Visceral/Pain Referral Patterns

Question 1

Heart referral pattern

Answer 1

upper quadrant

epigastrium

Question 2

Spleen referral pattern

Answer 2

left chest

Question 3

Lung and pleura referral pattern

Answer 3

abdomen

Question 4

Appendix and pancreas referral pattern

Answer 4

umbilicus

Question 5

Gallbladder referral pattern

Answer 5

shoulder blade

Question 6

RUQ pain

Answer 6

• Gallbladder
• duodenum
• pancreas
• kidney
• hepatic fissure

Question 7

LUQ pain

Answer 7

• stomach
• spleen
• kidney
• pancreas
• splenic fissure

Question 8

RLQ pain

Answer 8

• cecum
• appendix
• ovary and tube

Question 9

LLQ pain

Answer 9

• sigmoid

- ovary and tube

Question 10

Vascular pain

Answer 10

tearing pain in sternum or chest

Question 11

Neuralgia

Answer 11

• Shingles (sensory nerve root infection)
• Spinal cord
• Pressure from osteophyte

Question 12

Angina

Answer 12

-Left, right, or B jaw, neck, shoulder girdle, medial border of upper limb

Question 13

Lung: pancost’s tumor

Answer 13

Tumor of apical segment can compress lower nerve roots C8-T1

Question 14

Gallbladder referral pattern

Answer 14

cholecystitis can refer pain to C4 via diaphragm irritation

Question 15

Spondylogenic pain: Osseus

Answer 15

Infections, neoplasms, metabolic disease, trauma

Question 16

Spondylogenic pain: soft tissues

Answer 16

Ligaments, muscles

Question 17

Spondylogenic pain: articular

Answer 17

discs, z-joints, rib joints, nerve root entrapment, stenosis

Question 18

Spondylogenic pain: structural

Answer 18

Kypohsis, scoliosis

Question 19

Meadows: summary of serious disease and symptoms:

Neoplasm, osteoporotic/neoplasmic fracture

Answer 19

• Severe root pain

- Wedging/local kyphosis

Question 20

Meadows: summary of serious disease and symptoms:

Cardiac, Viscera, AS, neoplasm

Answer 20

• Pain related to stress
• Pain = activity
• Reduced SB, full rotation
• Severe chest pain without joint pain

Question 21

Meadows: summary of serious disease and symptoms:

Neoplasm, cord pressure or ischaemia

Answer 21

-Spinal cord signs

Question 22

Meadows: summary of serious disease and symptoms:

Viscera

Answer 22

Pain onset with eating

Question 23

Meadows: summary of serious disease and symptoms:

Aortic Aneurysm

Answer 23

Pulsating abdomen

Question 24

Dwyer: Z joint referral pattern

Answer 24

• C2/3 = head

- C5/6, 6/7 = shoulder girdle pain

Question 25

Cloward: anterior cervical disc referral

Answer 25

• C6-7 = inf angle of scap
• C5-6 = spine of scap and superior angle
• C3-4 = C7 SP and posteroir border of trap

Question 26

MacNab Classification of pain:

Viscerogenic

Answer 26

• Slow pain, hard to localize

- intense, unremitting pain, stabbing

Question 27

MacNab Classification of pain:

Vasculogenic

Answer 27

Diffuse, aching, poorly localized, may be referred

Question 28

MacNab Classification of pain:

Neurogenic

Answer 28

Intense pain of neuropathy

pain of stenosis or tumor

Question 29

MacNab Classification of pain:

Psychogenic

Answer 29

psychogenic

Question 30

MacNab Classification of pain:

Spondylogenic

Answer 30

Osseous, ligamentous, muscular, zjoint, ujoint.