The etiology of the disease is different. Often, intercostal dystonia is masked by symptoms of cardiac, gastrointestinal, pulmonary, renal diseases, which makes it difficult to carry out timely diagnosis and treatment, leading to complications. Due to the variety of symptoms, the treatment is carried out by a therapist, vertebrologist, neuropathologist, cardiologist, gastroenterologist, pulmonologist, oncologist.
Causes of pathology
Intercostal neuralgia occurs due to the following reasons:
- infectious processes in the body;
- traumatic nerve damage in spinal and chest injuries;
- compression of the nerves by the musculoskeletal system of the chest and back, caused by excessive physical exertion, prolonged exposure to uncomfortable posture, chronic vertebrogenic pain syndrome, malignant processes in the lungs and pleura, aortic aneurysm;
- irritation of the intercostal nerves due to diseases of the spine – osteochondrosis, spondylosis, intervertebral hernia, scoliosis;
- dysfunction of the costal-vertebral joints due to their deformation (arthrosis, injury);
- curvature of the spine, chest deformity;
- pathologies of the nervous system – polyradiculoneuritis, multiple sclerosis;
- intoxication with some medicines, alcohol, heavy metal salts, ionizing radiation;
- somatic and endocrine diseases, in particular, diseases of the gastrointestinal tract (GIT) and diabetes;
- weakened immunity;
- hypovitaminosis group B, anemia;
- the use of tight underwear in women;
- intensive growth of the skeleton in children;
- age changes in the elderly.
The pathogenetic factor distinguishes 2 main forms of the disease:
- radicular – due to irritation of the roots of the spinal cord, characterized by severe chest pain, similar to the heart;
- reflex – caused by muscle tension in the intercostal spaces.
According to the symmetry of the lesion, single and bilateral dystonia is isolated. Bilateral intercostal neuralgia is often found on the background of herpes infection, radiation intoxication, immunodeficiency.
Depending on the location of the pain occurs:
- In the upper part of the chest, around the clavicles – irradiation due to irritation or compression of the nerve roots in the lower spine. Algia is felt during the bends of the body, when turning the head, gives to the neck, arm, shoulder on the side of the lesion.
- Behind the sternum, between the shoulder blades – neuralgia of the thoracic spine.
- Between the shoulder blades, below the axillary fossa, left side, the nipple area – scapular-rib dystonia. Algiya can last a long time, be nagging or short-lived, stabbing. Feels when inhaling and exhaling.
- In the anterior chest – near the sternum, in the armpits. The pain is long lasting.
Based on the type of damaged nerve fibers, the symptoms of neuralgia are as follows:
- sensitive beams – piercing pain;
- motor – shortness of breath (impaired motor function of the muscles and diaphragm);
- vegetative – vegetative symptoms;
- mixed version.
One of the main signs of intercostal neuralgia is intercostal pain (thorakalgia), which has the following features:
- extends along the intercostal space from the spine to the sternum;
- increases with sudden movements, laughter, coughing, sneezing, turning the body, raising hands, affecting the affected area;
- more often wearing paroxysmal burning, shooting character, “as a shock”, but it can be aching;
- during an attack lasting several seconds – 2-3 minutes. the patient freezes, holds his breath while inhaling, tries to avoid any movements;
- duration and intensity can vary, does not depend on the time of day (does not decrease at night);
- the patient is forced to stay in a certain posture in order to minimize the range of motion;
- irradiates in different areas depending on the location – in the mammary gland, the heart area in women, at the level of the lower ribs on the left side, scapular, epigastric region in men;
- is shingles, if localized along the 1-2 intercostal nerves;
- an increase in intensity is observed as the disease progresses.
Other symptoms of intercostal neuralgia:
- sleep disturbance (insomnia);
- in children, convulsions, hyperexcitability, speech disorders;
- muscle cramps and numbness at the site of the lesion;
- increased sweating;
- hyperemia or pale skin in the affected area;
- paresthesia – feeling of “crawling goosebumps”, “running through electric current”;
- itching in herpetic etiology, then a rash in the intercostal space, appearing on the 2-4th day of pain. The rash is represented by pink spots that turn into bubbles, which eventually dry out. After the bubbles remain temporary pigmentation on the skin.
Diagnosis is based on complaints, anamnesis, an objective examination of the patient. During the medical history, the doctor asks about the injuries, operations, lifestyle of the patient, chronic diseases, takes into account age-related changes.
An objective examination determines the state of muscle tone, the localization of pain, the degree of sensitivity violation. If you suspect the presence of other pathologies, blurred clinical picture additionally used:
- magnetic resonance imaging (MRI) and computed tomography (CT) – in order to exclude hernia, malignant processes, study the condition of muscles, ligaments, nerve tissue;
- myelography – the study of the roots of the spinal cord through the introduction of a contrast agent in the spinal canal. Most informative when held together in CT;
- X-ray examination of the chest and spine – detection of traumatic, degenerative and dystrophic processes;
- electrospondilography – assesses the state of the spine;
- electroneurography – reveals the effects of injuries;
- electrocardiography – with similar symptoms and cardiovascular pathologies;
- ultrasound – the identification of inflammatory processes, diseases of internal organs;
- contrast discography of the spine, detecting changes in the intervertebral discs;
- gastroscopy – in case of suspected pathology of the gastrointestinal tract in history;
- general analysis and seeding feces – to identify the bacterial pathogen in infectious etiology;
- general and biochemical analysis of blood and urine – detection of diseases of internal organs;
- serological blood test – diagnosis of the state of the immune system, detection of viral pathogens.
Recognizing intercostal neuralgia is often difficult due to the similarity of manifestations with other diseases. It is necessary to diagnose intercostal neuralgia with:
- Cardiovascular diseases. Thorakalgia often radiates to the left shoulder blade, an area of the heart that resembles heart disease, in particular, angina pectoris. Unlike the last pain in dystonia, they are not stopped by drugs of the nitroglycerin series, they are aggravated by movements and palpations (during angina pectoris, the provocation of algy is caused by physical exertion, an attack of contraction). The diagnosis confirms the ECG.
- Thoracic radiculitis and intervertebral hernia – Algias are episodic against the background of constant dull back pain. Decrease during night sleep. Diagnostics is confirmed by the WG of the thoracic spine in case of suspected radiculitis, MRI of the spine in case of suspected hernia.
- Attacks of gastrointestinal pain, in which radiation is possible in the chest. In diseases of the stomach (gastritis, ulcer) algii of lesser intensity, longer. Pancreatitis is characterized by shingles pain, but it is always bilateral. In disorders of the gastrointestinal tract, pain is associated with food intake, which is the main difference from intercostal neuralgia. Confirms the diagnosis of gastroscopy, laboratory tests.
- Renal colic – similar symptoms are observed with neuralgia of the lower ribs – cramping pain in the lumbar region, giving up in the leg, groin. To confirm the diagnosis helps ultrasound.
- Pleurisy, atypical pneumonia, malignant tumors of the thoracic region – the diagnosis is based on data from the WG, CT, MRI.
Treatment of intercostal neuralgia complex and staged. Includes pathogenetic (etiotropic), aimed at eliminating the root cause and symptomatic therapy, relieving attacks of torakalgii, associated symptoms. Types of treatment – medical, physiotherapy, physiotherapy, massage, manual therapy, traditional medicine.
Tactics of etiotropic therapy depends on the genesis of neuralgia. Pathogenetic treatment includes:
- antibiotics, antivirals – for infectious diseases;
- anti-inflammatory drugs, analgesics, chondroprotectors, immunomodulators, physiotherapy, massage, exercise therapy, folk remedies – for diseases of the spine;
- detoxification therapy for drug, alcohol, radiation, chemical poisoning;
- therapy of somatic and endocrine diseases with drugs of the respective groups;
- vitamins, fortifying, immunostimulants with hypovitaminosis and immunodeficiency states;
- surgical intervention in malignant processes in the body.
Symptomatic drug therapy is aimed at:
- relief of thoracalgia – nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics. With the ineffectiveness of NSAIDs – intercostal blockade with corticosteroids;
- normalization of the neuro-psychological state, restoring sleep – sedatives;
- removal of muscle spasm – muscle relaxants;
- recovery of vegetative regulation – trace elements, vitamins of group B, tonic.
Stages of treatment
At the initial stage are widely used:
- physiotherapy techniques – magnetic therapy, UHF, ultraphonophoresis, reflexology;
- vitamins of group B, restoring nerve fibers;
- laser therapy.
During exacerbation, Novocain blockade, sedatives, electrophoresis, solux, UHF are used. Comply with bed rest for three days. The bed must be firm. When the acute stage passes, identify the cause of neuralgia and conduct pathogenetic treatment.
At the recovery stage, manual therapy, massage, osteopathy, manual therapy, acupuncture, physical therapy are carried out.
Massage contributes to the removal of muscle clamps, the overall relaxation of the body, improve blood circulation. During the procedure, rubbing and stroking the intercostal spaces, kneading and rubbing the back muscles from the loins to the shoulder blades.
Massage types – point, shiatsu, canned:
- Point – finger pressure on the active points responsible for a particular organ.
- Shiatsu is a Japanese massage based on pressure on the trigger zones of the affected intercostal space.
- Canister – based on the vacuum reflex effects on the nerve receptors. Banks are placed on the back, pre-lubricated with a cream for a better slip. Lead on the back towards the sacrum. It is contraindicated to place banks in close proximity to the spinal column due to the risk of damage to the vital centers of the spinal cord.
Acupuncture is based on the reflex principle, the effect of needles on certain points of the intercostal areas, back muscles, relieving pain syndrome. Recommended 3 courses with a break of 2 months.
Manual therapy helps to restore the anatomical position of the cervical and thoracic vertebrae, to increase the diameter of the hole through which the nerve passes, to improve blood circulation and metabolism in damaged nerve tissues. As a result, pain decreases or disappears altogether. An experienced vertebrologist does not allow the development of complications and recurrences of attacks.
Osteopathy – restoration of the anatomical position of the chest, due to which microcirculation of blood and lymph is normalized, pain decreases.
Therapeutic exercise allows you to restore the physical activity of the ribs, remove the tone and muscle spasm.
Is it possible to treat at home
At home, intercostal neuralgia is not treated with drugs. Carry out the following activities:
- local treatment – apply dry heat to the affected area (hot water bottle, warm sand, mustard plasters, pepper plaster);
- sleep on a hard flat surface, wear a corset;
- use traditional medicine – lotions, compresses, decoctions, tinctures. An effective effect is a mixture of glycerin and iodine. A tampon with this mixture smears the back (but not rubbed), put on cotton underwear and go to bed. The procedure is repeated every other day. Only 15 times.
In the absence of timely diagnosis and treatment, intercostal neuralgia can have the following consequences:
- violation of blood flow, nutrition of muscles and nerves, leading to dysfunction of the internal organs;
- persistent pain syndrome;
- frequent exacerbations of chronic gastrointestinal diseases;
- violation of the cardiovascular system – increased blood pressure, hypertension, ischemic stroke, angina pectoris;
- recurrence of neuralgia due to herpes.
In order to prevent the need to:
- Daily gymnastics, it is desirable to play sports, swim in the pool, to monitor posture.
- Avoid hypothermia, uncomfortable postures, excessive physical exertion, stress.
- Comply with the mode of work and rest, sleep, enough to be in the fresh air, eat right.
- Timely treat chronic, somatic and endocrine pathologies, diseases of the spine, infections.
- Women do not wear underwear.
- Give up bad habits – alcohol, smoking.
It is possible to get rid of intercostal neuralgia with timely visit to a doctor, diagnosis, complex treatment, compliance with all recommendations and measures to prevent recurrence.