Identification of Painful Tissue Orthopaedic Examination DX 612. James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic
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1 Identification of Painful Tissue Orthopaedic Examination DX 612 James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic
2 Generalized Pain Description Joint pain may be constant dull, deep ache but sharp upon motion Muscle pain may be a dull ache, crampy or spasm sensation Trigger points may be localized with pin point pain or diffuse with poor localization and paresthesias (formication)
3 Generalized Pain Description Nerve pain may be: Constant Burning and or hot Sharp pain without movement Stabbing or lightning-like Tingling and/or numbness
4 Generalized Pain Description Ligament pain may be a burning, dull or a deep ache but it may be referred to scleratomes Bone pain may be a deep burning or dull sensation Vascular pain is usually a throbbing sensation
5 0 = no pain Pain/Tenderness Grading Scale 1 = pain with palpation 2 = pain and wincing with palpation 3 = pain, wincing and withdrawal from palpation 4 = will not permit palpation Cipriano
6 Cervico-thoracic Pain Differentiate the types of tissues that may be involved with a chief concern of neck and upper back pain
7 Deep, burning, or dull pain Osseous Pain
8 Grade Three Sprain with Avulsion Osseous Pain
9 Osseous Pain
10 Spinal Muscle Pain
11 Muscle Anatomy
12 Cervical Musculature
13 Strain of Middle Trapezius Muscle Crampy pain Knot Spasm pain Dull ache
14 Myofascial Trigger Point
15 Myofascial Trigger Point Localized pain with palpation Active trigger point may produce referred pain
16 Myofascial Local Pain Pin point pain over paraspinal tissue trigger point
17 Myofascial Pain & Dysfunction Referred Pain Specific referenced muscle referral zones Anterior tibialis trigger point refers to the dorsum of foot and large toe Travell and Simons
18 Myofascial Pain Syndrome Paresthesias Crawling sensation (formication) Dull or deep ache Myotogenous Myotomal Referred Pain
19 Myofascial Referred Pain Upper Trapezius Fibers Headache Temporal Cervicogenic Tension neckache Angle of jaw pain
20 Sternocleidomastoid Muscle Clavicular Division Tension headaches Atypical facial neuralgia Cervicocephalgia
21 Joint Pain Zygapophyseal or Facet Joint Sharp pain on motion Constant dull or deep ache Dwyer, April, Bogduk
22 Ligament Pain Scleratogenous Pain Resembles radiating pain but it is a referred deep, dull ache
23 Scleratogenous or Myofascial Triggers Diffusely referred and hard to localize Deep and achey quality Kellgren & Feinstein
24 Prolotherapy Ligament Regeneration Therapy May relieve chronic pain related to scleratogenous origin and improve joint function with hypermobility due to lax ligaments
25 Nerve Pain Burning and/or hot Tingling and/or numbness Nerve root tension signs
26 Neuropathy Nerve Root Compression Sharp pain but not on motion Radiating pain Cervical compression tests
27 L Hermitte s Sign Nerve Pain Stabbing or lightning-like pain
28 Cervicogenic Cephalgia Head pain that is referred from the bony structures or soft tissues of the neck is commonly called "cervicogenic headache."
29 Cervicogenic Headaches Neurogenic Occipital neuralgias Greater Occipital (2 nd Cervical) Third Occipital Neurogenic
30 Cervicogenic Headaches Neurogenic Differentiate Cranial and Occipital neuralgias
31 Cardiovascular Pain Angina Chest pain with exertion that settles within a few minutes with rest
32 Cardiovascular Pain Myocardial Infarction Heaviness or tight chest pain possibly including upper posterior thoracic spine, throat and arm that does not settle within 20 minutes
33 Arteriosclerosis Intermittent Claudication Cramping pain in lower extremities with exertion that is relieved with rest or relaxing
34 Vascular or Muscle Cephalgia Tension headache is the most common primary headache and accounts for 90% of all headaches.
35 Vascular Pain Migraine and Cluster Headaches Neurovascular headaches are the second most common primary headaches. Throbbing pain
36 Headache Differential Diagnosis
37 Secondary Headache Secondary headaches are caused by other medical conditions, such as sinusitis, neck injuries or abnormalities, and stroke. About 2% of headaches are secondary headaches caused by abnormalities or infections in the nasal or sinus passages.
38 Differential Diagnosis
39 Cerebrovascular Cephalgia The worst headache ever... Unrelenting pain Unable to sleep Nausea, numbness, nystagmus Dizziness, diplopia, drop attack, dysarthria, dysphagia
40 FAST Testing Protocol Face = smile, stick out tongue Arms = raise arms and check for drifting Speak = able to converse, no confusion Treatment = Call 911 and arrange for ambulance
41 CVA or TIA Take vital signs Orthopedic testing, manipulation and myofascial treatments are contraindicated Do not leave the patient until ambulance arrives Do not treat patient with any manual methods
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