Causes of development, diagnosis and treatment of Roth's disease

Roth's disease affects men over 50 years of age. The most common cause is neuropathy of the lateral cutaneous nerve of the thigh with the manifestation of sensitive symptoms that require immediate treatment.

Roth-Bernhardt disease is compression of the lateral cutaneous nerve of the thigh in the area between the anterior superior iliac spine and the inguinal ligament with the appearance of sensory disturbances on the skin of the anterior surface of the thigh outside in its middle third. It is a common type of carpal tunnel syndrome.

As a rule, middle-aged men are affected, but familial cases of the disease also occur. In 1895, M. Bernhardt proposed an infectious-toxic theory of nerve damage, and V. K. Roth proposed a compression theory. As a result of compression of the nerve, the conduction of the nerve impulse changes and metabolic processes in the nerve fiber are disrupted, nerve atrophy, inflammation, pain, and swelling occur.

general description

Bernhardt-Roth disease (neuropathy of the external cutaneous nerve of the thigh) (G57.1) is damage to the external cutaneous nerve of the thigh due to compression of its fibers under the inguinal ligament in the region of the anterosuperior iliac spine, manifested by paresthesia, pain in the area of ​​the outer surface of the thigh.

The syndrome is more often observed in men 50–60 years old (75%).

Possible causes of the disease: abdominal obesity, use of a corset, tight belt, pregnancy.

Etiology of the disease

So, what is Roth syndrome, and why is the disease dangerous? Roth-Bernhardt syndrome acts as a neurological disease. In medical terminology, the disease has another name - tunnel syndrome. By definition, the disease is the repeated stretching or straining of muscles, which in turn leads to a pinched nerve .

As a rule, the disease occurs on the hips. Such a violation leads to innervation of the skin, as a result of which characteristic symptoms appear. The danger of the disease is that it is extremely difficult to cure Roth-Bernhardt syndrome , and you will also have to give up any physical activity.

Clinical picture

The disease develops gradually. The lesion is characteristically unilateral. Feelings of numbness, tingling, and burning occur first in certain areas of the thigh. Over time they become permanent. The pain appears over several months.

An objective examination of the patient reveals hypoesthesia/analgesia along the anterior outer surface of the thigh (up to 100%). In 80% of cases, pain is noted on palpation and percussion in the area of ​​the nerve trunk, pain increases with hip hyperextension, and decreases with flexion of the hip joint. The painful point is at the level of the notch under the anterior superior iliac spine.

Diagnostic measures

To determine the presence of Roth-Bernhardt syndrome, it is enough to perform a fluoroscopy of the hip area. Based on the results of instrumental diagnostics, it will be clear whether a pinched nerve is present.

But based on medical statistics, in 30% of cases a full neurological examination is required, including a test for sensitivity in the affected area, an external examination of the patient (no sweat, absence of characteristic hair, etc.). In such cases, electroenteromyography and ultrasound are prescribed to confirm or refute the established diagnosis.

As soon as the symptoms have been established and treatment for Roth-Bernhardt syndrome has begun, the patient must stop all physical activity until recovery.

Treatment of Bernhardt-Roth disease

Treatment is prescribed only after confirmation of the diagnosis by a medical specialist. Vitamin therapy, analgesics, massage, physiotherapy, therapeutic physical training, novocaine and hydrocortisone blockades, and surgery in the inguinal ligament are indicated. Measures such as normalizing body weight, eliminating external pressure factors and treating somatic diseases are important.

Essential drugs

There are contraindications. Specialist consultation is required.

• Voltaren (non-steroidal anti-inflammatory drug). Dosage regimen: IM at a dose of 75 mg (contents of 1 ampoule) 1 time/day.
• Ketoprofen (non-steroidal anti-inflammatory drug). Dosage regimen: IM - 100 mg 1-2 times a day; after pain relief, it is prescribed orally in a daily dose of 300 mg in 2-3 doses, a maintenance dose of 150-200 mg/day.
• Tramadol (analgesic). Dosage regimen: IV, IM, SC in a single dose of 50-100 mg, possible repeated administration of the drug after 4-6 hours. The maximum daily dose is 400 mg.
• Thiamine bromide (vitamin B1). Dosage regimen: IM, 2 ml of 6% solution 1 time/day. There are 25 injections per course.
• Cyanocobalamin (vitamin B12). Dosage regimen: IM, 200 mcg 1 time/day. There are 20 injections per course.

Causes of Roth-Bernhardt syndrome and methods of its treatment

Roth Bernhardt's disease was first described by the Russian scientist Roth and the German Bernhardt at the end of the 19th century. Another name is myalgia paresthetica. The disease is a compression of the lateral nerve of the skin of the thigh. The external nerve is a conductor of impulses from the outer and posterior zones of the thigh, ending near the knee. The nerve may have anatomical pathology. The disease itself is caused by abnormal structural features of the hip; it can be unilateral and in 20% of cases bilateral.

Factors leading to illness

Factors influencing congenital disorders:

• Manifestation of the disease in the area of ​​attachment of the inguinal ligament to the bone due to poor blood circulation.
• The appearance of a canal when the groin ligament bifurcates, where the nerve is pinched.
• Congenital sharp fracture of the nerve.
• Nerve close to the ilium, etc.

In addition to congenital, the disease can be acquired and manifests itself with age. This is facilitated by:

• Pressure on the lateral nerve caused by wearing tight clothing or a belt;
• Pregnancy, as the forward curve of the spine increases and the inguinal ligament becomes tense;
• Excess body weight, where the most problem areas are the stomach and thighs;
• Hernias in the groin;
• Neoplasms in the abdominal area;
• Pathological fluid in the abdominal cavity;
• Hematomas in the retroperitoneal region;
• Swelling and increased tissue size associated with surgical procedures or inflammation;
• Diabetes, lack of microelements, typhoid fever and other diseases in acute and chronic forms;
• Rachiocampsis
  . _

Signs of Roth Bernhardt's disease

Signs of the disease become obvious from the first moments of compression of the external nerve. Patients complain of:

• Burning;
• Numbness;
• Decreased sensitivity;
• Cold;
• The appearance of ulcers;
• Acute painful sensations;
• Skin inflammation;
• Intermittent claudication that occurs with physical activity and disappears when the person is immobile.

Ways to determine the disease

It is not difficult to identify a disease, but you need to find its root cause, on which treatment will depend. First, data is collected about the patient’s well-being and his complaints, then a visual and palpation examination is carried out. In order to make an accurate diagnosis, the following methods are used:

1. Electroneuromyography is used to assess muscle activity in response to a stimulus.
2. Ultrasound helps determine the area where the nerve is torn and other abnormalities.
3. MRI is prescribed to obtain a three-dimensional image of the area in any projection. Most often it is performed when there is a suspicion of the presence of neoplasms and internal hematomas.
4. CT also provides reliable information, but with the use of X-rays.
5. X-ray of the spine.
6. Autoimmune and biochemical blood tests.

If, after eliminating the obvious cause of the disease, the patient continues to complain of malaise, additional examinations are prescribed.

How is Roth-Bernhardt disease treated?

To cure the disease, a set of therapeutic and preventive measures are used to improve well-being and eliminate pressure on the nerve.

Medicines are prescribed for:

1. Relieving inflammation. For this, non-steroidal anti-inflammatory drugs like Diclofenac, Indomethacin, etc. are used.
2. Pain relief in the form of ointments, tablets or injections.
3. Improves blood circulation.
4. Obtaining the necessary elements. For this purpose, vitamin complexes are prescribed, especially those containing B12 and B1 and the minerals Mg, Ka, Cal, necessary for the heart.
5. Vasodilation using Nicotinic acid, Trental, etc.
6. For severe acute pain, hormonal drugs such as Prednisolone, Dexamitozone, etc. are recommended.

Physiotherapeutic treatment is prescribed in the form of:

• Hydrogen sulfide baths;
• Wraps;
• Mud treatment;
• Water massage;
• Magnetic laser procedures;
• UHF;
• Acupuncture.

The measures taken inhibit the inflammatory process, relieve pain, and improve blood flow to tissues and cells.

Gymnastic exercises have a positive effect on recovery. The most productive block is carried out daily for 15 minutes, including the following exercises:

1. The patient sits with his legs bent. Using sliding movements along the flooring, you need to straighten your lower limbs. Perform five times in two approaches.
2. The patient's position is to lie on his stomach. The hands are placed on the lumbar region. Raises the shoulders along with the head, lifting them off the floor at a slow pace three times. Do it twice.
3. The patient stands with his hands on his belt. Spreads his legs at a slow pace, sliding and leaving his feet on the floor. Performs four times, taking a 15-second pause between approaches.
4. The patient lies on his stomach and performs arm movements six times as with the breaststroke technique.
5. The patient lies on the side opposite the patient. The head is placed on the arm bent at the elbow. Raises the straight leg to a painless maximum about eight times.

During treatment, the patient is advised to:

• Refrain from uncomfortable clothes, replacing them with loose-fitting models, avoiding belts.
• Eat foods rich in microelements and vitamins, adhere to a proper sleep schedule.
• Monitor your weight, if it exceeds the norm, adjust your diet and increase physical activity.

For tumors and large-scale hematomas, operations to remove them are indicated, where a positive outcome predetermines the timely surgical manipulation.
To reach the nerve, a shallow incision is made in the skin under local anesthesia. If the operation is delayed, the growing death of nerve cells will interfere with recovery. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Incidence (per 100,000 people)

Symptoms

The disease manifests itself gradually. A person may not see a doctor right away. Most often it starts with numbness of the skin on the side of the thigh. There is a feeling of “dead skin”. Other characteristic symptoms are:

• burning sensation;
• crawling sensations;
• tingling.

The clinical picture of the disease in the early stages of the disease is not clearly expressed. As the disease progresses, the picture becomes more detailed. occurs:

• pulling pain under the skin;
• numbness;
• the skin becomes dry and flaky;
• pallor of the epidermis;
• veins dilate.

If any scratches appear, then in their place there may be trophic ulcers.

A characteristic feature by which one can determine that a person has Roth's disease is that when lying on one's side with the leg bent and the stomach pulled to the thigh, the pain and numbness disappear. This test will help tell whether you should sound the alarm.

Pain during the disease most often occurs only while walking. It occurs according to the type of so-called intermittent claudication. Skin changes appear over the painful area. Vertebrogenic pain syndrome may also develop.

Symptoms of Bernard-Roth disease can be confused with signs of the following diseases: herniated disc, spondylosis of the upper spine, arthrosis of the hip joint.

The patient may not seek help for many years because the pain is tolerable. Discomfort occurs only when walking.

The main symptoms may also correspond to additional ones. Such as hypoesthesia. Sometimes it reaches hyperarthria. Bernard-Roth disease can be accompanied by hair loss and thinning of the skin. A person can continue to move and perform certain actions. Limitations in this case are associated with pain during movements.