Step 1: Neurolocalization diagnosis (where symptoms appear):
When inquiring about the condition, according to the pain and numbness (if there is no numbness, according to the organ position of the main symptoms), according to the nerve location, the damaged part of the spinal nerve root is diagnosed and analyzed, and the diseased spine or joint is initially determined.
1, numbness and pain in limbs. According to the distribution of peripheral nerves, the range of spine was preliminarily diagnosed.
2. If there are visceral or organ diseases, according to the sympathetic nerve segment, such as supraventricular tachycardia, check whether the cervical vertebra 1-3 where the upper cervical sympathetic nerve segment (the upper cervical branch belongs to the accelerating nerve) is dislocated or tender.
3. For those with local symptoms of the spine, in addition to checking the spine, you should also check whether the attachment points of superior muscles and ligaments are strained.
Step 2: palpation, examination, diagnosis and location:
According to the results of spinal examination conducted by the operator, it includes finding the position of transverse process, deviation of spinous process and articular process, paravertebral tenderness, pathological positive reactants (induration, fricative sound, click sound, muscle atrophy or compensatory hypertrophy, etc. ), or the results of various examinations and nervous system examinations combined with the first localization diagnosis, to make a second localization diagnosis to further determine the diseased spine, joints and classification.
1. Diagnosis of transverse process and joint synapse: The operator gently placed the posterior part of cervical transverse process and articular process with his right thumb and forefinger (first touched the transverse process of the first cervical vertebra from the tip of mastoid, and then moved it downward and backward to the posterior joints of the second and third cervical vertebrae), and compared them by sliding up and down to find out whether the articular process is protruding and whether the transverse process is symmetrical. If there is any abnormality, check whether there is tenderness and pathological positive reactant induration, muscle spasm rope, fricative sound, etc. If there is, it is a sign of facet dislocation, if not, it is congenital malformation. (Because the spinous process of the cervical spine is bifurcated, and the length varies greatly, palpation is prone to errors. It is best to check the articular process of the transverse process. )
2. Spine-synapse diagnosis: used for examination of lower cervical vertebra and thoracic vertebra. The operator put the middle finger of his right hand together on both sides of spinous process and made a sliding comparison up and down. If the spinous process is uneven and curved, it is necessary to determine whether it is clinical or congenital malformation according to the diagnostic method of transverse synapse.
3. Positive reactant palpation method: The operator rubs his thumb up and down beside the spinous process, transverse process and articular process of the affected vertebra to check whether there is friction, tenderness and induration at the attachment point of the distal end of the muscle connected with the affected vertebra. If there is, it is the reactant of strain point or injury (such as aseptic inflammation or muscle spasm).
Step 3: X-ray cervical vertebra photograph localization diagnosis:
Observe the changes of the relationship between vertebrae, the variation of the spinal axis and the variation of the posterior edge of the vertebral body on the cervical X-ray film. The dislocation of the annular vertebra will change such as supination, inclination, supination, inclination and lateral rotation. The shape or displacement of each intervertebral joint is the manifestation of cervical joint dislocation. Observe the position and degree of intervertebral disc degeneration, intervertebral joint hyperosteogeny and ligament calcification. Combined with the first step and the second step, the final positioning diagnosis result is obtained.
1, excluding spinal tumor, tuberculosis, fracture, dislocation, rheumatoid disease, gout and other diseases.
2. Analyze the position and direction (type) of intervertebral joint dislocation, and it is feasible to perform CT examination for those with disc herniation.
3. Analyze the degree of intervertebral disc degeneration (traction osteopathy can be used in the early and middle stages), and the relationship between osteoproliferation site and symptom site.
4. Observe the intervertebral joint for inflammation, osteoporosis and calcification, and provide reference for treatment.
Not suitable for chiropractic therapy: spinal tumor, tuberculosis, fracture and dislocation, local purulent focus, bleeding tendency and various critical patients. Provided by Pan Guanghua.
Feature 2: Four Steps and Ten Methods of Cervical Orthopedic Surgery
1 head-up method: it is suitable for rotational dislocation of occipitoatlantoaxial joint. The patient was lying on his back with a low pillow. The surgeon holds his occipital part with one hand and his mandible with the other hand, so that the patient's head tilts upward (upward movement can lock the C2-7 cervical posterior joint at a fixed point) and turns sideways, instructing the patient to relax the neck muscles (moving slowly for 2-3 times). When the head rotates to the maximum angle, a limited flash force can be applied to reset the dislocated joint, and sometimes the snapping sound of joint reset can be heard during this operation. It can also be operated from a sitting position.
2. Bow-shaking method: suitable for rotational dislocation of 2-6 posterior joints of cervical spine. The patient lies on his side, lying flat on the pillow, with his head down (about 20 degrees if the middle cervical vertebra is dislocated). The flexion of the lower cervical spine is greater than 30 degrees. ) The operator gently holds the back neck with one hand, and the thumb is pressed under the dislocated transverse protuberance as a fixed point, while the other hand holds the cheek as a moving point and the pillow as a fulcrum to rotate the head. When shaking the head to the maximum angle, the moving hand presses the fixed thumb into resistance with limited flashing force, so that the joint is reset due to the resistance of the fixed point during movement. The slow reset method can be repeated 2-3 times as needed.
3-sided shaking head method: suitable for rotational dislocation, lateral bending and lateral dislocation of 2-6 uncinate process joints of cervical spine. The patient lay on his side with his head forward. The performer holds his head in the ear area with one hand, gently holds the back neck with the other hand, puts his thumb under the dislocated transverse process, and raises his head in a lateral flexion posture to shake his head, which is the same as the bow shaking method.
4 prone shoulder shaking method: suitable for rotational dislocation between the fifth cervical vertebra and the second thoracic vertebra. The patient lies on his side with his upper limbs vertical and his hands akimbo. The operator stands behind him, with his thumb and forefinger clamped at the front and back of the transverse process of the dislocated joint, and the other hand placed on his shoulder to sway back and forth, so as to make a fixed point to resist the resistance, so that the rotational dislocation can be recovered in the shaking. This method has the same principle and indications as the head shaking method, except that the moving point is downward and the shoulder is shaken, so that the force can easily reach the junction of neck and chest. Especially for patients with unstable upper cervical spine, it can avoid damaging the upper cervical spine segment due to too large swing angle. Pay attention to press down the shoulder when shaking, so as not to affect the reduction due to joint atresia.
Lateral correction method: it is suitable for the dislocation of uncinate process joint with 2-6 lateral curvature and lateral pendulum dislocation of cervical spine. The patient lies on his back, and the operator stands at the head of the bed, holding the back neck with one hand, holding the lateral side of the transverse process of the affected vertebra with the other hand, and pressing it toward the protuberance (only a little for those who swing sideways, and bottom-up for those who bend sideways). Hold the mandible with the other hand and stick it on your cheek with your forearm. Pull the patient's head up with both hands and bend it to the healthy side and then to the affected side (let the dislocated joint open first and then close). When the neck bends to the affected side to the maximum angle, the thumb will not relax, and the dislocated joint will be reset with the pulling, pressing and pulling of the moving hand. Sometimes patients can lie on their side, remove the pillow, and raise their heads for side pulling and pressing. For C6-T2 patients with lateral bending dislocation, the method of moving points can be changed to push and pull shoulders, and only by increasing the lateral bending activity of the dislocated intervertebral body can it be successful.
6. Method of turning arm angle: It is suitable for dislocation of C2-6 posterior joint, or joint synovial incarceration and joint swelling. The patient lies flat on the healthy side with a low pillow, bends his head forward to the healthy side, and fully expands the affected vertebral joints. The operator gently flicks the tense tendons in his neck (common in lifting scapula and clamping muscles) to induce the release of synovial incarceration, thus taking out the incarcerated synovium and kneading the neck muscles to relax it. Then fix one thumb on the swollen lower part, press the other hand on the head and face of the opposite side, raise your head and bend it 45 degrees to the anterolateral side of the healthy side, then move your head 45 degrees to the posterolateral side of the affected side to press the carina joint obliquely, and repeat for 2-3 times to restore the level.
7 prone impact method (rotating partial pressure method): It is suitable for dislocation of the joint at the cervical-thoracic junction (C6-T3). Take the left deviation of C7 spinous process and the right deviation of T 1 spinous process with tenderness as examples. The patient lies prone on a soft pillow, with his head hanging by the bed and his neck relaxed. The operator stands beside the bed, with the palm root of his right hand pressing on the left side of C7 spinous process, and the force point falls on the vertebral plate (spinous process root), and the left palm root pressing on the right side of T 1-T3 spinous process as a fixed point, so that the patient can take a deep breath. When he exhales, the operator presses his hands with limited impact pressure, and the strength of his right hand is slightly increased, which can be repeated for 2-3 times. Because the direction of the operator's hands is different, it needs to be rotated. For spondylolisthesis dislocation, the thumb can be pressed on both sides of the posterior process at the same time, and when the head and neck are pulled by both hands, the thumb can be pressed to achieve the purpose of traction and straightening. This method is also commonly used for thoracic dislocation.
8. Lateral decubitus correction: it is suitable for all kinds of anterior and posterior spondylolisthesis dislocation, and is effective for patients with straight neck axis and tensile resistance. The patient lies on his side, with his head down. With the thumb and two fingers as fixed points, the operator pinches the laminae on both sides of the spinous process of the posterior process, and pinches the mandible with the other hand to bend the head back and forth. When looking up, the fixed hand pushes forward slightly, so that the inverted vertebral body is pushed straight during the movement. If the slippage is serious, it is easier to push down with traction, or you can take a supine position and add traction to recover when pushing.