Treatment of autonomic disorders in the extremities

The treatment of vegetative disorders in the limbs is based on the impact on the primary factors causing these disorders. Therapeutic effects in neurovascular syndromes of the limbs should be directed, in turn, at the sources of vascular-trophic disorders: osteochondrosis of the spine, anomalies and deformations of the skeleton, muscles, fascia, compression and edema of the roots, atherosclerosis of the vessels, etc. The main principle of treating patients with various manifestations of osteochondrosis of the spine is a combination of orthopedic and physiotherapeutic measures, as well as pharmacological treatment.

Orthopedic measures include: a special regimen (position on a shield, on an inclined plane), traction of the lumbar and cervical spine on special devices. Novocaine blockades are recommended: epidural according to Catlen, paravertebral, muscle (anterior scalene, inferior oblique muscle of the head, pectoralis minor, gastrocnemius, piriformis). To prolong the action of novocaine and the local anti-inflammatory effect, hydrocortisone, vitamin B12, lidase are added to the novocaine solution. In addition, drug treatment should include analgesics, dehydrating drugs, ganglionic blockers, vitamins, etc. Physiotherapy is used: electrophoresis of drugs, sinusoidal-modulated currents, magnetotherapy, ultrasound, inductothermy, etc. massage, exercise therapy, spa treatment (hydrogen sulphide, sodium chloride baths, etc.).

Cases of persistent pain syndromes, long-term unsuccessful conservative therapy, signs of organic muscle changes, compression of neurovascular formations should be considered as indications for surgical treatment. Various types of surgical interventions are performed (various operations on the spine, intersection and excision of pathologically altered muscles).

There are no effective treatments for hereditary neuropathies. However, supportive and symptomatic therapy plays an important role in their treatment. All patients are advised to avoid excessive weight gain and to exercise regularly. Prevention of foot ulcers and their complications is of primary importance. For this purpose, patients are advised not to walk barefoot; the feet should be regularly lubricated with Vaseline. Already developed ulcers should be protected from the pressure of body weight until complete healing occurs. In case of infection, antibiotics may be necessary.

Compression-ischemic neuropathies should not be considered as a purely local process, therefore their treatment should provide for the elimination of disorders caused by both damage to the nerve itself and changes in other parts of the nervous system and the whole body. Conservative therapy should begin as early as possible; its tasks are to eliminate or reduce the severity of pain, stimulate nerve conduction and regeneration of nerve fibers, improve general and local blood and lymph circulation, prevent the formation of scars, trophic disorders at the site of injury. For this purpose, various types of blockades are used with novocaine, hydrocortisone, anticholinergics, ganglionic blockers, as well as neuroleptics, tranquilizers. The use of antihistamines (suprastin, diphenhydramine, etc.), vasoactive drugs (nicotinic acid, euphyllin, etc.) is indicated. To correct endocrine-hormonal shifts and changes in electrolyte balance, it is recommended to prescribe calcium salts and hormones. Acupuncture and transcutaneous electrical stimulation are very effective, especially for relieving pain.