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Diagnosis of osteochondrosis: questioning, examination
Last reviewed: 04.07.2025
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Clinical and functional diagnostics of spinal osteochondrosis is based on the general principles of research accepted in medicine: collecting anamnestic data, examination, palpation, determining the nature and degree of motor function impairment. In the process of clinical examination, various special methods of osteochondrosis diagnostics are used: instrumental, radiological, biochemical, electrophysiological, biomechanical, etc. In some cases, a single examination of the patient, even if carried out thoroughly, does not provide sufficient grounds for a final diagnosis. In such cases, it is necessary to resort to repeated studies, which will allow us to judge the dynamics of the pathological process, in addition, by the time of the repeated examination, new signs may appear or previously barely noticeable symptoms may become brighter, more definite, acquire specificity.
When examining patients, it is necessary to remember the integrity of the organism in both the physiological and biomechanical sense: dysfunction of one organ can disrupt the functions of the entire locomotor apparatus. For example, shortening of the lower limb after a fracture will inevitably cause a tilt of the pelvis towards the injured limb, compensatory curvature (deformation) of the spine, gait disturbance, etc.
[ Questioning the patient
"He who asks questions well makes a good diagnosis" (Zakharyin G.A., Botkin S.P.). Anamnesis is an important part of a comprehensive examination of a patient. Anamnesis is collected by questioning the patient, while following the WHO recommendations for defining health: "Health is a state of complete physical, mental and social well-being, and not just the absence of disease and physical defects."
The anamnesis is built according to a specific plan. First, the anamnesis of the disease is collected, then the anamnesis of life, taking into account the possible influence of heredity, social and family conditions, and professional hazards.
When compiling a medical history, the patient's complaints are clarified, the sequence of occurrence and interrelation of individual signs of the disease and the dynamics of the disease as a whole are analyzed. The causal factors and those contributing to the development of the disease are identified. They inquire about the previously established diagnosis and the treatment used, its effectiveness and tolerability of drugs.
Anamnesis of life gives a more complete and general idea of the body's characteristics, which is very important for individualization of treatment, as well as for prevention of exacerbations. Anamnesis can be collected according to the following scheme:
- past illnesses, injuries, operations;
- general biographical data by periods of life;
- heredity;
- family life;
- working and living conditions;
- bad habits.
Each physician can use the most suitable scheme for collecting anamnesis for his work, the features of which depend on the physician's specialty and the contingent of patients. General requirements for anamnesis of life should be completeness, systematicity and individualization.
When collecting anamnesis, it is necessary to consider the possibility of the patient's involvement in health-improving physical training or sports. Therefore, it is necessary to ask the patient (sports history), whether he/she was involved in health-improving physical training or sports, his/her athletic achievements, whether there were any injuries to the musculoskeletal system (MSS) (if there were, when, the course of treatment, its effectiveness), tolerance to physical activity.
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 musculoskeletal system: static load that is inadequate to the motor stereotype, adequate static load - long-term in the extreme position; inadequate dynamic load in the form of significant effort or jerky movement; passive overstretching; nociceptive reflex effects (visceromotor, vertebromotor, arthromotor, sensorimotor); motor-trophic insufficiency during immobilization.
Based on the collected anamnesis, the doctor is able to form an initial idea of the patient and his illness and build a working hypothesis. 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
A clinical examination of the patient allows us to identify not only gross anatomical abnormalities, but also barely noticeable, minor external manifestations, the initial symptoms of the disease.
Examination of the patient should always be comparative. In some cases, such an examination can be carried out by comparing with a symmetrical healthy part of the trunk and limbs. In other cases, due to the prevalence of damage to symmetrical parts, it is necessary to compare with an imaginary normal structure of the human body, taking into account the age characteristics of the patient. Examination also becomes important because it determines the course of further research.
The locomotor system does not represent separate organs unrelated to each other; the organs of support and movement are a single functional system, and deviations in any 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 ensured 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 limbs have a certain effect on the internal organs. Therefore, in order to avoid mistakes, one should not limit the examination to examining only one affected area.
A distinction should be made between general and special examination of the patient.
A general examination is one of the basic methods of examining a patient for a physician of any specialty. Although it is only the first stage of a diagnostic examination, it can be used to obtain an idea of the patient's general condition, valuable information needed to diagnose a disease, and sometimes to determine the prognosis of the disease. The results of a general examination of a patient predetermine, to a certain extent, the use of other targeted methods of medical examination.