1/7. A systematic history for the patient with chronic pelvic pain.Chronic pelvic pain is a source of frustration to both the physician and the patient. physicians have been ill equipped by their training to confront the multifaceted nature of the complaints of patients with chronic pelvic pain. patients have experienced a repetitive dismissal of their complaints by physicians too busy in their practices to address their problems comprehensively. The approach to the patient with chronic pelvic pain must take into account six major sources of the origin of this pain: 1) gynecological, 2) psychological, 3) myofascial, 4) musculoskeletal, 5) urological, and 6) gastrointestinal. Only by addressing and evaluating each of these components by a very careful history and physical examination and by approaching the patient in a comprehensive manner can the source of the pain be determined and appropriate therapy be administered. This article was developed to provide the clinician with a set of tools and a methodology by which the patient with this complaint can be approached.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/7. Differentiation of active and latent trigger points by thermography.OBJECTIVE: This study tested whether two distinct thermographic patterns attributed to myofascial trigger points could distinguish between active and latent trigger points. DESIGN: A retrospective chart survey was undertaken with thermographic data divided into two groups: a) increased thermal emission only over the trigger point and b) over the area of pain referral. The criterion standard used in a blinded comparison was physical examination findings separating active from latent trigger points. SETTING: All cases were drawn from a private practice referral center for thermographic evaluation of neck and low back injuries. patients: A sample of 65 cases showing physical examination findings of trigger points was chosen from 229 consecutive motor vehicle accident case files. RESULTS: There was moderate agreement between the two methods of differentiating active from latent latent trigger points (Kappa = 0.44) with a specificity of 0.70 and a sensitivity of 0.74. When cases in which spinal segmental dysfunction were eliminated, the agreement increased (Kappa = 0.54) with specificity of 0.82 and sensitivity of 0.74. CONCLUSIONS: thermography may be a useful tool in distinguishing active from latent trigger points, but the thermal imaging of spinal joint dysfunction may be a compounding factor.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
3/7. Differential diagnosis and treatment in a patient with posterior upper thoracic pain.BACKGROUND AND PURPOSE: Determining the source of a patient's pain in the upper thoracic region can be difficult. Costovertebral (CV) and costotransverse (CT) joint hypomobility and active trigger points (TrPs) are possible sources of upper thoracic pain. This case report describes the clinical decision-making process for a patient with posterior upper thoracic pain. CASE DESCRIPTION: The patient had a 4-month history of pain; limited cervical, trunk, and shoulder active range of motion; limited and painful mobility of the right CV/CT joints of ribs 3 through 6; and periscapular TrPs. Interventions included CV/CT joint mobilizations, TrP release, and flexibility and postural exercises. OUTCOMES: The patient reported intermittent mild discomfort after 7 physical therapy sessions. Examination findings were normal, and he was able to resume all preinjury activities. DISCUSSION: This case suggests that CV/CT mobilizations and active TrP release may have been beneficial in reducing pain and restoring function in this patient.- - - - - - - - - - ranking = 0.1052441225989keywords = physical (Clic here for more details about this article) |
4/7. Postherpetic pain: more than sensory neuralgia?OBJECTIVE: To describe a series of older adult patients with postherpetic myofascial pain, a heretofore rarely described complication of herpes zoster. DESIGN: Case series. SETTING: Outpatient older adult pain clinic. patients: Five older adults are presented with myofascial pain that developed as a complication of herpes zoster. RESULTS: Pain duration at the time of presentation ranged from 4 months to 7 years. All patients reported functional impairment from pain despite oral analgesics. Myofascial pathology was diagnosed by the presence of taut bands and trigger points in the affected myotome. Upon successful treatment of the myofascial pain with nonpharmacologic modalities (e.g., physical therapy, trigger point injections, dry needling, and/or percutaneous electrical nerve stimulation), all patients reported symptomatic improvement, and four out of five were able to significantly reduce or discontinue their opioids. CONCLUSION: Postherpetic pain is traditionally conceptualized as a purely sensory phenomenon. Identification of the intrusion of a myofascial component may be worthwhile, both from the standpoint of enhanced pain relief and reduction in the need for oral analgesics. Formal exploration of this phenomenon is needed.- - - - - - - - - - ranking = 0.1052441225989keywords = physical (Clic here for more details about this article) |
5/7. Postpartum cervical myofascial pain syndrome: review of four patients.Four postpartum patients with complaints of headache and neck pain were examined. All had received epidural analgesia and had a long second stage associated with prolonged pushing. Many similarities to postdural puncture headache were noted. The headache started the day after delivery and involved the occipital region primarily, along with the neck and shoulder girdle areas. However, the pain did not change with positional changes and was associated with marked tenderness of muscles at specific anatomic points. A diagnosis of cervical myofascial pain was made. All patients responded quickly to physical therapy. The authors suggest that many patients initially considered to have postdural puncture headache may actually have postpartum cervical myofascial pain.- - - - - - - - - - ranking = 0.1052441225989keywords = physical (Clic here for more details about this article) |
6/7. temporomandibular joint dysfunction syndrome. A clinical report.We have presented two clinical case reports of patients with TMJ dysfunction syndrome as an example of coordinated treatments between dentists and physical therapists. The clinical profiles of these patients with craniocervical pain were compiled from comprehensive physical therapy and dental-orthopedic evaluations. The significance of the relationship between the rest position of the mandible and forward head posture has been shown by the changes observed after correction of the postural deviations and vertical resting dimensions by dental treatments and physical therapy. Additional research is necessary to determine long-term effects of this combined approach in TMJ dysfunction syndrome.- - - - - - - - - - ranking = 0.31573236779671keywords = physical (Clic here for more details about this article) |
7/7. Scapulocostal syndrome.The scapulocostal syndrome, myofascitis of the shoulder muscles, is caused by altered posture, prolonged immobilization of the shoulder region or fixed scapular/spinal deformities. The author studied 440 patients ranging from 18 to 60 years of age whose altered posture caused deep pain in the shoulder region originating from the medial aspect of the scapular spine. Treatment consisted of infiltrating a trigger point in the subscapularis region of the medial aspect of the scapular spine (root of the scapular spine) with a mixture of 2cc plain 1% lidocaine hydrochloride (Xylocaine [Astra]) plus 1cc beta-methasone sodium phosphate and acetate suspension (Celestone Soluspan [Schering]) followed by physical therapy exercises. 190 patients (43.19%) received one block, 175 (39.77%) received two blocks, and 75 (17.04%) received three blocks. Upon completion of treatment, 97.7% of the patients were relieved of their discomfort and returned to their original occupation.- - - - - - - - - - ranking = 0.1052441225989keywords = physical (Clic here for more details about this article) |