RU2785556C1 - Method for diagnosing damage to the rotator cuff of the shoulder by measuring the electric potentials of the skin in dynamics - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: e invention relates to medicine, namely to traumatology and orthopedics, and can be used to diagnose damage to the rotator cuff rotators by measuring the electrical potentials of the skin. The electrical potentials of the skin are measured in dynamics at four corporal biologically active points Jian yu, Jian jing, Jian wai yu, Gao mann. Measuring the electric potentials of the skin is carried out in the first 24 hours after the injury and in the period 48-72 hours after the injury. The average value of the electric potentials of the four points is determined during the first measurement and the average value of the potentials of the four points during the second measurement. The results obtained are compared. If the average value of the indicators measured in the first 24 hours after the injury exceeds by 40% or more, the average values measured in the period of 48-72 hours, damage to the rotator cuff of the shoulder is diagnosed.

EFFECT: method enables effective diagnostics of damage to the rotator cuff rotators by measuring skin electrical potentials in dynamics.

1 cl, 2 tbl, 3 ex

Description

The invention relates to the field of medicine, in particular, to traumatology and orthopedics, and in particular to a method for diagnosing damage to the rotator cuff of the shoulder by measuring the electrical potentials of the skin in dynamics.

The change in the morphology of the affected joint is assessed using various imaging methods (radiography, ultrasonography, magnetic resonance imaging, arthroscopy, thermography). X-ray can detect only bone fractures and the presence or absence of a dislocation of the joint. The main disadvantage of this method is the impossibility of diagnosing damage to the soft tissue structures of the shoulder joint. Magnetic resonance imaging (MRI) is a highly informative method for visualizing soft tissue and bone structures. MRI has the highest resolution to detect pathological changes in these structures. MRI allows assessing the dynamics of the volume of the articular cartilage, its thickness, the content of the effusion, the structure of the synovial membrane, and the ligamentous apparatus. The disadvantages of this method include the following aspects: the inability to conduct objective monitoring of the quality of the treatment in a relatively short time period (days, weeks); high cost of research and limited availability of research in an outpatient setting. Ultrasonography (ultrasound) allows you to evaluate the dynamics of the thickness of the articular cartilage, synovial membrane (in mm), the content of the effusion, the structure of the ligamentous apparatus. The disadvantages of ultrasound include the inability to objectively monitor the quality of the treatment for a relatively short time period (days, weeks) and the relatively low information content of the study, as well as the subjective assessment associated with the training of the specialist conducting the study. Arthroscopy is able to directly visualize the depth and area of damage to the articular cartilage, ligaments, synovial membrane. The disadvantages of this method: invasiveness, the need for anesthesia, the risk of complications and the inability to objectively monitor the quality of the treatment in a relatively short time period (days, weeks). Thermography is a graphical recording of the thermal field of objects produced in various ways, i.e. their infrared radiation fields. A thermogram is a fixed two-dimensional image of the temperature field of a part or the entire body of the subject. In the case of effective treatment, the thermogram is characterized by a decrease in temperature asymmetry, a decrease in the intensity of hyperthermia, the temperature gradient drops to 0.4-0.8°C. The main disadvantage of this method is the low information content and the impossibility of diagnosing damage to the soft tissue structures of the shoulder joint.

Closest to the claimed invention is a method for assessing the quality of conservative treatment of primary traumatic shoulder dislocation by conducting a prognostic test for the development of deforming arthrosis of the shoulder joint in the long term (Prognostic test in the treatment of primary traumatic shoulder dislocation: application RU2014152096, Russian Federation, application 22.12.2014, publ. . 07/20/2016), which includes the study of electrical parameters in the course of treatment, characterized in that they measure the electrical potentials of the skin within an hour after reduction of the dislocation of the shoulder and on the second day after reduction, while measuring the electrical potentials of the skin at 4 corporal biologically active points ( BAP) located directly in the area of the shoulder joint, such as Jian yu, Jian jing, Jian wai yu, Gao man, and if the average values of the electrical potentials measured in the BAP on the first day after reduction of the dislocation of the shoulder are lower relative to the indicators, the change 30% or more in BAP immediately after reduction of the dislocation, this indicates the development of post-traumatic arthrosis of the shoulder joint in the long-term period.

The disadvantage of this technical solution is the inability to diagnose damage to the rotator cuff of the shoulder by measuring the electrical potentials of the skin in dynamics. Despite the technology used in assessing the quality of treatment, similar to the claimed invention, this method cannot be used for diagnostic purposes. This is due to the inability to assess the state of the soft tissue structures of the shoulder joint in dynamics.

The technical problem is the need to develop an effective, fast and easy-to-implement method for diagnosing damage to the rotator cuff of the shoulder by measuring the electrical potentials of the skin in dynamics, devoid of the above disadvantages.

EFFECT: enabling quick, simple and effective diagnosis of damage to the rotator cuff of the shoulder by measuring the electric potentials of the skin in dynamics.

The technical result is achieved by the fact that in the method for diagnosing damage to the rotator cuff of the shoulder by measuring the electrical potentials of the skin, during which the electrical potentials of the skin are measured in dynamics at four corporal biologically active points Jian yu, Jian jing, Jian vayu y, Gao mann, according to According to the invention, the measurement of the electrical potentials of the skin is carried out in the first 24 hours after the injury and in the period 48-72 hours after the injury, after which the average values of the electrical potentials are compared and indicate damage to the rotator cuff, provided that the average values measured in the first 24 hours after the injury , 40% or more higher than the average values measured in the period 48-72 hours after injury.

The method is carried out as follows.

On the first day after reduction, the patient is measured the electrical potentials of the skin at the biologically active points of the damaged shoulder joint - Jian yu, Jian jing, Jian vayu y, Gao mann. The measurements are carried out with a digital voltmeter F.216-1/3 at 4 points of the BAT, in the area of the damaged shoulder joint. 2 electrodes are used: indifferent, with an area of 2 cm ² and active - with a point copper tip, 0.6 mm in diameter. Measurements are made in mV. The projection zones of the points are treated with alcohol and slightly moistened with an isotonic sodium chloride solution. The duration of the measurement at each point is no more than 3 seconds. The results are entered into the BAT measurement map. The first measurements are carried out in the first 24 hours after the injury, and the next measurements in the period 48-72 hours after the injury. Next, the average values of electrical potentials are compared and indicate damage to the rotator cuff of the shoulder, provided that the average values measured in the first 24 hours after the injury are 40% or more higher than the average values measured in the period 48-72 hours after the injury.

In the prototype method, the electrical potentials of the skin are measured at 4 biologically active points (BAP) immediately after the reduction of the shoulder dislocation and on the second day after the reduction.

In contrast to the prototype, in the claimed method, electrical potentials are measured in dynamics: in the first 24 hours after injury and in the period of 48-72 hours.

A single measurement of skin electrical potentials in BAP only for one day (immediately after reduction) cannot reliably indicate the presence of damage to the rotator cuff, because the potential difference in such a short period of time may indicate the presence of the injury itself, swelling of the skin in this area, the presence of pain, etc. which can affect the value of electrical potentials. Measurement of skin potentials in BAP in dynamics: on the first day and on the second or third day is a more objective criterion in diagnosis, which is confirmed by our data (Table 1).

Table 1

The value of the average indicators of the electrical potentials of the skin in patients with damage to the rotator cuff of the shoulder, depending on biologically active points (BAP) and measurement time

Measurement time after injury in hours Average values of electric potentials in BAT one 2 3 four The value of average electrical potentials in% up to 24 49.1±6.8 52.7±6.6± 47.8±7.1± 68.4±5.7 52.0±6.7 25-72 20.5±7.3 27.4±5.9 24.2±4.9 32.7±6.4 26.2±6.2 Potential change value, in % 41.7 52.0 50.6 47.8 48.0

The data shown in Table 1 indicate a change in skin potentials, that the average values of the skin electrical potentials measured in the first 24 hours after the injury are 40% or more higher than the average values measured in the period 48-72 hours after the injury, which indicates damage to the shoulder cuff rotators during the first, second and third days without further significant dynamics in subsequent time periods. These data were confirmed by MRI of these patients, indicating the presence of damage to the rotator cuff of the shoulder. The performed MRI statistically confirmed the presence of damage to the rotator cuff in this group of patients in the presence of a decrease in the potential difference between 24 hours and 48-72 hours by 40% or more.

Skin electrical potentials were studied in 37 patients with traumatic dislocation of the shoulder. The first group consisted of 19 patients who were diagnosed with damage to the rotator cuff of the shoulder according to the magnitude of the electrical potentials in the area of the shoulder joint, confirmed by MRI and arthroscopy. In these patients, the value of electrical potentials in BAP was studied on the first day after injury and in dynamics on days 2-3, the obtained data showed that the average value of electrical potentials in 4 active points on the first day after injury by 48-72 hours after injury decreased by 40% and more, which indicates damage to the rotator cuff of the shoulder.

The second group included 18 patients with similar shoulder injuries. Conducted studies of the magnitude of electrical potentials during the first day (24 hours) after injury and within 2-3 (48-72 hours) days showed a decrease in electrical potentials by less than 40% in this group of patients. Additional studies of MRI and arthroscopy in patients of this group did not reveal damage to the rotator cuff of the shoulder (Table 2)

table 2

The value of the average indicators of the electrical potentials of the skin in patients without damage to the rotator cuff of the shoulder, depending on biologically active points (BAP) and measurement time,

Measurement time after injury in hours Average values of electric potentials in BAT one 2 3 four The value of average electrical potentials up to 24 53.3±5.7 57.8±6.5± 48.5±4.9 69.3±7.9 57.2±6.25±6.6 25-72 18.7±6.4 21.4±7.8± 16.9±5.9± 27.7±5.4 21.2±3.2 Potential change value, % 35.1 37.0 34.8 39.9 37.0

Thus, the proposed method for diagnosing damage to the rotator cuff of the shoulder is reliably confirmed by the data obtained.

The claimed invention is illustrated by examples.

Example 1

Patient M., 63 years old, was admitted to the St. Petersburg State Healthcare Institution Hospital for War Veterans on April 17, 2019, due to traumatic dislocation of the right shoulder. Under conduction anesthesia, the dislocation is reduced within the first hour after the dislocation. After reduction of the dislocation with a digital voltmeter, the electrical potentials of the skin were measured at four biologically active points (BAP) of the right shoulder joint. The value of electrical potentials at the first point Jian-yu was 50.1, at the second Jian-jing 42.2, at the third Jia wai yu 53.7 and at the fourth Gao mann 60.3 volts. The average potential value at all four points was 51.5. The right upper limb is fixed with an orthosis. On the second day (48 hours) after injury, the values of electrical potentials in the same BAPs were measured in a similar way. The value of electric potentials at the first point was 21.7, at the second 22.2, at the third 26.6, at the fourth 33.0. The average value of the potentials was 25.8 watts. The difference between the average electrical potentials measured in BAP between the first measurement (1st day) and the second (2nd day) was 25.7, which is 49.9%. This indicates a decrease in them by more than 40%, which, according to our application, indicates damage to the rotator cuff rotators. Performed on the third day after the injury, MRI confirmed the presence of damage to the rotator cuff rotators. During the arthroscopy operation (performed a week later), the diagnosis of rotator injury was confirmed.

Example 2

Patient B., 39 years old, due to a dislocation of the right shoulder, was admitted to St. Petersburg State Healthcare Institution "City Polyclinic No. 27". Under conduction anesthesia, the dislocation was reduced during the first day (24 hours). After reduction of the dislocation with a digital voltmeter, the electrical potentials of the skin were measured at four biologically active points (BAP) of the right shoulder joint. The value of electrical potentials at the first point of Jian-yu was 48.7; at the second Jian-jing, 49.4; at the third, Jiang wai yu, 52.8; The average potential value at all four points was 52.6. The right upper limb is fixed with an orthosis. On the third day (72 hours after the injury), the values of the electrical potentials in the same BAPs were measured in a similar way. The value of electrical potentials at the first point was 20.4; at the second, 21.3; at the third, 25.7; at the fourth, 31.9. The average value of the potentials was 24.8 watts. The difference between the average electrical potentials measured in BAP between the first measurement (1st day) and the second (3rd day) was 27.8, which indicates a decrease in them by 52.8%, i.e. more than 40%, which, according to our application, indicates damage to the rotator cuff rotators. Performed on the fourth day after the injury, MRI confirmed the presence of damage to the rotator cuff rotators. During the arthroscopy operation (performed a week later), the diagnosis of rotator injury was confirmed.

Example 3

Patient K., aged 57, was admitted to St. Petersburg State Healthcare Institution "City Polyclinic No. 27" for traumatic dislocation of the right shoulder. Under local anesthesia, the dislocation is reduced during the first day (approximately 14 hours after the injury). After reduction of the dislocation with a digital voltmeter, the electrical potentials of the skin were measured at four biologically active points (BAP) of the right shoulder joint. The value of electrical potentials at the first point Jian-yu was 51.7, at the second Jian-jing 59.2, at the third Jian wai yu 46.6 and at the fourth Gao mann 67.7 W. The average potential value at all four points was 56.3. The right upper limb is fixed with an orthosis. 48 hours after injury, the values of electrical potentials in the same BAPs were measured in a similar way. The value of electric potentials at the first point was 34.4, at the second 39.8, at the third 28.2, at the fourth 41.1. The average value of the potentials was 35.8 watts. The difference between the average electrical potentials measured in BAP between the first measurement (1st day) and the second (48 hours) was 20.5, which was 36.4%. This indicates a decrease of less than 40%, which, according to the claimed method, indicates the absence of damage to the rotator cuff rotators. Performed on the third day after injury, MRI confirmed the absence of damage to the rotator cuff rotators.

Thus, the claimed invention allows, in comparison with the prototype:

- to increase the efficiency of diagnosing injuries of the rotator cuff of the shoulder;

- reduce research time;

- simplify diagnostics and make it available for wide use (does not require hospitalization, participation of narrow specialists and expensive equipment), including for outpatient settings.

Claims (1)

A method for diagnosing damage to the rotator cuff of the shoulder by measuring the electrical potentials of the skin, during which the electrical potentials of the skin are measured in dynamics at four corporal biologically active points Jian yu, Jian jing, Jiang wai yu, Gao mann, characterized in that the measurement of the electrical potentials of the skin carried out in the first 24 hours after the injury and in the period 48-72 hours after the injury, then determine the average value of the electric potentials of the four points in the first measurement and the average value of the potentials of the four points in the second measurement; the results obtained are compared; in the event that the average value of the indicators measured in the first 24 hours after the injury exceeds by 40% or more, the average values measured in the period of 48-72 hours diagnose damage to the rotator cuff rotators.