Overview.
Reflex neuropathy is also known as somatic neuropathy. It is a disorder in which minor injury to sympathetic-rich peripheral nerves reflexively causes severe neurologic dysfunction in the innervated area of the affected nerve and in areas outside the innervated area.
Causes
This disease is mainly caused by minor trauma to the extremity, such as stabbing, smashing, cutting, shock injury, acupuncture or acupoint drug injection, etc., which damages peripheral nerves rich in sympathetic nerve fibers, such as median nerve, radial nerve, tibial nerve, etc., and forms a constant stimulation foci at the injury site, which stimulates the deeper nociceptive fibers and sends out pathological impulses, which are transmitted to the spinal cord continuously, and forms a pathologically dominant foci in the corresponding and neighboring segments of the spinal cord. When the pathologically dominant foci spread to the anterior horn of the spinal cord, it manifests as reflex paralysis when the inhibitory nature is dominant and reflex spasm when the excitatory nature is dominant; when the pathologically dominant foci spreads to the plant nerve center of the lateral horn, there can be plant nerve dysfunction. When the pathologically dominant foci are limited to one side of the spinal cord, the symptoms are ipsilateral, and when they affect the opposite side of the spinal cord segments at the same time (generalization phenomenon), the symptoms may be bilateral. The symptoms may be bilateral, but are often more severe on the primary side. In addition, psychiatric factors and excessive stress play a role in the development of the disease.
Symptoms
The clinical manifestations of this disease are special, with slight nerve damage at the extremities but heavy pathological reactions, and a small range of nerve damage but a large range of neurological dysfunction that goes far beyond the innervation range of the injured nerves. Its neurological dysfunction is characterized by:
1. Early obvious vegetative nerve dysfunction
Severe swelling of the affected limbs, reddening, purpling or marbling changes in skin color, sometimes with blisters, often within half an hour to several hours after injury. Skin temperature decreases. There may be pigmentation and trophic changes of the skin and nails in the later stage of the injury.
2. Severe motor disorders
It is mostly manifested as reflex paralysis or reflex contracture. The muscle atrophy of the affected limb appears earlier, and even spreads to the whole affected limb. Muscle excitability increases in response to mechanical and electrical stimuli. Tendon reflexes are often hyperactive, but may be reduced or absent.
3. Severe pressure and motor pain in and around the injured part.
At the time of injury, there can be severe pain in the injured area or radiating to the distal end at the same time. Objective examination may show sensitization (hypo- or hyperalgesia). There may be tenderness and motor pain in and around the injury.
Examination
Cerebrospinal fluid examination, X-rays, electromyography are possible.
Diagnosis
Diagnosis is not difficult based on the fact that the noxious stimulus to the injured limb is mild and limited in scope, while the clinical picture is characterized by severe neurological dysfunction that extends far beyond the innervation of the nerves that may be involved.
Treatment
1. Actively treat the irritated lesion of the affected limb.
First of all, the irritated lesion of the affected limb should be actively treated. Localized transdermal therapy, iodine ion or calcium ion direct current implantation or ultra-high frequency electric field treatment can be used to eliminate the irritation foci.
2. Nerve block
The second feasible nerve block, in order to reduce the excitability of sympathetic nerves and release the dominant foci of the corresponding spinal cord segments. For upper limb lesions, ipsilateral brachial plexus and cervical sympathetic ganglion block can be used; for lower limb lesions, sacral epidural and ipsilateral lumbar sympathetic trunk block can be used, as well as the corresponding spinal cord segments of hyperthermia, procaine, or calcium ion implantation and other therapies. For stubborn cases, surgical exploration of the injured part, excision of scar and neuroma or sympathetic ganglion excision on the side of the lesion are feasible.
3.Other
In addition, nerve trunk pulse current stimulation, acupuncture and traditional Chinese medicine can also be used.
Prognosis
After the onset of the disease, if timely treatment, can be cured in a relatively short period of time, and the prognosis is good. In severe cases that are not treated in time, the disease can be prolonged and persistent, leading to more serious motor and vegetative nerve disorders.