnel syndrome should be noted:
- the site of entry under the large fascia of the femoral muscles;
- transition zone under the inguinal ligaments;
- the site of exit from under the inguinal ligament.
All these localization zones undergo deformation when the body is tilted forward, walking fast, and carrying heavy loads. However, compression of the femoral lateral nerve does not always occur. In order for this nerve to be pinched, the presence of specific risk factors is necessary, which include:
- the period of pregnancy and the refusal to use in the process of bearing a child a special prenatal bandage that supports the anterior zone of the abdominal wall;
- high index of overweight;
- muscle weakness in the groin and lower abdomen;
- hernial protrusion in the groin and abdominal line;
- heavy physical exertion;
- visceral pressure on the pelvic area (with ascites and abnormalities of the abdominal organs);
- violations of posture and various kinds of curvature of the spinal table of a pronounced degree;
- wearing high-heeled shoes;
- Incorrect setting of the foot.
These are the most common causes of Bernhardt-Roth disease, although in real clinical practice there are much more. But it is necessary to exclude at least the above.
Risk factors
In addition to these risk factors, there are aspects that are more likely to be complicated by tunnel syndrome. Among them, all pathologies of the spine should be noted, which are ways to provoke compensatory disturbance of posture. This is osteochondrosis with radiculitis and radicular syndrome, spondylarthrosis, herniation of the intervertebral disc, protrusion, instability of the vertebrae, sprain, etc.
The mechanism of development of pathology
The pathogenesis of this disease is based on trophic disorders of the nerve fiber. The femoral lateral nerve, like all other tissues in the human body, must be fully supplied with blood for its functionality. If compression (compression) of the nerve occurs, then the process of blood flow through the capillary networks is violated. Due to this pathological phenomenon, the mechanism of the occurrence of Bernhardt-Roth disease begins to be realized:
- in axon cells, free radicals and decay products begin to gradually accumulate;
- these structures do not receive enough nutrition;
- toxic effect against the background of the lack of necessary blood supply starts the processes of necrosis (necrosis).
Dystrophy and further atrophy of the lateral femoral nerve give specific clinical symptoms. If, at the initial signs of the pathological process, one does not pay attention to it and does not start timely therapy, then literally in a six-month period absolute atrophy of the nerve may develop. To restore the sensitivity of the skin in the future becomes almost impossible. A change in the innervation of subcutaneous fat in the thigh is fraught with the fact that sclerotic and lipodystrophic changes begin to develop. Trophic lesions occur, rough scars develop.
Symptomatology
The clinical symptoms of Bernhardt-Roth disease begin to appear already in the early stages of the development of the pathological process. At first, the patient experiences a slight decrease in sensitivity in the area of the outer and anterior part of the thigh, with goosebumps in the areas from the hip joint to the knees. These signs, as a rule, arise after strong physical exertion. Further, as scar tissue forms in areas of compensatory inflammatory reactions, the clinical picture takes on a more detailed form. In the stage of full development, the symptoms of Bernhardt-Roth disease are as follows:
- tingling and burning in the thigh area from the front and outer surfaces;
- decreased sensitivity of the skin;
- complete numbness with the further occurrence of unpleasant sensations of restoration of blood circulation (a feeling of electric shock or exposure to boiling water may occur);
- tearing, pulling pain under the skin.
Signs in the later stages
In addition, in the later stages of the disease, typical signs of a violation of the blood supply (trophic) of the soft tissues of the thigh appear:
- the skin is peeling, dry to the touch;
- integuments become pronounced pallor;
- the veins of this zone are dilated and can be seen through the skin;
- with any minor damage or scratches, long healing trophic ulcers develop.
With the pathology of Bernhardt-Roth, the symptoms are unlikely to go unnoticed.
A long-running process of change in innervation leads to the development of lipodystrophy. This disease is known to many women as cellulite. In fact, dystrophic disorders in adipose (lipid) tissue begin to occur with a negative change in the processes of innervation of this part of the thigh. Not without reason, in most female patients, cellulite begins to actively form in the period after the first pregnancy and childbirth.
What other symptoms may be? Bernstardt-Roth paresthetic meralgia is an insidious disease.
Compression of the femoral lateral nerve can also lead to impaired performance of the arterial and venous bloodstream. This contributes to the formation of varicose veins in the lower extremities. Some patients have intermittent claudication: it becomes almost impossible to go up to the third floor and higher without stops for rest. In addition, with intermittent claudication, patients observe the impossibility of long walks, even at a quiet pace of walking.
Distinctive feature
The main distinguishing diagnostic feature of this disease is the following: if, while lying on one side, one leg is bent at the knee and hip joints and the thigh is lifted to the stomach, then crawling creeps, pain and numbness immediately disappear. How to detect Bernhardt-Roth syndrome?
Diagnostics
As diagnostic procedures, radiography of the hip and knee joints is prescribed. Further, angiography and ultrasound are performed. Identify areas of compression of the femoral nerve is possible only with a CT scan. To diagnose paresthetic meningy of Bernhardt-Roth, you need to contact a qualified neurologist. In addition, the patient may be assigned a diagnostic procedure such as electroneuromyography. This method is used to evaluate muscle activity in response to a nerve impulse.
Additional diagnostics are prescribed only in cases where the symptoms of the disease do not disappear after eliminating all the negative factors that are likely to provoke its development.
Bernhardt-Roth Disease Treatment
For the treatment of paresthetic meralgia in official medicine, a number of pharmacological agents are used that are capable of restoring damaged sections of the nerve fiber for a period of time. These medications include antispasmodics, drugs that dilate small blood vessels, B vitamins, muscle relaxants, etc. Specific drugs are also prescribed that stimulate the functionality of the nerve fiber (for example, Proserinum), but such drugs are only used in severe and advanced cases of the disease.
What else is used in the treatment of Bernhardt-Roth syndrome?
Corticosteroids
In the later stages of the disease, corticosteroids (anti-inflammatory hormonal drugs) are used to relieve symptoms. They stop soreness and paresthesia for a period of up to seven days. In advanced situations, when diagnosing total compression of the femoral nerves, surgical intervention is performed, during which the necessary innervation of the femoral tissues is provided.
To prevent the use of such radical therapeutic methods, it is recommended not to waste time and when the first unpleasant symptoms appear, start complex treatment. For this, manual therapy techniques are prescribed that allow the treatment of Bernhardt-Roth syndrome without the use of medications and a surgical scalpel.
Ideally, treatment of paresthetic meralgia should occur as follows:
- during the initial examination and history taking, the neurologist identifies the potential cause of the tunnel syndrome;
- the patient is given all the necessary recommendations for stabilizing body weight, eliminating ascites, removing tumors, and reducing excessive loads on the inguinal ligament;
- a special dietary nutrition scheme is being developed;
- recommendations are given on the organization of a sleeping and workplace;
- a course of treatment is prescribed.
Manual therapy
Of the techniques of manual therapy, the most effective results show the following:
- osteopathy and massage can restore the processes of microcirculation of lymphatic fluid and blood, start the activation of nutrition of soft femoral tissues;
- reflexology helps to restore damaged tissues, enhances their innervation;
- Kinesiotherapy and physiotherapy exercises improve the condition of ligaments and muscles.
In addition to the above therapeutic measures, laser exposure and other types of physiotherapy can also be used. Each therapeutic course must be developed individually, taking into account the physiological characteristics and capabilities of each patient.
Reviews of the treatment of Bernhardt-Roth disease are presented below.
Doctors reviews
Neuropathologists are involved in the treatment of paresthetic meralgia. In the reviews, they note that treating this disease in advanced stages is quite difficult, and sometimes impossible. The emphasis is on reducing pain and eliminating the main symptoms of the pathological process. If, according to experts, the patient seeks medical help in the early stages of the onset of the disease, then the treatment can be quite successful. The main area here is manual therapy and the normalization of blood circulation in the thigh.
Doctors also note that in most cases people come to the clinic only when the disease becomes irreversible, many simply ignore pain and other manifestations of paresthetic meralgia, which greatly complicates the treatment process.