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Differential Diagnosis for Physical Therapy: Introduction: Summary
L Shoulder Pain • Cardiovascular • Pulmonary • Gastrointestinal • Diaphragm • Spleen
Right Shoulder Pain • Liver
• Gallbladder • Pulmonary
Thoracic Spine Pain • Cardiovascular • Pulmonary • Gastrointestinal (stomach) • Pancreas
R Upper Quadrant • Gallbladder • Liver R Lower Quadrant • Intestine • Appendix • Renal
L Upper Quadrant • Spleen • Colitis L Lower Quadrant • Renal • Intestine
12. Chronic - pain that persists past the normal time of healing. ○ International Association for the Study of Pain has fixed 3 months as the most convenient point of division between acute and chronic pain Pain Screening Pain assessment is the central focus of therapist’s interview • Are you having any other symptoms of any kind anywhere else in your body we haven't talked about yet? • Is there anything else you think is important about your condition that we haven't discussed yet? Outcome Tools Numeric Rating Scale (NRS) ICF portion: Body/Structure/Function (BSF) • Universal pain screening with a 0-10 pain intensity of NRS has been widely implemented in primary care • Moderate accuracy • MDC and MCID - available dependent on type • MDC: ○ 3 neck ○ 2 Low back pain
8. Diffuse - may be difficult to distinguish diffuse pain characteristics of some diseases of the nervous system from diffuse pain caused by lesions of the moving parts ○ May require a medical diagnosis 9. Pain at rest - may arise from ischemia. Look for the 5 P’s: ○ Pain ○ Pallor ○ Pulselessness ○ Paresthesia ○ Paralysis Potential DD: Peripheral Vascular Disease (PVD) ○ Pain is usually described as burning or shooting ○ Usually worse at night and relieved by massaging or dangling the feet over the bed • Type I (HSV-1) 10. Activity - may be due to ischemia 11. Joint - pain that awakens the client at night is often due to bone disease or neoplasm. ○ Pain is described as deep, aching, and throbbing ○ Bilateral vs unilateral pain important to know for DD
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