RU2380034C1 - Myotonometry technique in patients with vertebragenous pathology - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine and can be used in neurology to estimate muscular tone in the patients with vertebragenous pathology. It involves integrated assessment of tone of groups of vertebral muscles in horizontal and vertical position with a mechanical myotonometre with graduated action. The muscular tone is assessed in 13 part with gradual increase of controlled activity 0.5 kg to 2 kg by installation of a probe of the myotonometre on certain topographical points to the right and to the left: 1 - gonial angle for the characteristic of brain stem by tone condition of masticatory muscles, 2 - paravertebrally at the level of VII cervical vertebra, 2 cm aside from spinous processes, for the characteristic of cervical department, 3 - along the midclavicular line in a projection of 4 rib for the characteristic of anterior muscles of thorax, 4 - at the level of VII thoracic vertebra, 2 cm aside from spinous processes, for the characteristic of posterior muscles of thoracic spine, 5 - at the level of navel 5 cm aside from the median line, for the characteristic of abdominal muscles, 6 - paravertebrally at the level of III lumbar vertebra, 2 cm aside from spinous processes, for the characteristic of lumbar spine, 7 - at the level of V lumbar vertebra, 15 cm aside, for the characteristic of gluteus, 8 - 15 cm in the proximal direction from patella along the midline for the characteristic of anterior muscles of hip, 9 - 15 cm in the proximal direction from patella along the medial line for the characteristic of medial muscles of hip, 10 - 15 cm in the proximal direction from patella along the lateral line for the characteristic of lateral muscles of hip, 11 - 15 cm in the proximal direction from popliteal space on the posterior line for the characteristic of posterior muscles of hip, 12 - 15 cm in the proximal direction from patella along the anterior surface, 2 cm aside from the edge of shin bone for the characteristic of anterior muscles of shin, 13 - along the medial-posterior line, 15 cm in the distal direction from knee joint, for the characteristic of posterior muscles of shin.

EFFECT: method allows improving objectivity of measurements in patients with vertebragenous diseases.

2 tbl, 1 ex

Description

The invention relates to medicine and can be used in neurology in determining muscle tone in patients with vertebral pathology.

Vertebrogenic pathology, in particular hernias and protrusions of the intervertebral discs, is one of the leading pathogenetic factors leading to dysregulation of muscle tone at various levels (mainly, segmental centers of reflex regulation). The leading sign of vertebral syndrome is limited or local myofixation of the spine. Violation of local muscle and ligamento-articular fixation is accompanied by various changes in the configuration of the spine - flattening or strengthening of lordosis, kyphosis, scoliosis, kyphoscoliosis or lordoscoliosis. Violation of the mobility of the vertebral-motor segments (PDS) is determined, first of all, by the tension of both deep and superficial polyarticular muscles. Myofixation can be compensated, subcompensated and decompensated. Assessing the tension of the divided muscles allows us to judge the degree of myofixation (Khabirov F.A. Clinical neurology of the spine. Kazan, 2003). Identification of the degree of violation of muscle tone in patients with vertebrogenic pathology is a prerequisite for determining the severity of vertebral syndrome, which led to the development of a diagnostic algorithm using the method of myotonometry.

Currently, the main way to study muscle tone is palpation, which has several disadvantages due to subjective assessment and the lack of digital values in determining tone, which makes it difficult to use in the diagnosis of diseases of the nervous system, while monitoring the effectiveness of the treatment. In addition, the study of muscle tone is carried out by various types of myotonometers that record only a single indicator - muscle deformation, which is also not enough for the diagnostic process.

Closest to the invention is the study of muscle tone using a mechanical myotonometer with dosed exposure, proposed Ivanichev G.A. in 1990 (Ivanichev GA "Painful muscle tightening", 1990). This method is called variable discrete tonometry, allows you to objectify the hard-elastic properties of painful muscle muscle seals. However, this study does not characterize the pathology of muscle tone in vertebrogenic pathology, when there is a need for a comprehensive study of muscle tone of muscles, even in the absence of painful muscle seals in them.

The aim of the invention is to develop a non-invasive method for studying muscle tone in patients with vertebral diseases, which allows to improve the diagnosis of this pathology.

In the proposed method takes into account the following:

1. The state of muscle tone in the horizontal and vertical position of the patient is determined. This is due to the constant influence of gravitational forces and, accordingly, the activation of the extrapyramidal system in a vertical position. The study is divided into two stages: in the patient lying position and in the patient standing position.

2. Previously, it was revealed that the most informative indicators were identified when exposed to from 2 to 4 kg (G. Ivanichev, “Painful muscle tightness”, 1990), an increase in pain was detected when the load on the muscle exceeded two kilograms. Therefore, the load was limited to 2 kilograms, taking into account the principle of variable-discrete myotonometry, the study is carried out with a gradual increase in the load:

1 measurement at a load of 0.5 kg;

2 measurement at a load of 1 kg;

3 measurement at a load of 1.5 kg;

4 measurement at a load of 2 kg.

3. The topographic points where the probe of the myotonometer is placed are determined, since at each point there is a group of muscles that perform one function.

4. The departments are highlighted:

- the brain stem is determined by the state of tonus of the masticatory muscles 1 - study,

- cervical spine - 2 studies;

- the front muscle group of the chest - 3 study,

- back muscle group of the thoracic spine - 4 studies;

- abdominal muscles - 5 research,

- lumbar spine - 6 studies;

- gluteal muscle - 7 studies;

- lower limbs - the front muscle group of the thigh - 8 study,

- medial thigh muscle group - 9 studies;

- lateral group of femoral muscles - 10 studies;

- back group of femoral muscles - 11 studies;

- Shin muscles - front group - 12 research;

- the back muscle group of the leg - 13 study.

The myotonometry method is as follows.

The first study - in the patient’s position on the back, the probe of the myotonometer located in the left hand is placed on the right angle of the lower jaw on the right and the measurement is performed sequentially with a gradual increase in load from 0.5 to 2 kg, a similar study is performed on the left.

The second study - in the patient’s position on the abdomen, the probe of the myotonometer is installed paravertebrally at the level of the VII cervical vertebra, 2 cm away from the spinous processes to the sides, and the indicators of the myotonometer on the right and left are also taken - the measurement is carried out sequentially with a gradual increase in load from 0.5 to 2 kg

The third study - in the patient’s position on the back, the probe of the myotonometer is installed along the midclavicular line in the projection of 4 ribs on the right and left, the indicators of the myotonometer are recorded - the measurement is performed sequentially with a gradual increase in load from 0.5 to 2 kg.

The fourth study - in the position of the patient on the abdomen, is produced on the thoracic spine; the probe of the myotonometer is installed at the level of the VII thoracic vertebra, 2 cm departing from the spinous processes to the sides, the indicators of the myotonometer are taken on the right and left - the measurement is performed sequentially with a gradual increase in load from 0.5 to 2 kg.

The fifth study - in the patient’s position on the back, the muscle tone of the anterior abdominal wall is examined, the myotonometer probe is set at the navel level by 5 cm, departing from the midline, to the right and left, the myotonometer readings are recorded - the measurement is performed sequentially with a gradual increase in load from 0.5 up to 2 kg.

The sixth study - in the patient’s position on the abdomen, the probe of the myotonometer is installed paravertebrally at the level of the III lumbar vertebra, 2 cm away from the spinous processes to the sides, the indicators of the myotonometer are taken on the right and left, the indicators of the myotonometer are recorded - the measurement is performed sequentially with a gradual increase in load from 0, 5 to 2 kg.

The seventh study - in the patient’s position on the abdomen, the probe of the myotonometer is installed at the level V of the lumbar vertebra, backing 15 cm to the sides, to the right and left, the indicators of the myotonometer are recorded - the measurement is performed sequentially with a gradual increase in load from 0.5 to 2 kg.

The eighth study - in the patient’s position on the back, the probe of the myotonometer is installed 15 cm proximally from the patella in the midline, the study is performed on the right and left, the indicators of the myotonometer are recorded - the measurement is performed sequentially with a gradual increase in load from 0.5 to 2 kg.

The ninth study - the position of the patient on the back, the probe of the myotonometer is set 15 cm proximal to the patella along the medial line, to the right and left, the indicators of the myotonometer are recorded - the measurement is performed sequentially with a gradual increase in load from 0.5 to 2 kg.

The tenth study - the patient’s position on the back, the probe of the myotonometer is set 15 cm proximal to the patella along the lateral line on the right and left, the indicators of the myotonometer are recorded - the measurement is performed sequentially with a gradual increase in load from 0.5 to 2 kg.

The eleventh study - the position of the patient on the abdomen, the probe of the myotonometer is set 15 cm proximal to the popliteal fossa in the back line, to the right and left, the indicators of the myotonometer are recorded - the measurement is performed sequentially with a gradual increase in load from 0.5 to 2 kg.

The twelfth study - the patient’s position on the back, the myotonometer probe is set 15 cm distal from the patella on the front surface, 2 cm from the edge of the tibia, left and right, the myotonometer readings are recorded - the measurement is performed sequentially with a gradual increase in load from 0.5 up to 2 kg.

The thirteenth study - the position of the patient on the abdomen, the probe of the myotonometer is installed along the medial-posterior line distal to the knee joint by 15 cm, the indicators of the myotonometer are recorded on the right and left - the measurement is performed sequentially with a gradual increase in load from 0.5 to 2 kg.

The second stage of the study is carried out in the patient’s standing position, a study of muscle tone is performed in the same sequence at the same topographic points. The study of the patient is carried out in a relaxed state, since even a slight voltage leads to increased pain.

The claimed method allows the use of this research method in the diagnosis of vertebral diseases, in assessing the treatment process in the dynamics of the disease in connection with its information content and non-invasiveness.

A specific example of the implementation is the study of a patient A., born in 1972, who was hospitalized in 1 neurological department of the Republican Clinical Hospital for Rehabilitation in Kazan from April 4 to April 22, 2008 with a diagnosis of Disk protrusion L III - SI (verified MPT), radiculopathy SI on the left, left-sided lumbar ischialgia due to osteochondrosis of the discs L III - SI, chronically relapsing course, severe pain.

Complaints upon admission to frequent, shooting pains in the lumbar region, aggravated by slight stato-dynamic loads, numbness on the outer surface of the thigh and lower leg.

Medical history. For the first time, pains in the lumbar spine arose 5 years ago, pains began to radiate into the left leg since November 2007.

At a neurological examination: FMN without features. Proprioreflexes from the hands D = S, reflexes of the knees D = S, Achilles reflex D> S; revealed hyposthesia S I on the left, strength in muscle groups 5 points. Lumbar lordosis enhanced. Movement in the lumbar performs in the presence of moderate lower back pain. Symptom Lasega D - 75 degrees, S - 65 degrees. Muscle tone is normal.

Restriction of movement in the lumbar 1 degree.

MRI of the lumbar spine from 02.17.2008.

Moderate local narrowing of the anterior arachnoid spaces at the level of the intervertebral disk LIV-LV and their slight narrowing at the level of the disk LIII-LIV. Disc protrusions LIV-LV up to 4.5 mm and LV-SI up to 4.5 mm.

At level LIII-LIV, the protrusion size is up to 1.7 mm.

Myotonometry in this way is presented in the table.

Despite the fact that during neurological examination no tonus abnormalities were detected, myotonometry revealed a decrease in tonus in the standing position of the abdominal muscles, lumbar spine and gluteal muscles, the changes are more pronounced on the left, the muscles of the lower extremities are more flaccid muscles of the anterior, medial, lateral groups of the thigh and the posterior group of the tibia on the left, which made it possible to detect changes in tone, in the absence of a violation of tone when measured by palpation.

Measurements of muscle tone correlated with the patient’s vertebral and extravertebral syndromes, which proves the objectivity and sensitivity of the method, even with minor changes in tone.

Sheet Table for indicators when measuring muscle tone with a myotonometer apparatus FULL NAME. examined A., born in 1972 RESEARCH DATE April 12, 2008 MUSCLE KG RIGHT SIDE LEFT-HAND SIDE RELAXED Lying STRESSED STANDING RELAXED Lying STRESSED STANDING Study No. 1 0.5 3.45 3.28 3.60 2.80 one 3.79 3,55 3.75 3.15 1,5 4.02 3.90 3.95 3.85 2 4.45 4.23 4.34 4.20 Study No. 2 0.5 6.61 4,58 5.65 4.87 one 6.78 5.59 6.24 5.46 1,5 7.24 6.76 7.35 6.87 2 7.67 7.12 7.67 7.34 Study No. 3 0.5 4.48 4.30 5.17 4.75 one 5.29 5.20 5.40 5.07 1,5 5.37 5.30 6.01 6.24 2 6.43 6.35 6.35 6.20 Study No. 4 0.5 2.65 2.41 2.89 2.59 one 3,50 3.22 3.41 3,51 1,5 3.88 3.74 3.70 3.63 2 4.20 3.91 4.15 3.87 Study No. 5 0.5 5.61 6.20 5.81 6.30 one 6.19 7.03 6.61 6.90 1,5 6.59 7.50 6.70 7.30 2 7.87 8.78 7.65 8.45 Study No. 6 0.5 5.89 7.60 6.01 7.30 one 6.70 8.95 6.80 8.81 1,5 7.20 9.39 7.21 8.70 Study No. 7 2 it hurts More than 10 it hurts More than 10 0.5 6.21 7.05 7.11 7.35 one 7.05 8.20 8.30 8.80 1,5 8.30 9.36 9.40 9.80 2 More than 10 More than 10 More than 10 More than 10 Research No. 8 0.5 3.75 3,50 4.01 3.61 one 4.31 4.05 4.87 4.35 1,5 4,50 4.95 5.05 4.49 2 5.56 5.08 5.78 5.30

2 sheet Table for indicators when measuring muscle tone with a myotonometer apparatus FULL NAME. BUT. Born 1972 RESEARCH DATE April 12, 2008 MUSCLE KG RIGHT SIDE LEFT-HAND SIDE RELAXED Lying STRESSED STANDING RELAXED Lying STRESSED STANDING Study No. 9 0.5 4,54 4.06 4.61 4,50 one 5.23 4.45 5.45 5.20 1,5 5.39 5.15 5.69 5.34 2 5.59 5.35 5.75 5.45 Research No. 10 0.5 2,38 3.46 3.81 3.56 one 3.01 4.23 4.90 4.35 1,5 5.12 4.97 5.71 4.45 2 5.65 5.35 5.87 5.57 Study No. 11 0.5 4.30 3.77 4.10 3.29 one 4.70 4.60 5.35 4.84 1,5 5.01 4.95 6.01 6.34 2 5.51 5.40 6.61 5.93 Study No. 12 0.5 2.79 2,57 2.80 2.06 one 3.19 2.88 3.41 2.75 1,5 3.45 3.15 3.65 3.56 2 3.67 3.23 3.97 3.86 Research No. 13 0.5 4.01 2,57 4.34 2,50 one 4.35 3.45 5.20 4.34 1,5 4.68 3.82 5.55 4.78 2 4.76 4.24 5.78 5.02 Culvimetry Cervical lordosis (kyphosis) - 3.5 cm Thoracic kyphosis (lordosis) - 2 cm Lumbar lordosis (kyphosis) - 5 cm

Claims (1)

The method of myotonometry in patients with vertebral pathology, including a comprehensive assessment of the tone of the spinal muscle groups in the horizontal and vertical position of the patient, carried out by a mechanical myotonometer with dosed exposure, characterized in that the assessment of muscle tone is performed in 13 departments with a gradual increase in the dosage load from 0.5 to 2 kg by installing the myotonometer probe on certain topographic points on the right and left: 1 - angle of the lower jaw to characterize the brain stem as masticatory muscle tone; 2 - paravertebral at the level of the VII cervical vertebra, 2 cm departing from the spinous processes to the sides, to characterize the cervical spine; 3 - along the mid-clavicular line in the projection of 4 ribs to characterize the anterior group of chest muscles; 4 - at the level of the VII thoracic vertebra, 2 cm departing from the spinous processes to the sides, to characterize the posterior muscle group of the thoracic spine; 5 - at the navel level by 5 cm, departing from the midline, to characterize the abdominal muscles; 6 - paravertebral at level III of the lumbar vertebra, 2 cm departing from the spinous processes to the sides, to characterize the lumbar spine; 7 - at the level V of the lumbar vertebra, retreating 15 cm to the sides, to characterize the gluteal muscle; 8 - 15 cm proximal from the patella in the midline to characterize the anterior muscle group of the thigh; 9 - 15 cm proximal to the patella along the medial line to characterize the medial group of femoral muscles; 10 - 15 cm proximal to the patella in the lateral line to characterize the lateral group of femoral muscles; 11 - 15 cm proximal to the popliteal fossa in the posterior line to characterize the posterior thigh muscle group; 12 - 15 cm distal from the patella on the front surface, backing 2 cm from the edge of the tibia to characterize the anterior muscle group of the leg; 13 - along the medial-posterior line distal to the knee joint by 15 cm to characterize the posterior group of the leg muscles.