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Unformatted text preview: ORTHOPEDIC DIAGNOSIS EXAM 1 PAIN Pain is detected by nociceptors. Tissue damage releases serotonin, substance P, histamine, and kinin peptides. These are all nociceptive substances that activate pain signals by acting on free nerve endings. Skin, joints, arterial walls, and periosteum have lots of nociceptors. It is important that the patient identifies where the pain if by touching the area and indicate borders if possible. Quality of Pain • Aching muscle, tendon, ligament • Bounding vascular, circulation • Burning nerve root, arterial • Cramp muscle • Deep boring pain cancer, bone pain • Unrelenting deep pain cancer, visceral • Dull musculoskeletal, visceral • Gnawing ulcer • Radiating (with borders) nerve (causalgia – burning pain from periph nerves • Radiating (diffuse) sclerotogenous or myogenous • Sharp/localized facet, visceral referred • Stabbing visceral • Shooting nerve root, entrapment • Tearing aneurysm, severe sprain • Throbbing vascular, circulation • Tingling (segmental) nerve root, peripheral nerve • Tingling (non-segmental) bilateral – cord compression, MS, diabetes; • Tingling (non-segmental) unilateral – plexus Pain Patterns • Dermatogenous – sharp, stabbing, demarcated pain along the sensory distribution of a nerve root • Myogenous – paid referral within muscular or fascial tissue. Trigger points within the muscle will refer pain to a distant site. Myofascial. • Scleratogenous – pain referred from somatic structures (cartilage, ligament, joint capsule or bone). Typically don’t follow dermatome. Dull, achy, diffuse pain difficult to pinpoint. Timing of Pain • Pain with use that gets better with rest is mechanical. • Serious night pain is cancer, if it is aggravated by motion it is mechanical. • Pain with rest, but worse with the beginning of use is inflammatory • Constant pain is cancer or visceral. Referred Pain Site of referall Organ Right shoulder, inferior scapula right lung, liver, gallbladder Left shoulder left lung, stomach, spleen Jaw, neck, left shoulder and arm heart Either shoulder diaphragm Flank kidney Substernal esophagus, heart, lung Spine at T10 pancreas Suprapubic Bladder Occiput, forehead Eye Temporal headache TMJ TERMINOLOGY • Strain – over stretched/over exerted of the muscle including tendon. Pain on contraction, active motion, and resisted motion • Sprain – over stretched/ruptured ligament. Pain on active or passive motion • Strain/Sprain Differential – resist motion so that the muscle contracts but joint doesn’t move, if pain occurs it is strain. Passively move the joint, if pain occurs it is sprain. • Bursitis – inflammation of a bursa. Called calcific bursitis is calcium infiltration has set in. Include the anatomical location in the name, subacromial bursitis....
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This note was uploaded on 11/23/2011 for the course DIAG 2730 taught by Professor Ronaldg.mayne during the Winter '11 term at Life Chiropractic College West.
- Winter '11