Intro to Orthopedics Flashcards
Referred pain
pain perceived at a site adjacent to or distant from the site of origin
example: pain brought on from myocardial ischemia … angina pectoris, arm pain, neck pain
Radiating pain
pain that moves from the original area outwards to another part of the body
example: arm and shoulder pain from facet irritation at C5
Radicular Pain (radiculitis)
pain along the dermatomal distribution of a nerve root due to inflammation or other irritation of the nerve root … example: sciatica from irritation of L5 nerve root
Radiculopathy
spinal nerve root irritation along the distribution of a that leads to pain, numbness or muscle weakness and may be associated with trophic changes or muscle atrophy. Usually detected by abnormal deep tendon reflexes, muscle strength or sensory tests.
What 3 basic questions must be asked about pain?
Location - Where is the pain?
Quality of Pain - what it feels like
Severity of Pain - how bad is it?
Viscerl vs. musculoskeletal
Visceral pain (more referred/diffuse) Painful area: 1 - 2 fingers (musculoskeletal) vs. broad area (visceral)
Origin of visceral vs. musculoskeletal pain
visceral pain … pain originating from visceral dysfunction (generally organs) • somatic pain… pain originating from somatic dysfunction (generally
musculoskeletal)
Trauma
- many times musculoskeletal pain has no mechanism that the patient can identify
- sometimes the mechanism is an easily identifiable major trauma such as a fall or motor vehicle collision
- sometimes the mechanism is minor repetitive trauma such as from use of a keyboard or repetitive work related activities
- usually visceral pain will not have an easily identifiable mechanism of injury
Onset of Pain
Provocation …
• aggravation of musculoskeletal pain is usually related to
Palliation …
• musculoskeletal pain is usually relieved by …
Quality of Pain …
• most visceral pathology has pain that is …
Orthopedic Interviewing
Takes place regionally
Common Signs and Symptoms with Possible Causes …
- Pain with isometric contraction …
• the muscle being contracted is injured or irritated
- Pain with passive stretching …
• injury to either ligaments, muscle, or tendon
• if passive stretching in one direction is painful and active isometric
contraction in the opposite direction is painful, the injury is probably muscular and/or tendinous
- Pain in a muscle belly with direct pressure …
• trigger point, tendonitis or muscle strain
- Pain with joint distraction, gapping or shearing …
• articular or ligamentous injury
- Pain in a joint with compression of the joint…
• cartilagenous injury
- Painless crepitus …
• Degenerative Joint Disease (DJD), congenital deformity, muscle spasms
Crepitus: grinding, usually fine
- Painful crepitus …
• Degenerative Joint Disease (DJD) - deeper grinding than painless.
- Tender areas of muscle belly with referred pain …
• trigger points (TrPs) … TrPs have consistent referral patterns that are well-documented
- Tenderness directly over the joint line …
• ligamentous injury
- Tenderness at muscle origin and insertion …
• chronically weak muscles
- Chapman’s reflexes that are exquisitely tender, grainy or frankly painful …
• active Chapman’s reflexes (neurolymphatic reflexes)
