RU2555383C1 - Method for detecting vegetative fibre injuries of peripheral nerves of upper extremities - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves the thermovision examination of dorsal and palmar surfaces of hands and fingers of both extremities before and after a cold test. If the recovery stage is characterised by an initial thermal presentation of locally disturbed temperature gain in a self-contained innervation area of the peripheral nerve of the hand both form the side of the involvement, and in the symmetrical region of the intact hand, the presence of type II complex regional pain syndrome signs is stated. No locally disturbed temperature gain on the intact hand shows the presence of type I complex regional pain syndrome signs.

EFFECT: method enables reliably typing complex pain syndrome in the remote post-traumatic period that is ensured by studying the temperature characteristics of the self-contained innervation regions of the intact and involved patient's hands.

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Description

The present invention relates to medicine, in particular to diagnosis, and can be used to determine the pathology of peripheral nerves.

A known method, including electrical stimulation of the nerve with an estimate of the speed of the impulse along the axial cylinder of the nerve or its myelin sheath (Badalyan L.O., Skvortsov I.A. Clinical electroneuromyography: Hand. For doctors. - M .: Medicine, 1986. - C . 37-109).

However, this method makes it possible to study only thick myelinated motor or sensory nerve fibers. The method is not always adequate and causes pain in patients, especially in the first weeks after an injury.

Closest to the proposed technical solution is a method of thermal imaging diagnostics of the pathology of peripheral nerves, which consists in assessing the thermal picture of the hands and fingers before and after a cold test (Kolesov S.N., Volovik M.G., Priluchny M.A. Medical thermal imaging: a modern methodological Approach. - N. Novgorod: Federal State Institution "Scientific Research Institute of Medical Technologies", 2008. - P. 122-129).

However, the known method determines only the degree of conduction disturbance along the vegetative fibers that make up the mixed peripheral nerves, and does not make it possible to determine the presence of a complex regional pain syndrome of types I and II caused by vascular and trophic changes in soft tissues and bones.

The task of the invention is to improve the method.

EFFECT: possibility of determining complex regional pain syndrome (CRPS) of types I and II in the long-term period of injury.

The technical result is achieved due to the fact that in the method, including thermal imaging functional study of the back and palmar surfaces of the hands and fingers before and after the cold test, upon receipt at the stage of restoration of the initial thermal picture of local violations of the increase in temperature values corresponding to the autonomous innervation zone of any the peripheral nerve of the hand not only on the affected side, but also in the symmetrical region on the hand of a healthy limb, conclude that there are signs of CRPS II ipa, and if violations of the local temperature values on the hand of the healthy limb is not observed, concludes that there is evidence of CRPS type I.

The proposed method is as follows.

A thermal imaging functional study of the back and palmar surfaces of the hands and fingers of both limbs is carried out. To do this, first record their initial thermal picture. Then a cold test is carried out, placing the hands up to the wrist joints in a container of water at room temperature for 1 minute, then they are dried with a towel and the dynamics of restoration of the thermal picture of the hands and fingers is recorded minute by minute for 15 minutes. If a violation of the thermal picture is detected, not only in the autonomous zone of innervation of the damaged peripheral nerve, but also in the symmetrical region on the fingers of the hand of a healthy limb, it is concluded that the corresponding peripheral nerve underlying the formation of complex regional pain syndrome (CRPS) of type II is suffering. If there is no violation of the thermal picture in the autonomous zone of innervation of any nerve, a conclusion is made about type 1 CRPS.

Clinical example.

Patient T., 59 years old. Outpatient treatment at the rehabilitation department of FSBI “NNIIITO”. Diagnosis: Sudeck syndrome of the right hand after a fracture of the distal metaepiphysis of the right radius Contracture of the right wrist joint. Moderate persistent pain syndrome. The injury was received on 09/19/13 as a result of a fall in the country on his right hand. In the trauma center, manual repair of fragments was carried out, a plaster cast was applied.

In the following days, pain in the area of the right wrist joint intensified, a feeling of numbness of the fingers, swelling of the hand appeared.

During the examination - flexion in the wrist joint 40 degrees, extension - 60 degrees. When bent, the fingers do not reach the palmar folds of 2 cm. Swelling of the hand is (+1 cm).

Thermal imaging examination before treatment (12.11.13) of the back and palmar surfaces of both hands and fingers.

In the initial thermal picture of the right hand there is a widespread moderately pronounced increase in infrared glow, occupying the entire surface of the hands and fingers. On the right hand - significant violations of thermoptopography was not detected. The average gradient of thermal asymmetry on the back of the hands is 0.9 ° C, on the palmar - 1.2 ° C, on the nail phalanges of the fingers - does not exceed 0.5 ° C.

1 minute after the cold test, moderate thermal imaging signs appeared of the opening of arterio-venular shunts on the nail phalanges of all fingers, but only of the right hand.

After 2 minutes - a further uniform increase in infrared radiation on all nail phalanges of the fingers of the right hand and only the initial signs of the opening of arterio-venular shunts, but on all fingers and the left hand.

4 minutes after the test, the level of luminescence of the right hand and fingers reached the initial values, and on the nail phalanges of the fingers - reliable signs of the formation of a hyperthermic reaction. The average thermo-asymmetry gradient on the back surface of the hands is 1.1 ° C, on the palm of the hand is 1.5 ° C, on the nail phalanges of the fingers is 2.1 ° C.

6 minutes after the test, the thermal pattern of the right and left hands are almost similar, the level of infrared radiation is slightly higher on the right hand. The average gradient of thermo-asymmetry on the back of the hands is 0.5 ° C, on the palmar - 0.7 ° C, on the nail phalanges of the fingers - 0.5 ° C.

Thermal imaging report. In the initial thermal picture of the right hand, the predominance of an increase in infrared glow, which occupies the entire surface of the hand and fingers, is registered. On the hand of a healthy limb - a normal variant.

The dynamics of changes in the temperature parameters of the hands after a provoking cold test indicates an accelerated increase in infrared radiation on the affected side according to the classical variant of thermoregulation and simultaneously on all fingers.

Such TV information is in favor of type 1 CRPS.

Clinical example.

Patient B., 55 years old. Outpatient treatment at the rehabilitation department of FSBI “NNIIITO”. Diagnosis: closed fracture of the distal metaepiphysis of the left radius, distal metaepiphysis of the left ulna with displacement of fragments, in the stage of incomplete consolidation. The condition after the operation of osteosynthesis of the radial bone with a plate on the screws, the ulna with a spoke from 01/17/13. Sudek syndrome, contracture in the joints of the fingers of the left hand and in the left wrist joint. Pronounced neuropathy of the median nerve at the level of the carpal tunnel.

Complaints of pain in the area of the hand and forearm. During the examination - swelling of the left hand (+1.5 cm), restriction of the opposition of the first finger, when bending the II-III fingers do not reach the palmar fold 3 cm, hypesthesia of the I-II fingers, to a lesser extent the third finger.

Electroneuromyography data. Signs of a pronounced mixed neuropathy of the left median nerve.

02/25/13 conducted a thermal imaging examination before treatment of the back and palmar surfaces of both hands and fingers.

In the initial thermal picture of the left hand, there is a moderately pronounced increase in IR glow, occupying the entire surface of the hand and IV-V fingers and a pronounced local decrease in the projection of II and III fingers. Temperature indicators on the nail phalanges: I finger - 27.6 ° C; II - 24.2 ° C; III - 28.7 ° C; IV - 31.5 ° C; V - 31.2 ° C. On the right hand - significant violations of thermoptopography was not detected. Temperature indicators on the nail phalanges: I finger - 30.9 ° C; II - 30.8 ° C; III - 30.8 ° C; IV - 31.0 ° C; V - 31.2 ° C.

2 minutes after a cold test on the left hand, an increase in IR radiation was registered only on the nail phalanges of the fourth and fifth fingers, in the absence of such changes on the first, second, and third fingers. Temperature indicators on the I finger - 21.9 ° C; II - 21.9 ° C, III - 21.9 ° C; IV - 24.4 ° C; V - 25.2 ° C.

On the right - changes occurred on the nail phalanges of all fingers, the severity of the increase in infrared radiation is different: the smallest on the II and III fingers - 23.1 ° C and 23.0 ° C; respectively, and the largest on the I, IV, V fingers - 28.4 ° C, 25.7 ° C, 25.4 ° C, respectively.

4 minutes after a cold test on the left hand, a further increase in infrared radiation was recorded only on the nail phalanges of the fourth and fifth fingers, while maintaining a pronounced decrease in infrared radiation on the first, second and third fingers. The temperature indicators on the IV and V fingers are 24.4 / 27.4 (+ 3 ° C) and 25.7 / 29.9 (+ 4.2 ° C), respectively. On I, IV, V fingers - 21.9 / 21.9 ° C (0 ° C).

On the right, there is a further increase on all fingers, but, as before, a decrease in luminescence on the II and III fingers is preserved, compared with the rest. The temperature indicators on the nail phalanges of the II and III fingers are 23.1 / 26.2 (+ 3.1 ° C) and 23.0 / 25.5 (+ 3.4 ° C); respectively. On I, IV, V fingers - 28.4 / 30.8 (+ 2 · 4 ° C), 25.7 / 30.5 (+ 4.8 ° C), 25.4 / 29.5 (+ 4.1 ° C), respectively.

After 6 minutes - on the left hand, a further increase in infrared radiation is also only on the IV and V fingers, while maintaining a pronounced decrease in infrared radiation on the I, II, III fingers. The temperature indicators on the IV and V fingers are 27.4 / 28.5 (+ 1.1 ° C) and 29.9 / 30.8 (+ 0.9 ° C), respectively. On I, IV, V fingers - 21.9 / 21.9 ° C (0 ° C).

On the right, there is a further increase on all fingers, but, as before, a decrease in luminescence on the II and III fingers is preserved, compared with the rest. The temperature indicators on the nail phalanges of these fingers are 26.2 / 29.3 (+ 3.1 ° C) and 25.5 / 29.6 (+ 4.2 ° C); respectively. On I, IV, V fingers - 30.8 / 32.2 (+ 1 · 4 ° C), 30.5 / 31.2 (+ 0.7 ° C), 29.5 / 30.9 (+ 1.4 ° C), respectively.

At the end of the examination (10 min after the test) - a significant decrease in infrared radiation on the I-II-III fingers is preserved on the left hand, compared with the rest. Temperature indicators 22.8; 21.9 and 25.2 and 30.4 and 31.6 ° C.

On the right hand and fingers - the thermal pattern is more uniform. The temperature on all fingers is in the range of 31.5-31.7 ° C.

Thermal imaging report. In the initial thermal picture of the left hand, a moderately pronounced increase in infrared glow was observed, occupying the entire surface of the hand and fingers, with the exception of the II and III fingers, where there is a local area of hypothermia (autonomous zone of innervation of the median nerve). On the hand of a healthy limb - a normal variant.

The dynamics of changes in the temperature parameters of the hand on the affected side after a provoking cold test indicates that in the first 6 minutes there were no signs of an increase in infrared radiation only in the autonomous zone of innervation of the median nerve, with accelerated growth in other areas.

On the hand of a healthy limb - a delay in the growth of infrared radiation was recorded only in the projection of the II and III fingers (mirror syndrome of the suffering left median nerve).

Such TV information is in favor of type II CRPS.

The method for determining damage to the autonomic fibers of the peripheral nerves of the upper extremities is informative, it allows the determination of type 1 and type II CRPS in the long term period of injury, does not have harmful effects on the human body and does not cause inconvenience to patients.

Claims (1)

A method for determining damage to autonomic fibers of the peripheral nerves of the upper extremities, including thermal imaging functional examination of the back and palmar surfaces of the hands and fingers of both limbs before and after a cold test, characterized in that when the initial thermal picture receives local disturbances in the increase in temperature values corresponding to the autonomous zone innervations of any peripheral nerve of the hand not only on the side of the lesion, but also in the symmetrical region on the hand a healthy limb, conclude that there are signs of a complex regional pain of type II, and if local disturbances in temperature values on the hand of a healthy limb are not observed, conclude that there are signs of a complex regional pain of type I.