Monthly Archives: March 2014

了解上臂叢神經損傷

上臂叢神經受傷往往和創傷相似,這會導致頸椎損傷,也能體現類似的症狀發生。如下面的圖中,臂叢神經是由幾個頸椎神經根和T1神經根的形成。
有時會傷到臂叢可以在一個過度拉伸的創傷性事件直接導致。例如,在同一個側身碰撞產生影響的對側的神經(以及由此產生的彎曲)可以被拉伸和/或撕裂。 [見下圖]
傷到周圍的肌肉可間接導致傷害到臂叢神經,以及。臂叢神經的前,中斜角肌,它連接了頸椎和第一肋骨之間運行。在車禍意外,頸部過伸可過度伸展這些肌肉,這表現在如下圖所示。
當這些肌肉被拉伸,即使頸神經根或臂叢本身可以不直接受傷,但由此產生的腫脹或痙攣和頸神經根損傷症狀一致。 [見下圖]
胸廓出口綜合徵是另一種機制,使臂叢可能會受傷。下圖顯示了腋鞘,其中包含來自臂叢神經和腋靜脈和動脈的神經,穿過鎖骨和第一肋骨之間形成的開口。
可發生胸廓出口綜合徵無論是第一肋骨(1)由於scalenes的痙攣或神經支配(2)損失的斜方肌和/或其他肌肉上插入鎖骨或肩胛骨抬高,造成肩下垂[見下圖]。無論發生哪種變化,鎖骨和第一肋骨之間的開口封閉,並且通過胸廓出口周遊神經和血管受到壓迫。
正如人們可以在下面的圖看到,一個受傷的臂叢神經會影響手臂的運動和感覺功能。早期的損傷治療可以有更好的機會防止永久性損壞。然而,這也依賴於初始損傷的嚴重程度。有時,手術是必要解決撕裂/破裂神經傷害。

《都市日報》基層童義診脊

姿勢不良

港童最常見的健康問題為鼻敏感、呼吸系統毛病及專注力不足等,這些均可能是由寒背、高低膊等不良姿勢令脊骨神經受壓引發。兒童脊科基金將籌募經費,推行全港基層兒童義診計劃。

根據衞生署數字,過去15年患有脊骨健康問題的兒童人數不斷上升;學生健康服務調查更顯示,前年參加健康評估的學生中,疑有脊柱側彎的比例達一成半。

兒童脊科基金副主席唐右天說,脊骨神經主導人體大部分功能,若兒童出現脊骨側彎、高低膊或寒背等脊骨錯位問題,或影響神經系統的正常運作,產生各種健康問題,「好多時睇到嘅只係表面病徵,尋根究底就會發現係脊骨神經出現問題。」脊科治療旨在找出脊骨錯位及進行矯正,令神經系統回復正常運作,從而提升身體的自愈能力,使身體回復最佳狀態。

患脊骨病童數字升

小五的瑩瑩半年前起經常頭痛、腳痛,不能上學,每周缺課兩、3日。看普通門診醫生都診斷她是呼吸道感染或鼻敏感,母親便以為是讀書壓力引致。直至兒童脊科基金到該校為學童進行義診,始發現瑩瑩有輕微脊柱側彎,接受治療後情況已改善。

Understanding the Brachial Plexus Injury

Injuries to the brachial plexus can often take place from trauma similar to that which causes cervical spine injuries and can also manifest similar symptoms. As shown in the illustration below, the brachial plexus is formed by several of the cervical nerve roots and the T1 nerve root.
Sometimes injury to the brachial plexus can be the direct result of excessive stretch during a traumatic event. For example, in a motor vehicle collision with a violent side impact the nerves on the contralateral side of the impact (and resulting flexion) may be stretched and/or torn. [see illustration below]
Injury to the surrounding muscles can indirectly cause injury to the brachial plexus, as well. The brachial plexus runs between the anterior and middle scalene muscles, which connect the cervical spine and first rib. In a motor vehicle collision, hyperextension of the neck may excessively stretch these muscles, as demonstrated in the illustration below.
When these muscles are stretched, the resulting swelling or spasm can result in symptoms consistent with cervical nerve root injury even though the cervical nerve roots or brachial plexus themselves may not be directly injured. [see illustration below]
Thoracic outlet syndrome is another mechanism by which the brachial plexus can be injured. The illustration below shows that the axillary sheath, which contains the nerves from the brachial plexus and the axillary vein and artery, passes through the opening created between the clavicle and first rib.
Thoracic outlet syndrome can occur either by (1) the elevation of the first rib due to spasm of the scalenes or (2) the loss of innervation to the trapezius and/or other muscles that insert on the clavicle or scapula, causing the shoulder to droop [see illustration below]. By either mechanism, the opening between the clavicle and first rib is closed and the nerves and blood vessels that travel through the thoracic outlet become compressed.
As one can see in the illustration below, an injury to the brachial plexus affects the motor and sensory function of the arm. The earlier the injury is identified and treated, the better chances are for recovery and preventing permanent damage. However, this is also dependent on the severity of the initial injury. Sometimes surgical intervention is needed to address torn/ruptured nerves andexcessive scarring.