From Big Medical Encyclopedia

DIAGNOSTIC PAINFUL POINTS (grech, diagnostikos capable to distinguish) — painful points which definition can promote specification of character and localization of pathological process.

Depending on character of the studied fabrics Must be t. define in those body parts where the nerve or a vessel which is in patol, a state, can be pressed to the subject bone; they are defined also at irritation of deep fabrics (fastion, places of an attachment of muscles to bones) and at diseases of internals in Zakharyin's zones — Geda (see. Zakharyina-Geda of a zone ).

There is a t. it is necessary to distinguish from diffusion morbidity of muscles, hypodermic cellulose at their prelum in zones of an innervation of the sympathetic nodes which are in a condition of irritation and also from «kurkovy» zones at neuralgia of trigeminal and glossopalatine nerves.

On localization distinguish the following there is a t.

Painful points in the head and a neck: 1) in the field of an exit I, II, III branches of a trifacial — at neuralgia of this nerve, sinusitis, a meningism, meningitis, arachnoidites. Degree of manifestation of pain reaction (decrease or absence) with a pressure upon painful points of a trifacial can be one of indicators of depth of coma; 2) the vascular points described And. M. Grinstein — at an internal corner of an eye-socket according to an exit of a frontal branch of an orbital artery and in the field of a darkness according to an anastomosis between arteries of a firm meninx and branches of an outside carotid artery on the surface of a skull — at migraine and other vasculomotor headaches; 3) in a temple according to a superficial temporal artery — at temporal arteritis, migraine, simpatalgiya of the person; 4) in the field of a mastoid, and also a kpereda and from top to bottom from an auricle — at neuritis of a facial nerve; 5) in the field of an exit small and big occipital nerves — at neuralgia of these nerves, cervical osteochondrosis, meningitis, inflammatory processes and some tumors of a brain; 6) points of acanthas of cervical vertebrae, points of cervical intervertebral disks, juxtaspinal — at cervical osteochondrosis, at hernias of intervertebral disks; 7) a point of a vertebral artery on the line connecting top of a mastoid and an acantha of the II cervical vertebra medialny the rear edge grudino - a clavicular and mastoidal muscle — at pathology of a vertebral artery, cardialgias.

Painful points in the field of a shoulder girdle and a hand: 1) at the outer edge grudino - a clavicular and mastoidal muscle — at cervical osteochondrosis; 2) at the place of an attachment of a front scalene to the I edge — at a syndrome of a front scalene, cervical osteochondrosis; 3) in the field of a coracoid of a shovel — at a humeroscapular periarthritis, cervical osteochondrosis; 4) on a front surface of a shoulder joint — at a reflex cardiohumeral syndrome (shoulder pain at stenocardia, a myocardial infarction); 5) on the course of a sosudistonervny bunch on an inner surface of a shoulder — at damages of a humeral artery and its branches, at the phenomena of irritation of a cervicothoracic (star-shaped) node; 6) supraclavicular and subclavial points of Erba at an inflammation of a brachial plexus; 7) on the course of peripheral nerves of a hand — at neuralgia, polyneurites.

Painful points in a thorax and a stomach: 1) points of acanthas of chest vertebrae and juxtaspinal — at osteochondrosis, hernias of intervertebral disks, estramedullary tumors, destructive changes in vertebrae; 2) in intercostal spaces on paravertebral, axillary and okologrudinny lines — at intercostal neuralgia; 3) in the field of an epigastrium, a little to the right from a midline — at a solar plexitis, reflex solyaralgiya; 4) points juxtaspinal at the X—XII level of chest vertebrae (see. Boasa painful points ) and points in the field of acanthas of the VIII—X chest vertebrae — Openkhovsky's points — at a peptic ulcer of a stomach; 5) at the outer edge of the right direct muscle of a stomach in the place of crossing by its costal arch — at cholecystitises; 6) Mac-Berney's point in the place of decussation of the line going from the right upper front awn of an ileal bone to a navel and the outer edge of the right direct muscle of a stomach — at appendicitis; 7) Ortner's point — bottom edge of a costal arch on the right — at diseases of a liver; 8) a point of Myussi over a clavicle, between legs grudino - a clavicular and mastoidal muscle — at the diseases which are followed by irritation of a phrenic nerve (cholecystitis, subphrenic abscess, etc.).

Painful points in the field of a pelvic girdle and legs: 1) in the place of an exit of a femoral nerve in the middle of an inguinal fold — at neuritis of this nerve; 2) Vallée's points — lateralny acanthas of lumbosacral department of a backbone, at a comb of a back upper awn of an ileal bone, at the middle of a crest of this bone, at a sciatic hillock, on the middle of a back surface in the lower third of a hip, in a popliteal space, behind a head of a fibular bone, at an outside anklebone, on the back of foot — at lumbosacral radiculitises and radiculoneurites; 3) Gar's points — during the pressing on cross shoots of the IV—V lumbar vertebrae, in the field of a podvzdoshnokresttsovy joint, acanthas of a sacrum and the IV—V lumbar vertebrae, at a posterosuperior awn of a comb of an ileal bone — at lumbosacral radiculitises and radiculoneurites; 4) Dezherin's points — at an acantha of the I sacral vertebra — at lumbosacral radiculitises and radiculoneurites; 5) Bekhtereva a medioplantarny point — on the middle of a sole at lumbosacral radiculitis.

Are described and many others Must be t. at various diseases of internals that is explained by irradiation of painful impulses from the affected internals to the sites of skin connected with these bodies a community of spinal segments.

Bibliography: Expert Ya. K. Lumbosacral radiculitis, M., 1971, bibliogr.; Birbrair L. B. Semiotics of painful points in pathology of the autonomic nervous system, in book: Vegetative nervn. sist. normal and patol., under the editorship of G. I. Markelov, page 371, Odessa, 1934; Bogolepov N. K. Comas, M., 1962, bibliogr.; Vartenberg R. Diagnostic tests in neurology, the lane with English, M., 1961; Grinstein A. M. and Popov N. A. Vegetative syndromes, M., 1971, bibliogr.; G. N lip. Neurologic symptoms, syndromes and functional trials, Kiev, 1969, bibliogr.; Yerokhina L. G. Front pains, M., 1973, bibliogr.; M. B. and Fedorov E. A. crawl. Main neuropathological syndromes, M., 1966, bibliogr.; Markelov G. I. Diseases of the autonomic nervous system, Kiev, 1948, bibliogr.; Mikheyev V. V. and Rubin L. R. Stomatonevrologiches-kiye syndromes, M., 1966; Platonova E. P. Headaches, M., 1960, bibliogr.; Popelyansky Ya. Yu. Cervical osteochondrosis, M., 1966, bibliogr.; Propaedeutics of internal diseases, under the editorship of V. of X. Vasilenko, etc., M., 1974.

L. G. Yerokhina.