Presentation types Flashcards
Subjective - Presentation Features: Impaired mobility (12)
Older age
Less episodic
Less variation in symptom intensity
Slower to resolve when aggravated
Not increasing in frequency
Associated with stiffness
Morning pain
Pain with position change
Relief with stretching
Less when warmed up
Less intense
Less likely to be ‘immobilised’ or ‘stuck’
Subjective - Presentation Features: Impaired Control (13)
Younger age
More commonly episodic
Tends to be more intense
Quicker resolution of severe pain
Aggravated by mid-range loading
Aggravated by sudden movements
Aggravated by unguarded movements
Aggravated by UL loading
‘immobilised’ or ‘stuck’
‘neck going into spasm’
Mid-range pain
Frequent manipulation
Post trauma
Presentation Features: Nociplastic pain type (17)
Persistent high levels of pain
Never free of pain
Widespread pain not within usual anatomical boundaries
Extensive spreading of pain from original area
Pain shifts around
Unpredictable patterns of provocation
Unclear mechanical pattern
Spontaneous pain
Sensitises easily
After pain
Non-noxious triggers to pain
Other sensitivities (noise, smell etc.)
Non-restorative sleep
Extreme fatigue
Concentration problems
Widespread hyperalgesia
Widespread allodynia
Radicular pain only (4)
Referred pain worse than neck pain
Neuroanatomical distribution - along line of nerve
Nerve trunk pain only
Associated symptoms less common - non-dermatomal distribution
Radicular pain with radiculopathy (5)
Nerve trunk pain and dyaesthetic pain
Associated symptoms - P+N, numbess
Stretch and compression sensitive
Latent pain
After pain
Input dominant (8)
Well defined area of pain
Clear neuroanatomical patterns
Standard history
Appropriate level of irritability for stage
Behaves mechanically
Has a position of ease
Clear stimulus response relationship - consistent and predictable
Reasonably stable
Somatic pain (4 + 9)
Neck pain main problem
Deep aching pain
Well localised
Sharp and catching
Referred pain is:
- deep
- aching
- dull
- static
- expands slowly if stimulus increases
- aware of where centred but hard to localise boundaries
- above the elbow
- non-tender in referred area
- no latent or after pain (generally)
Neurogenic pain (20)
Arm pain worse than neck
More severe
Radiates below the elbow
Nerve trunk pain and/or dyaesthetic pain
Antalgic posture that unloads nerve
Relevant movement dysfunction
Nerve effects
IVF effects
Aggravated by position that close IVF (comp)
Aggravated by activities that load nerve
Relief by activities that open IVF
Relief with positions that unload nerve
Pain reproduced on NDT
Positive neural palpation
Neural integrity can be positive or negative
Hypersensitive in arm
Relevant mechanical impairments
Poor mobility into opening
Poor control of closing
Poor control of tensioning
Onset/relief with sustained positions
Latent and after pain responses to testing
Nerve trunk pain (8)
Deep, aching pain
Pulling, dragging pain
Heaviness
Along line of nerve
Tension point pain
Linking up of pains neuroanatomically
Mild paraesthesia (non dermatomal)
Peripheral tenderness along nerve
Dyaesthetic pain (14)
Sharp, shooting, lancinating, stabbing
Burning quality
Gripping pain
Paroxysmal pain
Felt in sensory distribution of nerve
Localised Paraesthesia
Localised Anaesthesia
Localised Weakness
Localised Hyperalgesia
Localised Allodynia
Latent pain, after pain
Feel awful, wearing
Autonomic changes
Peripheral tenderness dermatome
Objective presentation features: Impaired Control (11)
Good mobility
Soft end feel
Relative Flex favour neck
Mid-range abnormalities
Worse after PAIVM
PPIVM increased into PD
Poor local muscle function
Poor control provocative load
Poor thoracic mobility PD
Poor thoracic recruitment
??generalised hypermobility
Objective presentation features: Impaired mobility (7)
Hard end feel
End range problem
Better after PAIVM
PPIVM decreased into PD
Relative flex favours thorax or UCS
Muscle system OK
OK control of provocative load
Objective presentation features: Radicular pain only (6)
Stretch sensitive
Not very compression sensitive
Positive neurodynamics
Neural palpation varies
Negative neurology
Less common local hyperalgesia
Objective presentation features: Radicular pain with radiculopathy (7)
Stretch sensitive
Compression sensitive
Positive neurodynamics
Positive neural palpation
Positive neurology
Local hyperalgesia
Local allodynia
Objective features: Thoracic outlet syndrome (5)
- Ref for imaging if vascular or no change with conservative trial of nTOS
- Nerve conduction tests
- Neural sensitivity tests
- Neural integrity signs (true)
- Special tests for TOS - Pulse and symptoms
- Impaired TO function
o Flexed posture and lack of extension capacity
o Behaviour rib 1 under caudal load
o Evidence of excessive scalene activity
Breathing and poor DNF function
o Scalene extensibility – rib neck dissociation
o Subclavius extensibility – clavicle rib dissociation
o Pec minor extensibility – scapula rib dissociation -> compression
o Upper trapezius capacity – ability to laterally rotate scap to open hole
