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Differential Diagnosis for Physical Therapy: Introduction: Summary
Types of Pain 1. Muscular - intensified by use of muscles as well as mechanical forces such as pressure or stretch ○ With pain due to ischemia, there is a direct relationship between the degree of circulatory insufficiency and muscle work 2. Heart - consequence of muscle ischemia, and correlates with metabolic demand ○ May develop when the work of the heart increases such as with exertion, cold, or emotion, and subsides with rest and relaxation 3. Arterial/Pleural/Tracheal - pain arising from arteries increases with systolic impulse ○ Exercise, fever, alcohol consumption or bending over may intensify already throbbing pain ○ Pain from pleura as well as trachea, correlates with respiratory movements 4. Gastrointestinal - pain from GI tract tends to increase with peristaltic activity ○ Pain increases with ingestion and typically decreases with fasting or after emptying involved segment
5. Myofascial - pain referred from active myofascial trigger points with associated dysfunction ○ Trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle or muscle’s fascia ○ Myofascial Pain Syndrome (MPS): ■ Muscle Tension – ischemia, increased cellular metabolites ■ Muscle Spasm –secondary to overuse/ injury ■ Muscle Trauma – w/o pain (eccentric), broken fibers leak K+ ■ Muscle Deformity – secondary to weakness/stiffness 6. Radicular - (radiating) pain experienced in the musculoskeletal system in a dermatome, scleratome, or myotome because of direct irritation or involvement of a spinal nerve 7. Referred pain - perceived at a location other
than the site of the painful stimulus ○ Radiating pain - adjacent to organ; slightly different from referred pain
Referred Pain Chart
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