My medical path

Chapter 82 Preoperative Discussion
On Tuesday, the early shift ends.

A patient was admitted to the hospital yesterday, considering cervical spondylosis, and plans to arrange surgery tomorrow.

Because cervical spine surgery is a fourth-level surgery, pre-operative discussion is required before surgery.

The patient is in Wu Zhennan's bed, so he will report the medical history.

"Patient Zhang Jiahui, male, 65 years old, was admitted to the hospital due to repeated neck and shoulder pain and right hand numbness for 2 years. This is his film..."

Wu Zhennan read the patient's film and said:

"The physical examination mainly showed numbness of the little finger in the middle ring of the right hand, and atrophy of the hypothenar and interosseous muscles. From the film, it was cervical 5/6 and cervical 6/7 intervertebral disc herniation...the diagnosis of cervical spondylotic radiculopathy...planned for cervical spondylosis Intervertebral disc removal, bone graft fusion and internal fixation..."

Wu Zhennan's introduction is relatively concise and focused, which is the basic ability of an attending physician.

"From the results of symptoms, physical examination and filming, cervical spondylosis is indeed the first consideration..."

After listening to Wu Zhennan's introduction, Chen Bo had a preliminary impression in his mind.

The patient was admitted to the hospital by Wu Zhennan, and he was the only one who had seen the patient. Now after he reported the medical history, according to the procedure, the superior doctor needs to check the patient number himself. If the diagnosis is correct, the treatment plan will be carried out according to Wu Zhennan's introduction.

So after watching the film, Director Wei asked Pang Minghui to take the patient to the office.

"Why are you uncomfortable?"

Director Wei asked after seeing Zhang Jiahui coming to the office.

"I just have shoulder and neck pain, and then my hands are numb, and I feel clumsy when I do things with my hands..."

Zhang Jiahui replied.

"Which places are numb?"

Director Wei asked.

"The most important thing is these three fingers." Zhang Jiahui gestured to his little finger in the middle ring, "Also it is a little numb here..." Zhang Jiahui pointed to the inside of his right forearm.

"Minghui, check him for the nerve tapping sign and the brachial plexus pulling test."

Director Wei looked at Pang Minghui and said.

"Ok!"

After hearing Director Wei's words, Pang Minghui stepped forward for an inspection.

Tapping the position of the ruler tube and the elbow tube with his middle finger successively, Pang Minghui looked at the patient and asked:

"Do you feel a discharge?"

"No."

The patient replied.

"Well, the nerve percussion signs at the ulnar tube and the elbow tube are negative, which means that the nerve entrapment site is not here..."

After Chen Bo saw that Pang Minghui had checked these two parts, he evaluated in his heart.

Then Pang Minghui pulled the patient's right upper limb abducted, and then performed a head pressure test on the left side, asking:

"How do you feel now?"

"Well, hemp, hemp, very hemp!"

Zhang Jiahui replied.

"Positive brachial plexus stretch test..."

When Chen Bo saw this, his first reaction was the same as that of Wu Zhennan. This patient really fits the symptoms of cervical spondylotic radiculopathy.

"Numbness of the little finger on the inside of the forearm and the middle ring, which is a manifestation of damage to the median nerve and ulnar nerve, and the herniated discs in cervical 5/6 and cervical 6/7 can indeed cause damage to the trunk of these two nerves... "

After seeing the inspection done by Pang Minghui, Deputy Director Zhao nodded approvingly to Wu Zhennan, and said:

"The medical history, symptoms and signs, and auxiliary examinations all support the diagnosis. I think the operation can be arranged as planned. What do you think, director?"

Director Wei nodded when he heard Deputy Director Zhao's words, and was about to make a concluding speech when he saw Chen Bo walking up to the patient and pressing his right side of the neck with his hand.

"What is this kid doing here? Does he have other ideas?"

Director Wei was puzzled, so he was not in a hurry to make a conclusion at this time.

Director Wei then saw Chen Bo pull up the patient's hand like Pang Minghui just now to make Zhang Jiahui's right upper limb abduct, the difference is that this time he did not perform the movement of pressing the head.

"How do you feel now?"

Chen Bo looked at Zhang Jiahui and asked.

"Ma, the same Ma as before!"

Zhang Jiahui replied.

"It's numb even if you don't press your head? Is the patient's intervertebral disc so serious?"

Seeing the results of Chen Bo's inspection, Wu Zhennan and Deputy Director Zhao thought to themselves.

At the same time, Deputy Director Zhao frowned, expressing dissatisfaction with Chen Bo's behavior.

"I've already said my opinion, and now you're here to check again. What does that mean? It means you don't believe my judgment and have your own ideas?"

He criticized Chen Bo severely in his heart, but on the surface, Deputy Director Zhao did not show it. After all, this was a pre-operative discussion, and everyone is entitled to express their opinions.

"The patient's hand abduction will show symptoms of nerve compression..."

After Chen Bo checked the patient, he muttered in his heart:

"There are no symptoms of pain points and nerve entrapment in the compression of the anterior scalene muscle..."

Chen Bo sorted out the information he had, and found that the results all pointed to the diagnosis of cervical spondylotic radiculopathy, but there was something wrong...

Start smart system scan...

Chen Bo first looked at the cervical spine of the patient, and he did see disc herniation in cervical 5/6 and cervical 6/7..., huh... the intervertebral disc and the nerve root are only in contact?The nerve root is not compressed!

This discovery moved Chen Bo's heart.

In other words, the diagnosis of cervical spondylotic radiculopathy by this patient number is not valid...

"Then what disease caused the nerve compression symptoms?"

Chen Bo had no idea for a moment.

"Then just follow the path of the brachial plexus and take a look!"

Chen Bo has a wisdom system, which is playing a big role at this time.

Starting from the nerve root, Chen Bo looked down in order.

"No, the situation here is not right..."

When Chen Bo saw that the brachial plexus was deformed to the subclavian position, the system scan showed that the nerve was obviously compressed at this position!
Continuing to look down, the nerves have returned to their general shape. Scanning all the way to the nerves in the hands, Chen Bo did not see any constriction or adhesion during the trip.

It turned out that the part under the collarbone was under pressure, and a relatively unfamiliar term appeared in Chen Bo's mind——

Thoracic Outlet Syndrome!
"No wonder I think this sick number is a bit weird, so it's like this... the intelligence system is really awesome!"

Chen Bo sighed in his heart.

Back to the area under the collarbone, Chen Bo used the smart system to look carefully again.

The nerve is not only compressed, but also adhered. It is estimated that because the nerve has been compressed for a long time, the nerve fibers in this part have become thinner...

Chen Bo continued to scan to see the bony structure, and a special place caught Chen Bo's attention...

"It turns out that the problem is here!"

Under the display of the smart system, Chen Bo saw that there was an osteophyte on the upper edge of Zhang Jiahui's first rib!
"If this disease is not considered, this position will be ignored?"

Chen Bo thought to himself:

"It appears that this osteophyte is causing a narrowing of the space between the first rib and the clavicle where the brachial plexus passes through the subclavian..."

(End of this chapter)