Intercostal neuropathy

Intercostal neuropathy is a medical condition characterized by dysfunction of the intercostal nerves that run between the ribs in the thoracic or abdominal region. This neuropathy can cause a variety of symptoms and discomfort associated with pain in the ribs and perineal tissues.

Causes of intercostal neuropathy may include the following factors:

1. Trauma: Injuries such as blows, broken ribs, car accidents and falls can damage the intercostal nerves and cause neuropathy.
2. Inflammation: Inflammatory processes such as osteochondrosis, arthritis, infections and nerve inflammation can also be the cause of intercostal neuropathy.
3. Compression: Compression of the intercostal nerves due to the presence of a tumor, herniated disc, or other anatomical abnormality can cause symptoms of intercostal neuropathy.
4. Intense physical activity: Certain types of exercise or increased exertion can cause strain and damage to the intercostal nerves.
5. Unknown cause (idiopathic intercostal neuropathy): In some cases, the cause of intercostal neuropathy remains unclear.

Symptoms of intercostal neuropathy may include pain, burning, tingling, numbness, or a feeling of pressure in the area between the ribs. The pain can be acute or chronic, and the intensity can vary. Symptoms often get worse with movement, deep breathing, coughing, or physical activity.

Diagnosis of intercostal neuropathy may include a physical examination, discussion of medical history, and additional tests such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans to identify the cause of symptoms.

Treatment may include pain management, physical therapy, relaxation exercises and, in some cases, surgery to correct the cause of the neuropathy. [1]

Causes of the intercostal neuropathy

The causes of intercostal neuropathy can be varied and can include:

1. Trauma: Trauma such as a blow, rib fracture, or thoracic surgery can damage the intercostal nerves and cause neuropathy.
2. Shingles (herpes zoster): A viral infection caused by herpes zoster can affect nerves and cause pain along the intercostal nerves.
3. Intercostal Neuroma: This is a benign tumor that can irritate the intercostal nerves and cause symptoms of intercostal neuropathy.
4. Osteochondrosis of the spine: Degenerative changes in the spine can compress the intercostal nerves, which can cause intercostal pain.
5. Intercostal Nerve Tunnel Syndrome: This is a condition in which the intercostal nerves are compressed due to inflammation or other factors, which can cause pain and discomfort.
6. Lung cancer: In some cases, lung cancer can metastasize to the intercostal nerve area and cause intercostal neuropathy.
7. Other medical conditions: Some medical conditions such as diabetes, inflammatory diseases, multiple myeloma, etc. Can affect the nervous system and trigger intercostal neuropathy.
8. Unknown cause: In some cases, the cause of intercostal neuropathy may remain unclear (idiopathic intercostal neuropathy).

Symptoms of the intercostal neuropathy

Here are some of the symptoms characteristic of intercostal neuropathy:

1. Pain: One of the most common symptoms of intercostal neuropathy is pain. This pain can be sharp, stabbing, burning, or throbbing and can occur in the area between the ribs, in the upper abdomen, or along the rib area.
2. Tingling and numbness: Patients with intercostal neuropathy may experience tingling, numbness, or burning in the area where the affected nerves are located.
3. Worsening pain with movement: Pain mayworsen with movement, coughing, sneezing, or stretching the muscles of the chest area.
4. Pressure sensitivity: It is not uncommon for the skin in the area of intercostal neuropathy to become sensitive to pressure, and light touch can cause pain.
5. Muscle cramps: Some patients may experience muscle cramps or spasms in the chest area.
6. Restriction of movement: Pain and discomfort can lead to restricted movement, especially in the chest area.
7. Pain Points: Pain points can form in areas where nerves have become irritated, which when pressed cause pain.
8. Symptoms may worsen at night: Many patients notice that the symptoms of intercostal neuropathy may worsen at night.

The symptoms of intercostal neuropathy can be of varying degrees of severity and can last either briefly or for long periods of time. [2]

Diagnostics of the intercostal neuropathy

Diagnosing intercostal neuropathy involves a number of medical procedures and tests to determine the cause of intercostal pain and discomfort. Here are some of the methods that may be used in diagnosing this condition:

1. PhysicalExam: The doctor will perform a physical examination of the patient, including palpation (palpation) of the intercostal area to look for painful points, skin changes, and muscle spasm. It is important to tell the doctor about the nature of the pain, its intensity, and other symptoms.
2. MedicalHistory: The physician will ask questions about the patient's medical history, including previous injuries, surgeries, illnesses, and medications.
3. Sternal radiography: This may be performed to rule out other pathologic conditions of the chest, such as rib fractures or bone tumors.
4. MRI (magnetic resonance imaging) or CT (computed tomography): These imaging techniques allow visualization of soft tissues and structures in the chest area to detect possible nerve damage, intervertebral discs, and other changes.
5. Electromyography (EMG): This is an electrophysiologic study that can be used to evaluate muscle and nerve function in the intercostal region.
6. Ultrasonography (ultrasound): Ultrasound may be performed to evaluate the soft tissues and nerves in the intercostal spaces.
7. Clinical assessment of symptoms: The patient should describe in detail the nature of the pain, its location, intensity, factors contributing to or worsening the symptoms, and other associated symptoms.
8. Exclusion of other causes: The doctor should rule out other medical conditions that can mimic the symptoms of intercostal neuropathy, such as heart disease, lung disease, gastroesophageal reflux disease (GERD), etc.

Differential diagnosis

The differential diagnosis of intercostal neuropathy involves identifying and distinguishing this condition from other possible causes of chest and intercostal pain. It is important to rule out other potential medical problems that may mimic the symptoms of intercostal neuropathy. [3] Here are some of the most common conditions that require differential diagnosis:

1. Intercostal neuropathy and osteochondrosis: Intercostal pain may be similar to pain associated with osteochondrosis of the spine. Differential diagnosis may require x-ray, MRI, or CT scan to evaluate the spine.
2. Intercostal neuropathy and cardiac problems: Pain in the chest area can sometimes be associated with heart problems such as angina pectoris (pain in the heart area) or other heart conditions. This requires an electrocardiogram (ECG) and other cardiac tests.
3. Intercostal neuropathy and pulmonary problems: Some pulmonary problems such as pneumonia, pleurisy, or pulmonary artery thrombosis may also cause chest and intercostal pain. X-rays of the lungs and other examinations may help in the differential diagnosis.
4. Intercostal neuropathy and gastroesophageal reflux disease (GERD): GERD can lead to heartburn and pain in the chest area, which may resemble symptoms of intercostal neuropathy. Esophagogastroduodenoscopy (EGDS) may be performed to evaluate the esophagus and stomach.
5. Intercostal neuropathy and muscle pain: Muscle pain or tension in the intercostal area can mimic the symptoms of intercostal neuropathy. Your doctor may perform a physical exam and muscle evaluation.
6. Intercostal neuropathy and emotional problems: Stress and emotional problems can also cause pain in the thoracic region. Psychological evaluation can be helpful in the differential diagnosis.

Treatment of the intercostal neuropathy

Treatment for intercostal neuropathy may involve several steps, and each step depends on the severity of the symptoms, the cause of the neuropathy, and the individual patient. Here are the common stages of treatment:

1. Diagnosis: The first step is diagnosis. The doctor performs a physical examination and collects a medical history, and may order additional tests such as X-rays, magnetic resonance imaging (MRI), computed tomography (CT), electromyography (EMG), or other tests to determine the cause of intercostal neuropathy.
2. Pain control: If pain is present, it is important to begin pain management. This may include taking analgesics and/or anti-inflammatory medications under a doctor's supervision.
3. Physicaltherapy and physical rehabilitation: Physical therapy can help strengthen muscles, improve flexibility and reduce compression of the intercostal nerves. Your doctor or physical therapist will develop an individualized physical rehabilitation program.
4. Relaxationand Stress Management: Relaxation and stress management techniques can help reduce tension and improve overall well-being.
5. Treatment of the underlying condition: If intercostal neuropathy is caused by an underlying condition such as osteochondrosis, neuroma, or infection, treating that cause becomes an important step in treatment.
6. Surgery: In rare cases, if other treatments do not work, surgery may be necessary to address the cause of intercostal neuropathy, such as removal of a neuroma.
7. Psychological support: If the pain and symptoms of intercostal neuropathy are causing stress or depression, the patient may need psychological support or counseling from a psychologist.

Literature

Gusev, E. I. Neurology : national guide : in 2 vol. / ed. By E. I. Gusev, A. N. Konovalov, V. I. Skvortsova. - 2nd ed. Moscow : GEOTAR-Media, 2021. - Т. 2.