Importance Of Diagnosis - Diagnosis is the Origin of Treatment and Privention
In case of any disease , prevention as well as treatment starts from diagnosis . As for Cervicobrachial Disorder, you can not work without anxiety unless a doctor properly diagnosis, treats you, and secures you recovery when you will have such trouble. Since it is an occupational disease, ultimately you will have to establish measures for its prevention at your work place, but diagnosis is still the starting point for that.
When clinicians see the patient of Cervicobrachial Disorder, their duties are to diagnosis the gravity of the disorder, to diagnosis diffrencially, to instruct treatments, and to guide recuperation.
A saucer for Cervicobrachial Disorder is mainly orthopedics as a window to contact, but what is the reality?
The situation was different 10 years ago, but now“the Cervicobrachial Disorder of sign language interpreters”is perhaps diagnosed as Cervicobrachial Disorder anywhere, I think.
The present day medical education and clinical medicine regard a checkup and a differntial diagnosis as important. The level of the differential diagnosis has been highly elevated. It seems to be no problem to diagnose it there is a known disease or not.
The real problem with Cervicobrachial Disorder, however, remains to decide its gravity, to take an appropriate step according to the degree (recuperative division diagnosis ),and to instruct proper treatments. These are the most important points, but they are not satisfactorily being practiced.
This is How you can differenciate the Gravity by Grasping objective observation
I would like to express my views on how to grasp objective observations and gravity of Cervicobrachial Disorder. Its method has not yet been established abroad as well as in Japan.
Amang the diseases which are the components of the Cervicobrachial Disorder, hand-finger peritendinitis, epicondylitis of humerus, carpal tunnel syndrome and thoracic outlet syndrome( scalenus syndrome ) are relatively easily diagnosed as usual orthpedic diseases.
As far as you catch them as RSI ( Repetitive Strain Injury ) which is a key word in the western countries , you can not surpass the category of the concept of these diseases. That is a great fault.
If you regard them as the “peculiar cases ” of the Cervicobrachial Disorder, you can call the following symptoms “ non-peculiar cases ”, which seem to have more essential meaning than the former. They are muscular stiffness and pressure pain over the whole back to the lower libms, also neck to the upper limbs, abnormally notable fatigue, lassitude, headache, insomnia, sensitivity to cold , etc . ; “ chronic fatigue symptpms, ”.
As for these subjective syndromes, since it was difficult to grasp the objective obserbations and record them by usual orthopedic and neurological examination, clinicians had a hard time trying to diagnose and finally described,“ variegated subjective symptoms, but few objective observations ”.
For this reason , the clinicians strongly tended to consider them as mental and psychogenic symptoms.
Non-peculiar symptoms of the Cervicobrachial Disorder are not “ deficiency phenomena ”. They are not like external injuries and degenerative diseases. So that is had to be difficult to grasp the objective observations of the Cervicobrachial Disorder by the following ways.
(1) Muscular stiffness Spread
Objective judgment of muscular stiffness is very difficult, even thouth you can not say it is impossible. Now I intend to pay attention on the stiffness spread, judge and describe to diagnose.
To put it concretely, you will decide the right or left nape as the reference point (10 points), and check the nape to the gastorocnemius of the leg. You as examinar press the patient with fingers and let the patient self-valuate how widely the stiffness spreads horizontally right to left and vertically down to the legs, and record them.
When the Cervicobrachial Disorder is advanced and hardly curable, the spread of muscular stiffness can not be considerd as “ peculiar ” or local trouble. You can conceive that stiffness spread is parallel with development of “ non-peculiar ” cases.
In case of a complication of the cervical discogenic pain, hyperalgesia and perception disorder on half the body, you should decide the reference point at other place than where the abovementioned symptoms are noticed.
(2) Test of Hyperalgesia
The test of pressure pain is measured by 4 kg, Society of Pain stipulates. Diferent doctors often get different results of the test, while patients find it difficult to distinguish between stiffness and pain.
For this solution I turned my attention to traditional tapping test with finger tips. If the patient sensitively reacts to light tapping and feels painful, I judge it as “ hyperalgesia ”. By this tapping test you can comparatively easily and speedily decide the extent of hyperalgesia. Test results do not change very much by doctors. It is easy to write medical records like perception test.
When I tested the patients of the Cervicobrachial Disorder by this way of medical examination, I found 28 patients out of 183 ( 15 . 3 % ) who showed fixed and rather large area of hyperalgesia relatively for a long period.
Hyperalgesia range discords from spinal ganglion and peripheral nerve territory. Supersensitive is the superficial tissue like skin and fascia. Hyperalgesia range develops a tendency to extend from points ,faces, territory and the whole body.
You can also see the range extended symmetrically or on only one side of the body. Anyhow central nervous system seems to be involved in this extending tendancy.
Cases of hyperalgesia are all advanced and intractable cases without exception. Hyperalgesia range and degree could be one of substantial indexes of chronicity and intractability.
It is an important notice for diagnosis and record that the pressure pain test is always positive at the hyperalgesia range, but the pressure pain point is not always hyperalgesia.
(3) Perception disorder on half the body
Perception disorder on half the body is a comparatively rare objective sign which is found with 5 patients out of 183, and it is definitely an index to tell hoe advanced and intractable it is.
Perception disorder on vertically half the body is neurologically regarded as one of hysterical troubles. Perception disorder on half the body is here a little bit more vague disturbance of sensation like being coverd with heavy film and sensitive to cold. He / she feels worse with the half side of the body with trouble.
Since the troubled half is slow in perception , it is hard to test stiffness and hyperalgesia.
(4) Grip strength and Back strength
The patient consciously or unconsciously prefers to be diagnosised his / her condition as advanced. Becides this reason, since back stregth test has risk to worsen lumbago, there are not many clinicians and researchers who admit significance of grip strength and back strength test for Cervicobrachial Disorder.
At our hospital, however, we can let the patients the test safely if we properly guide them, and we record the monthly course which you can see graphically. I think that is one of the best tests to grasp the course of patient’s condition. Significance of the measurement for Cervicobrachial Disorder is as blood pressure taking for patients with hypertention.
Concretely the standard for working women between 20 years old and 50, grip strength is right 25, left 25, and back strength 70 kg. When the figures go down to 15, 15, and 40 kg, they could be the criteria to judge whether to need a drastic retrenchment of work or to take sick leave to recuperate. Of course, during the steps of rehabilitation and comeback, the result of the test of grip and back strength is also very good measurement to decide whether to start working again.
Summary : Gravity Diagnosis of Cervicobrachial Disorder
Gravity of Cervicobrachial Disorder is synthetically diagnosed like other physical disorders by subjective social life disability evaluation as a basis and objective finding degree.
1) gravity valuation by inquiry is one of very important diagnosis procedure. We utilize the scale of chronic fatigue syndrome for Cervicobrachial Disorder even though they are entirely different diseases. That scale is the easiest to use at present.
2) to grasp existence and gravity of hand-finger peritendinitis, epicondylitis of humerus, carpal tunnel syndrome and thoracic outlet syndrome ( scalenus syndrome ) and other specific diseases.
3) stiffness spread
4) hyperalgesia spread
5) existece or nil of perception diorder on half the body
6) test results of grip strengh and back strengh
Deterioration Phenomenon At Early Recuperation
In cases of Cervicobrachial Disorder, drastic retrenchment of work, leave of absence and recuperation are supposed to recover the symptome and improve measurment figures. On the contrary, however, the condition is going on deteriorating for several months.
Why despite of leave of absence and recuperation? The phenomenon looks like paradoxical, but you might be able to interpret that easily as the reaction of the living body ; “ mode change ” of working to leave of absence and recuperation at the extream situation.
Non-peculiar cases of Cervicobrachial Disorder are well supported by objective findings ( i.e. stiffness spread, hyperalgesia, perception disorder on half the body, grip and back strengh reduce ). They are not deciduous cases but super sensitive cases, adoptive cases and defence mechanism which appears and advances in the central nervous system.
It is the same as generally said that Cervicobrachial Disorder is “ brain fatigue ”. It is significant to verify this hypothesis from every aspect, and I think we should do that.