concepts for examination and diagnosis of neuromusculoskeletal movement problems

what is referred pain?

• pain at a site other than the site of the lesion

• location of pain is in tissues supplied by same or adjacent neural segments that supply the diseased organ

  • visceral pain patterns

• occurs by the way of shared central pathways for afferent neurons, does not follow nromal anatomic pathway

• localized but borders not sharply demarcated

• may have local tenderness in tissues of referred pain but without sensory changes

• often associated with muscle hypertonicity over referred area

what is radiculopathy?

• symptoms from irritation of spinal nerve roots

• sensory fibers: pain, numbness/tingling in a dermatomal pattern

• motor fibers: weakness or decreased reflexes in a myotomal pattern

what is a sclerotone?

• pain from bone or fascia supplied by a single nerve root

• deep, diffuse, achy pain

what is a myofascial trigger point?

hyperirritable spot, usually within a taut band of skeletal muscle or its fascia that is painful to compression and produces a characteristic pattern of referral, not in a dermatomal pattern

what is the order of soft tissue differential diagnosis?

• AROM

• PROM

• resisted test

• palpation

what is clearing?

specific tests used to clear joints which may refer pain to the area of symptoms

how to perform clearing tests?

• overpressure at end of PROM (common for peripheral joints)

• combination of movements/quadrants

• active quick tests (squat)

when do you perform a clearing test?

• ONLY WHEN

  • PROM of peripheral joints is full and symptom free

  • AROM of spine is full and symptom free

    • cervical spine: able to perform ROM with OP but not so easily for thoracic or lumbar spine

    • clinicians may perform a quadrant test for the spine

what is centralization?

symptoms present moves from a distal or lateral position to a proximal or central position

what is peripheralization?

symptoms present (or produced) moves from a central or proximal to a lateral or distal position