Third lumbar transverse synovial syndrome
It is a common disorder in patients with low back pain, and it occurs in young and middle-aged manual laborers. The main symptom of this syndrome is lumbar pain, which varies from person to person, ranging from very severe pain to persistent dull pain. It is often aggravated after prolonged sitting and standing.
Since the transverse process of the third lumbar vertebra is particularly long and extends horizontally, it is at the apex of the physiological anterior convexity arc of the lumbar vertebra and is an important part of the mechanical transmission, with vascular nerve bundles passing nearby and more myofascial attachments. It is easy to be affected by external forces, causing tears, bleeding, scar adhesions, and thickening and contracture of the fascia, which causes symptoms due to friction, irritation and compression of the vascular nerve bundle. The anatomical variation of the transverse process of the third lumbar vertebra, such as excessive length or asymmetry on both sides, is also one of the internal causes. Cold stimulation can also induce the disease.
Anatomical features.
1, the transverse process of the third lumbar vertebra has greater posterior extension curvature than the other lumbar vertebrae, extends longest laterally, lacks rib and iliac bone protection, and is therefore vulnerable to damage.
2, the end of the transverse process of the lumbar spine is attached to many muscles and fascia that are closely related to trunk activities, and changes in intra-abdominal pressure can affect the tissue at the end of the transverse process through the transversus abdominis muscle.
The third lumbar vertebra is located at the apex of the anterior lumbar curve, and the fibers of the iliopsoas portion of the latissimus dorsi muscle end at the transverse process of the third lumbar vertebra, which is subject to the greatest leverage. The longer the transverse process, the higher the incidence.
4. The posterior end of the transverse process of the third lumbar vertebra is immediately behind the posterior branch of the second lumbar nerve root, which causes reflex pain reaching the buttocks and anterior thighs when forward flexion and bending to the opposite side. The lateral femoral cutaneous nerve trunk of the lumbar plexus nerve passes on the deep anterior surface and is distributed to the lateral thigh and knee.
Clinical manifestations
1.More often seen in young adults engaged in manual labor, more often in males, often complaining of a history of lumbar trauma of varying severity.
2. The main symptom of this syndrome is lumbar pain, which varies from person to person, with some having very intense pain and some having persistent dull pain. It is often aggravated after prolonged sitting and standing. Can’t get up directly and need to get up sideways. Bending is limited. May have pain radiating downward along the thighs, but does not increase painful symptoms due to increased abdominal pressure (e.g. coughing, sneezing, etc.).
3. the important sign is the outer edge of the transverse process of the third lumbar vertebra, which corresponds to 4 cm next to the spinous process of the third lumbar vertebra. the tip of the transverse process may be palpable and have significant pressure pain and limited myotonia or myospasm, especially in lean and long patients.
4, the straight leg raise test may be positive, but the straight leg raise foot dorsal extension test is negative.
Auxiliary examination
The diagnosis of this disease can generally be made by combining the medical history, and the examination shows significant pressure pain at the tip of the transverse process of the third lumbar vertebra, and hard nodules in the form of cords can be palpated. X-ray examination may reveal hypertrophy of the transverse process of the third lumbar vertebra on the affected side without special auxiliary examination.
How to prevent
1, for acute injury to the lumbar area to be promptly treated.
2, pay attention to the correction of poor posture.
3, the waist can be girded to protect the waist, it is appropriate to sleep on a hard bed.
4.Keep warm and avoid fatigue.