RU2711377C2 - Method of topographic tensoalgometry - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine and can be used in evaluating mechanical characteristics of biological tissues. For this purpose, at 1stage, before the classical massage procedure, the diagnostic points are determined by setting the markers in three conditional vertical lines on the right and left side from the back middle back line corresponding to the anatomical lines: 1line - paravertebral, 2line - scapular, 3line - posterior axillary line. All the lines start from the conditional horizontal line crossing the back median line in the projection of the fourth lumbar vertebra (LIV), and end: 1line - at the level of the horizontal line drawn through the seventh cervical vertebra (CVII), 2line - in the projection of the middle of the dystrophic cavity of the scapular bone, 3line - in the posterior axillary fold. Further, each line is divided conditionally into 4 equal sections, obtaining 5 diagnostic points on each line to the right and left of the spinal column, total - 30 points, the numbering of which begins on each line from the upper thoracic area of the back and continues down to the lumbar region. At the second stage, strainometry is carried out by evaluating tissue density in each of the previously determined diagnostic points and by measuring the soreness intensity in the same pre-determined diagnostic points. To this end, a tensometry device comprising a strain gauge is used, by pressure until the fixing portion of the device contacts the skin of the person being tested in the test diagnostic point, obtaining and fixing the data in gf/cm. For algometry pressure of the sensor is increased to the tested diagnostic point, wherein intensity of soreness is controlled by the patient himself and stopped at his command. Data obtained and measured in pounds are obtained and recorded. Strain gage sensor is connected to a personal computer through an analogue-to-digital converter, in form of MES 9000 Muscle Testing device, wherein the sensor generates an output signal directly proportional to the applied force. At the third stage, the obtained quantitative data of strain gages and angular geometry for each line and specific points are entered into two Microsoft Office Excel tables, respectively, which are used to construct two outline diagrams using Microsoft Office 365 package. Diagrams are analyzed for the presence of diagnostic points with increased density of tissues and diagnostic points of muscle soreness, in the areas of the body, the diagnostic points of which showed the highest indices during strain gauging. Classical massage involves the trituration techniques to the greatest extent, while the body areas, in the diagnostic points of which the greatest indices of the point tenderness are found, are transversal kneading techniques. At the end of the therapeutic massage course, the topographic tensoalgometry is repeatedly performed at the specified stages in the previously determined diagnostic points, and comparing the measurement results before and after the massage course, its effectiveness is determined.EFFECT: method provides an objective assessment of the effectiveness of the course massage effect by evaluating the mechanical characteristics of the superficial soft tissues.1 cl, 5 dwg, 1 ex

Description

The invention relates to medicine, namely, at the junction of two specialties of manual therapy and medical massage, and can be used in medical institutions of rehabilitation and sanatorium-resort profiles.

The relevance of the invention lies in the high demand for clinical medicine, a method for determining the characteristics of surface soft tissues, which allows not only to evaluate the biomechanical indices of a particular local area, but also, identifying existing changes in the entire area subject to manipulation, as well as give recommendations on the choice of specific massage techniques.

Traditionally, biomechanical characteristics of soft tissues are determined by palpation: for the skin, this is a rotational compression test (for determining skin tone) and a test for the formation of skin folds (elasticity test), and for assessing muscle tone, a transverse hardness (resistance) of the muscle and depths of immersion (indentation) [Timofeev G. Methods of apparatus research of human skin. "Cosmetics and medicine", 2005, No. 4]. Thus, the deformation of pressure, displacement, tension, twisting of soft tissues (skin, subcutaneous tissue, muscles) is evaluated. The obvious shortcomings of the palpation method for assessing the biomechanical characteristics of the state of soft tissues is that it is indicative, does not have clear criteria, and is characterized by extreme subjectivity.

In recent years, more and more in clinical practice, hardware technologies for assessing the condition of the skin and muscles are beginning to be used. These include the diagnostic device PIERA HC-220 (TANITA CORP., Japan), Cutometer MPA 580 (Courage + Khazaka electronic GmbH, Germany), characterizing the elastic and elastic properties of the skin, Pat. Dr. SZIRMAI (ELEKTROIMPEX, Hungary), used for the purpose of myotonometry [M. Eremushkin Manual treatment methods in a complex of rehabilitation measures for pathology of the musculoskeletal system: abstract of thesis. ... doctors of medical sciences: 14.00.22, 14.00.51 / Center, scientific researcher. Institute of Traumatology and Orthopedics N.N. Priorov. - Moscow, 2006; Korolkova T.N., Soghomonyan A.V. Methods of functional diagnosis of the skin to assess the effectiveness of the treatment of ganoid lipodystrophy. Russian Journal of Skin and Sexually Transmitted Diseases. 2015, No. 6]. However, the use of these devices is limited to any one interested area (skin of the frontal region, projection of a single muscle, etc.). In addition, the research results obtained with their help are in no way connected and are considered separately.

Regarding the registration of the pain threshold and tolerance to pain, mechanical algometers (such as Wagner Force Ten Digital Force Gage FPX 50, Wagner instruments, USA) have been actively used recently. A simpler tool for measuring the pain threshold is described in the patent for the invention of the Russian Federation No. 2342063 "Method for the quantitative assessment of individual pain thresholds". However, these tools are not designed to assess areas of narrow local pain, and when used for this purpose, either the determination of a statistical norm or a comparison of indicators in similar symmetrical parts of the body is required.

The closest in technical essence to the proposed is a method for assessing the level of pain in trigger points (painful muscle seals) proposed by Vasilenko A.M. under the name "tensoalgometry" [Vasilenko A.M., Zhukolenko L.V., Popkova A.M. Tenzalgometry (clinical use). Russian medical journal. 1998, No. 1 - S. 51-56], which consists in the use of a strain gauge made on the basis of household spring scales. Moreover, depending on the location of the measurements, interchangeable tips are used (for measurements carried out in the head and distal extremities, the diameter of the working surface is 1.5 mm, and in the region of massive skeletal muscles - 5 mm). Direct tensometric analysis is carried out by smooth or stepwise increase in pressure on the test area of the body until the subject's command to stop pressure.

However, this method has the following disadvantages:

- does not assess the condition of the skin and subcutaneous tissue;

- does not evaluate large areas of surface tissues;

- non-calibrated and non-calibrated instruments are used;

- does not give recommendations on the use of specific manual techniques,

as a result of which the tensoalgometry method does not fully reflect the functional state of the superficial soft tissues, and also does not make it possible to evaluate the treatment results and select the most optimal way to correct existing disorders.

The technical result of the proposed method of topographic tensoalgometry is an assessment of the functional (biomechanical) state of soft tissues, including tensometry (assessment of the elasticity / firmness of the skin and subcutaneous tissue) and algometry (assessment of local muscle soreness) on symmetrical sections of the patient’s back surface, followed by visual analysis of the results and serving to diagnose and evaluate the effectiveness of treatment of pathology of the musculoskeletal system, which compares favorably with the prototype a.

The specified technical result is achieved by the following algorithm of actions performed before the start of the course massage massage: the 1st (installation) stage consists in determining 5 diagnostic longitudinal lines on the back of 30 diagnostic points; The 2nd (measuring) stage includes carrying out tensometry and algometry at the established 30 diagnostic points; The 3rd (analytical) stage consists in constructing two “contour diagrams” created in Microsoft Office Excel, which visually represent the state of density (elasticity / firmness) of the skin and subcutaneous tissue and muscle soreness, based on the data obtained in the previous stage and entered in tabular forms. If you find areas with increased density of the skin and subcutaneous tissue, it is recommended to add at least 50% of rubbing techniques to the massage technique, and if there are areas of painful muscles, at least 50% of cross kneading techniques. If necessary, after completion of the massage course, topographic tensoalgometry is repeated and the effectiveness of massage manipulations is evaluated when comparing the measurement results (tenso and algometry) presented on the "contour diagrams" and in tabular form before and after the exposure.

Description of the method.

1. Installation stage (preliminary).

At the beginning of the survey, markers are set according to landmarks. Conventionally, the back region to the right and left of the posterior median line (running along the spinous processes of the vertebrae) is divided into three longitudinal lines corresponding to the classical anatomical lines - paravertebral (1st line), scapular (2nd line) and posterior axillary (3rd line). All lines begin from a conditional horizontal line crossing the posterior midline, in the projection area of the fourth lumbar vertebra (LIV). End: 1st line - at the level of a horizontal line drawn through the seventh cervical vertebra (CVII); 2nd line - in the projection of the middle of the supraspinatus fossa of the scapular bone; 3rd line - at the extreme point of the posterior axillary fold.

Further, all lines are divided into equal 4 segments. Thus, 5 diagnostic points are determined on each longitudinal line of the back on the right and left. In total, 30 diagnostic points are used. Point numbering starts from the upper thoracic spine and continues down to the lumbar region.

The position of the conditional lines and points for measurement is illustrated in figure 1:

1 - the back median line,

2 - left rear axillary line (Line 3 on the left),

3 - left scapular line (Line 2 on the left),

4 - left paravertebral line (Line 1 on the left),

5 - right paravertebral line (Line 1 on the right),

6 - right scapular line (Line 2 on the right),

7 - the right back axillary line (Line 3 on the right).

2. The measuring stage (diagnostic).

Then, using the “Diagnostic meter” tool (patent for the invention of the Russian Federation No. 2627679 dated 08/09/2017), the density (elasticity / firmness) of the skin and subcutaneous tissue is assessed at all previously determined diagnostic points. Strain measurement is carried out by pressure until the fixing part of the instrument comes into contact with the skin of the subject. The obtained data (measured in gf / cm ² ) are entered in the table.

The next step is performing algometry using the MES 9000 Muscle Testing instrument (MYOTRONICS-NOROMED, USA) also at all previously determined diagnostic points. Algometry is carried out by gradually increasing pressure on the test area of the body. The assessment of the intensity of point pain is controlled by the subject himself and is terminated at his command. The resulting data, measured in pounds (1b), is entered in the table.

3. The analytical stage.

At the end of the measurements, data from two completed tables (strain gauges and algometry) are entered into the Microsoft Office Excel program of the Microsoft Office 365 software package (© Microsoft 2018) and two “contour diagrams” are built. The diagrams clearly show the state of density (elasticity / firmness) of the skin and subcutaneous tissue and muscle soreness.

If areas with increased density of the skin and subcutaneous tissue are found, it is recommended that at least 50% of rubbing techniques be added to the massage technique, and if there are areas of painful muscles, at least 50% of the cross kneading techniques.

Specifications. To conduct topographic tensoalgometry, we used:

“Diagnostic meter”, having the patent for the invention of the Russian Federation No. 2627679, the date of state registration in the State Register of Inventions of the Russian Federation from 08/09/2017, the patent holder of the Federal State Budget Scientific Institution of Scientific and Research Center for Rehabilitation and Balneology of the Ministry of Health of Russia.

Muscle Testing Muscle Testing System MES 9000 Muscle Testing (registration certificate of the Federal Service for Supervision in Healthcare and Social Development No. FSZ 2008/01481 dated 1.08.2008) based on the use of a strain gauge connected via a standard interface to a personal computer. This sensor generates an output signal that is directly proportional to the applied force. The signals from the strain gauge, passing through the MES 9000 device, which is an analog-to-digital converter, enter the computer through its USB port. The original computer software is a set of commands loaded into the computer's memory, necessary for processing, storage and display of the received data.

Microsoft Office Excel is part of the standard Microsoft Office 365 software product suite (© Microsoft 2018).

Results.

For the period from January to May 2018, we examined 48 volunteers aged 18 to 49 years, 29 males and 19 females. Of these, 5 examinees with a diagnosis of “almost healthy” who did not show complaints and 43 with various pathologies of the musculoskeletal system, with a diagnosis of “lower back pain” (ICD-10 code - M 54.5). After diagnosing the condition of patients according to the claimed method, we gave instructions to massage nurses to change the methodology of manual exposure (using the classical massage technique), introducing either rubbing methods or kneading methods, depending on the data obtained with topographic tensoalgometry. As a result, in all 43 cases of correction of the massage technique during repeated research by the claimed method, a positive dynamics of the state of superficial soft tissues was noted — the disappearance of areas of increased skin density and subcutaneous tissue or areas of muscle soreness.

A clinical example of the method.

Patient I., 28 years old, engaged in physical labor. Complaints of pain in the lower back and right scapular region. The history of this disease. Considers himself ill for more than one year. Actively not treated. According to the results of the visual-analogue pain scale, the pain syndrome was 6 points. According to x-ray, signs of thoracic and lumbar osteochondrosis of 2 tbsp. With topographic tensoalgometry, an increased density of subcutaneous tissue in the lumbar region (Figure 2) and a pain zone in the region of the right scapula and lumbar region (Figure 3) is revealed. When prescribing a course of massage procedures for the back area, using the classical massage technique, include in the massage technique 50% only rubbing and kneading techniques on the lumbar region and 60% kneading techniques on the right scapular region (40% were stroking and rubbing techniques). After 12 procedures performed daily, the patient's condition improved significantly. According to the visual analogue pain scale, 2.5 points. Actively does not show complaints. According to the results of repeated topographic tensoalgometry, the area of the compaction zone of the subcutaneous tissue of the lumbar region decreased (Figure 4), and the pain zones in the lumbar and right scapular regions disappeared (Figure 5).

Thus, we have shown the advantages of the proposed method of topographic tensoalgometry, its practical feasibility and clinical usefulness.

Claims (1)

The method of topographic tensoalgometry, which includes a step-by-step assessment of tissue density and muscle pain sensitivity at diagnostic points, characterized in that at the first stage, before the classical massage procedure, diagnostic points are determined by setting markers along three conventional vertical lines on the right and left sides the posterior median line of the back corresponding to the anatomical lines: 1st line - paravertebral, 2nd line - scapular, 3rd line - posterior axillary, while all lines begin from the condition horizontal line crossing the posterior midline in the projection of the fourth lumbar vertebra (LIV), and end: 1st line - at the level of the horizontal line drawn through the seventh cervical vertebra (CVII), 2nd line - in the projection of the middle of the supraspinatus fossa of the scapular bones, the 3rd line - in the rear axillary fold, then each line is conditionally divided into 4 equal segments, receiving 5 diagnostic points on each line to the right and left of the spine, 30 points in total, the numbering of which begins on each line from the upper thoracic section from ins and extends down to the lumbar region; at the 2nd stage, tensometry is performed by assessing tissue density at each of the previously determined diagnostic points and algometry by assessing the intensity of pain at the same previously determined diagnostic points; for this, a strain gauge device containing a strain gauge is used, by pressure until the fixing part of the device contacts with the skin of the subject a diagnostic test point, receiving and capturing data in gf / cm ^2, and for algometrii increase the pressure sensor to a test diagnostich ical point, the intensity of pain is controlled by the subject himself, and ceases at his command to give and record data, measured in pounds; the strain gauge sensor is connected to a personal computer through an analog-to-digital converter, which is used as a MES 9000 Muscle Testing device, and the sensor generates an output signal that is directly proportional to the applied force; at the 3rd stage, the obtained quantitative data of strain gauge and algometry for each line and specific points are entered, respectively, in two Microsoft Office Excel tables, from which two contour diagrams are then constructed using the Microsoft Office 365 package, the diagrams are analyzed for diagnostic points with by increasing the density of tissues and diagnostic points of muscle soreness, in areas of the body, the diagnostic points of which showed the greatest performance in tensometry, during classical massage, they are used to the greatest extent rubbing techniques, and in the areas of the body, in the diagnostic points of which the highest indices of point pain were revealed - transverse kneading techniques; at the end of the massage course, topographic tensoalgometry is repeated at the indicated stages at previously determined diagnostic points and, comparing the measurement results before and after the massage course, determine its effectiveness.

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