Peripheral nerves refer to all nerves except the brain and spinal cord, includingganglion、Neural trunk、PlexusAnd nerve terminal devices;Peripheral nerves can be divided into those connected to the brain according to the different parts connected to the centerCerebral nerveAnd connected to the spinal cordspinal nerve；There are 12 pairs of brain nerves and 31 pairs of spinal nerves.Peripheral nerves can also be divided intoSomatic nerveandVisceral nerve；Somatic nerves are distributed on the body surface, bone, joint andskeletal muscle, visceral nerves are distributed in viscera, cardiovascularsmooth muscleAnd glands.
In addition, peripheral nerves can also transmitNerve impulseThe directions of are divided intoAfferent nerveandEfferent nerve。The afferent nerve transmits nerve impulses from the periphery to the center to generate sensation, also known assensory nerve；The efferent nerve transmits nerve impulses from the center to the periphery to generate movement, also known asmotor nerve。There are afferent nerves (sensory nerves) and efferent nerves (motor nerves) in the brain and spinal nerves, somatic nerves and visceral nerves.If the visceral nerves can be subdivided intoVisceral sensationNerves and visceral motor nerves.Visceral motor nerve is also called autonomic nerve orAutonomic nerveThe visceral motor nerve can be divided intosympathetic nerveandparasympathetic。
Foreign name
peripheral nerve
Alias
peripheral nerve
Visiting department
Neurology
Multiple population
Excessive exercise and bad habits
Common location
whole body
Common causes
Some parts of peripheral nerve are caused by inflammation, poisoning, ischemia, nutritional deficiency, metabolic disorder, trauma, etc
Nerve disease refers to ischemia of some parts of peripheral nerve due to inflammatory poisoningNutritional deficiencyMetabolic disorderA group of diseases and injuries caused by trauma, which are usually called inflammatory diseases and injuriesneuritis。
It often occurs after peripheral nerve injuryEdemaContracture, etccomplicationPrecautions shall be taken.
treatment
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For theseLesionProcessing of, withmedication、surgical treatmentAnd rehabilitation treatment.General drug treatment is mainly used for lesions, and early surgical treatment is used forConservative treatmentIneffective injuries that are suitable for or need surgical treatment, while rehabilitation treatment is not only effective inperipheral neuropathy Early andconvalescenceOr before and after surgeryShould beconduct.The purpose of rehabilitation treatment is to eliminate or relieve pain, prevent and relieve musclestendoncontractureJoint stiffness, preventMuscular atrophy, EnhancedMuscle strengthRecovery movement andSensory functionAnd finally restore the patient's ability to live and work.If the function of the affected limb can not be fully recovered or can not be recovered at all, auxiliary devices should be designed and prepared for compensatory function training according to the specific situation.
1、 Prevention and treatment of complications
peripheral nerve
1. Edema: the affected limb can be raised,Elastic bandageCompression, affected limb massage andPassive motion, hot compress, warm water bath, wax bathinfrared, electric light bath andultrashort wave, shortwave or microwave to improve local blood circulation and promoteTissue edemaOr absorption of accumulated fluid.
2. Contracture: prevention is extremely important.In addition to the method of preventing edema, the affected limbs and joints should also be kept in the functional positionTriangular towel, plywoodPlaster bracketOr othersBraceIt should be fixed or supported, and attention should be paid to avoiding the compression of the sensory loss part, so as not to cause new damage.
threesecondaryTrauma: In case of traumaWoundOftenNutritional disordersIt is difficult to treat.Always keep the parts that lose feeling clean and protect them.Ultrashort wave, microwaveultraviolet rays, laser and other methods to promote wound healing.
Early application for patients after conservative treatment and nerve repairphysiotherapyBeneficial to damaged nervesRegeneration processAt the same time, nerve regeneration promoting drugs can be applied.
Ineffective to conservative treatment but suitable or in need of surgical treatmentperipheral nerve injury Patients should receive surgical treatment in time.
Peripheral nerve damage is easily confused with single nerve damage and multiple nerve damage diseases.
complication
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It is prone to edema, contracture and secondary trauma.
Peripheral nervous system
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Peripheral nervous systemInclude Divisioncentral nervous systemAll nerves except the brain and spinal cord.Cranial nerveConnect the head and face directly to the brain, and also connect the eyes and nose to the brain.The remaining peripheral nerves connect the spinal cord to the rest of the body.
The connection between brain and trunk is completed by 31 pairs of spinal nerves.These nerves emanate from the spinal cord, each pairspinal nerveIt includes: a nerve located in front of the spinal cord, which transmits information from the brain to the muscles;The other nerve is behind the spinal cord, and it will feelinformation transferTo the brain.The spinal nerves pass through each other in the neck, shoulder and pelvisPlexusThey connect, then branch, and dominate further areas of the body.
PeripheraldysfunctionCould be due to damage to the nerve fiber itselfnerve cellSoma，Schwann cellOr the myelin sheath.When the myelin sheath is damaged andMyelinLost（Demyelination changes）Nerves can not transmit impulses normally.However, myelin sheath can regenerate rapidly to fully recover nerve function. Neural cells are different from myelin sheath. When it is damaged, self repair and regeneration are slow. Sometimes regeneration may lead to abnormal neural connections. For example, if a nerve is wrongly connected to a muscle, this will lead to reflex or clumsy movement.Ifsensory nerveWrong growth can cause a person to receive touch orsense of pain。
Muscle brain pathway
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The connection between nerves and information transmission is throughSynapseCompleted.onceMuscle movementThere are two complexNeural pathwayParticipation: sensory and motor pathways.It includes the following 12 basic steps:
2. The signal goes along the sensory nerve to the spinal cord.
3. Sensory nerve and spinal cordneuronThey are connected by synapses.
4. The sensory nerve crosses to the opposite side of the spinal cord.
5. This signal is transmitted upward in the spinal cord.
6. OnthalamusThe signals carried by the spinal cord are transmitted toSensory centerThe nerve fibers of.
7. The sensory center receives signals and can triggerMotor cortexThe center generates movement signals.
8. The nerve fibers carrying motor signals cross to the opposite side in the brain stem.
9. The signal goes down to the spinal cord.
10. Synaptic connection in the spinal cordsignal transmission To the motor nerve.
11. The signal is transmitted along the motor nerve.
12. Signal arrivalMotor endplateWhere it stimulates muscle movement.
Peripheral nerve related diseases
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Muscle irritant disease
. Symptoms
Amyotrophic lateral sclerosisIt is a progressive disease, and its initial manifestation is weakness of both hands, while it does not often occur in both feet.Muscle weakness can progress faster, more obvious on the same side of the body than on the other side, and will generally develop to the upper arms and legs.Spasm is also common and can occur inMyastheniaAppears before, but feels intact.In addition to progressive muscle weakness, rigidity also occurs, muscles become tense, followed by spasms, and tremors can occur.Weak speaking and swallowing muscles will lead to difficulty in speaking（Dysarthria）AndDysphagia。Finally, disease can makeDiaphragmWeak, leading to respiratory disorders;Some people needrespiratorHelps breathe.
Amyotrophic lateral sclerosisAlwaysSexual developmentAlthough the pace of progress can vary.About 50% of people suffering from this disease will die within 3 years of the first symptoms.10% of patients can live for 10 years or moreActive30 years.
stayProgressive bulbar paralysisThe nerves that control the masticatory, swallowing and speaking muscles are affected, so that these functions become difficult.Strange things can happen to people with progressive bulbar paralysisEmotional response, often without reason, the happy expression quickly changes into the sad expression;Often have abnormal emotions to vent.DysphagiaIt often causes food or saliva to be inhaled into the lungs and usually dies within 1-3 years after the onset of the disease. The common cause of death ispneumonia。
Primary lateral sclerosisAnd progressivenessPseudobulbar paralysisThey are rare. They change slowlyAmyotrophic lateral sclerosis。Primary lateral sclerosis first affects both upper arms and thighs, while progressive pseudobulbar palsy first affects facial, buccal and pharyngeal muscles.In these two diseasesMyotoniaAccompanied by muscle weakness.Fascicular tremorAnd shrinkage does not occur, labor force is gradually lost, and the development time can exceed several years.
. Diagnosis
When an adult appearsProgressive myastheniaAnd noneHypoesthesiaDoctors should suspect this kind of disease.Physical examination andSupplementary ExaminationIt can help eliminate other causes of muscle weakness.determinationelectromyogramCan judge whether it is a nerve or a muscle problem, butlaboratory examination It is not possible to determine which neurological disease is causing these problems.Doctors can make a diagnosis by observing and analyzing the involvement of body muscles, when the symptoms start, the first symptoms and how the symptoms evolve.
. Treatment
There is no special treatment for these diseases,physicotherapeuticsHelp patients maintain muscle strength and prevent muscle stiffness (contracture)DysphagiaPeople must give greater care to help them eat and avoid suffocation;Some people have to go throughGastric canalWhen eating, the stomach tube is inserted into the stomach through the abdominal wall.Leorexol(Beckrofen) can reduce muscle rigidity, sometimes it can alleviateMuscle spasm。Other drugs can reduce cramps and saliva production.
Researchers are experimenting with a substance that can promote nerve growth（Neurotrophic factor）。clinical research Its efficacy has not been confirmed.
Neuromuscular transmission disorder
The nerve connects with the muscle at the neuromuscular junction.When the nerve isNeuromuscular junctionWhen the muscle is stimulated at the place, the muscle will contract, and neuromuscular transmission obstacles include:myasthenia gravisMyasthenia syndrome (Yi Lan syndrome), botulism.
In myasthenia gravis,immune systemMany antibodies are produced that act on receptors located on the muscular side of the neuromuscular junction.These special damaged receptors are those that receiveacetylcholineconductionNeural signalReceptors for.Acetylcholine is a chemical that transmits nerve impulsesmaterial（Neurotransmitter）。
Other neuromuscular transmission disorders
MyastheniaThe syndrome is similar to myasthenia gravis, and it can also cause myastheniaAutoimmune diseaseBut myasthenia syndrome is caused byacetylcholineInsufficient release, not due toacetylcholine receptorAbnormality of antibody.Myasthenia syndrome can occur singly, but usually as acancer, especiallylung cancerIt is accompanied by symptoms.
Many drugs, such as some kind of insecticide（Organophosphorus pesticide）And onChemical warfareUsed inNerve gasCan affectNeuromuscular junction。Some of these poisons prevent the natural decomposition of acetylcholine released after nerve impulses are transmitted to muscles.High doses of some antibiotics can cause muscle weakness in the same way.
Plexus disease
The nerves that emanate from the plexus are like electricityJunction boxSeparate many wires to different parts of the house.Damage to the nerves in the plexus will causeInnervationOfLimb dysfunction。The main nerve plexus in the body arebrachial plexusIt is located in the neck and divides many nerves to the arm.Another major plexus is the lumbarSacral plexus, which is located below the back (waist) and divides nerves to the pelvic cavity and lower limbs.
. Etiology
When the body produces antibodies that attack its own tissues (aimmune reaction）The nerve plexus is often damaged.The autoimmune reaction may cause acute brachial plexus neuritis, when the brachial plexus suddenly appears abnormal function.When the body is damaged or has cancer, the nerve plexus is damaged more often.An accident that pulls the arm at the shoulder joint or bends the arm excessively may damage the brachial plexus. Similarly, falling (falling) external forces can damage the lumbosacral plexus.stayApex of lungregion growing OftumourIt can invade and destroy the brachial plexus, while the small intestine, bladder orprostateThe lumbosacral plexus can be invaded by 20% of the tumors.
. Symptoms and diagnosis
Abnormality of brachial plexus function will cause pain and weakness of the arm, and weakness can only affect one part of the arm, such as the forearmthe bicepsOr the whole arm.When the cause is an autoimmune disease, the arm can lose muscle strength in a day to a week, and muscle strength recovery is slow, more than a few months.The injury recovery was also slow, more than a few months;Some serious injuries can causePermanentMyasthenia。The dysfunction of the lumbosacral plexus causes pain in the lower back and thigh, and causes weakness in part or the whole lower limbs.The weakness can be limited to the feet orGastrocnemius muscleTo move or cause to moveParalysis of lower limbs。Recovery depends on the cause.Because the nerve plexus damaged by autoimmune disease can slowly recover after several months.
From sensory and motorMiscibilityThe doctor can judge the damageNerve plexus damageAnd know which nerve plexus is involved from the location.The study of EMG and nerve conduction can help to locate.CTorMRIScanning can help determine whether it is cancer or somethingNeobiosisCaused byPlexus disease。
. Treatment
The treatment depends on the cause of nerve plexus disease.The cancer near the nerve plexus can pass throughradiotherapyorchemotherapyhandle.Occasionally, tumors or thrombi endangering the nerve plexus must pass throughsurgical operationeliminate.Sometimes, doctors givecorticosteroidTreatment of acute brachial plexus neuritis and other suspectedAutoimmunityHowever, these drugs have not been proved to be effective.When injury causes plexus disease,Nerve repairIt takes a long time.
Thoracic outlet syndrome
Thoracic outlet syndromeIt is a disease that has not yet been accurately defined. They are combined because all of these diseases cause pain and unusual feelings in the hands, neck, shoulders or arms（Paresthesia）。
. Etiology
Thoracic outlet syndromeWomen are more common than men, usually affecting those aged between 35 and 55.The different causes of these diseases are often uncertain, but they may occur at the thoracic outlet, and there areesophagus、Large blood vessel, trachea and some structures between neck and chest pass through.This passage is very crowded. When the blood vessels or nerves to the arm are compressed between the ribs and muscles, various symptoms may occur.
. Symptoms and diagnosis
Hands, arms and shoulders may be swollen or purple due to lack of oxygen（Cyanosis）。No test can specifically identify thoracic outlet syndrome, but doctors can rely on medical history, physical examination and information obtained from some tests to judge.
There are two tests that can help doctors judge whether the thoracic outlet path is very narrow and affects thePoor blood flow。Adelson test: when the patient's head leans backward and turns to the opposite side, maintain a deep inspiratory state, and determine whether the wrist pulse weakens or disappears.Allen test: Raise the arm, and the pulse may be cut off when the head turns to the uninvolved side.Doctors canStethoscopeAbnormal vascular sounds are heard, which indicates abnormal blood flow in the affected artery.Angiography(Use a specialStainInject into the blood vessel and take backX-ray film）Abnormal blood flow of the arm can be displayed.But not all of these findings can confirmThoracic outlet syndromeThe negative results of these tests cannot completely exclude the diagnosis.
. Treatment
Most are accompanied byThoracic outlet syndromePeople with symptoms followphysicotherapeuticsAnd training.Surgery can be used for a few people with definite abnormalities, such as a small rib in the neck（Cervical rib）Compress arteries.However, most doctors try to avoid surgery because it is difficult to make an accurate diagnosis, and often symptoms still exist after surgery.
peripheral neuropathy
peripheral neuropathy (Peripheral nerve damage) is the abnormal function of peripheral nerves.
Peripheral neuropathy causes sensory, muscle activity, or visceral dysfunction.Symptoms can occur alone or in combination.For example, after nerve damage, the muscles it innervates become weak or atrophy.Pain, numbnessacupunctureFeeling, swelling and redness.No matter damage to a nerve（Mononeuropathy）, two or more nerves（mononeuropathy mul-tiplex ）, or damage many nerves in the whole body at the same time（Multiple neuropathy）All of the above performances can occur.
Guillain Barr syndrome (acute ascendingPolyneuritis）It's acuteMultiple neuropathyIt rapidly weakens muscles, sometimes leading to paralysis.
The possible cause is the autoimmune reaction - physicalimmune systemAttack the myelin sheath.In about 80% of patients, symptoms begin with mild infection, surgery, orImmunizationThe next 5 days to 3 weeks.
