Diagnosis of osteochondrosis: general examination

General examination is carried out according to a certain plan: first assess the general condition of the patient according to the state of his consciousness, the position of the totality of the external features of the constitution, growth and type of constitution, posture and gait. Then, the skin, subcutaneous tissue, lymph nodes, trunk, limbs and muscular system are examined sequentially.

General examination gives an idea of the patient's mental state (apathy, excitement, change of gaze, depression, etc.).

The patient's position during examination can be assessed as active, passive and involuntary.

Active position is arbitrarily chosen by the patient without visible limitations.

Passive position, indicating the severity of the disease or damage, is observed with severe bruises, paresis and paralysis. In such passive positions, one can establish a certain regularity, typical for each injury or disease.

As an illustration, we give the following observations:

• with paralysis of the ulnar nerve, the fingers of the hand are dislocated in the main phalanges, the IV and V fingers are bent in the interphalangeal joints. The flexion of the V finger is more pronounced than IV.
• with paresis of the radial nerve, the hand hangs, setting in the position of palmar flexion. The fingers are lowered, their movements are possible only in the direction of further bending.

The forced position in diseases or injuries of the ODA can extend to the entire body (general stiffness, for example, with Bekhterev's disease, in severe forms of cerebral palsy, etc.) or be limited to smaller areas, capturing individual segments. Two types of such provisions should be distinguished:

• forced position caused by pain syndrome (sparing setting). In these cases, the patient tries to maintain a position in which he experiences the least painful manifestations (for example, pain syndrome in the osteochondrosis of the lumbosacral spine);
• forced position is provided by morphological changes in tissues or by disruption of the interposition of segments at the joint ends. Especially these features are manifested during dislocations.

Ankyloses and contractures, especially those that are not sufficiently treated, are often accompanied by involuntary settings typical for each individual joint. This group includes pathological settings, which are a manifestation of compensation and in some cases are observed far from the affected area. For example, with a limb shortening, a change in the pelvic axis is determined.

[1], [2], [3], [4]

Set of external features of a constitution, growth and the constitution, a posture and a gait

The idea of the appearance of the patient is obtained mainly from visual inspection following signs.

1. Features of a constitution - growth, transverse sizes, proportionality of separate regions of a body, a degree of development of a muscular and fatty fabric.
2. The physical condition, for the evaluation of which considerable importance is, in particular, the peculiarity of posture and gait. Straight posture, fast and free gait indicate good physical training and health; abnormal posture, slow, tired gait with some inclination of the trunk forward characterize the physical weakness that develops in some diseases or with significant physical overstrain.
3. Age of the patient, the ratio between his actual age and the estimated from the survey data. In some diseases, people look younger than their years (for example, with some early acquired heart defects), in others (for example, atherosclerosis, fat metabolism disorders, etc.) - older than their metric age.
4. Skin color, especially the distribution of its color, which are pathognomonic for certain disorders of general and local circulation, disorders of pigment metabolism, etc.

To objectify the morphological abnormalities noted above, anthropometry methods are used.

Types of constitution

In our country, the most common nomenclature of types of constitution, proposed by MV Chernorutsky, is asthenic, normostenic, hypersthenic. Along with this, other names of these types of constitution can be found in the literature.

The asthenic type of constitution is distinguished by a narrow, flat chest with a sharp epigastric angle, a long neck, thin and long limbs, narrow shoulders, oblong face, mild muscle development, pale and thin skin.

The hypersthenic type of constitution is a broad, stocky figure, with a short neck, a round head, a broad chest and a protruding belly.

Normostenic type of constitution - well-developed bone and muscle tissue, proportional addition, wide shoulder girdle, convex thorax.

The above classification suffers from a significant drawback, since it does not include intermediate types of constitution. It is for this reason that objective measurement methods of research are increasingly used.

Posture

In addition to the physique in the external appearance of man, his habitual posture or what is called a posture is of great importance. The posture of man has not only aesthetic value, but influences (positively or negatively) the position, development, condition and function of various organs and systems of the body. Posture depends on the position of the head, neck, shoulders, scapula, the shape of the spine, the size and shape of the abdomen, the pelvic incline, the shape and position of the limbs, and even the setting of the feet.

Normal posture is characterized by the vertical direction of the trunk and head, unbent in the hip joints and completely lowered in the knee joints by the lower extremities, the "unfolded" thorax, the shoulders slightly backward, closely fitting to the thorax with the scapulae and the tightened abdomen.

In a person of regular constitution in an ordinary, relaxed stance with closed heels and dilated toes, the line of gravity as the vertical axis of the body begins from the middle of the crown, runs vertically downward, crossing the conditional lines connecting the external auditory canals, corners of the lower jaw and hip joints, and ends on the back surface Stop. Normally, in a person with a correct posture, the lumbar flexure has the greatest depth in the region of the vertebra L ₃; in vertebra Th ₁₂ lumbar bending proceeds chest, the apex of which is vertebra Th ₆.

Signs of normal posture

1. The location of the spinous processes of the vertebral bodies along the plumb line, lowered from the knoll of the occipital bone and passing along the interannual region.
2. The location of the forearms is on the same level.
3. The location of the angles of both blades is at the same level.
4. Equal triangles formed by the trunk and freely lowered arms.
5. Correct bends of the spine in the sagittal plane.

Disorders of posture are manifested most often by increasing or decreasing natural curvatures of the spine, deviations in the position of the shoulder girdle, trunk and head.

The following unfavorable factors underlie the development of pathological (nonphysiological) posture:

• anatomo-constitutional type of spine structure;
• lack of systematic physical training;
• visual defects;
• disorders of nasopharynx and hearing;
• frequent infectious diseases;
• unsatisfactory nutrition;
• a bed with a soft feather bed, a spring;
• School desks that are not age-appropriate;
• insufficient time for physical exercise, insufficient time for rest;
• a weakly developed muscular system, especially the back and abdomen;
• hormonal disorders.

The most common disorders of posture are the following: flat back, round and rounded back, saddle-shaped back, often accompanied by changes in the configuration of the anterior abdominal wall.

It is also possible to combine various deviations from the posture, such as a round-concave, flat-concave spin. Often there are violations of the shape of the chest, pterygoids, as well as the asymmetric position of the shoulder girdle.

Lateral curvature of the lumbar spine

The lateral curvature of the lumbar spine - ishalgic scoliosis, occurs quite often. The direction of scoliosis is indicated taking into account the convex side of the lateral curvature. If this bulge is facing the affected leg (and the patient is inclined to the "healthy" side), scoliosis is called homolateral or homologous. If the direction is reversed, scoliosis is called heterolateral or heterologous.

Scoliosis, in which, along with the affected lumbar spine, and the overlying parts of the trunk are called angular. When the overlying divisions compensate in the opposite direction, scoliosis is called S-shaped.

For ishalgic scoliosis, static-dynamic loads in the conditions of the affected disc turn out to be decisive. Against this background, in connection with the emergence of the pain syndrome, special - analgesic and other mechanisms of curvature of the spine are formed. Scoliosis is formed under the influence of a certain state of the spine muscles, and they react reflexively to impulses not only from the spine, but also from other spinal tissues innervated by the sinuvertebral nerve. If one-sided radicular impulses may be crucial for a sharply expressed, especially alternating scoliosis, then in the remaining cases it is necessary to take into account the impulse from the posterior longitudinal ligament and other tissues both to the right and to the left. Many authors paid attention to vertebral muscles and as a source of proprioception, an important role in this was assigned to the defeat of nerves of deep sensitivity and sympathetic nerves of joints and muscles.

Scoliosis usually develops against a background of moderate and severe pain, and only severe fixed scoliosis is more frequent (more than twice) in patients with sharp and severe pains.

Angular scoliosis is especially common, less often S-shaped, and a combination with deformities in the sagittal plane (more often kyphoscoliosis) in 12.5% of cases. The formation of a second, oppositely directed apex in S-shaped scoliosis is obviously associated with the severity and duration of the primary curvature in the lower lumbar spine.

To assess the severity of ishalgic scoliosis, given its dynamic nature, Ya.Popelyansky singled out three degrees:

• 1 st degree - scoliosis is detected only with functional tests (extension of the trunk, flexion and inclination to the sides);
• 2 nd degree - scoliosis is well defined by visual inspection in the patient's standing position. The deformation is impermanent, disappears when sagging in parallel chairs and in the supine position;
• 3rd degree - persistent scoliosis that does not disappear when sagging on chairs and in the patient's position lying on the stomach.

ATTENTION! Once emerged, scoliosis remains for a long time, regardless of whether it appeared for the first time or repeatedly in this patient.

At the heart of alternative scoliosis lie some kind of anatomical relationship, folding between the disc hernia and the spine. Hernial protrusions of the disc in these patients are never large and are often spherical. This circumstance makes it possible for the patient, under the appropriate conditions, to move the spine through the point of maximum protrusion of the disk to the right or to the left. Then there is this or that position of alternating scoliosis. The inclination of the trunk reduces in such cases the tension of the rootlet over the hernia of the disc and facilitates the change in the position of the trunk. In all patients with this form of scoliosis, the phenomenon of extinction of scoliosis is observed (physical exercises, traction therapy). At this reception radicular pain and scoliotic deformation disappear. These LFK means clearly confirm that the decreased volume of the hernial protrusion at the end stops the tension of the spine and the irrigation from it and this immediately leads to the elimination of deformity. However, it is only the patient to stand on his feet, i.е. Load the spine and thereby restore the previous volume of disc herniation, as the previous radicular pain and scoliosis reappear.

A single look at the occurrence of scoliosis in osteochondrosis explains not only the cause and their various types, but also facilitates the diagnosis, allows more correctly to judge the course of the disease, as well as the effectiveness of treatment.