Symptoms of nerve tension. Symptoms of tension osteochondrosis

If the patient, raising a straight leg while lying on his back, feels severe pain in the area lumbar, they say that he has a positive symptom of Lasegue. Often, pathology occurs with osteochondrosis and affects sciatic nerve- the largest in human body. Degenerative changes in the spine provoke pain and spasm of muscle tissue, which leads to symptoms of nerve fiber tension, and during sudden movements, the risk of their rupture increases.

Symptom pathogenesis

To establish the pathology, the patient needs to lie down to raise the leg without bending it, forming an angle of 60 °. In this position, the sciatic nerve is under the greatest load.

The main factor in the development of the Lasegue symptom is the loss of the ability of the nerve tissue to stretch. This is due to the fact that the nerve fibers are clamped by the vertebrae, or pathological stretching occurs against the background of an intervertebral hernia. At rest, a person is not disturbed by pain. Testing is necessary to determine the syndrome.

Most often, the largest nerve suffers from osteochondrosis. This disease affects not only individuals old age but also young people under 30. Degenerative processes affect the bone and cartilage tissue, disrupting the structure of the vertebra. This provokes clamping not only of the nervous tissue, but also of the blood vessels. An additional risk factor is the formation of osteophytes characteristic of osteochondrosis.

Symptoms

Pain in a person begins to appear when the leg is raised to an angle of 60 degrees.

Lasegue's syndrome is often detected at the time. The manifestation of pathology is the occurrence sharp pains when the sciatic nerve is stretched. If, after bending the leg, the pain does not disappear, the disease is called negative. It is impossible to independently determine the disease, since there are several manifestations of the violation:

With slow raising of the leg, the symptom reaches a peak when the limb is positioned at an angle of 60 °.
In the presence of intervertebral hernia the maximum angle of the syndrome is less.
If the patient has reduced flexibility and discomfort due to stretching of muscle tissue, a false positive result is possible.

The degree of manifestation of the Lasegue symptom

First. Pain syndrome occurs when the hip is raised at an angle of 60 °.
Second. The pain appears when the angle has reached 45°. There is a spasm of muscle tissue of a protective nature.
Third. The reaction of the autonomic nervous system and muscle tissue is observed when reaching the 30-degree mark.

Features of diagnostics

If sciatica is the cause of the pathology, the patient has Neri's symptom - a connection between head tilts and sensations in the lumbar region.

At a positive result test, the pain in a person should pass when he bends his leg at the knee.

Testing does not require much effort. Despite the simplicity of the examination, the patient's response allows you to determine a number of parameters. During the procedure, several features of the diagnostics will be distinguished:

The patient lies down on the couch. He performs leg raises on his own or with the help of a doctor.
If pain sensations arose at the level of 30°–40°, then the syndrome is positive. In this case, the pain should recede when the leg is bent at the knee.
Loss of sensitivity of the skin on the anterior surface of the thigh is allowed. This is a sign of osteochondrosis and compression of the 5th lumbar or 1st sacral nerve root.
Pain, arising at the level of 70 °, speak of the pathology of muscle tissue and are not related to pinching of the sciatic nerve.
If the pain does not subside after bending the leg, the test is called negative. Cause discomfort in this case are diseases of the joints.

During the examination, the following rules must be followed:

When lifting the leg, do not bend it, as this will not allow the sciatic nerve to stretch.
If at around 60 ° the patient feels pain, then the examination stops. When lifting the leg even higher, despite the pain, the risk of rupture of nerve fibers increases.
All movements should be slow and smooth.
The examination should not be carried out if the patient has taken an anesthetic drug, as the result will be inaccurate.
If the symptom of Lasegue is detected, additional diagnostics are prescribed. An MRI is recommended to visualize nerve fibers.

Lasegue's symptom occurs against the background of tension of the roots of the sciatic nerve, which occurs due to the infringement of the nerve fiber in the spine or spasmodic contraction of the lumbar and gluteal muscles. This and some other symptoms make up the group of "tension symptoms" - pain that occurs when the nerve fibers are stretched.

Soreness in the projection of damaged nerve fibers occurs when the leg is lifted up when the person is lying on his back. Pathogenetic mechanism the onset of the symptom is due to the fact that when the lower extremities move, the sciatic nerve has to be stretched, but when it is infringed, the length of the nerve fiber decreases. Against this background, when the limbs are slowly lifted up, the sciatic nerve is "overstretched", so pain occurs.

What it is

Physiologically, the sciatic nerve is normally able to stretch to a length of up to 15 mm. It passes through the gluteal muscles and innervates the thigh and lower leg. Theoretically, its infringement can be localized throughout, but in practice, compression is more common in the lumbosacral region and the gluteal region. Consider the mechanism of occurrence of Lasegue's symptom:

In the supine position, the sciatic nerve roots are relaxed;
Lifting up the leg with a bent knee does not lead to pain, since the sciatic nerve is not "stretched";
Raising up a straight leg in a supine position leads to pain in the lower back with compression of the sciatic nerve.

False-positive symptom of Lasegue

A false positive Lasegue symptom is observed in people with reduced endurance of the muscle groups of the back of the thigh. If it is present, lifting the leg up leads to soreness of the femoral muscles. False-positive "triggering" is observed in older people. Its pathogenesis is not associated with compression of the sciatic nerve.

Neurological symptom assessment

When evaluating the state of the sciatic nerve in patients with suspected vertebrogenic lumbishalgia, neurologists note not only the presence of pain. What you need to pay attention to when assessing the symptom of Lasegue:

The appearance of pain in the lower back when lifting the lower extremities to an angle of 60 degrees is doubtful. Pain is associated with psychological state than with compression of the sciatic nerve fiber;
Pain syndrome when lifting the legs over 60 degrees is a reliable confirmation of a decrease in the length of the sciatic nerve.

It is impossible to raise the lower limbs above the achieved level if the patient has pain. The sciatic nerve is able to withstand loads up to 3 kg. Such pressure on it occurs with the upper position of the leg above the horizontal plane at an angle of 60-65 degrees. With excessive loads, there is a risk of rupture of the nerve fiber!

Important rules for checking with Lasegue:

You can not quickly raise the lower limbs;
The procedure is performed smoothly and stops after reaching the pain syndrome, even if the angle of elevation is only 15 or 20 degrees;
You can check the pathological changes in the lower parts of the spinal column using magnetic resonance imaging (MRI);
It is impossible to check s-m Lasegue after the introduction of anesthesia or taking painkillers. They distort the test results.

Reasons for the appearance

The most common cause pathological symptom of tension of the sciatic nerve - herniated disc in the lumbosacral spine 2 and 3 degrees.

With a pronounced prolapse of the disc into the area spinal cord at the L5-S1 level, the patient has pain along the femur and lower leg due to vertebrogenic lumbishalgia, so the assessment of tension symptoms does not supplement the clinical status with important information. In the presence of such symptoms, an x-ray of the lumbar spine is mandatory. If possible, an MRI of the lumbosacral part of the spinal column is performed.

Other diseases in which tension of the sciatic nerve is observed:

Piriformis syndrome - the nerve root is compressed not at the level of the spine, but in the gluteal region;
Osteochondrosis of the lumbosacral spine;
Bechterew's disease - calcification (deposition of calcium salts) of the ligamentous apparatus of the spinal column;
Compression of the lower part of the spinal cord (cauda equina syndrome).

If pathological symptoms of tension are detected, the neurologist necessarily refers the patient to additional examinations: X-ray of the spine, magnetic resonance (MRI) and computed tomography (CT). They are carried out to determine the cause of the disease and establish a reliable diagnosis.

On the video - checking the symptom of Lasegue:

The basis of the so-called symptoms of "tension" and "position" is myopically (reflex, subconscious) of the affected motor segment due to irritation of the receptors of its deformed tissues and causing an increase in intradiscal pressure in a number of symptoms. When conducting experiments on animal corpses, it was proved that the nerves have a margin of length and the ability to move relative to the adjacent tissues in the fascial bed, as a result of which there is practically no tension on the nerve.

The main symptoms of position and tension are:

1. Symptom Fentz - the phenomenon of "oblique" rotation. If the head tilted forward is rotated in both directions and pain occurs, this indicates the presence of rubbing spondylotic growths of adjacent vertebrae. 2. Klein's symptom - with forced turns and tilting of the head, sensations of dizziness, nausea, and noise in the head may occur. This indicates the interest of the vertebral artery in cervical osteochondrosis. 3. Spurling's symptom - the phenomenon of "intervertebral foramen". With a load on the head, tilted to the shoulder or tilted and turned to the diseased side, paresthesias or pains occur, extending into the zone of innervation of the root, which is subjected to compression in the intervertebral foramen. 4. Berchi's test - the patient sits on a chair, the doctor stands behind the patient and embraces lower jaw, presses his head to his chest, rises on his toes, as a result, traction occurs cervical spine (compression of the roots is removed, blood flow through the vertebral arteries improves). If the nature and intensity of noise and pain in the neck, head or ear changes, then this indicates the interest of the cervical spine in the occurrence of cerebral symptoms. 5. Symptom of Neri - with active and passive tilts of the head forward, pain occurs in the area of the affected root. 6. Symptom of "axial load" - with pressure on the patient's head along the vertical axis, pain and paresthesia increase in the area of the affected root. 7. Symptom of Lermitte - with a sharp tilt of the head forward, pain occurs in the form of an electric current passing through the entire body along the spine. 8. Symptom of "raised and lowered hand" - a decrease in pain with a horizontal position of the hand and an increase with the addition of paresthesia at night with a lowered hand; allows to differentiate discogenic process from infectious and toxic. 9. Symptom of "reins" - in case of damage to the thoracic vertebrae, the long muscles of the back below the level of the lesion are tense and, when the patient bends, they tense up in the form of stretched reins. Usually the symptom is sharply positive in secondary radiculargia (tuberculosis, metastasis, Schmorl's hernia). 10. Bonnet test - adduction of the thigh is accompanied by tension of the piriformis muscle, and in the presence of neuroosteofibrosis and soreness. 11. Symptom of Lasegue - there are three degrees of its severity:

I - mild: pain appears when the leg is raised to an angle of 60 °, not intense, there is a moderate protective contraction of the back muscles, abdominal wall, pelvis;

II - moderately pronounced: pain appears when the leg is raised to an angle of 45 °, there is a sharp protective contraction of individual muscles, a moderate autonomic reaction;

III - pronounced: the angle of raising the leg up to 30 °, there is a generalized protective muscle contraction and a sharp vegetative reaction. There are modifications of the symptom of Lasegue, which can be used in expert cases: a) the appearance of pain when lowering the leg from the edge of the couch in the position of the patient lying on his stomach; b) the study of the symptom of Lasegue in the position of the patient standing; c) Vengerov's technique: contraction of the abdominal muscles when examining Lasegue's symptom (it is necessary to divert the patient's attention beforehand), etc. 12. Ankylosing spondylitis (Lasegue's cross symptom) - the occurrence of pain in the "sick" leg when examining Lasegue's symptom on the healthy side. 13. Symptom of "landing" - bending of the sore leg or both legs when the patient tries to sit up in bed with straightened legs. 14. Waserman's symptom - the appearance of pain along the front surface of the thigh when lifting up the straightened leg in a patient lying on his stomach. 15. Matskevich's symptom - the appearance of pain along the anterior surface of the thigh when the leg is bent in a patient lying on his stomach. 16. Symptom of Dejerine ("cough point") - the appearance of pain in the lower back when coughing, sneezing, straining. 17. Sicard's symptom - pain along the sciatic nerve with strong plantar flexion of the foot in a lying patient. 18. Symptom of Gowers - Sicar - pain along the sciatic nerve with strong dorsiflexion of the foot. 19. Symptom of Turin - pain along the sciatic nerve with a strong dorsal extension of the thumb. 20. Symptom of Razdolsky (“bell”) - when pressing on the interspinous ligament, spinous process, paravertebral points, pain radiates to the radicular or sclerotomy zone of the diseased leg. 21. Symptom of "locked back" - the patient has a feeling of a backache after an attempt to lift a weight or at the moment of a sharp inclination, extension of the body in the form of severe pain in the lower back or in the lumbosacral region, fixing the body in a bent position; patients cannot move, as any movement causes a sharp pain. 22. Symptom of Amos - characterized by a peculiar transition from a lying position to a sitting position: trying to sit down, the patient helps himself, resting his hands on the lumbar region. This symptom is noted in vertebrogenic lumbosacral pain syndrome. 23. Marching test Panov - Lobzin - Churilov - in a standing position, the patient is asked to march in place, simultaneously palpating the lumbar paravertebral muscles. On the side of pain (homolateral side), pronounced muscle tension is found.

Often, patients with vertebrogenic pathology also have vegetative disorders. So, trophic changes are manifested in the skin, subcutaneous tissue in the form of a violation of sweating (anhidrosis or hyperhidrosis), skin peeling, wrinkling, thinning, swelling; in the form of pain at the points of attachment of muscles and tendons to bone protrusions.

A number of vegetative pain points are also palpated.

1) A. M. Grinshtein's point (orbital) - at the inner corner of the orbit. 2) Point of the temporal artery - palpated by sliding palpation. 3) Point of the vertebral artery - located medially to the posterior edge of the sternocleidomastoid muscle, below the occipital points on the line connecting the apex of the mastoid process and the spinous process of the epistrophy at the border of the outer and middle thirds. 4) The point of the upper cervical sympathetic node - at the level of C2-C7 vertebrae medial to the naderb points on the anterior-lateral surface of the bodies. 5) The point of the stellate node is from the transverse process of the C7 vertebra to the head of the first rib. 6) Markelov points - Birbrair - carotid artery, upper trigeminal, phrenic nerve (above the middle of the clavicle), shoulder girdle (in the middle third), median point of the shoulder, radial artery, thenar, intercostal, vertebral (D-3), solar plexus (midway between the navel and pubis), Lapinsky (near the inner edge of the popliteal fold), arteries of the feet.

Vasomotor disorders are manifested by chilliness of the extremities, a pronounced venous pattern; decrease in temperature of both or one foot, back of the hand, forearm (Erben's symptom); a decrease in the pulsation of the arteries of one or both feet, more often on the side of more severe pain (Wartenberg's symptom).

There is asymmetry in the color of the skin of the feet and hands. So, if the limb is pale and cold to the touch, then arterioles suffer; if cyanotic, cold - then arteries and venules; if cyanotic, warm - then venules.

The easiest to detect vegetative-vascular changes is the Bogolepov test. The patient stretches his arms forward - determine the color of the skin of the hands and blood supply. Then he raises one limb as high as possible, and lowers the other down. After 30 seconds, the patient raises his arms to the starting position. In healthy individuals, the color of the nails becomes the same after 30 seconds.

Patients with vertebral artery irritation syndrome experience hazy sensations before their eyes, headache, paracusia, intolerance to noise and bright light, dizziness, nausea, palpitations, and pain in the region of the heart (cervical migraine). The state of the tone of the intracerebral vessels is judged by the state of the arteries of the retina, by the sensations that arise when turning and tilting the head and when stretching according to Bertschi.

Patients may develop a sensitivity disorder of sympathetic origin, mild hypoalgesia in the form of a half-hood or half-jacket. There may also be reflected visceral symptoms, especially from the urinary and gallbladder.

They also pay attention to the presence of a direct symptom of Claude - Barnard - Horner (narrowing of the pupil, palpebral fissure and retraction of the eyeball) or vice versa. The reaction to UV radiation changes (less on the pain side), the indicators of the galvanic test change, blood pressure, pulse, rheovasography, kymography.

It is likely that the nerve is damaged during sudden movements, including this can lead to the fact that the nerve fibers are torn. Nerve, one of the most massive, lower limb- sciatic, it is he who is involved in the case of pain syndrome localized in the lumbosacral region.

Under such conditions, a positive symptom of Lasegue can be determined, which is observed on both sides or is isolated on only one side.

In general terms about the symptom of Lasegue

One of the most informative diagnostic symptoms used in neurological practice is Lasegue's symptom. Another common name is tension symptom.

Implementation this study necessary for those patients who have a suspicion of various kinds of diseases of the spine, pathology of the nerve roots, sciatic nerve, and so on, which is directly related to osteochondrosis and other diseases.

If the nerve fibers are limited in elongation, the Lasegue symptom appears, this is considered its main cause. This limitation occurs when the nerve roots are crushed in the intervertebral foramen.

In addition, with excessive stretching of the nerve, when it needs to “go around” another additional bulge, which tends to be formed due to a herniated disc.

The final value, which manifests itself in the possibility of lengthening the fibers of the sciatic nerve, as well as the achievement of lengthening will inevitably be accompanied by pain on the side of the lesion - in the part where osteochondrosis develops or a hernial protrusion is located.

Lasegue confirmation video test

The clinical picture of the Lasegue symptom

The symptom of tension is a consequence of the pathology of the roots in the lumbosacral part of the spinal cord or nerves that come from the sacral plexus.

During a clinical examination of patients who have signs of root damage in the lumbosacral region, at the very beginning, a study is made for the presence of symptoms of tension, one of which is - a symptom of Lasegue.

The symptom of Lasegue is checked when the patient lies on his back, and the specialist makes a passive movement of his leg in the following phases:

Phase 1- raising the patient's leg (flexion until pain appears in the hip joint);
Phase 2- bending in knee joint legs;
Phase 3- extension in the knee joint of the leg.

Signs that may indicate a positive symptom of Lasegue, there are the following:

In the first phase, pain of an intense nature is manifested along the back or outer surface of the lower leg or thigh;
In the second phase, the pain may disappear or at least decrease;
In the third phase, pain returns.

In order to objectify the symptom of Lasegue's tension and assess its dynamics, it would be appropriate to measure in degrees the angle between the raised leg and the horizontal surface at which pain occurs.

There is a division into three degrees according to the severity of the Lasegue tension symptom:

Grade I characterized by pain that arose when the lower limb was raised by 60 °;
Grade II characterized by a sensation of pain when raising the lower limb by 45 °, a moderate vegetative reaction is observed, a sharp contraction of individual muscles develops, a protective plan;
Grade III, at which the angle of raising the lower limb reaches 30 °, is characterized by the appearance of a protective muscle contraction, of a generalized nature, and a sharp vegetative reaction also occurs.

Identification of the negative and positive symptom of Lasegue

There is such a thing as a negative and positive symptom of Lasegue. To correctly identify the symptom of Lasegue's tension in such a difference, the patient must take a supine position.

Then the specialist, without sudden movements, gradually begins to raise the straightened leg to the patient. The subject, in principle, can also independently raise the lower limb, while the doctor only directs and holds it.

A similar action is carried out until the patient feels pain along the back of the thigh (along the sciatic nerve). After detection of pain, the study is stopped.

Positive symptom of Lasegue's tension it can be considered if pain sensations arose when the specialist raised the patient's leg 30-40 ° above the level of the horizontal surface, where the patient actually lies.

And when the doctor gradually begins to bend the subject's leg in the knee and hip joints, the pain disappears.

This option positive symptom Lasegue traction may well be associated with compression (lesion) of the lumbar (in other words, lumbar) 5th root or sacral (sacral) 1st root. In most cases the reason for this phenomenon may lie in osteochondrosis.

In the case of the appearance of pain when lifting the leg in a straightened state of the subject at 70 ° above the horizontal surface - we are talking about non-radicular pain that can be provoked pathological changes thigh muscles, paravertebral muscles and so on.

In the case when the pain syndrome in the knee and hip joint does not go away when the lower limb is flexed - Lasegue's tension symptom is considered negative.

Then it is not the symptoms of neurological origin that are taken into account at all. Pain may be due to pathology of the hip or knee joint.

A patient who is found to have such clinical picture in the study, additional diagnostics are needed to establish true reason, which could cause pain.

Pain in the leg can very often manifest itself due to a psychogenic factor. As a result of diagnostic studies, no relationship will be found between changes in the position of the lower limb and the appearance of symptoms in the subject. Pains of a similar nature are common in women who are subject to hysteria.

A specialist, or rather a neuropathologist, will be able to identify the symptom of Lasegue. Self-diagnosis will most likely fail therefore, it is not recommended to carry out at home.

It is quite likely that mistakes will be made, both in the diagnostic technique and in the very evaluation of the final results of such a research procedure.

The symptoms of root tension and “position” are examined, most of which are based on reflex myopically of the affected motor segment of the spine due to irritation of the receptors of its deformed tissues.

De Klein's symptom. With forced turns and tilting of the head, sensations of dizziness, nausea, and noise in the head may occur. This indicates the interest of the vertebral artery.

Fentz's symptom is a phenomenon of "oblique" rotation. If, with the head tilted forward, its rotation in both directions causes pain, then this indicates the presence of rubbing spondylotic growths of adjacent vertebrae.

Symptom Neri. With active and passive tilts of the head forward, pain occurs in the area of the affected root.

Spurling's symptom is the phenomenon of "intervertebral foramen". With a load on the head, tilted to the shoulder or tilted and turned to the diseased side, paresthesias or pains occur, extending into the zone of innervation of the root, which is subjected to compression in the intervertebral foramen.

Symptom of Lhermitte. With a sharp tilt of the head forward, pain appears in the form of an electric current passing through the entire body along the spine.

Berchi's test. The patient sits on a chair, the doctor stands behind the patient, covers the lower jaw with his hands, presses his head to his chest, rises on his toes and stretches the cervical spine. If this changes the nature and intensity of noise in the ear or in the head, pain in the neck, then this indicates the interest of the cervical spine in the occurrence of symptoms.

The symptom of "reins". With damage to the thoracic vertebrae, the long muscles of the back below the level of the lesion are tense and, when the patient bends, they tense up in the form of stretched reins. It is usually found in secondary radiculalgia (tuberculosis, tumor metastasis, less often Schmorl's hernia).

Bonnet test - adduction and rotation inside the thigh is accompanied by pain due to the tension of the piriformis muscle.

Symptom of Lasegue-Lazarevich. There are three degrees of its severity.

I degree (mild) - pain along the dermatome (root) appears when the leg is raised to an angle of 60 °. The pain is intense, there is a moderate protective contraction of the muscles of the back, abdominal wall, pelvis;

II degree (moderately pronounced) - pain appears when the leg is raised to an angle of 45?, there is a sharp protective contraction of individual muscles, a moderate autonomic reaction;

III degree (sharply pronounced) - the angle of raising the leg is up to 30 °, there is a generalized protective muscle contraction, a sharp vegetative reaction.

Modification of the symptom of Lasegue, which can be used in expert cases: 1) the appearance of pain when lowering the leg from the edge of the couch in the position of the patient lying on his stomach; 2) research of a symptom of Lasegue in position of the patient standing; 3) Vengerov's technique - contraction of the abdominal muscles in the study of the symptom of Lasegue (it is necessary to first divert the attention of the patient).

The symptom of "landing" is the bending of the sore leg or both legs when the patient tries to sit up in bed with straightened legs.

Ankylosing spondylitis (cross-symptom of Lasegue) - the occurrence of pain in the "sick" leg when examining the symptom of Lasegue on the healthy side.

Waserman's symptom - the occurrence of pain along the anterior surface of the thigh when lifting up the straightened leg in a patient lying on his stomach.

Symptom Matskevich - the appearance of pain on the anterior surface of the thigh when bending the lower leg in a patient lying on his stomach.

The symptom of "cough shock" (Dejerine) is the appearance of pain in the lower back when coughing, sneezing, straining.

Gowers-Sicard syndrome - pain along the sciatic nerve with strong dorsiflexion of the foot.

Sicard's symptom - pain along the sciatic nerve with strong plantar flexion of the foot in a lying patient.

Symptom of the "bell" - when pressing on the interspinous ligament, spinous process, or, better, on the paravertebral points - the pain radiates to the radicular or sclerotomy zone of the diseased leg.

Amos symptom - characterized by a peculiar transition from a lying position to a sitting position - trying to sit down, the patient helps himself, resting his hands on the lumbar region. The symptom is noted with vertebrogenic lumbosacral pain syndrome.

Most of them are based on myopically (reflex, subconscious) of the affected motor segment of the spine due to irritation of the receptors of its deformed tissues.

Fentz's symptom is a phenomenon of "oblique" rotation. Tilt your head forward and rotate in both directions. The occurrence of pain indicates the presence of rubbing spondylotic growths of adjacent vertebrae.

With forced turns and tilting of the head, dizziness, nausea, noise in the head can occur. This indicates involvement of the vertebral artery in the process.

Spurling's symptom - the phenomenon of "intervertebral foramen". With a load on the head, tilted to the shoulder or tilted and turned to the diseased side, paresthesias or pain occur, extending into the zone of innervation of the root, which is subjected to compression in the intervertebral foramen. Often, the recoil zone corresponds to the point of the shoulder girdle, and a nodule of neuroosteofibrosis is palpated there.

Berchi's test - the patient sits on a chair, the doctor, standing behind him, covers the lower jaw with his hands, presses his head to his chest, rises on his toes and stretches the cervical spine. If the nature and intensity of noise and pain in the ear or head, neck, then this indicates the involvement of the cervical spine in the process.

Symptom Peri - with active and passive tilts of the head forward, pain occurs in the area of the affected root.

Symptom axial load- when pressing on the head along the vertical axis, pain and paresthesia increase in the area of the affected root.

Symptom Lermitte - with a sharp tilt of the head forward, pain occurs in the form of an electric current passing through the entire body along the spine.

A symptom of a raised and lowered hand is a decrease in pain with a horizontal position of the hand and its increase with the addition of paresthesia at night with a lowered hand; allows to differentiate discogenic process from infectious and toxic.

Symptom of the reins - with damage to the thoracic vertebrae, the long muscles of the back below the level of the lesion when bending over are strained in the form of stretched reins. Usually this symptom is positive in secondary radiculargia (tuberculosis, metastases, Schmorl's hernia).

Bonnet test - hip adduction is accompanied by tension of the piriformis muscle, and in the presence of neuroosteofibrosis - and soreness.

Symptom Lasegue - the patient lies on his back. The diseased leg unbent at the knee is taken by the foot and lifted up, as a result of which the sciatic nerve is stretched and appears strong pain along the length of the nerve, radiating to the lower back. However, if the leg is bent at the knee, the pain stops (the nerve stretched before this relaxes).

4) carotid artery - upper trigeminal nerve(trigeminal), phrenic nerve (above the middle of the clavicle), shoulder girdle (in the middle third), median point of the shoulder, radial artery, eminence thumb(thenar), intercostal, solar plexus (in the middle between the navel and pubis), Lapinsky (near the inner edge of the popliteal crease), arteries of the foot;

5) superior cervical sympathetic ganglion.

6) stellate node - from the transverse process.