Diagnosis of osteochondrosis
Last reviewed: 11.04.2020
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Clinical and functional diagnostics of the osteochondrosis of the spine is based on general research principles adopted in medicine: the collection of anamnestic data, examination, palpation, elucidation of the nature and extent of impairment of motor functions. In the process of clinical study, a variety of special diagnostic methods for osteochondrosis are used: instrumental, radiologic, biochemical, electrophysiological, biomechanical, etc. In a number of cases, a single study of the patient, even conducted carefully, does not provide sufficient grounds for the final diagnosis. In such cases, it is necessary to resort to repeated studies that will allow to judge the dynamics of the pathological process, in addition, by the time of the re-examination, new signs may appear or the previously weakly noticeable symptoms will become brighter, more specific, acquire specificity.
When examining patients, it is necessary to remember the integrity of the organism in both physiological and biomechanical sense: a violation of the function of one organ can disrupt the functions of the entire locomotor apparatus. So, for example, shortening of the lower limb after a fracture will inevitably cause a pelvic inclination towards the injured limb, compensatory curvature (deformation) of the spine, gait disturbance, etc.
[Patient's inquiry
"Who questions well, he makes a good diagnosis" (Zakharin GA, Botkin SP). Anamnesis is an important part of a comprehensive examination of the patient. Anamnesis is collected by questioning the patient, while following WHO's recommendations for determining health: "Health is a state of complete physical, mental and social well-being, and not only the absence of disease and physical defects."
Anamnesis is built according to a certain plan. First, they collect an anamnesis of the disease, then an anamnesis of life, taking into account the possible influence of heredity, social and family conditions, occupational hazards.
When drawing up an anamnesis of the disease, the patient's complaints are clarified, the sequence of occurrence and relationship of individual signs of the disease and the dynamics of the disease as a whole are analyzed. Identify causal factors and contributing to the development of disease factors. Cope with the previously established diagnosis and treatment, its effectiveness and drug tolerance.
The anamnesis of life gives a more complete and general concept about the characteristics of the body, which is very important in the individualization of treatment, as well as for the prevention of exacerbations. The anamnesis can be collected according to the following scheme:
- the transferred diseases, traumas, operations;
- general biographical data on periods of life;
- heredity;
- family life;
- working and living conditions;
- bad habits.
Each doctor can use the most appropriate for his work pattern of anamnesis, the characteristics of which depend on the specialty of the doctor and the patient population. General requirements for the anamnesis of life should be completeness, systemic and individualization.
When collecting an anamnesis should provide for the possibility of the patient practicing recreational physical culture or sports. Therefore, it is necessary to ask the patient (sports history), whether he was engaged in recreational physical training or sports, his sports successes, whether there were injuries to the musculoskeletal system (if there were, then, the course of treatment, its effectiveness), the tolerance of physical exertion.
When interviewing patients, it is important to establish a number of factors that are known to contribute to the development of pathobiomechanical changes in the OA: inadequate motor stereotype static load, adequate static load - prolonged in extreme position; inadequate dynamic load in the form of considerable effort or jerky movement; passive hyperextension; nociceptive reflex effects (viscero-motor, vertebro-motor, arthro-motor, sensor-motor); motor-trophic insufficiency during immobilization.
On the basis of the collected anamnesis, the physician is given the opportunity to compile an initial picture of the patient and his illness and to construct a working hypothesis. The subsequent careful examination of the patient is conducted in the aspect of this hypothesis and allows either to confirm or reject it as incorrect.
Clinical examination
Clinical examination of the patient reveals not only gross anatomical disorders, but also subtle, insignificant external manifestations, initial symptoms of the disease.
The examination of the patient should always be comparative. In some cases, such an examination can be carried out by comparison with a symmetrical healthy part of the trunk and extremities. In other cases it is necessary to compare with the imaginary normal structure of the human body due to the prevalence of the defeat of the symmetrical divisions, taking into account the age characteristics of the patient. Inspection is also important because it determines the course of further research.
The locomotor apparatus does not represent unconnected disparate organs; the organs of support and movement are a single functional system, and deviations in one part are inevitably associated with changes in other parts of the trunk and limbs that compensate for the defect. Compensatory adaptations are closely related to the activity of the central nervous system, and the possibility of implementing adaptive changes is provided by the motor zone of the cerebral cortex. The latter, as is known, is an analyzer of kinesthetic proprioceptive stimuli emanating from skeletal muscles, tendons and joints.
Changes in the trunk and extremities have a certain effect on internal organs. Therefore, in order to avoid mistakes, one should not limit oneself to examining by examining only one affected department.
It is necessary to distinguish between general and special examination of the patient.
General examination is one of the main methods of examining the patient for a doctor of any specialty. Although it is only the first stage of a diagnostic examination, it can provide an overview of the patient's general condition, valuable information necessary for diagnosing the disease, and sometimes for determining the prognosis of the disease. The results of a general examination of the patient determine to a certain extent the use of other targeted methods of medical research.