RU2328218C2 - Method of knee tendo-ligamentous apparatus injury estimation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: knee joint painful syndrome is estimated by points. Palpatory tenderness are estimated, duration palpatory tenderness, palpatory tenderness localisation, quantity of pain points of knee joint, quantity of pain sites of knee joint, expressiveness of spontaneous pains in knee joint, puffiness character. Factors are calculated in points. On the basis of these calculations conclusion about slight severity of knee tendo-ligamentous apparatus injury in case 1-10 points calculated; average severity of knee tendo-ligamentous apparatus injury is evidenced within 11-20 points and considerable severity of knee tendo-ligamentous apparatus injury is indicated with 21 points and more.

EFFECT: method allows point estimation of defeat of severity of knee tendo-ligamentous apparatus injury for prescription of timely adequate therapy.

7 tbl, 3 ex

Description

The invention relates to medicine, in particular to therapy.

Complaints about the involvement of periarticular soft tissues account for up to 59% of primary patient visits in the practice of a rheumatologist and up to 15% of consultations with general practitioners [C A Speed / BMJ 2001; 323: 382-386 (18 August)]. Currently, the diagnosis of such lesions is based on clinical and instrumental methods, such as ultrasound and magnetic resonance imaging [J Braun, M A Khan, J Sieper / Ann Rheum Dis 2000; 59: 985-994 (December)].

Unfortunately, these methods are either very expensive and / or require the involvement of specially trained personnel, or, being high-quality, give a general description of all affected joints, not allowing each joint to be evaluated separately.

A prototype of the invention is the Mander enthesis index (1987), which consists of a score for enthesopathies [L Heuft-Dorenbosch, A Spoorenberg et al / Annals of the Rheumatic Diseases 2003; 62: 127-132].

This index allows you to evaluate enthesopathies quantitatively, but it is cumbersome and time-consuming, and also, when applied to the attachment sites of tendons and ligaments, it does not allow to directly characterize these structures.

The aim of the invention is a point (0-80 points) assessment of lesions of the tendon-ligamentous apparatus of the knee joint, dynamic control of changes, analysis of the severity of these manifestations, in particular, for the timely appointment of adequate therapy, in a way that is effective and affordable for most medical institutions.

The clinical result is achieved by the fact that the index characterizes the pain syndrome by the semi-quantitative method of all tendons and ligaments of the knee joint and their attachment sites, as well as a general characteristic of the pain syndrome of the entire knee joint.

Number of pain points

local pain at one point 1 point local pain in 2-3 points 2 points local pain at more than 3 points 3 points spilled pain, no specific point 0 points

The severity of spontaneous pain:

alone no pain, appear when moving 1 point slight at rest, aggravated by movement 2 points strong at rest, movement in the joint is limited due to pain 3 points

The nature of puffiness:

connection of puffiness with a specific bag, tendon sheath:

1-3 tendon bags of the knee joint and / or tendon sheath 1 point 4-5 tendon bags of the knee joint and / or tendon sheath 2 points more than 5 tendon bags of the knee joint and / or tendon sheath 3 points joint effusion is determined 0 points

The number of painful areas:

in a projection of a joint 1-3 sites are defined 1 point 4-5 sections are determined 2 points defined more than 5 sites 3 points

Soreness Duration of pain Radiating pain Localization of soreness Quadriceps tendon Patellar ligament "Goose foot" Medial ligament Semi-membranous tendon Lateral ligament Thigh Biceps Tendon

Note: Points are determined as follows.

Sore areas:

on palpation, the patient indicates the presence of pain 1 point facial expression 2 points motor reaction 3 points

Duration of soreness:

Lasts 1-5 seconds 1 point Lasts 6-60 seconds 2 points Lasts more than 1 minute 3 points

Palpation pain irradiation

soreness is localized at the site of palpation 1 point spreads along the tendon, ligament 2 points spreads to adjacent tissues 3 points

Localization of soreness

In the place of attachment of the investigated structure (tendon, ligament) 0 points Along the studied structure 1 point

The severity of the lesion:

weak 1-10 points; average 11-20 points; Significant more than 21 points.

The proposed method differs in that only one knee joint is evaluated, all the main tendons and ligaments of the knee joint are described, a more complete description of local (soreness, irradiation, duration of soreness) and general (number of pain points, number of painful areas, severity of spontaneous pains, character puffiness) manifestations of damage to periarticular tissues.

Example No. 1.

Patient M-va Z.A., 64 years old, was admitted to the city rheumatology center (case history No. 5160) in Kazan with a diagnosis of Osteoarthrosis, mainly gonarthrosis, Ro II, FN II.

The patient was treated on an outpatient basis for a year without a satisfactory result. Upon admission, the patient was determined by the clinical status, including using a score of damage to the tendon-ligamentous apparatus of the knee joint.

Number of pain points

local pain at one point 1 point

The severity of spontaneous pain:

slight at rest, aggravated by movement 2 points

The nature of puffiness:

connection of puffiness with a specific bag, tendon sheath:

1-3 tendon bags of the knee joint and / or tendon sheath 1 point

The number of painful areas:

4-5 sections are determined 2 points

Soreness Duration of pain Radiating pain Localization of soreness Quadriceps tendon - - - - Patellar ligament - - - - "Goose foot" 2 one one one Medial ligament 3 2 2 0 Semi-membranous tendon 3 3 one one Lateral ligament one 2 one 0 Thigh Biceps Tendon one one one one

Result: 34 points; severity of damage: significant.

The resulting high value made it possible to draw a conclusion about the predominance of damage to the periarticular tissues in the clinic of pain, on the basis of which it was decided to prescribe local therapy (drugs were administered periarticular).

After the treatment, the patient noted a significant improvement in the condition with a decrease in pain and an improvement in the functional state of the knee joints.

Number of pain points

local pain at one point 1 point

The severity of spontaneous pain:

alone no pain, appear when moving 1 point

The nature of puffiness:

The number of painful areas:

in a projection of a joint 1-3 sites are defined 1 point

Soreness Duration of pain Radiating pain Localization of soreness Quadriceps tendon - Patellar ligament - "Goose foot" one one one 0 Medial ligament one 2 one 0 Semi-membranous tendon 2 2 one 0 Lateral ligament one one one 0 Thigh Biceps Tendon -

Result: 18 points; severity of lesion: medium.

Example 2

Patient Х-va G.K., 60 years old, was admitted to the city rheumatology center (case history No. 3165) in Kazan with a diagnosis of Osteoarthrosis, mainly gonarthrosis, Ro II, FN I.

The patient was treated on an outpatient basis for 3 years without a satisfactory result. Upon admission, the patient was determined by the clinical status, including using a score of damage to the tendon-ligamentous apparatus of the knee joint.

Number of pain points

local pain at one point 1 point

The severity of spontaneous pain:

slight at rest, aggravated by movement 2 points

The nature of puffiness:

connection of puffiness with a specific bag, tendon sheath:

1-3 tendon bags of the knee joint and / or tendon sheath 1 point

The number of painful areas:

4-5 sections are determined 2 points

Soreness Duration of pain Radiating pain Localization of soreness Quadriceps tendon - Patellar ligament one one one 0 "Goose foot" - Medial ligament 2 2 one 0 Semi-membranous tendon 3 2 one one Lateral ligament 3 2 one 0 Thigh Biceps Tendon 2 2 one 0

Result: 32 points; severity of damage: significant.

The resulting high value made it possible to draw a conclusion about the predominance of damage to the periarticular tissues in the clinic of pain, on the basis of which it was decided to prescribe local therapy (drugs were administered periarticular). After the treatment, the patient noted a significant improvement with a decrease in pain. Palpation tenderness of the joint also decreased.

Number of pain points

local pain at one point 1 point

The severity of spontaneous pain:

alone no pain, appear when moving 1 point

The nature of puffiness:

The number of painful areas:

in a projection of a joint 1-3 sites are defined 1 point

Soreness Duration of pain Radiating pain Localization of soreness Quadriceps tendon - Patellar ligament - "Goose foot" - Medial ligament 2 one one 0 Semi-membranous tendon 3 one one one Lateral ligament one one one 0 Thigh Biceps Tendon -

Result: 16 points; severity of lesion: medium.

Example No. 3.

Patient K-on R.Sh., 55 years old, was admitted to the city rheumatology center (case history No. 5139) in Kazan with a diagnosis of Osteoarthrosis, mainly gonarthrosis, Ro II, FN I.

The patient was treated on an outpatient basis for a year without a satisfactory result. Upon admission, the patient was determined by the clinical status, including using a scoring of lesions of the tendon-ligamentous apparatus of the knee joint, on the basis of which it was concluded that there was damage to the periarticular tissues in the clinic of the pain syndrome.

Number of pain points

local pain in 2-3 points 2 points

The severity of spontaneous pain:

slight at rest, aggravated by movement 2 points

The nature of puffiness:

connection of puffiness with a specific bag, tendon sheath:

1-3 tendon bags of the knee joint and / or tendon sheath

1 point

The number of painful areas:

4-5 sections are determined 2 points

Soreness Duration of pain Radiating pain Localization of soreness Quadriceps tendon - Patellar ligament - "Goose foot" 2 2 one 0 Medial ligament 3 2 one 0 Semi-membranous tendon 3 2 one one Lateral ligament one one one 0 Thigh Biceps Tendon -

Result: 28 points; severity of damage: significant.

It was decided to prescribe local therapy (drugs were administered periarticularly). After the treatment, the patient noted a significant improvement in the condition with a decrease in pain and an improvement in the functional state of the knee joints.

Number of pain points

local pain at one point 1 point

The severity of spontaneous pain:

alone no pain, appear when moving 1 point

The nature of puffiness:

connection of puffiness with a specific bag, tendon sheath:

The number of painful areas:

in a projection of a joint 1-3 sites are defined 1 point

Soreness Duration of pain Radiating pain Localization of soreness Quadriceps tendon - Patellar ligament - "Goose foot" - Medial ligament 2 one one 0 Semi-membranous tendon 2 one one 0 Lateral ligament - Thigh Biceps Tendon -

Result: 11 points; severity of lesion: medium.

Information sources

1. With A Speed / BMJ 2001; 323: 382-386 (18 August).

2. J Braun, M A Khan, J Sieper / Ann Rheum Dis 2000; 59: 985-994 (December).

3. L Heuft-Dorenbosch, A Spoorenberg et al / Annals of the Rheumatic Diseases 2003-62: 127-132.

Claims (1)

A method for assessing lesions of the tendon-ligamentous apparatus of the knee joint by determining pain of the entire knee joint, characterized in that a point assessment of pain of the knee joint is carried out, assessing pain on palpation: the patient indicates pain - 1 point, mimic reaction - 2 points, motor reaction - 3 points; with irradiation: pain on palpation: localized at the palpation site - 1 point, spreads along the tendon, ligament - 2 points, spreads to adjacent tissues - 3 points; and also the duration of pain on palpation: lasts 1-5 s - 1 point, lasts 6-60 s - 2 points, lasts more than 1-3 minutes - 3 points; localization of pain during palpation: at the place of attachment of the investigated structure: tendon, ligament - 0 points, along the studied structure - 1 point; the number of knee joint pain points: local pain at one point - 1 point, local pain at 2-3 points - 2 points, local pain at more than 3 points - 3 points, diffuse pain, no specific point - 0 points; the number of painful sections of the knee joint: in the projection of the joint, 1-3 sections are determined - 1 point, 4-5 sections are determined - 2 points, more than 5 sections are determined - 3 points; the severity of spontaneous pain in the knee joint: at rest there is no pain, appear when moving - 1 point, slight at rest, intensify when moving - 2 points, strong at rest, movement in the joint is limited due to pain - 3 points; the nature of puffiness: the relationship of puffiness with a specific bag, tendon sheath: 1-3 tendon bags of the knee joint and / or tendon sheaths - 1 point, 4-5 tendon bags of the knee joint and / or tendon sheaths - 2 points, more than 5 tendon bags of the knee joint and / or tendon sheaths - 3 points, determine the effusion in the joint - 0 points; they calculate indicators in points and based on these calculations conclude that the degree of damage to the tendon-ligamentous apparatus in the presence of 1-10 points is weak; about the average degree of damage to the tendon-ligamentous apparatus in the presence of 11-20 points; and about a significant degree of damage to the tendon-ligamentous apparatus in the presence of more than 21 points.