myneurologytips

Wednesday, September 5, 2018

Trophic changes

On a surface level, trophic changes are simply changes in soft tissue (skin, fascia, muscle), resulting from interruption of nerve supply (Baluk 1992). Neurogenic inflammation is continuing inflammation in the musculoskeletal system, generated by nerve impulses and the release of inflammatory substances from the sensory axon at the site of the original injury. These substances are typically, but not limited to: Substance P (SP), Calcitonic Gene Related Peptide (CGRP), and Neurokinin-A (NKA). Prolonged inflammation and pain can lead to protective muscle spasms, but it more commonly leads to an accumulation of fibrous tissue—which are trophic changes . Devor (1999) stated that the fibrous tissue forms trophic changes, which become palpable taut muscle bands and trigger points; such muscle dysfunction and spasm lead to compression of blood vessels, and decreased blood flow, implicating pain stimulation, and decreased joint mobility. The somatic motor system and the autonomic nervous system influence the skeletal muscular system by stimulating muscles to contract and nerves to secrete during the regulation of molecular organization of other cells, like collagen in soft tissue repair during rehabilitation of an injury. These effects are referred to as trophic, or nutritional, functions of the nervous system (Portenoy, 1994). The key to clinical treatment is to reverse the stimuli that trigger the noxious chemical and mechanical stimuli, which trigger the neurogenic inflammatory response. Manipulation of joints, manual muscle treatments, and interventions that directly target the nervous system like acupuncture and electro-stimulation are key allies in the minimization of trophic changes and the acceleration of soft tissue healing (Lombardi, 2012).

Friday, August 4, 2017

White Hand sign

The white hand sign is a medical sign observed as a visible whitening of skin on the hand when the subject elevates the hands above the shoulder girdle with fingers pointing to the ceiling and palms facing forward. The appearance of the paleness, sometimes cadaveric, in one or both hands is called the White Hand Sign. It results from this change in position causing a compression of the subclavian artery and temporary loss of circulation, as often occurs in patients with thoracic outlet syndrome, a complex syndrome involving the compression of various nerves and blood vessels between the axilla (armpit) and the base of the neck.

The use in the physical examination of a triad consisting of tenderness of the supraclavicular area, paleness and/or paresthesias on elevation of the hands, and weakness of the abductors and adductors of the 5th finger, will make the diagnosis of Thoracic Outlet Syndrome consistent and reproducible.

A new physical sign called the White Hand Sign is described. When used with the diagnostic triad in the routine physical examination, it will standardize the diagnosis of Thoracic Outlet Syndrome.

The White Hand Sign will objectively assess the postural vascular compression at the thoracic outlet. The absence of the color changes on the elevation of the hands should not be construed that Thoracic Outlet Syndrome is not present, severe nerve compression can exist without vascular compression.