Differential Diagnosis for the Orthopedic Physical Therapist by James Meadows

By James Meadows

Handbook muscle checking out is a cornerstone task in actual and occupational treatment. Designed to counterpoint, no longer complement present tomes within the literature, this e-book provides info that's contained, yet now not easily available within the different books. every one muscle or muscle workforce is gifted on a web page unfold. every one unfold is chock jam-packed with info, containing an image of the muscle try out, step by step directions for acting the try out, the muscle's beginning and insertion issues, and so forth.

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This is an en­ larging lesion. It may be an increasing herniation, or it may be some­ thing less benign such as an infection or a growing neoplasm. 3l The opposite of this would be the patient who tells you that the pain started in the lumbar spine and then shifted to the right buttock. This would suggest something moving rather than enlarging and is a better prog­ nostic indicator. Third, is the severity of the pain lessening? If it is, we can assume that the pain stimulus is abating. However, by itself this may not be an indication of an improving condition.

It is easy to misjudge and apply too ag­ gressive a treatment and flare the patient. The following table may help to distinguish the type of pain encoun­ tered, always remembering the complexity of the nature of pain in its dependence on context, on the individual, and on the source and level of stimulation. However, also remember that pure chemical or pure mechanical pains are rarities and some degree of overlap is usually present. Chemical Pain Mechanical Pain • Intermittent • Morning stiffness lasting less than a few minutes and relieved with rest and appropriate activity • Eased by rest • Sleep without waking from pain ~ • Constant or continuous nocturnal • Morning stiffness lasting more than 2 hours • Unaffected by rest • Night pain may disturb sleep , is either com­ ;s factors.

Liver and gall bladder disease is usually felt in the right upper quad­ rant or epigastrum, with referral potential to the right shoulder, midtho­ racic, and right inferior scapular regions. Midline or left to midline pain may be pancreatic in origin and may radiate to the lumbar region or, if the diaphragmatic peritoneum is af­ fected, to the left shoulder. The appendix is generally felt in the right abdominal lower quadrant with referral into the epigastrum, the right groin and hip, and occasion­ ally the right testicle.

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