First, clinical manifestationA comprehensive and systematic understanding of the clinical manifestations of tendon injury is an important li
First, clinical manifestation
A comprehensive and systematic understanding of the clinical manifestations of tendon injury is an important link in the diagnosis of tendon injury, the correct analysis and induction of the collected clinical data is the basis for the correct diagnosis. The main clinical manifestations of the tendon injury are pain, swelling and dysfunction, but also because of the size, nature and degree of the external injury. The clinical manifestations were related to the degree and location of injury. The incidence of acute tendon injury suddenly, most of them have a more obvious history of trauma, clinical symptoms are more typical, easy to diagnose, but should pay attention to whether there are fractures, dislocations and other complications. Chronic tendon injury generally has no obvious trauma history, the onset is slow, the cause of the disease is also a variety of symptoms gradually appear, often misdiagnosed, misdiagnosis, attention should be paid to the differential diagnosis. It is helpful to grasp the clinical manifestations of tendon injury to improve the diagnosis of tendon injury.
Affected by the impact of external violence, strong twist or pull compression, the first cause of local pain at the injured. General acute injury more severe pain, chronic mild injury pain, for pain, pain, or distraction related activities. Nerve contusion numbness or fulguration like radioactive pain. Muscle, nerve or vascular injury in the injured immediately after the onset of persistent pain, and tendon, fascia, rib cartilage injuries caused by pain often remission time in a sudden attack, then the pain gradually worsened.
In general, there are different degrees of local swelling in the tendon injury, the degree of which is related to the size of the external force and the degree of injury. The external force is small, the degree of injury is light, the local swelling is light, the external force is large, the degree of injury is serious, the local swelling is more serious. After injury, blood vessel rupture hematoma formation, local swelling showed purple ecchymosis, generally relatively limited, local hematoma bleeding more of a wave motion. Those who do not break the blood vessels are often caused by nerve reflex reaction and increase the permeability of blood vessel wall. A large area of crush injury, damage caused by the larger, exudate also more swelling occurred in shallow, wave sense is obvious, clinically known as subcutaneous avulsion injury. In addition, is also a common clinical manifestations of chronic swelling of the distal limb swelling, the end temperature decreased, color of skin dark or cyanosis, late show chronic congestion, the distal limb is low when the swelling was aggravated, also known as orthostatic edema. It is mainly due to impaired muscle injury after limbs and severe injuries, blood runs sluggish; or bandage too tight, affect blood circulation; or limb prolapse, less activity, local poor venous reflux in elderly patients.
There may be deformity after tendon injury, but there is a significant difference with the fracture deformity. Muscle injury is caused by the rupture of muscle and ligament. Such as muscle, ligament rupture, there may be a contraction bulge, there are hollow defects in the fracture defects. For example, serratus anterior muscle injuries can occur in the wing of the scapula deformity, should be carefully identified and compared with the contralateral limb.
Because of pain and swelling, most of the injured limbs will appear different degrees of dysfunction. Check the joint movement and range of motion and muscle strength, for the diagnosis of the injury site is very helpful. There is no movement beyond the normal range of motion, the identification of muscles, tendons or ligaments, such as laceration or rupture of great significance. Nervous system damage can lead to sensory dysfunction or loss of limb function in the control area. Because of nerve injury, tendon rupture caused by dysfunction, which is characterized by active movement disorders, passive activity. If the joint active and passive activities are limited, usually due to the injury of muscle, tendon, joint capsule contracture caused by joint movement disorders.
Two, differential diagnosis
Tendon injury disease through interrogation mainly patients understand the tendon injury location, time, and after the violent nature of injury, injury and postprocessing change situation, through the analysis, can have a preliminary estimate of the injury. The inquiry content mainly includes the following aspects:
Includes 1 general information: name, sex, age, occupation, marital status, race, nationality, address, work unit, telephone number, postal encoding, identity card number, the content is not only a reference for diagnosis, but also conducive to the establishment of medical record, to facilitate inquiries, contact and follow up.
2 complaints asked the main symptom and injury time. This is a reminder of the nature of the disease and the main reason for patients to come to see a doctor, but also the most problems to be solved. Therefore, the chief complaint is mainly based on syndrome differentiation in. Content concise and to the point.
3 present medical history refers to the onset of systemic and local conditions, including:
(1) the wound: for the injury situation should be carefully asked, such as pain, swelling, limb activity, there is no abnormal activity.
(2) injury: ask the injured parts of the patients, the injured process is faint, faint time and wake up with no blackout, as well as the rescue measures, in order to understand the severity of the injury.
(3) the time of injury: ask when the patient is injured, ask the date and time to determine whether it is acute or chronic injury. If the patient has been treated before the treatment, but also to ask the treatment time and.
(4) the cause and position of injury: the cause of injury is a variety of reasons, so when asked to ask the specific details of the injury, including the nature of the violence, the intensity and the position of the injured patients. For patients with chronic injury also asked whether their occupation and living environment is wet, cold, etc..
(5): cold chills, fever about the duration and extent of injury and the relationship with the. As early as heat injury blood stasis heat, the temperature is not more than 38 DEG C, and high fever for wound infection pathogen, hot meat rot simmer pus, temperature often at 38 DEG C.
(6) pain: tendon injury patients have pain, to be asked in detail about the onset time, location, nature and degree of pain. Is pain, pain or numbness about; pain is persistent or intermittent, increase or reduce pain, is in the range of the expansion of narrow, limited or fixed do not move, multiple or walk, there is no pain, radiating to where, taking analgesic drugs can reduce weight, different actions (cough, sneeze, etc.) the impact of pain, and the weather changes have no relationship, and the rest day and night have no effect on the degree of pain. General pain and hurt, pain, mild injury is lighter, more pain is chronic injury, pain is pain to qi stagnation, blood stasis, ache is chronic muscle injury, wandering pain is pathogenic wind invasion.
(7) the function of the body: if there is dysfunction, it should be clear that the injury occurred immediately after the injury, or after a period of time after the injury occurred. General fracture, dislocation of the active function after the loss of many, most of the tendon injury with swelling and gradually aggravated symptoms. There are also those who have difficulty in asking whether they are long-term or intermittent, and the long-term existence is mostly after the injury, and there are some obstacles in the intermittent. For example, there are loose bodies in the joint, when the free body is embedded in the joint cavity, the phenomenon of joint locking occurs.
Outside the human body in vivo and the viscera are closely linked, so we should pay attention to the inspection of tendon injuries not only the observation of local damage, but should include the body of God, color, shape, tongue, to infer changes in body condition.
1 look at the whole body
(1): look look look look and look to God, the survival is fundamental to infer the severity of the outcome. General muscle injury has little effect on the look, or tendon injury tendon injury more serious lack of physical weakness may appear apathetic, dull color, gaunt. If the muscle injury after confusion, respiratory micro promotion, pale or cyanosis, indicates that the essence of decline, is a sign of danger card.
(2) look shape: posture and postural strength, fat and body constitution were observed. For example, patients with acute lumbar sprain body multiple ipsilateral lateral flexion, and hand posture in patients with lumbar support, stiff neck stiff neck, head often together with the body rotation etc..
(1) hope deformity: tendon injury may cause limb deformity, but the tendon injury is often no fracture, dislocation of the deformity is obvious, so need to carefully observe. For example, when the hip muscle injury, the lower limb may appear false long, radial nerve injury occurs when the wrist deformity.
(2) look swollen, skin color: swelling is a common symptom of tendon injury. The swelling in the early stage of tendon injury was limited, and the swelling was not obvious. Swelling and wave motion, indicating that there is blood or effusion. The new wound bleeding and swelling, and local skin bruising. Local skin yellowing old wounds blood stasis is absorbed, expand the scope of. Local redness of skin and skin temperature increased. With the pale and cold, the blood circulation disorder. Local skin color is black, it shows tissue necrosis.
(3) look at the limb function: pay attention to the observation of limb function, such as upper limb can lift, lower limbs can walk, and then further check whether the joint flexion and extension, rotation, etc.. For example, the normal activity of shoulder abduction and adduction, flexion, extension, pronation and supination six. Where the abduction of the upper limb is less than 90 degrees, and the shoulder blades are moved together during abduction, the abduction action is restricted. When the elbow flexion, shoulder adduction, elbow tip can not close to the midline, indicating limited adduction movements. If the patient's hair movement is restricted, indicating that there are external rotation dysfunction. If the patient can not be placed on the back of the hand, indicating internal rotation dysfunction. If there are obstacles to further identify the activities should be what kind of disability, often with touch method, this inspection method combined with, through the contrast method to determine the active and passive degree function.
3 to observe the tongue and tongue tongue. Although the tongue can not directly determine the location and nature of the tendon injury, but the tongue is the heart of the seedlings, the spleen and stomach outside, and the organs are closely linked. So, the tongue can reflect the ups and downs of human blood, body fluid loss, illness, disease and evil nature, disease bit depth and muscle injury after the change of the body, so the tongue is an important content of muscle injury syndrome.
The tongue and the tongue to reflect the muscle injury condition in the aspect, on the whole, reflected in the tongue of the blood changes as the focus, reflected in the tongue to taste changes as the focus, the observation of tongue can be verified.
(1) look at the tongue: normal tongue is pale red, bright color moist. Pale white tongue, suggesting that the lack of Qi and blood or blood gas injury. The tongue fat fat side has the tooth mark, is the spleen deficiency wet stagnation. Red tongue is seen in the real heat or Yin, also common red tongue blood stasis of early severe thermal injury. The tongue is dark red tongue, the main heat and Yin Huo wang. Green tongue purple or blue matter called red with purple tongue, the main blood stasis. The purple tongue said all the poor blood or blood stasis degree is heavy, the local purple said local blood stasis or blood stasis to a lesser extent. There are heat purple tongue, but purple with crimson.
(2) coating: coating can be divided into two aspects and moss moss color.
Saw Moss: thick moss for Xie Sheng, thin fur for evil to decline, from thin to thick moss for exacerbations by thinner for disease loss, wound infection in the patients in common. Moss moist with body fluid, dry for body fluid deficiency. Greasy, body dampness, phlegm retention or indigestion. Peel and moss light, as Yin heat, body fluid deficiency or damage to fluids.
Moss color: white, yellow, gray, black and so on 4 kinds. The main table white card, cold dampness syndrome. Taijing thin and moist as normal tongue or disease early in the table, white fur and slippery for cold syndrome, thick white and smooth for the cold syndrome of cold phlegm or phlegm, thin white dry for lack of fluid, thick white drying dampness heat, white greasy to block phlegm. Yellow, the main interior heat syndrome. Thin yellow Ergan said heat evil injury Tianjin, yellow greasy for damp heat, Huang (yellow), Jiao Huang (black and yellow) for damp heat accumulation, yellow and white said the pathogen from the table into the inside, by cold heat. Gray fur can be found in the main interior, in the heat, it can also be seen in in cold syndrome. The gray moss that is light colored moss can be transformed from white moss, but also with yellow fur and see. Moss grey and runduo dampness resistance or phlegm fluid retention, gray white fur and dry to hot or Yin Yin Huo wang. Black moss main interior, the main hot and cold fill the main. Black moss by gray fur or coke yellow fur and black, and cracks, even for extreme heat prick Tianjin, black and lubricating more Yang yang.
(3) at the base of tongue vein: all dark purple tongue vein said tendon injury blood stasis disease.
By the two aspects including listening to sound and smell, in addition to pay attention to the patient's language, breathing, cough, vomit, olfactory wound, two or other waste odors and other general content, muscle injury disease inspection also should pay attention to the following points.
1 joints of the joints in patients with loose body, the joint can be active when the ring. The knee meniscus injury in patients with knee joint flexion and extension flexion movement, can occur more clear and elastic.
2 rub the tendon and tendon sheath with myotenositis patients in the examination can often hear crepitus, common in the surrounding exudation of extensor muscles, thigh, good hair at the forearm and lower leg unit four biceps tendon. With the flexor tendon tenosynovitis patients in flexion movement, can be heard playing sound.
3 patients with joint friction and degenerative arthritis in the active joints, often hear the joint friction sound. Patients with patella osteomalacia in the patella grinding, but also often hear the friction sound.
(four) the pulse
The pulse is divided into two part and pulse palpation. It is mainly master the changes of Qi and blood in the human body, and the actual situation, etc.. Touch through the patient's skin, limbs, chest and abdomen and other parts of the touch press, in order to identify the severity of injury and depth of the site. The pulse in the muscle injury examination is widely used and important.
1 pulse or pulse. Tendon injuries are common in the pulse can be summarized as follows.
(1): floating pulse light according to the means, but not diminished by heavy empty, in the new injury bruising pain. If found in major bleeding and patients with chronic diseases, indicating the lack of righteousness.
(2) sink pulse: light should not be, according to the beginning. The main practice. In the internal blood, injury pain.
(3): slow slow pulse, breath pulse to less than 4 times. The general pulse main cold, master yang. In tissue contracture, blood stasis.
(4) the number of pulse: pulse rate, breath pulse to more than 5 times. The number of powerful, more heat syndrome, but is unable to count the hyperactivity of fire due to yin deficiency, damage in the heating period.
(5): current pulse fluency, such as disk ball, which should be smooth. In the chest contusion, blood gas and solid in pregnancy.
(6): unsmooth pulse pulse shape and fine later, exchanges difficult, such as light bamboo knife. The main blood deficiency, blood stasis, Qi stagnation.
(7) string pulse: pulse shaped end straight to long, such as the strings, inch, off, the ruler of the three straight straight down. The main pain, liver disease, yin deficiency and yang hyperactivity. More common in chest injury and severe pain, as well as liver and gallbladder diseases, hypertension, arteriosclerosis and other patients. Is a powerful tight pulse, in the cold of the lumbago.
(8) soft pulse: floating pulse gas and soft, weak, relatively and taut pulse. In two, blood deficiency strain.
(9): pulse surge as full pulse, to Sheng to decline. More common in patients with post injury blood stasis heat.
(10) thin veins: veins, such as fine lines, should be clearly marked. In the deficiency of Qi and blood, the virtual strain or infirm long illness.
(11): vein floating hollow, such as onion tube. More common in all kinds of bleeding after injury.
(12): the general node intermittent intermittent pulse. Sometimes a slow pulse to check, check no fixed number of node, pulse to move and abort, not for a long time, complex, check for a certain number of l.. More severe pain in the tendons, pulse, when the gas does not converge.
Muscle injury disease by pulse method program, can be summarized as follows: 1. Blood stasis stop product more empirical, pulse should be strong and real, not imaginary fine and astringent. Small smooth, heavy details of evil. The Hemorrhagia excessive system deficiency, deficiency and fine veins should be astringent, not strong and real. Small Shun Hong Shen, who is evil. The six fuzzy, card is light, and the bad prognosis. The card was heavy, and the pulse to ease with God, the prognosis is good. In serious pain, pulse string tight junction, the occasional intermittent pulse system, temporary pain syndrome, not evil.
2 touch also known as touch, it can provide an important basis for diagnosis. The "golden mirror of medicine, orthopedic gist said:" heart "in the hand, self aware of the situation." Said: "the touch, with his hand to touch the injury...... The tendons are strong, the tendons are soft, the tendons are crooked, the tendons are straight, the tendons are broken, the tendons are walking." Therefore, there is a clear understanding of the situation of the injury site, especially in the absence of inspection equipment is more important.
(1) main contents
The touch pain: according to the pain location, range, degree to identify the nature of the injury. Such as direct tenderness may be part of the tendon injury, such as the pressure of pain and radiation pain may be related to the nerve.
Touch deformity: touch the surface of the bone changes, to determine the nature of the deformity, location, such as lumbar disc herniation who have scoliosis and lumbar muscle tension.
Touch the skin temperature: through the change of local skin temperature can distinguish cold syndrome and heat syndrome. Skin temperature is high, said the new injury or local blood stasis heat, heat the meat rot, skin temperature is low, said cold disease or blood circulation disorders. Touch the skin temperature, the general test to the back of the hand is appropriate.
The abnormal activity of touch: beyond the normal range of the activities of the limb joints is ligament rupture performance.
The masses touch: to understand the anatomical level of the masses, the surface is smooth, clear texture, size, shape, boundary, understanding activity etc..
(2) common methods
The touch with the fingers carefully touch the wound, to discern the partial injury situation.
The extrusion method: hand squeezing lesion on the left, before and after the diagnosis of the bone is broken according to the conduction of force, to exclude fracture.
The tapping method: to check whether the use of bone fracture and the impact of distal limb longitudinal percussion.
The rotating method: with the bottom hand injured limb, rotate gently, observe the wound has no pain, disability or special sound etc..
The flexion and extension method: hold the adjacent joints do flexion and extension movements, to measure the joint flexion and extension activities according to the degree of function.
The resistance method: choose proper posture, medicine hand fixed with the distal limb, the patients with resistance exercise, muscle strength and damage location, check the limb muscle pain.
To do the above palpation examination, we must pay attention to the comparison with the healthy side, because congenital malformation and other factors can affect the accuracy of diagnosis. At the same time, should also be compared before and after treatment.
The great difference of clinical manifestations of muscle injury, the nature and extent of damage to external size, different clinical manifestations caused by clinical data is not the same, so it must be at the smell and asked four clinics collected, combined with modern means to check the correct diagnosis.
3 measurement of extremity limb joint movement is mainly rely on the joint and surrounding muscle coordination to complete, through joint activities, limb length and limb circumference measurement, analysis and understanding of body injury, it is necessary for the diagnosis, treatment and curative effect observation.
(1) the measurement range of motion: the joints of the body has its normal physiological range (1-1 ~ 1-8), occurrence of disease or injury in the body, the scope of their activities can be changed, the activity decreases or increases, also can appear beyond the physiological range abnormal activity. At present, more commonly used in clinical measurement method is based on the neutral O degrees, referred to as the neutral O degree method, the measurement should be taken to remove the additional activities around the joints (Table 1-1). If the shoulder joint activity is measured, the scapula should be fixed; the pelvis should be fixed when measuring hip movement. Attention should also be paid to the differences in the range of normal human joint motion, and to compare the activity of the joints on both sides if necessary. For the parts that are not easy to measure accurately, the joint function can be used to measure the relative motion range of each bone. For example, cervical flexion can be measured under the chin to the sternum distance measured at the lumbar flexion ptosis of the fingertip and ground distance etc..
(2) the measurement of limb length: the length of the body is mainly used for the differential diagnosis of tendon injury, fracture, dislocation, congenital or secondary deformity. Table commonly used limb length measurement and fixed markers are shown in table 2.
(3) the measurement of the circumference of the body: the patients with tendon injury often show swelling or atrophy of the limbs, and measure the degree of swelling or atrophy is helpful to understand the severity of the disease and evaluate the treatment effect. The commonly used tape measurement of limb circumference measurement, taking swelling or shrinking the most obvious, and the measurement of the contralateral symmetrical parts of the circumference were recorded, compared with. The mass measurement is recorded in diameter or volume.
4 neurological examination method of nerve injury is an important content of muscle injury disease, diagnosis or improper treatment often will give patients bring irreparable consequences. Therefore, accurate judgment is particularly important without nerve injury and injury site, understand the cause of injury, injured parts, paralysis occurred time should be Pro Card (after the injury occurs immediately or gradually) and whether the phenomenon of recovery after injury. The specific examination should include the sensory examination, the movement examination and the reflection inspection and so on.
(1) sensory examination
The touch: Patients with eyes closed, medical cotton or cotton swab to gently touch the skin, touch and compare the changes of different parts. The tactile intensity can be divided into 4 levels: normal, sensitive, dull and disappearing.
The pain with acupuncture skin to check the pain, the operation should grasp the stimulation intensity, can never feel to normal area. Check to be systematic, top-down, pay attention to both sides contrast. pain
Sleep is divided into normal, sensitive, dull and disappear 4. Temperature sense: the glass tube with 5 to 10 degrees of cold water or the temperature of 40 to 50 degrees Celsius to check the skin temperature sensation.
The sense of position: Patients with closed eyes, the doctor will be patients with distal finger (toe) joint passive activity, and inquired about their location.
The vibration perception: with a tuning fork handle end on the subject bone or bone surface, such as the ankle, patella and iliac crest, spine, sternum or clavicle, check the vibration sense. When the examination, the patient should close the eyes.
The sensory changes should be recorded in detail and shown in the area.
(2) exercise test
Muscle volume: pay attention to the appearance of muscle atrophy and swelling. The circumference of the limbs was measured and compared with the healthy side.
Muscle tension: muscle tension, muscle tension at rest, passive movement joints have resistance, seen in upper motor neuron damage. Decreased tension, muscle relaxation, muscle weakness, or disappearance, seen in lower motor neuron injury.
Muscle strength: when examining muscle strength, it is necessary to examine one of the major muscles below the level of nerve injury and compare it with healthy or normal persons in order to estimate their muscle strength. Generally, the normal muscle strength is divided into 6 grades.
Level 0: complete paralysis of muscles, completely without contraction.
Level 1: muscle power is small, can not drive joint movement.
2 level: muscle power can drive the movement of the horizontal joint, but can not resist gravity.
3 level: the ability to resist the limb weight without resistance to the joint movement.
Level 4: able to resist greater resistance, but weaker than normal.
Level 5: normal muscle strength.
(3) reflex examination: examination should make the patient position appropriate, muscle relaxation, to avoid tension. The doctor percussed to accurately position the uniform force, and pay attention to both sides of the contrast.
Superficial reflex: the reflection caused by the stimulation of the body surface receptor, and the disappearance of the reflex arc. Commonly used in clinical shallow reflex and its corresponding spinal segments:
Abdominal reflex: blunt abdominal wall or finger lightly on both sides, the middle and lower parts of the skin, visible to the abdominal muscle contraction reaction. Epigastric reflex tips: (7 ~ 8) of thoracic injury, abdominal reflex tips: (9 ~ 11) of thoracic injury, abdominal reflex tip down 11 to 1 lower thoracic spinal injury.
Cremasteric reflex: with a blunt scraping thigh skin, cause cremaster muscle contraction, testis increased, reflex tips (1 ~ 2): waist injury.
Anal reflex: with a blunt scraping the skin around the anus, caused by sphincter contraction. Reflex tips (1 ~ 5): sacral injury.
Deep reflection: it is the reflex that stimulates the body, muscle and joint of the body, and the deep reflex and the corresponding spinal cord segment are commonly used in clinic:
Biceps reflex: the forearm in pronation semiflexion, the doctor will put his thumb on two humeral head tendon, with percussion hammer percussion thumb, caused by the contraction in the biceps, neck: (5 ~ 6) control.
Triceps reflex: the forearm in pronation semiflexion, healer in holding the forearm, with percussion hammer percussion elbow brachial triceps tendon three head, caused by shrinkage, neck down (6 ~ 7) control.
Reflection: the elbow with membrane radius half flexion and forearm pronation, tapping the radial styloid process, cause the forearm flexion and supination external action, by the neck: (7 ~ 8) control.
The knee jerk: check should enable patients to relax the muscles, with percussion hammer percussion of the patellar ligament, caused by knee extensor movements, waist down (2 ~ 4) control.
Achilles tendon reflex: caused by foot with percussion hammer percussion plantar flexion tendon. Check the patient supine, the knee flexion half, heel inward. The doctor left foot grip (thumbs on, more than 4 fingers in the dorsum of foot, the foot is dorsiflexion), right hand percussion tendon caused by contractions of the triceps surae and foot plantar flexion, the lower sacral (1 ~ 2) control.
Hoffman (Hoffmann) syndrome: the doctor left hand to hold the right hand with the palm of the hand, index finger and middle finger grip with finger and thumb flick with nails. Such as the cause of the thumb and the rest of the finger flexion movement as a positive reaction, suggesting that motor neuron injury.
Babinski (Babinski) syndrome: to blunt the stroke patients with lateral plantar toe dorsiflexion, cause of extension, the other 4 toe sector separately for the positive reaction, this is one of the most important pathological reflex showed pyramidal tract injury.
Patellar clonus: patient supine straight leg. The doctor pressed his finger on the upper edge of the patella, pushing the patella downward, and pushing the patella in the position. Such as the four strands of the rhythmic contraction of the tendon and the rapid acceleration of the patella to move up and down, it is positive.
Ankle clonus: patient supine, doctors use the right hand holding the foot, knee flexion in half, thrust the foot ankle dorsiflexion. If there is a rhythmic movement of the ankle joint, it is positive.
5 special inspection
(1) spinal examination
The head percussion test: patients sitting, doctors a hand flat according to the patient's head, with the other hand fist percussion in patients with palm dorsal metacarpal head. If the patient felt discomfort or pain to the upper limb pain, numbness, that is positive. Examination for cervical spondylosis or spinal injury.
The intervertebral foramen extrusiontest: patients sitting, head slightly to the side of the rear side tilt, and two cross, hold the head downward pressure. If the patient feels neck pain and radiate to the upper limb, that is positive. Examination for cervical spondylosis.
The brachial plexus traction test: patients sitting, doctors holding a patient side of the wrist, the other hand hold the patient's head, hands push and pull in opposite directions. If the patient feels pain and radiation to the upper limb, that is positive. Examination for cervical spondylosis.
The test of straight leg raising: patient supine, legs straight. Do straight leg raising action, and then passively raise. Both sides of the lower limb elevation amplitude and pain. If the elevation of the side to reduce, while the lower limb radiation pain is positive, indicating that the nerve root compression. The number of legs raised should be recorded. For prolapse of lumbar intervertebral disc and sciatica check.
The straight leg raising test and strengthening dorsiflexion test position with the straight leg raising test. When the patient to raise the lower limb pain, slightly lower the patient's lower limb to make it do not feel pain. The doctor took the patient's foot and gave it back. If the patient suffered from sudden pain or cause pain in the affected limb is positive. For prolapse of lumbar intervertebral disc and sciatica check.
The hip flexion and knee extension test: supine position and try to make the medical patients with lower limb flexion of the hip, knee, and then gradually straighten the knee. If the lower limb pain occurs when the knee is positive. For the examination of sciatica.
The hip and knee flexion test: supine position, medicine the hip and knee to hold hands with two patients with knee flexion, and head to push the hips to leave the bed. If lumbosacral pain is positive. If the waist muscle injury, strain or lumbar joints, lumbosacral joint, sacroiliac joint lesions or lumbar tuberculosis were positive, but lumbar disc herniation do this test is usually negative.
The sacroiliac joint separation test: also known as the "4" test. With the patient in the supine position, the doctor will do after the injured limbs flexion on the contralateral knee shaped cross legged, then a hand on the contralateral iliac crest, the other hand to knee lateral compression. If the sacroiliac joint pain is positive. It is used for the examination of sacroiliac joint lesions, but the hip joint should be excluded.
To straddle test and bed test. The patient lying on the back of the bed, the health side in the bed, suffering from the side of the bed. Healers holding the contralateral knee flexion, hip flexion, the other hand on the ipsilateral thigh forced under pressure, try to make hip extension, if sacroiliac joint pain is positive. Sacroiliac joint disease.
(2) upper extremity examination
Abduction of the shoulder abduction test (pain arc test): Patients with upper limb abduction 0 degrees to 60 degrees without pain, abduction of pain from 60 to 120 degrees, and then lift up to 120 degrees to 180 degrees instead of pain is positive.
Prompt supraspinatus tendinitis.
The supraspinatus tendon rupture test: after the supraspinatus tendon rupture, the upper limb can not maintain a good external booth. The harder the patient is, the higher the shoulders.
The tennis elbow test: the forearm in pronation and wrist flexion and extension of the elbow, the extensor carpi radialis muscle tension caused by lateral epicondylitis pain increases, which is positive.
The fist test: the ipsilateral ulnar fist, thumb grip in the palm inside. The doctor had a hand holding a wrist, will suffer from carpal ulnar tilt, such as the radius styloid process of pain that is positive. Used to check the radial styloid tenosynovitis.
The wrist flexion test: the doctor will hurt patients with wrist flexion, and compression of the median nerve 1 ~ 2 minutes. Such as the palm side numbness aggravated pain radiating to the index finger, middle finger is positive. Carpal tunnel syndrome.
(3) examination of lower limbs
Hip flexion contracture test: Thomas's sign. Patients take supine position, as far as possible flexion of the hip and knee joints, so that the thigh close to the trunk, waist close to the bed surface. If the hip can not be stretched flat on the bed surface, or although it can straighten out the front of the lumbar protrusion is positive. Used for the examination of the stiffness of the hip joint, the rigidity and the spasm of the psoas muscle.
Single leg stand test: middle gluteal muscle test. With the healthy limb standing on one foot, lift the affected limb, the ipsilateral pelvic and the lateral hip fold rise is negative. The patients with limb standing on one foot, the healthy limb lifted, while the contralateral pelvic and hip fold down, which is positive. This test was used to examine the dislocation of the hip or the gluteus medius and the minor muscle, and any disease that caused the gluteus medius and minimus weakness.
The floating patella test: patient supine, ipsilateral knee extension, to relax the stock four muscles. The doctor in the hand above the patella squeeze, squeeze the synovial fluid of suprapatellar bursa area to the patella below, another hand to press the patella. If there is a sense of floating patella is positive, indicating that the knee joint effusion.
The knee joint separation test and knee joint collateral ligament pull test. The ipsilateral knee extension, healers holding lower leg, the leg abduction, the other hand on the knee joint lateral to medial push. Such as the medial knee pain and lateral activity is positive, indicating the tibial collateral ligament injury or fracture. In contrast to the fibular collateral ligament.
The push and pull test and drawer test. Patients with supine position, knee flexion. The doctor hands holding the ipsilateral knee below, push pull forward. If a calf excessive forward, said anterior cruciate ligament rupture or relaxation, on the other hand, said the posterior cruciate ligament relaxation or fracture.
The McMurray test: also called McNamara levy. The patient took the supine position, the doctor one hand in the knee and the other hand. The limb to knees, then the leg full supination adduction, abduction, or rotation, and gradually straighten out. In the process of extension of knee pain and playing sound is positive, knee pain and snapping their leg abduction, pronation extension examination, more suggestive of lateral meniscus injury, leg adduction, knee pain and spin out snapping, hint of medial meniscus, but may also have clinical and the opposite result.
The grinding test: with the patient prone. The doctor hands holding the limb ankle at 90 degrees, and then forced to squeeze down along the long axis of the calf knee joint, and internal and external rotation. If the knee joint pain inside and outside the side is positive, indicating the medial and lateral meniscus injury. In addition, such as the calf to pull up, do internal and external rotation activities cause pain, it shows that the knee, tibia collateral ligament injury.
The meniscus gravity test: also called knee flexion test. The patient in the lateral position, left limb bed. The patients were subjected to flexion and extension of the knee joint, and the medial collateral ligament and the lateral meniscus were compressed by the gravity of the calf. If there is a sound or pain, suggesting meniscus or collateral ligament injury.
(five) modern diagnostic methods for tendon injuries
The general significance of tendon injury diagnosis of 1 X-ray mammography, sometimes in diagnosis of tendon and ligament and cartilage injury has a certain reference value, and is mainly used for differential diagnosis of fracture, dislocation and bone disease etc.. The X-ray manifestations of post-traumatic tendon injury mainly has the following features: soft tissue thickness increased, localized swelling; local soft tissue image and tissue density increase; the original level of confusion is not clear; for subcutaneous tissue interstitial edema and reticular structure; and because of intra-articular effusion and hematocele caused by joint capsule swelling long, pushed or narrows and can cause extracapsular fat pad fat line.
The X-ray radiography of tendon injury mainly includes the following.
(1): General X-ray diagnosis of tendon injury has little significance, mainly used for differential diagnosis and fracture, dislocation and bone disease.
(2) X-ray film under stress: it is mainly used to check the joint laxity, joint dislocation and ligament injury. Inspection method is to be checked on a limb, forcing in varus or valgus, abduction adduction or radiography, from the observation of the joint anatomy have no abnormal change.
(3) contrast examination is helpful for the diagnosis of some tendon injuries, such as the intramedullary spinal canal can be used to determine the pathological changes of the spinal canal.
2 electromyography EMG is a method of recording the electrophysiological basis of skeletal muscle, morphology, distribution and scope of pathological EMG, can determine the site of nerve injury, judge the degree and prognosis of nerve muscle injury, further to the upper and lower motor neurons were identified. The clinical significance of electromyography:
(1) the emergence of tremor potential is a reliable sign of lower motor neuron injury.
(2) the EMG manifestations of partial nerve injury are various. When muscle relaxation, it showed a normal functional motor unit potential, the muscle contraction of the general appearance of a simple phase, but may also interfere with the phase.
(3) progressive multiple muscle testing is helpful for the localization of the diagnosis, and it is certain that there is no damage to the peripheral nerves.
(4) a long period of denervation of the muscle will lead to complete fibrosis, and all kinds of pathological potentials will disappear, and the pathological electrical resting state.
(5) primary myopathy and disuse muscle atrophy due to the absence of nerve damage, muscle relaxation for electrical resting state, muscle atrophy appeared during muscle contraction potentials, interference of low voltage phase can be strong muscle contraction.
(6) EMG can differentiate neurogenic muscular atrophy, muscular atrophy and other causes of muscle atrophy, but also distinguish the anterior horn cells and peripheral neuropathy.
(7) the nerve conduction velocity can reflect the nerve conduction function. Peripheral nerve disease, the most obvious change in conduction velocity. Spinal cord anterior horn cell disease, such as not associated with peripheral nerve degeneration, the conduction velocity is more than normal. Therefore, the slow conduction velocity is the manifestation of peripheral nerve injury, but also the difference between the lesions in the spinal cord anterior horn cells or peripheral nerve in the main basis.
3 computer tomography (CT) computer tomography examination has important reference value in the diagnosis of lumbar disc herniation, lumbar spinal stenosis, tendon injury and disease, and that the nature and scope of soft tissue lesions.
4 magnetic resonance imaging (MRI) the principle of magnetic resonance is that some substances in the nucleus of the atom with a single atom or neutron, can be measured by the micro magnetic force. When these magnetic nuclei are placed in a strong magnetic field when they rotate around the magnetic field, the magnetic line cycle according to the strength and the core varies depending on the type of a certain strength. The magnetic resonance images of tissue showed different steps through data processing, according to the brightness shows the following order: fat, brain and spinal cord, liver, muscle, fluid filled cavity, ligaments and tendons, with rapid blood flow, corticalbone, air, which can result in significant contrast. The application of magnetic resonance imaging is similar to that of computed tomography, which can be used for the examination of spinal cord, intervertebral disc, knee joint, ligament lesion, synovial hypertrophy, soft tissue tumor and primary muscle diseases. However, it is not widely used because of its expensive equipment.
5 laboratory examination laboratory examination is an indispensable part in the diagnosis of tendon injury, but the significance of injury diagnosis is mainly used for reinforcement, diagnosis and differential diagnosis of patients with severe muscle injury, and as an important indicator to judge and guide the treatment of the condition changes, the development of. With the development of basic research on muscle injury, laboratory examination is becoming more and more important in clinic.
6 arthroscopy is currently used primarily for the examination of the knee joint, and is being used for the examination of other joints such as the shoulder, elbow, wrist, knee or ankle. In addition, percutaneous endoscopic discectomy. The indications of arthroscopy and its application value are as follows.
(1) clear diagnosis: the diagnosis of joint diseases can not be clearly diagnosed by arthroscopy. Clinical diagnosis has been made
And to determine the surgical treatment of joint diseases, arthroscopic surgery before surgery, in order to further clarify the clinical diagnosis, so as to avoid unnecessary surgery.
(2) to determine the location and extent of the lesion: to determine the specific location of the injury and the extent of the injury, and to determine the treatment.
(3) biopsy under direct vision: the pathological changes can be obtained under arthroscopy. Arthroscopy can not only be used to check the diagnosis, but also can be used for the treatment of certain joint diseases, such as the use of knee arthroscopy in the joint meniscus resection.
Arthroscopy has been recognized as a valuable method for diagnosis and treatment, which has high accuracy and less complications, and is widely used in clinic. However, arthroscopy can not be excluded or replaced by other diagnostic methods, should be used in clinical practice.
Three, complications of tendon injury
In addition to local symptoms, tendon injuries often cause a series of reactions and complications. Clinical diagnosis, treatment should be comprehensive and careful examination, pay attention to the occurrence of complications of tendon injury, timely prevention of its development. Common complications of tendon injury are the following.
(1) early complications
1 when the tendon is injured, the avulsion fracture can be found at the tendon attachment point. A slight, repeated or sustained muscle contractions, such as running, Long March, the stress concentration in bone caused by a fracture, said fatigue fracture, such as the second and 3 metatarsal fatigue fracture.
The main function of the 2 rib joint dislocation is joint with complex shape, affiliate, our main joint movement. Due to muscle injury or fracture, or endocrine disorders, inflammation and other factors caused by ligament laxity, stretch, limb gravity force acting on the muscle, the stability of joint destruction caused by subluxation or complete dislocation. Such as subluxation concomitant with injury of knee joint cruciate ligament of knee joint, cervical inflammation, pelvic inflammatory disease complicated with atlantoaxial subluxation of sacroiliac joint bone fractures.
At the same time can be combined with nerve injury tendon injury in 3 nerve injury, such as injury of sciatic nerve and brachial plexus injury, common peroneal nerve injury, according to the sensory function of the body movement, have no obvious loss, muscle atrophy, nerve injury can be determined.
4 vascular injury tendon injury and complicated with vascular injury, such as injury of brachial artery, popliteal artery injury.
(two) late complications
1 muscle atrophy is a complication of chronic tendon injury. After tendon injury due to blood stasis, pain and bandage fixed and the lower limb activity, decreased muscle contraction ability caused by blood circulation disorder, a leading to inactive limb muscle atrophy, called atrophy of muscle. In addition, the nutritional dystrophy is the cause of unexplained muscle degeneration disease, characterized by genetic lesions, multiple restricted to a muscle group of the body, the degree of atrophy is more obvious, slow recovery, poor prognosis. Lower motor neuron or peripheral nerve injury, also common muscle atrophy.
2 joint ankylosis after injury due to loss of treatment, treatment, often cause muscle contracture and adhesion, so that active and passive joint movement of the joints and the occurrence of joint stiffness. Especially the hand tendon injury treatment should pay attention to early functional exercise, in order to prevent the occurrence of interphalangeal joint ankylosis.
The relationship between osteoporosis and the viscera and 3 closely, especially in liver and kidney two dirty. Liver reinforcement movement, the main reservoir of blood, kidney essence, bone marrow, liver and kidney, loss and muscle injury showed Yaotui activity is ineffective. Because the liver blood deficiency, blood without a band, even there is foot juluan, limb numbness, flexion and extension. The hard bone depend on kidney nourishing kidney essence, sufficient bone marrow bone marrow by biochemical active, nourishing and strong strong. Such as the kidney qi deficiency, deficiency of kidney essence, bone marrow is void, source shortage, osteoblast dysfunction and the occurrence of osteoporosis, bone fragility, showed two lower limb flaccidity fatigue, back pain, activity limitation, etc.. In the clinical application of the patients with tendon injury in the long-term bedridden, limb fixation or loss of use, can also be caused by disuse osteoporosis.
4 tissue adhesion tendon injury after blood overflow pulse, repair of fibrosis prone repair site with the surrounding tissue adhesion and influence of joint activities, such as injury of hand tendon injury, knee joint collateral ligament. Therefore, attention should be paid to the early functional exercise during treatment to prevent the adhesion of tendon injury.
5 thickening and lumen stenosis in chronic muscle injury, injury and repair of tendons at the same time, a long time after occurrence of hypertrophic degeneration of tendons, such as flexor tendon, ligament and spinal Neihuang, these tendons in the lumen, if hypertrophic degeneration will cause stenosis, clinical symptoms.
6 local hemorrhage and calcification and ossification of bone hyperplasia after acute tendon injury, a hematoma, the injured tissue hyperplasia and calcification. In addition, due to the accumulation of strain, strain can lead to ligament calcification, joint bone hyperplasia strain. Such as neck ligament calcification, lumbar and knee bone hyperplasia.
7 the joint body injury with cartilage injury, in the later can be turned into small blocks, and free falling body.