Three-step diagnosis of neck, shoulder, back and leg pain

source:Zhejiang Banger Medical Investment Management Co., Ltd.     Date of publication:2019-06-12     Browsing volume:1328

Guide reading:

The first step: diagnosis of nerve location, asking about medical history and symptoms

When asking about medical history, in addition to gender, age, and occupation, it is important to understand the following contents: Ask about the history of trauma in detail. From childhood to history, including the history of trauma in adolescence, children should know whether they have a birth injury. Head, neck, back, waist, and buttocks are often not immediately symptomatic, especially in chronic strains, because the history of trauma is easy to ignore during the first visit. The importance of paying attention to the history of trauma is of particular importance for the development of treatment options.

To have a holistic view of the spine, ask about the time of symptom onset and the sequence of various symptoms in each part. Ask about the nature of the pain, is it sore, numbness, dull pain, burning pain or radiation pain? Is it persistent or intermittent pain? Impact on body pain when changing position: increase, decrease or not change? The specific part of the pain should be accurate, in which range of the head, neck, chest and abdomen, back, hips and limbs. Feel abnormal, if there is an abnormality, do you want to know whether it is numbness, acupuncture, swelling, coldness or burning? Feel there is no decline or disappear. Are there any motor dysfunctions? To what extent? Does the muscle have atrophy or compensatory hypertrophy? Is there any phenomenon in the upper limbs? Is there any stiffness in the lower limbs and a feeling of cotton? Are there any cases of paraplegia, hemiplegia, single or crossover and facial paralysis?

In short, when inquiring about the condition, it should include the clinical manifestations of the spinal cord segment, peripheral nerve and sympathetic damage associated with the onset of the spine, and whether the blood circulation and lymphatic circulation are normal. Through the above inquiry, preliminary analysis of what tissue (spinal cord, nerve root, sympathetic nerve, muscle, blood vessel or lymphatic vessel) was damaged, and initially determined the onset of the spine or joint

Simply summarized as:

1 numbness, painful limbs, according to the distribution of peripheral nerves, make the initial positioning judgment of the onset of the spine.

2 There are internal organs and organ diseases. According to the sympathetic and parasympathetic segments, the initial judgment of the diseased spine is made.

3 If there are local symptoms of the spine, judge the intervertebral relationship by the paravertebral muscles, ligaments, and fascia.

4 Without the above clinical manifestations, judge the arterial blood supply, brain and spinal cord damage at the symptomatic site.

The second step: palpation, diagnosis and diagnosis

1. Tender point check:

There may be spinous processes, articular processes and lateral tenderness in the lesions; tenderness of the ligaments between the spinous processes; tenderness in the back and back muscles of the neck; tenderness at some point on the spinous processes (where the joints are at the joints), deep in the inflammation of the nerve roots Pressure will appear along the nerve radiation pain, suggesting that there may be disc herniation; tenderness between L5/S1, there may be lumbosacral joint dislocation, strain, free spinous process, sacral spine or pelvic spine. ­

2. Palpation check:

(1), transverse process, joint synapse diagnosis method: the operator uses the right thumb and index finger to gently place the patient behind the cervical vertebrae and the articular process (first touch the first cervical vertebrae from the tip of the mastoid, then move back down to 2 3, posterior joint of the cervical vertebrae, sliding up and down contrast, to see if there is bulge in the joint process and whether the transverse process is symmetrical. If there is any abnormality, it should be checked whether there is tenderness and pathologically positive reactants at the same time - induration, tendon of the tendon, friction sound, etc. If there is any sign of misalignment of the facet joint, if not, it is a congenital malformation. (Because the spinous processes of the cervical spine are often bifurcated, and the length is very different, palpation is easy to have errors to check the transverse process joints better.) WeChat public platform: spine health alliance

(2), spinous process palpation: for the lower cervical vertebrae and thoracic and lumbar spine examination. The right hand food and the middle two fingers are placed together on the sides of the spinous process for up and down sliding comparison. In case of uneven and high hemiplegia, the transverse process palpation method is used to identify whether it is pathogenic or congenital malformation.

(3), the positive reaction palpation method: the surgeon uses the thumb to rub the vertebral spine, the transverse process, the articular process above and below the sputum, and check the distal attachment point of the muscle connected to the affected vertebra with or without friction, tenderness And induration. If present, it is a strain point or a damaged reaction (such as aseptic inflammation or tendon).

3. Special test of orthopedics:

Those who are dissatisfied with palpation examination can use the special trials commonly used for spinal diseases.

For the spine and transverse process, there is hemiplegia, but those without paravertebral tenderness and related symptoms should use the orthopedic related examination method or the neurological examination method for differential diagnosis. Where the vertebrae with obvious hemiplegia are examined, the clinical symptoms and paravertebral tenderness have been eliminated after diagnosis and treatment, but palpation still has hemiplegia. It should be considered that it is a dislocation of the joint caused by the variation, and the dislocation is corrected. After the symptoms are eliminated, but the form of the mutation still exists. If the physiological variation is a pathological dislocation and continues the orthopedic bone, it will lead to new damage and should be highly vigilant.

The third step: X-ray spine photo localization diagnosis

Observe the changes of the intervertebral relationship of the cervical X-ray films, the variation of the axis of the spine, and the variation of the posterior border of the vertebral body. Changes in elevation, tilt, tilting, tilting, and lateral rotation appear when the ring is misaligned. The shape or displacement of each intervertebral joint is a manifestation of cervical joint dislocation. Observe the disc degeneration, intervertebral joint bone hyperplasia, the location and extent of calcification of each ligament. And combined with the first and second step positioning diagnosis analysis, the final positioning diagnosis results.

(1) Exclusion of contraindications for orthopedic massage. Including fractures, dislocations, tuberculosis, tumors, eosinophilic granuloma, suppurative inflammation, etc. Observe the degree of osteoporosis, and choose the rapid reset method or the slow reset method when the bone is massaged.

(2) Careful observation and classification of the intervertebral joint dislocation, the type of dislocation (dislocation direction), the location, the changes in the intervertebral relationship of the positive and lateral slices. (3) Observe the degree of degeneration of the spine and analyze whether the degeneration is the main cause of the disease. Degeneration of the intervertebral disc (bulging), bone hyperplasia of the vertebral body joints, location and extent of calcification of each ligament. Clinical examination of patients with signs of spinal cord injury should be performed by MRI or CT to determine the choice of surgical or non-surgical treatment.

Relationship between three steps

In the first step of the neuropositioning diagnosis, the initial judgment of the onset of the spine range, combined with the second step of palpation and localization diagnosis, to further determine the onset of the spine joints and types. The final image localization diagnosis, comparative analysis and elimination of disease. Using the information collected in three steps, conduct a comprehensive analysis, go to falsehood, find the root cause of the disease, and get the correct diagnosis.

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