Tissue Pathologies

Question 1

Bone Pathologies

Answer 1

• History: Sudden onset, local pain. Deep, boring, aching, or throbbing. Constant with disease or fracture.
• Inspection: Unremarkable unless there is deformity or swelling.
• Function: Positions that stress the bone increase pain unless severe.
• Palpation: Increased pain with vibration, tapping, or clinical ultrasound.
• Neurologic Tests: Negative.
• Special Tests: Positive radiographs, bone scans, CT, MRI.

Question 2

Muscle Pathologies

Answer 2

• History: Sudden onset after strenuous activity (e.g., lifting) or trauma. Gradual onset with sustained/repeated activity.
  
  • Pain worse with tension in the muscle. Local or diffuse pain.
• Inspection: Muscle guarding or spasm common.
• Function: Active and resisted movements hurt. Passive movements in the opposite direction hurt.
• Palpation: Local tenderness with guarding. May palpate gaps in ruptured areas.
• Neurologic Tests: Negative.
• Special Tests: MRI, EMG, x-ray for suspected myositis ossificans.

Question 3

Synovial Joint Capsule Pathologies

Answer 3

• History: Pain often localized to the joint.
• Inspection: May show swelling.
• Function: Pain during movements that stress the joint.
• Palpation: Tenderness over the joint line; pain with passive intervertebral motion (PIVM).
• Neurologic Tests: Negative.
• Special Tests: X-rays, arthrogram, injection.

Question 4

Ligament Pathologies

Answer 4

• History: Usually traumatic, worse with movements that increase tension on the tissue.
  
  • Pain localized, dull, or sharp. May report instability or giving way.
• Inspection: Possible joint effusion due to synovial reaction. Longstanding instability may cause degenerative changes.
• Function: Passive movements stressing the joint are painful; resisted tests negative.
• Palpation: Tenderness over the ligament, potential joint effusion.
• Neurologic Tests: Negative.
• Special Tests: Positive x-rays, MRI.

Question 5

Discogenic Pain Pathologies

Answer 5

• Typically caused by chemical irritation from a herniated disc.
• Pain: Central, unilateral, or radiating to the extremity.
• Worse with sitting and flexed postures.
• Better with lying down or standing.

Question 6

Nerve Root Pain

Answer 6

• History: Gradual or sudden onset from foraminal stenosis (herniated disc or bone spur).
  
  • Symptoms: Burning, tingling, numbness, pins and needles. Weakness in affected dermatome.
• Worse with positions that stretch or compress the nerve root.
• Must differentiate between nerve root compression and irritation.