Orthopedics (Pain)

Question 1

What are the four types of pain?

Answer 1

referred pain, radiating pain, radicular pain, radiculopathy

Question 2

What is referred pain?

Answer 2

pain perceived at a site adjacent to or distant from the site of origin

Question 3

What is radiating pain?

Answer 3

pain that moves from the original area outwards to another part of the body

Question 4

What is radicular pain?

Answer 4

pain along the dermatomal distribution of a nerve root due to inflammation or irritation of the nerve root (eg. sciatica)

Question 5

What is radiculopathy?

Answer 5

spinal nerve root irritation along the distribution of a path that leades to pain, numbness or muscle weakness that may be associated with trophic changes/atrophy. detected by abnormal DTRs, muscle strength of sensory tests

Question 6

A patients broad flat hands rubbing a large area often indicates what type of pain?

Answer 6

referred pain

Question 7

one or two fingers pointed to a specific spot often indicates what?

Answer 7

exact somatic structure that is damaged

Question 8

What are the two types of pain onset?

Answer 8

insidious

sudden

Question 9

What are three qualities of most visceral (organ) pain?

Answer 9

poorly localized
dull
accompanied by autonomic symptoms (diaphoresis, nausea, anxiety, pallor, weakness)

Question 10

What are four qualities of most somatic pain? (bone/muscle)

Answer 10

sharp or dull
well-localized or diffuse
deep or superficial
usually doesnt have autonomic components

Question 11

Pain with isometric contraction generally indicates:

Answer 11

that the muscle being contracted is injured/irritated

Question 12

Pain with passive stretching generally indicates:

Answer 12

injury to either ligaments, muscle or tendon
*if passice stretching in one direction is painful and active isometric contraction in the other direction is painful, injury is likely muscle/tendon

Question 13

Pain in a muscle belly with direct pressure generally indicates:

Answer 13

trigger point, tendonitis or muscle strain

Question 14

Pain with joint distraction/gapping or shearing generally indicates:

Answer 14

articular/ligamentous injury

Question 15

Pain with a joint in compression generally indicates:

Answer 15

cartilaginous injury

Question 16

Painless crepitus generally indicates:

Answer 16

degenerative joint disease, congential deformity, muscle spasms

Question 17

Painful crepitus generally indicates:

Answer 17

degenerative joint disease

Question 18

Tender areas of a muscle belly with referred pain generally indicates:

Answer 18

trigger points

Question 19

tenderness directly over the joint line generally indicates:

Answer 19

ligamentous injury

Question 20

tenderness at muscle origin and insertion generally indicates:

Answer 20

chronically weak muscle

Question 21

Chapmans reflexes that are exquisitely tender, grainy or painful generally indicate:

Answer 21

(visceral malfunction), active Chapmans reflexes

Question 22

Pain at rest along a meridian or at its alarm point generally indicates:

Answer 22

deficient chi

Question 23

Tenderness to palpation along a meridian or its alarm point generally indicates:

Answer 23

excessive chi

Question 24

pain on either side of a spinous process generally indicates:

Answer 24

probably joint dysfunction at that level

Question 25

tenerness of a muscle belly that decreases with a passive shortening of the muscle generally indicates:

Answer 25

muscle strain

Question 26

Correct muscoluskeletal diagnosis depends on what four things:

Answer 26

knowledge of functional anatomy,
accurate patient history
diligent observation
thorough exam

Question 27

How long is considered acute pain?

Answer 27

7-10 days

Question 28

How long is considered subacute pain?

Answer 28

10 days-7 weeks

Question 29

How long is considered chronic pain?

Answer 29

greater than 7 weeks

Question 30

What kind of pain is generally worse with activity and better with rest?

Answer 30

mechanical

Question 31

What kind of pain is generally worst in the morning with stiffness but better with activity?

Answer 31

chronic inflammation/edema

Question 32

What kind of pain is generally late-day pain, with or without stiffness?

Answer 32

joint congestion

Question 33

What kind of pain is worse with initial motion and no better with rest?

Answer 33

acute inflammation

Question 34

What kind of pain doesnt generally change quality with rest or activity?

Answer 34

bone, cancer, or visceral disease

Question 35

What is the circle concept of instability?

Answer 35

injury to structures on one side of a joint that cause instability can cause injury to structures on the opposite side. Thus, with trauma the entire joint complex needs to be examined