The 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 groove with an artery and a vein, deploying under them.
The upper 6 intercostal nerves reach the sternum, here they are called the anterior cutaneous 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 anterior wall of the abdomen, penetrate between the internal oblique and transverse muscles, pierce the rectus abdominis muscle and end in the skin of the anterior abdominal wall. They innervate the same muscles.
The anterior cutaneous branches of the upper 6 nerves innervate the following muscles: intercostal external and internal, hypochondrium and levator ribs muscles, transverse chest and abdomen muscles, named abdominal muscles, square muscle of the lower back and pyramidal muscle of the abdomen.
In the space up to the costal angle, the intercostal nerves are covered by the parietal pleura and intrathoracic fascia. Thus, the thoracic nerves innervate all the muscles and skin of the chest and abdomen in front andfrom the side, the parietal pleura and peritoneum, and the mammary glands.
What is included in the nerve
All intercostal nerves are mixed because they contain motor, sensory and sympathetic fibers.
- Motor - innervate the intercostal muscles, the diaphragm, provide respiratory movements. This allows a person not to suffocate from suffocation. Together with the diaphragm, a person can voluntarily take a deep breath.
- Sensitive - provide and carry skin, pain, tactile, temperature and other sensitivity to the spinal cord. They form a pain (primary) reaction in neuralgia.
- Vegetative - control the work of blood vessels, sweat glands, etc. They are responsible for the increase in skin temperature, vasodilation, the appearance of goosebumps, sweating from the skin of the chest; all of these reactions occur at an unconscious level.
The Path of Pain
In case of neuralgia, the primary analyzer of pain is the thoracic segments of the spinal cord, their gelatinous substance. It is located in the form of a group of neurons in the gray matter of the posterior horns of the spinal cord. These groups are interconnected along the entire vertical of the spine. Further, the sensory bundles as part of the spinal-thalamic tract cross, pass to the thalamus and then to the cerebral cortex, where the pain is emotionally colored. At the same time, vegetative manifestations in the form of skin hyperemia, burning sensation are also characteristic.
And the proximity of the conductive beams feeling tactiletouch and temperature can give pain of a different nature: excruciating, burning.
Intercostal neuralgia
Neuralgia of the intercostal nerves 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.
Etiology can be any - hypothermia, intoxication, infringement, infection, etc. The age of the patient can be any, for children the diagnosis is uncharacteristic.
Neuralgia of the intercostal nerves or thoracalgia is not life-threatening, but it often occurs against the background of more serious pathologies and is complicated. Pain in neuralgia on a scale is in 3rd place after renal colic.
Reasons
The most common cause of neuralgia is osteochondrosis of the thoracic spine with radicular syndrome or intervertebral hernia and protrusion. Then they say that pinched the intercostal nerve.
Neuralgia can be provoked by herpes zoster (the herpes virus loves to sit on the 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, Bechterew's disease.
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 be provoked by careless sudden movement, in which muscle spasm, hypothermia, age-related changes occur. Contributing factors - alcoholism, chronic fatigue, hypovitaminosis gr. B, reduced immunity.
Symptoms of intercostal neuralgia
Symptoms and treatment of intercostal nerves have the closest relationship. The main symptom is a sharp sudden unilateral penetrating 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 to an electric shock and call it a backache.
The pain may not be as strong at first, but it quickly builds up and becomes unbearable. It can give to the back, shoulder blade, heart, epigastrium. Associated symptoms: pallor or redness of the skin, local sweating. This is due to irritation of the sympathetic fibers in the composition of the nerve.
Symptoms of a pinched intercostal nerve give characteristic repetitive attacks that last from a few seconds to 2-3 minutes. The patient at the same time freezes on inspiration, trying not to move, because this increases the pain. Any movement, even normal breathing, coughing, laughing, talking - everything leads to increased pain.
In the period between pain attacks, symptoms of the intercostal nerve appear, such as paresthesia along the nerves - a feeling of tickling, crawling.
Whenherpetic infection, intercostal neuralgia is supplemented first by itching, then by skin rashes on the intercostal space that occur on the 2-4th day of neuralgia. At first, these are pink spots, they turn into bubbles, burst and then dry out with the formation of crusts.
Complement thoracalgia with their pain. Temporary hyperpigmentation remains in place of the crusts.
Treatment of intercostal neuralgia
Treatment of intercostal nerves should be carried out comprehensively. It is etiotropic, i.e. is aimed at eliminating the cause of the disease in the first place.
Further, pain is eliminated and the affected nerve is restored. To do this, they use anti-inflammatory, analgesic treatment, antispasmodics, sedatives, neurotropes, muscle relaxants, as well as alternative medicine: physiotherapy, massage, osteopathy, IRT, folk methods.
Folk methods can help at home only with mild to moderate neuralgia. In severe cases, it is necessary to carry out blockades permanently.
In anti-inflammatory therapy, NSAIDs dominate first, in severe cases - GCS.
Anti-inflammatory non-steroids - Piroxicam, Ibuprofen, Diclofenac, Nimesulide. Their application is general and local.
An auxiliary tool in the treatment of pinched intercostal nerve to relieve pain is the appointment of sedatives that will help reduce the increased excitability of the nervous system. Topical treatment - creams, ointments, patches and gels with anti-inflammatory,relaxing, analgesic and warming effect.
It is good to apply ointments containing poisons of bees and snakes. They have all of these features. These include Viprosal, Apizartron, etc. In addition to snake venom, Viprosal also contains camphor and fir, which gives an analgesic effect.
Muscle relaxants are used in the presence of muscular-tonic syndrome: "Tizanidine", "Tolperisone hydrochloride".
In the treatment of pinching of the intercostal nerve at the exit of the intervertebral foramen due to osteochondrosis, accompanied by displacement of the vertebrae, manual therapy, spinal traction helps. This will take the compression off. 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 gr. B - B1, B6, pantothenic acid (B5), "Pentovit".
Anspasmodics are prescribed for spasms, i.e. increased muscle tone surrounding nerve fibers with their damage. As long as there is muscle spasm, the pain does not go away. Assign "Galidor", "Besalol", "Papazol", "Drotaverin" and others. Can be used in tablet or ampoule form.
From analgesics shown "Analgin", "Baralgin", "Spazdolzin", "Tempalgin", "Ketorol" and others.
Physiotherapeutic methods - ultraphonophoresis, laser therapy, magnetotherapy, electrophoresis, UHF, "Darsonval". All of them activate defense mechanisms and relieve inflammation,relieve pain.
Topical treatment
Ointments and gels are used for treatment:
- "Fastum-gel" - relieves puffiness, has an analgesic effect.
- "Capsicam" - effective as a warming agent. The ointment enhances blood flow and helps restore tissue trophism.
- "Finalgon" is also a warming ointment. Expands blood vessels due to heating, increases the supply of oxygen to tissues, improves trophism.
- "Indomethacin", "Ortofen", "Naklofen", "Ibuprofen" - ointments with anti-inflammatory, decongestant and analgesic effect.
- "Menovazin" - anesthetic ointment. The effect comes from local cooling of the skin.
- "Chondroxil" - is considered a chondroprotector, improves the mobility of the spine.
For topical treatment, it is preferable to use ointments, because they have a higher penetrating power. With sharp pains, warming ointments are usually not prescribed, because they increase stimulation and can lead to an ischemic crisis, a heart attack due to an increased outflow of blood from the heart vessels.
Massage for neuralgia
What is its use? It improves blood flow in capillaries and small arteries, enhances metabolic processes, accelerates the elimination of toxins and substances that promote inflammation, relieves pain and improves the conduction of nerve impulses.
Acupuncture for intercostal neuralgia
Acupuncture (acupunctureor TCI) - refers to TCM (traditional Chinese medicine). With this method of treatment, special very thin needles are inserted into the active points of the desired meridians.
Effects of acupuncture: relieve inflammation, pain, have a sedative effect, increase immunity by increasing metabolism and improving blood flow.
Manual therapy for intercostal neuralgia
Since neuralgia in most cases is caused by a pinched nerve when it exits the spinal canal, the actions of a chiropractor eliminate this compression. At the same time, the posture is straightened and the work of the entire vertebral column improves.
Osteopathy for neuralgia
Osteopathy refers to a variety of etiotropic treatment. It is similar to massage and manual therapy, but the doctor's movements are lighter, more accurate and pressing. The osteopath must be an excellent manipulator. 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 the pinched nerve. Manual therapy is a combination of the impact of the doctor's hands on the musculoskeletal system. Osteopathy, on the other hand, affects various organs, bringing the body to the “right wave”. It aims to eliminate the cause of the disease as a whole. Completely painless.
Therapeutic exercise for intercostal neuralgia
Shown only when the acute manifestations of the disease subside. Conducted and selected under the supervision of a medical instructor. With neuralgia of the intercostal nerves, it is recognized as very usefulswimming.
How to treat severe neuralgia?
In case of severe neuralgia, treatment is only inpatient. Here it is possible to apply stronger means:
- blockade of intercostal nerves - chipping of the nerve area with anesthetic solutions (novocaine, lidocaine, etc.);
- tranquilizers - to improve and relax anxiety, nervous tension and indirectly, improve mood;
- sedative drugs of various groups.
Indications for surgical treatment of intercostal neuralgia
Surgery is used for herniated intervertebral discs, pronounced changes in the vertebral column in 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 the attending physician. By his permission, certain ointments can be applied that will be most effective - anti-inflammatory and warming.
Many families have the opportunity to use home physiotherapy devices and methods:
- "Darsonval" - device for magnetotherapy;
- you can call a massage therapist or a chiropractor for procedures;
- use hand massagers.
With the permission of a doctor, you can prepare homemade ointments according to folk recipes.
Prognosis and prevention of intercostal neuralgia
Neuralgia is perfectly treated. Prevention is early treatmentvertebral diseases, prevention of scoliosis and kyphosis, therapy of chest injuries. It is necessary to exclude hypothermia. Protection against infections will be high immunity, which ensures a he althy lifestyle and hardening.
