RU2302852C2 - Method for manually diagnosing pain syndromes in chest area - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining regulatory systems stress when manual provocation does not make things clear in the field of clinical significance of costal displacements. VLF% level being greater than 58.0%, parasympathetic reactivity HF% being less than 20% in hyperventilation test, pain syndrome in chest area is to be diagnosed.

EFFECT: high accuracy in differentiating clinically significant costal dysfunctions.

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Description

The invention relates to medicine, namely to reconstructive medicine (medical rehabilitation), manual therapy, neurology, therapy, and can be used in medical and preventive institutions.

Diagnosis of pain in the chest remains one of the urgent problems of modern medicine. The medical and social significance of this pathology is due to the predominance of sick people of working age (25-50 years), the number of which has been steadily increasing in recent years, and large amounts of money have been spent on their rehabilitation [Alliluyev I.G. Chest pain. - M., IVF, 2001 .-- 144 p .; Autonomic disorders: Clinic, treatment, diagnosis (edited by A.M. Wayne). - M.: Medical News Agency, 2000. - 752 p.].

Currently, there is considerable experience in the diagnosis of pain in the chest. At the same time, lack of accuracy, the lack of an integrated approach contributes to the search for more reliable and promising diagnostic methods [Wayne AM, 2000].

A number of authors indicate a connection between chest pain and vertebrogenic pathology, rib pathology, changes in the myofascial-ligamentous structures of the chest and shoulder girdle [Veselovsky VP Practical vertebral neurology and manual therapy. - Riga, 1991 .-- 341 p .; Ivanichev G.A. Fibromyalgic syndrome. - Kazan, 2004 .-- 164 p .; Popelyansky A.Ya. Clinical propaedeutics of manual medicine. - M .: MEDpress-inform, 2002. - 136 p .; Schmidt I.R., Peganova M.A. Pathobiomechanical changes in patients with neurological manifestations of thoracic osteochondrosis // Manual Medicine 1997-1998. - No. 12-13. - S.13-17].

In this regard, manual diagnostics is a promising method, since it is successfully used to test pathobiomechanical changes in vertebral neurological pathology [Chechenin A.G. Neurogenic functional biomechanical disorders of the motor system in osteochondrosis of the spine // Abstract. diss .... dr. honey. sciences. - M., 2000. - 48 p.].

The effective use of manual testing in the diagnosis of pain in the chest area is hindered by insufficient knowledge of pathobiomechanical changes, including costal dysfunctions, and most importantly, the state of the regulatory systems of the body, namely they often determine the prognosis and course of the disease [Wayne AM, 2000].

At the same time, a diagnostic technique remains undeveloped, taking into account the state of the autonomic regulation of the body. [Analysis of heart rate variability when using various electrocardiographic systems: guidelines / Bayevsky PM, Ivanov GG, Chireykin LV, Gavrilushkin AN, Dovgalevsky I.Ya., Kukushkin Yu.A., Mironova T. F. and others // Bulletin of arrhythmology. - 2001. - p.65-86].

The most adequate method for studying autonomic regulation in pain syndromes is the method of spectral analysis of heart rhythm using a hardware-software complex based on a personal computer [Fleishman A. N. Slow hemodynamic oscillations: Theory, practical application in clinical medicine and prevention. - Novosibirsk: Nauka, 1999. - 264 p.]. The method allows a differentiated assessment of various levels of vegetative regulation [Ryabykina GV, Sobolev A.V. Heart rate variability. - M .: "Star'Ko", 1998. - 200 p .; Babunts I.V., Miridzhanyan E.M., Mashaekh Yu.A. ABC of heart rate variability analysis. - Stavropol: Print master, 2002. - 112 p.]. We evaluate very low-frequency waves (VLF), which reflect the activity of central ergotropic mechanisms of heart rhythm regulation, low-frequency waves (LF), which reflect the activity of the sympathetic centers of the medulla oblongata (pacemaker and vasoconstrictor), high-frequency waves (HF), which reflect the activity of the parasympathetic cardioinhibitory center of the longitudinal spectrum power (TP), which reflects the total effect of influence on the heart rhythm of all levels of regulation (Table 1).

Table 1 Characterization of the waves of the frequency ranges of the spectral profile in the analysis of 3-minute waves [Analysis of heart rate variability when using various electrocardiographic systems: guidelines / Baevsky RM, Ivanov GG, Chireikin LV, Gavrilushkin AN, Dovgalevsky I.Ya., Kukushkin Yu.A., Mironova T.F. and others // Bulletin of arrhythmology. - 2001. - p.65-86]. Parameter Name Parameter Description frequency range VLF c ² / Hz × 100 Very low frequency wave power 0.40-0.15 Hz VLF% Relative value of the power of very low frequency waves VLF% = VLF / TP × 100 LF c ² / Hz × 100 Low frequency wave power 0.15-0.04 Hz LF% The relative value of the power of low-frequency waves LF% = LF / TP × 100 LF n.u. LF n.u. - normalized LF / (TP-VLF) × 100 HF c ² / Hz × 100 High frequency wave power 0.15-0.4 Hz HF% The relative value of the power of high-frequency waves HF% = HF / TP × 100 Hf n.u. Hf n.u. - normalized HF / (TP-VLF) × 100 TP c ² / Hz × 100 The total effect of exposure to all levels of regulation TP = VLF + LF + HF

A patent was found for methods for diagnosing painful muscle syndromes using visual diagnostics in statics and dynamics [Vasilieva L.F. Manual diagnosis and therapy (clinical biomechanics and pathobiomechanics) .- SPb .: IKF Foliant, 1999. 400 p .; A method for the diagnosis of dynamic violations of patent No. 2124311, 1999, L.F. Vasiliev, O.G. Kogan and Static - Patent No. 2134532, 1999, L.F. Vasiliev, I.R. Schmidt, O.G. Kogan]. The patient undergoes visual diagnostics in statics and dynamics with the determination of pathogenetically significant regional postural muscle imbalance. However, the method does not provide for the diagnosis and determination of the type of costal dysfunction and also does not take into account the state of the autonomic nervous system, which leads to an increase in the number of diagnostic tests.

The closest analogue in technical performance is the method of F. Greenman [Greenman Philip E. Principles of manual medicine.- Baltimore: Williams Wilkins, 1996. - 572 p.]. Patients are diagnosed and determine the type of costal dysfunctions. However, the analog does not take into account the type of costal dysfunction (ventral or dorsal displacement of the rib, torsion, etc.) in the formation of localization of pain and a specific clinical syndrome (interscapular pain syndrome, anterior chest wall syndrome, etc.), as well as changes in autonomic regulation to determine the clinical significance costal dysfunctions.

The objective of the invention is to develop a method for the manual diagnosis of pain in the chest in patients with an initial violation of autonomic regulation with the goal of accurate differentiated manual diagnosis of clinically significant rib dysfunctions without manual therapy, quick relief of pain, reducing the number of diagnostic tests and treatment procedures.

This is achieved by the fact that the localization of pain and the formation of a specific clinical syndrome (interscapular pain syndrome, anterior chest wall syndrome, etc.) directly depend on the type of clinically significant costal dysfunction (ventral or dorsal displacement of the rib, torsion, etc.). In cases where manual testing does not fully clarify the clinical significance of costal dysfunction, the tension of the body's regulatory systems (at a VLF% level of more than 58.0%, a decrease in parasympathetic reactivity - HF% of less than 20.0% on a hyperventilation test) indicates clinical significance costal dysfunctions.

The method is as follows. First, the doctor assesses the biomechanical situation and diagnoses the type of costal dysfunction, then determines their clinical significance. In cases where manual testing does not give full clarity about the clinical significance of costal dysfunction, the doctor determines the level of autonomic regulation (by spectral analysis of heart rhythm), in which costal dysfunctions significantly lose their sanogenic character and acquire clinical significance.

The biomechanical situation and diagnosis of the type of rib dysfunction consists of a palpation assessment of the position of the rib (the presence or absence of its linear (ventral, dorsal, etc.) or angular displacement (torsion, lateroflexion) and fixation, the degree of change in the movement of the rib, the presence of pathological tissue structure and pain on palpation, assessment of respiratory movements).

The clinical significance of costal dysfunctions is determined by the following criteria: 1) provocation (manual palpation) enhances clinical manifestations; 2) manual therapy leads to a decrease or disappearance of clinical manifestations. Provocation is carried out by creating a state of prestress in the dysfunctional joint in the direction of limiting movement. Manual therapy is carried out depending on the biomechanical situation from the state of prestressing, successively carrying out phases of tension (the patient is offered to strain the muscles of the segment in isometric mode), relaxation (the patient is offered to relax the muscles of the segment as much as possible), block resolution (the doctor stretches the muscles and allows the block).

In order to determine the type of clinically significant costal dysfunction in the formation of localization of pain and a specific clinical syndrome, we performed preliminary studies.

We analyzed the response in the form of increased pain in patients to manual provocation (palpation of the rib), as well as the effectiveness of manual therapy in the form of reduction or disappearance of pain. Analysis of the research results allowed for each pain syndrome to identify the leading types of costal dysfunctions by clinical significance, as well as their combination and localization.

Pain in the interscapular region (51) was most often caused by rib dysfunctions according to the type of dorsal displacement of the III rib (Pearson consent criterion χ ² = 7.5 at p <0.01), IV rib (Pearson consent criterion χ ² = 3.8 when p <0.05), V ribs (Pearson's consent criterion χ ² = 10.3 at p <0.01), VI ribs (Pearson's consent criterion χ ² = 6.0 at p <0.05); according to the type of internal torsion of the IV rib (Pearson's consent criterion χ ² = 5.8 at p <0.05), V rib (Pearson's consent criterion χ ² = 4.2 at p <0.05).

Pain in the subscapular region (17) was a consequence of costal dysfunction according to the type of external torsion of the VII rib (criterion χ ² = 5.1 for p <0.05) and to the type of dorsal displacement of the VII rib (Pearson's consent criterion χ ² = 6.5 for p <0.05).

Pain in the suprascapular region (13) was determined by costal dysfunctions according to the type of cranial flexion of the second rib (Pearson's consent criterion χ ² = 4.2 at p <0.05), according to the type of dorsal displacement of the second rib (Pearson's consent criterion χ ² = 5.7 at p <0.05), according to the type of external rotation of the III rib (Pearson's consent criterion χ ² = 5.6 at p <0.05).

Pain in the anterior chest wall (22) was determined by costal dysfunctions according to the type of cranial displacement of the 1st rib (Pearson consent criterion χ ² = 5.8 at p <0.05), according to the type of cranial flexion of the second rib (Pearson consent criterion χ ² = 7 , 9 at p <0.01), III ribs (criterion χ ² = 9.8 at p <0.01), IV ribs (Pearson's consent criterion χ ² = 6.0 at p <0.05), V ribs (Pearson's consent criterion χ ² = 6.3 at p <0.01), according to the type of ventral displacement of the IV rib (criterion χ ² = 5.2 at p <0.05), V ribs (Pearson's consent criterion χ ² = 6 5 at p <0.05), according to the type of external torsion of the III rib (Pearson's consent criterion χ ² = 8.1 at p <0.01), IV ribs (Pearson's agreement criterion χ ² = 4.6 at p <0.05), V ribs (criterion χ ² = 4.2 at p <0.05).

Pain in the sternal region (5) was caused by rib dysfunctions according to the type of ventral displacement of the III rib (Pearson's consent criterion χ ² = 5.7 at p <0.05), VI rib (Pearson's consent criterion χ ² = 6.9 at p <0 , 01), by the type of external torsion of the VI rib (Pearson consent criterion χ ² = 3.4 at p <0.05), by the type of lateral compression of the V rib (Pearson consent criterion χ ² = 4.2 at p <0.05 )

Pain in the region below the mammary gland (5) was caused by rib dysfunctions according to the type of ventral displacement of the VII rib (Pearson's consent criterion χ ² = 4.6 at p <0.05).

Pain in the lateral thoracic region (3) was caused by rib dysfunctions according to the type of cranial flexion of the VI rib (Pearson consent criterion χ ² = 6.1 at p <0.05), according to the type of ventro-dorsal compression of the V rib (Pearson consent criterion χ ² = 4.9 at p <0.05).

Pain in the subclavian region (5) was determined by costal dysfunctions according to the type of cranial displacement of the 1st rib (Pearson's consent criterion χ ² = 3.9 at p <0.05), ventral displacement of the second rib (Pearson's consent criterion χ ² = 5.5 at p <0.05).

Manual testing showed that a cranial displacement of the 1st rib was observed against the background of functional blocks in the vertebral-motor segments (PDS) C _VII - Th _I (in 67.7% of cases) and Th _I - Th _II (in 32.3% of cases). In 30.5% (43) patients, the cranial displacement of the first rib was determined on both sides. In healthy individuals, a cranial displacement of the first rib was observed in 33.3% (10) cases, and on one side only, while all dysfunctions were neutral.

Cranial flexion of the II rib was observed on the background of rotation and lateroflexion of the first thoracic vertebra as a result of a sharp lateral tilt in the cervical and thoracic PDS, shortening of the posterior scalene and subclavian muscles.

Structural dysfunction III-VIII ribs type ventral displacement observed on a background functional blocks in the VCP Th _II - Th _VIII flexion type rib dysfunction III-VIII edges of dorsal displacement - amid functional blocks in the VCP Th _II - Th _VIII ekstenzionnogo type. Cranial lateroflexion of III-VIII ribs was accompanied by rotation and lateroflexion of the thoracic vertebrae to the left, shortening of the anterior dentate muscle. Torsion dysfunction type internal torsion determined on a background functional blocks ekstenzionnogo type VCP Th _II - Th _VIII and outer torsion - amid flexion type of functional blocks in the DSP Th _II - Th _VIII. Ventro-dorsal compression was often the result of traumatic compression in the anterior or posterior direction. Torsion-type costal dysfunctions were the result of a sharp turn of the body, costal dysfunctions in the form of a cranial displacement — a stereotypical movement in the form of a hand lifting up, rib dysfunctions by the type of cranial flexion — a sharp lateral tilt.

In patients, structural dysfunctions of the ribs were accompanied by functional ones when the rib was not displaced, but respiratory movements were limited. The most characteristic was the restriction of movement on the inspiration of I-II ribs (93.3% on the right and 6.7% on the left). At the same time, restriction of movement on the exhalation of X-XI-XII ribs on the right was observed in all patients. In healthy individuals, clinically significant dysfunctions of the II-VII ribs were not observed.

In order to determine the level of autonomic regulation (by spectral analysis of the heart rhythm) at which pathobiomechanical changes significantly lose their sanogenic character and acquire clinical significance, we performed preliminary studies. Based on this, we identified two groups of patients. The first group consisted of patients (59 people), whose provocation did not affect the intensity of pain, and therefore there was no complete clarity about the clinical significance of costal dysfunctions. The second group consisted of patients (82 people), in whom provocation led to increased pain and manual therapy of clinically significant costal dysfunctions led to a decrease or disappearance of the pain syndrome.

We analyzed the response in the form of increased pain in patients to manual provocation (palpation of the rib towards movement restriction) at different levels of low-frequency (VLF%) and high-frequency (HF%) waves. A statistical analysis (using a non-parametric method using the Pearson agreement criterion χ ² ) showed that with a percentage contribution of VLF% to the total spectrum power of more than 58.0%, rib dysfunctions are significant (Pearson criterion 6.1 at p <0.05) acquired clinical significance (Table 2).

table 2 The dependence of the clinical significance of rib dysfunctions on the initial level of the percentage contribution of VLF to the total power of the spectrum. Response to ongoing manual provocation in groups 1 and 2 The percentage contribution of VLF to total power,% Total - more than 58.0 - less than 58.0 χ ²
p abs. % abs. % 1. No response 59 42 71.2 17 28.8 6.1
<0.05 2. There is a response 82 73 89.0 9 11.0

The percentage contribution of HF% to the total spectrum power with a hyperventilation test of less than 20.0% reliably (Pearson criterion 9.7 at p <0.01) determined the clinical significance of rib dysfunctions (Table 3).

Table 3 The dependence of the clinical significance of costal dysfunctions on parasympathetic reactivity (the level of percentage contribution of HF to total power in a hyperventilation test) Response to ongoing manual provocation in groups 1 and 2 The percentage contribution of HF in the sample,% Total - less than 20.0 - more than 20.0 χ ²
R abs. % abs. % 1. No response 59 35 59.3 24 40.7 9.7
<0.01 2. There is a response 82 69 84.1 13 15.9

With a combination of “unfavorable” (maximally altered) indicators of autonomic regulation (VLF%> 58.0% and HF <20.0%), the probability of the clinical significance of rib dysfunctions significantly (p <0.01) increased (Table 4).

Table 4 The dependence of the clinical significance of costal dysfunctions on a combination of “unfavorable” indicators (VLF% and parasympathetic reactivity) Response to ongoing manual provocation in groups 1 and 2 The combination of "unfavorable" indicators (VLF% and level of parasympathetic reactivity) Total there is No χ ²
R abs. % abs. % 1. No response 59 32 54,2 27 45.8 6.97
<0.01 2. There is a response 82 63 76.8 19 23,2

The proposed diagnostic method examined 141 patients with pain in the chest area.

The clinical significance of rib dysfunctions was confirmed by the clinical efficacy of manual therapy. Studies have made it possible to develop a manual therapy technique for patients with pain syndromes, in which treatment of clinically significant costal dysfunctions is mandatory.

The proposed method of manual therapy treated 106 patients (the method consisted in the fact that these patients used manual therapy of dysfunctions of the thoracic spine and costal dysfunctions). As a control group, 35 patients were treated without manual therapy of clinically significant costal dysfunctions.

The analysis of the effectiveness of this diagnostic method showed that treatment with mandatory manual therapy of clinically significant costal dysfunctions allowed patients in the first group to assess pain by 0.14 ± 0.04 points (p <0.001) on a visual-analogue scale (YOUR). In patients in the second group without manual therapy of clinically significant costal dysfunctions, the subjective pain score decreased from 4.66 ± 0.33 to 2.81 ± 0.24 (p <0.01).

The observed clinical phenomena accompanying pain after manual therapy of clinically significant costal dysfunctions in patients in the first group changed the severity or were not determined.

Thus, the restriction of respiratory movements detected in 97.2% was not observed, the feeling of discomfort in the chest was reduced from 81.6% to 12.2%, discomfort and heaviness in the abdominal cavity from 10.6% to 3.4%.

Statistical processing using Pearson's consent criterion (χ ² ) showed that in patients in the first group who underwent manual therapy of clinically significant costal dysfunctions, clinical manifestations of heartbeat phenomena and hyperventilation equivalents were observed significantly less frequently (Tables 5 and 6).

Table 5 The dependence of the clinical manifestation of the heartbeat phenomenon on the use of manual therapy of clinically significant costal dysfunctions Manual therapy in groups 1 and 2 Manual Therapy Results Total No sensation Have a feeling χ ²
R heartbeats heartbeat abs. % abs. % 1. Using 106 99 93,4 7 6.6 7.7
<0.01 manual therapy of clinically significant costal dysfunctions 2. Without the use of manual therapy of clinically significant costal dysfunctions 35 26 74.3 9 25.7

Table 6 Dependence of the clinical manifestation of hyperventilation equivalents on the use of manual therapy of clinically significant costal dysfunctions Manual therapy in groups 1 and 2 Manual Therapy Results Total No hyperventilation equivalents There are hyperventilation equivalents χ ²
R abs. % Abs. % 1. Using manual therapy of clinically significant costal dysfunctions 106 103 97.2 3 2,8 4,5
<0.05 2. Without the use of manual therapy of clinically significant costal dysfunctions 35 thirty 85.7 5 14.3

In the first group, in which manual therapy of clinically significant costal dysfunctions was performed, a decrease in the number of patients with non-optimal motor stereotypes was observed to 68.9% (from 106 to 73 people), and in the second group, to 88.6% (from 35 to 31 person) (Table 7).

Table 7  The dependence of changes in motor stereotype (DS) on the use of manual therapy of clinically significant costal dysfunctions Manual therapy in groups 1 and 2 Manual Therapy Results Total No criteria for non-optimality There are non-optimality criteria χ ²
p DS DS abs.% abs.% 1. Using 106 33 31.1 73 68.9 4.3 manual therapy <0.05 clinically significant costal dysfunctions 2. Without the use of manual therapy of clinically significant costal dysfunctions 35 four 11,4 31 88.6

Diagnosis and treatment of clinically significant costal dysfunctions reduced the number of persistent and recurrent functional blocks in the thoracic spine from 93.9% to 7.3%, in the cervical spine from 73.0% to 3.2%, and also reduced the incidence of muscle dysfunctions with pain syndromes.

In patients, manual therapy of clinically significant costal dysfunctions significantly led to a decrease in the activity of central ergotropic regulation mechanisms (decrease in VLF% from 58.4 ± 1.5 to 53.8 ± 1.7 at p <0.05 and centralization index from 9.9 ± 1.3 to 4.5 ± 0.3 at p <0.001), increased activity of the autonomous regulation loop with activation of the parasympathetic system (decrease in the vagosympathetic index from 2.3 ± 0.4 to 1.0 ± 0.1 at p < 0.001), i.e. reducing the voltage of regulatory systems.

In patients of the second group, activity of central ergotropic and humoral-metabolic regulation mechanisms was observed (increase in VLF% from 58.4 ± 1.5 to 69.2 ± 2.5 at p <0.001 and an unreliable change in the centralization index from 9.9 ± 1, 3 to 13.8 ± 2.8 at p> 0.05), a decrease in the activity of the autonomous regulation circuit with activation of the sympathetic system (unreliable decrease in the vagosympathetic index from 2.28 ± 0.35 to 1.9 ± 0.4 at p> 0.05).

The invention is illustrated by the following example.

Example. Patient V., 28 years old. Diagnosis: vertebrogenic dorsalgia, chronic course, period of exacerbation. Pain in the interscapular region is disturbed for 2 years, the frequency of exacerbations 2 times a year, duration - about a month. Aching, deep (subjective assessment of pain according to YOUR 2-3 points), mainly in the projection of the rib-transverse joints, corners of the ribs, begins gradually with a feeling of discomfort, lasts several hours. The pain intensified when performing rotational movements with extension, while trying to "keep your back straight." During such enhancements, pain appeared that penetrated the anterior chest wall and reached an intensity of 7-8 points according to YOUR. The pain disappeared or decreased with a change in body position. The immediate cause of the pain that arose for the first time was a prolonged static load in a sitting position with increased thoracic kyphosis. Dorsalgia was accompanied by restriction of respiratory movements in the chest, palpitations.

Objectively, a violation of the motor stereotype, distortion of the pelvic bones, fixation of the sacroiliac joint on the right, relative shortening of the right leg, and a change in the statics of the spine are observed.

On palpation of the angles of the III-VI ribs, the intensity of the pain syndrome did not change. Tension, increased tone, pain mainly of the rhomboid, trapezius muscle, muscle that raises the scapula, especially at the point of attachment to the upper medial corner of the scapula, subclavian muscle, intercostal muscles, and also the muscle compaction zone (local hypertonicity, trigger points) were found. Functional blocks of the extensional type, dysfunctions of the III - VI ribs in the form of dorsal displacement, external torsion, and cranial lateroflexion were found. Autonomic peripheral disorders in the form of changes in dermographism, hand hyperhidrosis, hemigipesthesia of the type of “half-jacket” were revealed.

Previously, the patient received manual therapy aimed at treating all diagnosed pathobiomechanical disorders, except for costal dysfunctions. The course of manual therapy was usually 7-8 procedures. After the procedures, the patient constantly had an increase in pain, accompanied by the appearance of autonomic dysfunction in the form of general weakness, lethargy, and hyperhidrosis of the hands.

The patient underwent clinical and electrophysiological assessment of autonomic regulation. Diagnosed with autonomic peripheral changes in the form of hyperhidrosis of the hands, changes in dermographism, hemigipesthesia type "half jacket". Spectral analysis of the heart rhythm showed activation of central ergotropic and humoral metabolic regulation mechanisms, centralization of regulation, as evidenced by the high percentage contribution of the VLF component to the total spectrum power, as well as high indices of centralization and vagosympathetic balance. The dysfunction of parasympathetic activity and a decrease in its reactivity level are shown by the initial HF and its percentage contribution to the total spectrum power during the hyperventilation test (Table 8).

Table 8 Characterization of spectral parameters in patient B Spectral indicators Research phases Background Try Recovery Vlf 159 81 70 Lf 22 27 25 Hf fourteen fourteen 8 TR 195 122 103 VLF% 81.5 66,4 67.9 LF% 11.3 22.1 24.3 HF% 7.2 11.5 7.8 Lf n.u 61.1 65.9 75.8 Hf n.u. 38.9 34.1 24.2 All 1,6 2.0 3,1 IC 12.9 7.7 11.9

Based on the results of a study of autonomic regulation, a conclusion was made about the clinical significance of rib dysfunctions and the scope and tactics of manual therapy were determined.

As a result of the proposed method for diagnosing and treating pain, they stopped, exacerbations of pain and autonomic dysfunction were not observed, the biomechanical characteristics of the motor stereotype were restored. The course was 4 procedures. Observation continued for 3 years.

Thus, the proposed method for the manual diagnosis of pain in the chest area allows you to accurately differentiate clinically significant costal dysfunctions, reduce the number of diagnostic tests, quickly reduce or remove pain, determine treatment tactics and its effectiveness, as well as reduce the number of procedures.

Claims (1)

A method for manual diagnosis of pain in the chest area, including determining rib displacements, characterized in that the displacement of the ribs is determined by manual testing, manual provocation of the clinical manifestations of rib displacement, and when manual provocation does not give full clarity that the rib displacement is clinically significant, determine the level of autonomic regulation and the voltage of the regulatory systems of the body and at a level of VLF% more than 58.0% and a decrease in parasympathetic reactivity HF% m Less than 20.0% of a hyperventilation test diagnoses pain in the chest area.