- "My doctor doesn't treat pain, he/she treats dysfunction."
- Hypermobile joints cause pain.
Hypomobile joints cause achiness and stiffness.
- Pain from the subacromial joint may cause pain at the lateral acromion, deltoid muscle and sometimes in the forearm or fingers, but never in the neck or trapezius area.
- Pain from C7 root compression can occur in the pectoral region, medial axilla, the dorsal forearm and elbow, and the index and middle (or all) fingers. Local tenderness will appear on the medial aspect of the shoulder blade opposite the third to fourth thoracic spinouses.
- An important part of the examination is to reproduce the patient's pain.
- Severe localized spasm and rigidity of three contiguous vertebral segments may be due to a cord reflex preventing that portion of the spine from moving. Be wary of immediate adjustment, since in the cervical spine it may represent a vascular lesion. In the thoracic spine, it may represent a metastasis. In the lumbar spine, it may be due to prostatic or uterine cancer.
- The typical ankle inversion sprain may not get well because treatment was not also directed to the medial portion of the ankle, just as chronic low back pain may require treatment to the anterior pelvic area.
- If a patient exhibits a tilted head standing which straightens upon sitting, think of a pelvic lower extremity causation.
- In an acute acromioclavicular sprain, the most sensitive area on palpation will be the A-C joint itself. Surprisingly, tenderness at the coracoid process will be more common than the pain created by horizontal adduction.
- Of the many meniscus tests, the most sensitive test for a knee meniscus tear is palpation of pain at the posterior medial joint line.
- The most frequent clinical finding in adhesive capsulitis of the shoulder is a loss of passive external rotation.
- The most frequent clinical finding in determining osteoarthritis of the hip is a loss of passive hip medial rotation.
Warren I. Hammer, MS, DC, DABCO
Norwalk, Connecticut
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