Non-Neuromusculoskeletal Sources of Skeletal Symptoms

Question 1

What is a sign?

Answer 1

Clinical findings:
- swelling
- RROM
- Strength
- sensation
- joint integrity

Question 2

What is a symptom:

Answer 2

what the patient reports
- pain
- nausea
- fatigue
- unstable

Question 3

Referred symptoms

Answer 3

symptoms that are felt at a location other than their site of origin

Question 4

Radicular symptoms

Answer 4

symptoms associated with nerve root compression/pressure
- irritation or nerve root
- weakness in myotome
- numbness tingling over the dermatome
- and reflexes changes (hypo reflexive)

Question 5

Pain descriptors of Musculoskeletal origin:

Answer 5

Ache, sore, heavy, hurting, dull, cramping, deep

Question 6

Pain descriptors of Neurogenic Origin:

Answer 6

Sharp, crushing, pinching, burning, hot, searing, itching, stinging, pulling, jumping, shooting, pricking, gnawing, electrical

Question 7

Pain descriptors of vascular origin

Answer 7

Throbbing, Pounding, Pulsing, beating

Question 8

Pain descriptors of emotional origin

Answer 8

Tiring, Miserable, Vicious, agonizing, nauseating, frightful, piercing, dreadful, punishing, torturing, killing, unbearable, annoying, cruel, sickening, exhausting

Question 9

Pain assessment model

Answer 9

PQRST

Question 10

P of the pain assessment model

Answer 10

provocation/palliation
- What makes it better or worse

Question 11

Q of the pain assessment model

Answer 11

quality/type:
- Pain descriptors

Question 12

R of the pain assessment model

Answer 12

region/radiation
- Where is it located, did the symptoms move

Question 13

S of the pain assessment model

Answer 13

severity
- Pain scale

Question 14

T of the pain assessment model

Answer 14

timing
- What brings it on and how long does it stay

Question 15

what are constitutional symptoms

Answer 15

Theses can be yellow/red flags that the problem may lie outside of your scope of practice

Question 16

what are examples of constitutional symptoms

Answer 16

Fever
Diaphoresis
Sweats
Nausea
Vomiting
Diarrhea
Pallor
dizziness/syncope
Fatigue
Weight loss (esp. unexplained weight loss)

Question 17

Non-Neuromuscularskeleatal symptoms:
- sources
- what do they mimic
- what do they represent

Answer 17

• sources can be visceral structures or systemic conditions
• mimic neuromuscular skeletal symptoms in location
• ususally represent a medical condition

Question 18

What are the mechanisms of referred visceral pain

Answer 18

1. embryologic development
2. multi-segmental innervation
3. direct pressure

Question 19

Embryologic development of referred pain

Answer 19

• Pain is referred to site where organ was located in fetal development
• As we develop organs and tissue migrate
• Ex: Heart was closer to the cranium but pericardium was closer to the gut

Question 20

Multi-segmental innervation of of referred pain

Answer 20

• Major visceral organs are innervated by afferent fibers from multiple spinal levels
• More than 1 root level

Question 21

Direct pressure an shared pathways:

Answer 21

• Organs impinging the respiratory diaphragm can refer pain
• A diseased organ puts pressure on the diaphragm which can cause pain into the neck and shoulder

Question 22

What commonly refers to the cervical spine

Answer 22

• lung
• liver
• heart

Question 23

What commonly refers to the shoulder

Answer 23

• lung
• liver
• heart
• gall bladder
• pancreas
• duodenum

Question 24

What commonly refers to the lumber spine

Answer 24

• GI
• Uterus
• Kidneys

Question 25

What commonly refers to the buttock, hip, thigh

Answer 25

• GI
• uterus

Question 26

Examination philosophy categories

Answer 26

• medical: medical conditions
• mechanical: within our scope of practice
• medical/mechanical: a mechanical problem that needs a medical intervention