RU2460457C2 - Method of diagnosing vertebrogenic pain syndromes of degenerative-dystrophic diseases of spine - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to manual therapy, neurology, traumatology and orthopedics and includes detecting painful muscular indurations by palpation with involvement of area on which patient complains. Palpation is performed taking into account comparative analysis of patient's responses and phenomenon of pain recognition. Maximally painful point (MPP), in the place on which patient complains, in case if irradiation from it is present, is taken for principal trigger point (PTP). Following centrifugal direction of irradiation from PTP, MPP is determined, which are taken for distal trigger points (DTP). Belonging of muscles to one sclerotome, which determines corresponding intervertebral joint, is used to judge about the latter as source of pain syndrome, taking it for main trigger point (MTP). Scheme of pain syndrome is built in form of trigger chain: MTP-PTP-DTP, where presence of irradiation on sclerotome into trigger points PTP and DTP is used to testify to inflammation of this joint. Intervertebral joint, symmetrically located with respect to MTP is palpated, and if pain from it irradiates into muscles of sclerotome, determined by said joint, judgment about chain of latent trigger points, built in similar way, is made.

EFFECT: method ensures increase of reliability of diagnostics of vertebrogenic pain syndromes with identification of precise localisation of pain syndrome source and interconnected with it painful muscular indurations in respective sclerotome, taking into account patient's individual psychophysiological, constitutional peculiarities.

2 cl, 2 ex

Description

The invention relates to medicine and can be used in neurology, traumatology and orthopedics, in manual therapy, rehabilitation medicine in the treatment of reflex manifestations of degenerative-dystrophic diseases of the spine.

A known method for the diagnosis of painful muscle seals (trigger points) by palpating the area that the patient complains about, and determining densified points (trigger points) in this area. (See Trevel J. and Simone DG Myofascial pains. M: Medicine, 1989, v. 1, p. 37).

The disadvantage of this method is the limited search for painful muscle seals in a small area of the body that the patient complains about, which often leads to an error in diagnosis,

A known method of finding painful muscle seals in osteochondrosis of the spine (see RF patent No. 2080090, IPC ⁶ A61B 5/107, A61H 23/00, publ. 05.27.1997). During the implementation of the method, muscle tightening (trigger point) is found by palpation of the area that the patient complains about, then find the muscle power spiral on which this point is located, and palpate the entire muscle power spiral, finding the rest of the painful muscle tightness (trigger points).

Among the shortcomings of the known method, it should be noted the uncertainty of the concept of “the area that the patient complains of,” since pain in the area that the patient complains of can occur in various diseases that do not have a vertebrogenic character. From the description of the method it is not clear whether there is a study of the spine and how the pain syndrome of the patient relates to this study. A significant disadvantage of this method is that the cause of the pain or the source of its origin is not installed. The method has not revealed a connection of trigger points with the spinal-motor segment. In addition, it is not clear why they find the muscle power spiral if the trigger point (trigger point) is already defined. The described techniques do not reflect the relationship of the muscle spiral with the vertebral-motor segment and the trigger point located outside the vertebral-motor segment. The need to find other painful muscle seals that the patient did not complain about is not specified, the relationship between pain and these seals is not shown, it is also not clear how one seal (trigger point) differs from another seal.

When creating the invention, the task was set - to establish the source of the pain syndrome and the painful muscle seals interconnected with it in the corresponding sclerotome to eliminate and prevent reflex manifestations of spinal diseases.

This problem is solved by the fact that in the known method of finding painful muscle seals by palpation and involving the place complained of by the patient, in accordance with the invention, palpation is carried out in the area complained of by the patient, and based on a comparative analysis of the patient's reactions, the place of greatest pain is found and if there is irradiation from him, they take him for the main (explicit) trigger point (OTP) located in the area that the patient complains about, after which he palpates muscle seals in a centrifugal direction from it, define it as the distal trigger points (RTA) associated with OTP depending on the degree of irradiation of pain. After that, palpation is carried out along the axis of the spine and, based on a comparative analysis of the patient’s reactions, the inflamed vertebral-motor segments (PDS) are found, then the intervertebral joints symmetrically located relative to the spinous processes are found in the PDS data and they are inflamed, acting on them in accordance with the radiation in the place the patient complains of (OTP), and following in the centrifugal direction, muscle seals (DTP), establish the source of the origin of pain, taking it for chapters the first trigger point (GTP) associated with the main one depending on the degree of pain radiation in the corresponding sclerotome according to the following scheme: GTP-OTP-DTP, where

GTP - the main (hidden) trigger point located proximally;

OTP - the main (explicit) trigger point located in the area that the patient complains about;

An accident is a distal (“mute”) trigger point located in a place that the patient may or may not complain. If there is a place other than the one the patient complains of, palpation is carried out along the axis of the spine and, based on a comparative analysis of the patient's reactions, inflamed vertebral-motor segments (PDS) are found, then the intervertebral joints symmetrically located relative to the spinous processes are examined in the PDS data and found among they are inflamed, and in the presence of irradiation from him, they take him for the main trigger point (GTR), affecting which, in accordance with the irradiation of pain to the place complained of I take the patient for OTP, following in the centrifugal direction, muscle seals take for DTP, establish the source of the origin of pain, taking it for the main trigger point (GTP) associated with the main depending on the degree of pain radiation in the corresponding sclerotome according to the following scheme: OTP-accident. After that, if there is an irradiation of pain from the intervertebral joint, symmetrically located relative to the inflamed joint of this PDS, a pattern of latent trigger points is likewise built.

The analysis of the prior art by the applicant, including a search by patent and scientific and technical sources of information with the identification of sources containing information about analogues of the claimed method, made it possible to establish that the applicant did not find any source characterized by features identical to all the essential features of the claimed invention. The identification among the identified analogues of the closest in the totality of the features of the analogue adopted for the prototype made it possible to establish a set of essential features for solving the tasks set by the invention, which are set forth in the claims. Therefore, the claimed solution meets the criteria of the invention of "novelty."

The inventive method allows you to constantly be in contact with the patient and take into account all of his individual psychophysiological, constitutional features, while using the principle of biological feedback based on the patient’s feelings regarding the irradiation of pain, the source of its origin is established. The true cause of pain in a particular patient is established taking into account the concept of sclerotome as a structural unit for the occurrence of pain and other manifestations of vertebral diseases of the musculoskeletal system. The claimed solution allows to identify, based on the phenomenon of recognition, a clear localization and location of inflamed vertebral-motor segments (PDS), intervertebral joints or muscles (trigger points), when exposed to which pain, numbness, and other sensations accompanied by irradiation to another site appear, which disturb the patient. The diagnostic method allows you to display the clinical picture of vertebrogenic disease, presented in the form of a trigger chain: GTP-OTP-DTP. In the trigger chain, constructed according to the location of the trigger points relative to the main (hidden) trigger point (GTR), which is the source of the pain syndrome, the relationship with other trigger points (main and distal) of the corresponding sclerotome is displayed. This chain, even in the absence of functional blocks, is the basis, the “recipe” for prescribing treatment for the patient. Declared as a diagnostic method, the solution allows us to establish not only the clinical picture of any disease of the spine, but also provide the ability to identify the latent nature of vertebrogenic disease, which contributes to the timely treatment and prevention of pain in the future. Using the proposed solution, you can judge the time and timing of the onset of recovery after the prescribed course of treatment. The diagnostic method allows, when using it, to minimize the methods of examining the patient and to confirm the diagnosis to be limited to x-ray data.

Thus, the claimed solution from the prior art known to the applicant for a specialist does not explicitly follow, since the influence of the essential features of the invention to solve the problem is not identified from the prior art determined by the applicant. Therefore, the claimed invention meets the criterion of "inventive step"

The method is as follows.

After examining the patient, they clarify the nature of the pain that bothers him (acute or dull, numbness, weakness), while finding out the presence of localization, irradiation in the place he complains about. The patient should show the area of pain (limb, head, chest, abdomen) and how it spreads over it. Find out the duration of pain, the time period of this condition and the relationship with the static-dynamic load. Examination also reveals the presence of posture disorders (leg length difference, flat feet), signs of anomalies in the development of the musculoskeletal system. To establish biomechanical disorders of the musculoskeletal system, movements in the spine and joints of the limbs are checked. In this case, the presence of functional blocks or their absence is revealed. Then they begin to study the area that the patient complains about. Based on a comparative analysis of the patient’s reactions, a painful muscle spasm is found, palpation reveals the place of greatest pain (tension, spasm), the patient reports that he has the pain or sensation that bothers him (recognition phenomenon), is taken as the main trigger point (OTP) ) By the occurrence of irradiation of pain in the centrifugal direction, then they alternately act on the remaining muscle seals, following this to the area of the sclerotome where the patient indicates when the pain is spreading, and other trigger points are found according to his pain sensations, taking for distal ones. Based on the monosymptomatic nature of the pain in the place the patient complains of, the main trigger points (OTP) are distinguished, from which irradiation is more clearly indicated by the sclerotome pattern. When determining a trigger point located distally relative to the main one, it is assumed that the pain from this point is directed only to the final area of the sclerotome pattern. Then proceed to the study of the vertebral motor segments (PDS) of the patient. Moreover, along the axis of the spine with little effort, layer by layer (through the skin of the muscle to the bone) palpation is carried out first on the healthy or less affected side, then on the patient. On the basis of a comparative analysis of the patient’s reactions when exposed to the healthy and diseased sides, painful muscle spasm is found, indicating inflammation of the vertebral-motor segment (hereinafter PDS). After that, the spasmodic muscle is brought into a relaxed state, and when examining symmetrically located relatively spinous processes of the revealed PDS of the intervertebral joints, the inflamed joints are also found by comparative analysis. On palpation of the revealed inflamed joints or muscles around them at the point of attachment of the muscle of greatest pain (tension, spasm), the patient reports that he has the pain or sensation that bothers him (recognition phenomenon). Upon the occurrence of pain radiating to the place where the patient complains (OTP), the painful trigger points (DTP) located in the centrifugal direction, establish the source of its origin, taking it for the main trigger point (GTP), since the pain sensation from exposure to it spreads throughout the sclerotome and is polysymptomatic. Identified trigger points, depending on the degree of irradiation of pain in the sclerotome, are positioned relative to the main one according to the following scheme: GTP-OTP-DTP, where

GTP - the main (hidden) trigger point located proximally;

OTP - the main (explicit) trigger point located in the place the patient complains about;

An accident is a distal (“mute”) trigger point in a place that the patient may or may not complain. If there is a place other than one that the patient complains about, they begin to study the patient's spinal-motor segments (PDS). Moreover, along the axis of the spine with little effort, layer by layer (through the skin of the muscle to the bone) palpation is carried out first on the healthy or less affected side, then on the patient. On the basis of a comparative analysis of the patient’s reactions when exposed to the healthy and diseased sides, painful muscle spasm is found, indicating inflammation of the vertebral-motor segment (hereinafter PDS). After that, the spasmodic muscle is brought into a relaxed state, and when examining symmetrically located relatively spinous processes of the revealed PDS of the intervertebral joints, the inflamed joints are also found by comparative analysis. On palpation of the revealed inflamed joints or muscles around them at the point of attachment of the muscle of greatest pain (tension, spasm), the patient reports that he has the pain or sensation that bothers him (recognition phenomenon). Upon the occurrence of pain radiating to the place where the patient complains (OTP), the painful trigger points (DTP) located in the centrifugal direction, establish the source of its origin, taking it for the main trigger point (GTP), since the pain sensation from exposure to it spreads throughout the sclerotome and is polysymptomatic. Identified trigger points, depending on the degree of irradiation of pain in the sclerotome, are positioned relative to the main one according to the following scheme: GTP-OTP-DTP.

After this, the presence of irradiation of pain from the intervertebral joint, symmetrically located relative to the inflamed joint identified in the studied inflamed vertebral-motor segment (PDS), is established. In the presence of pain radiating from exposure to this joint, it is taken for the latent main trigger point (GTP). Then, following the patient’s sensations, they palpate the place where the pain radiates from exposure to the latent main trigger point (GTP). If there is an irradiation of pain from this place, it is taken for a latent main trigger point (OTP) and, just as when finding trigger points associated with an inflamed joint, a latent distally located trigger point (DTP) is found. The latent trigger points scheme is built in the same way.

Method implementation examples

1. Patient K., born in 1978, complaints of dull pain in the right shoulder joint, right upper limb on the back surface, in the region of the right shoulder blade. The pain worries about 6 months, worse when moving or with physical activity. Injuries of the musculoskeletal system are not noted, a temperature increase over the past month denies.

During a general examination, the inclination of the head to the right is determined, the shoulder girdle on the right is higher than on the left. The amount of movement to the right in the lower cervical spine is limited due to pain. On palpation, an increased tone of the muscles of the neck, shoulder girdle, and shoulder blade is determined on the right. At the same time, the presence of maximum pain in the area that worries the patient (scapula on the right) and irradiation along the posterior surface of the upper limb (recognition phenomenon) are noted, therefore this trigger point is taken as the main one (OTP).). Further, following the direction of irradiation, in the triceps muscle of the shoulder and in the brachioradialis muscle find the distal trigger point (DTP). Then, tilting the patient’s head to the right, the C6-C7 intervertebral joint is palpated. At the same time, pain is irradiated to the area that worries the patient (the right scapula), the triceps muscle of the shoulder and the brachioradialis muscle, therefore this joint C6-C7 is taken as the main trigger point (GTP). As a result of a diagnostic study, the patient was diagnosed with cervicobrachialgia C5-C6-C7 on the right, osteochondrosis of the cervical spine. When radiography of the cervical spine, the diagnosis was confirmed.

2. Patient S., born in 1961, complaints of a dull pain that begins in the right buttock and spreads along the back of the thigh, and then along the anteroposterior surface of the lower leg and intensifies with movement, notes the appearance of pain for about a year, connects them with physical activity. In 2001, he underwent surgery, diskectomy of the spinal-motor segment L4-L5. Injuries of the musculoskeletal system are not noted, a temperature increase over the past month denies. On examination, visually determined increased muscle tone in the lumbosacral region on the right. When checking movement due to pain in the lumbosacral region, the inclination to the right is limited; when leaning forward, movement is limited due to pulling pain in the right lower limb. As a result of palpation of paravertebral points (PVT) at the level of the vertebral-motor segment L5-S1, their pain on the right and irradiation to the region of the right buttock were established, spreading first along the posterior surface of the thigh, then along the anterior outer surface of the lower leg. Based on this, the L5-S1 intervertebral joint is taken as the main trigger point (GTP). Then, acting on the patient’s feelings, they palpate the area to which his complaints belonged and where the pain comes from according to his feelings, that is, the gluteal region. This area is painfully tense, from it there is irradiation into the piriformis muscle, which is taken as the main trigger point (OTP). Further, following the pattern of the irradiation line, distally located points (DTPs) are established in the biceps muscle of the posterior thigh and in the muscle of the anterior external surface of the lower leg. The diagnosis of lumbar ischialgia L5-C1, osteochondrosis of the lumbar spine (POP) is confirmed by the results of magnetic resonance imaging, which indicate degenerative changes in this part of the spine and the presence of a lateral hernia L4-L5 in the back.

Claims (2)

1. A method for the diagnosis of vertebrogenic pain syndromes of degenerative dystrophic diseases of the spine, including finding painful muscle seals by palpation involving the area that the patient complains of, characterized in that palpation is performed taking into account a comparative analysis of the patient's reactions and the phenomenon of pain recognition, while it is as painful as possible the point in the place where the patient complains, in the presence of irradiation from him, is taken as the main trigger point (OTP); following the centrifugal direction of irradiation from the OTP, determine the most painful points that are mistaken for distal trigger points (DTP); by the fact that the muscles belong to one sclerotome, which determines the corresponding intervertebral joint, the latter is judged as a source of pain, taking it for the main trigger point (GTP); build a scheme of pain in the form of a trigger chain: GTP-OTP-DTP, where the inflammation of the intervertebral joint is indicated by the presence of sclerotom radiation in the trigger points of OTP and DTP; then the intervertebral joint, symmetrically located relative to the GTP, is palpated, and in the presence of irradiation of pain from it into the muscles of the sclerotome defined by this joint, a chain of latent trigger points is judged, which is built in a similar way. 2. The method according to claim 1, characterized in that in the presence of more than one painful spot that the patient complains of, a trigger chain for each sclerotome is determined, following the centrifugal direction of irradiation from the gtr, the most painful points that are taken as the main trigger point are determined (OTP) and distal trigger points (DTP); build a scheme of pain in the form of a trigger chain: GTP-OTP-DTP.