REVIEW OF POSSIBLE CAUSES



REVIEW OF POSSIBLE CAUSES OF JOINT PAIN

Motion Palpation Notes

I TRAUMA

Trauma produces an inflammatory reaction; the same as a bacterial invasion. This reaction is designed to contain and wall off the bacteria to prevent further spreading. In the case of trauma it serves only to detrimentally contain the products of the injured tissues themselves. For some reason, the body's reaction to trauma is always too great.

The resolution of inflammation is FIBROSIS (scarring) which can be especially harmful if the joint has not returned to absolute normal movement. Acute inflammation can develop into chronic inflammation which can last for twenty years. Therefore, it is necessary to treat each trauma excessively until ALL pain, soreness, tenderness, etc. is eliminated. Pretty good is not good enough. It is also worth noting, ligaments are never tender unless pathological. The diagnosis should be accurate, but it is often multiple. More than one, tissue is affected by one trauma.

The treatment is specific for each tissue affected or each diagnosis. Basically, the first step is to reduce the swelling and relieve the pain. The second phase is to promote healing with movement in the form of massage, manipulation, passive and active exercise. It is also imperative that you adjust the neurological segment in retracing to the spine. This cuts-out the reflex feedback that facilitates prolonging the effect and also eliminates a possible source or cause of a subluxation complex.

II INTERNAL DERANGEMENT OF A JOINT

There are two categories of significance in the rationale approach to joint manipulation: The hypermobile situation obviously does not need to be mobilized with a dynamic recoil or impulse thrust. The hypomobile (whichever terminology is comfortable to you) is the finding that which requires manipulation.

JOINT PLAY

1) Cannot be produced by voluntary muscles or corrected by exercise.

2) Voluntary movement depends on the integrity of joint play specific for each plane of voluntary movement.

3) Loss of joint play produced pain on testing, stressing said joint play .

4) Muscles that move a joint with joint dysfunction become hypertonic due to irritation and pain; therefore, the active range of motion is also restricted.

CAUSES OF JOINT DYSFUNCTION

1) Trauma - It is a post-traumatic effect after the inflammation has cleared.

2) Arthritis - Especially osteo-arthritis. Correcting the loss of joint play can effect a complete reduction of the swelling and crepitice and PAIN of an osteoarthritic joint.

3) Disuse - Long bed rest, post casting, disuse of old age.

4) Pathology - Actual in joint area.

5) Viscero - Motor reflex producing pain and disuse of a joint. e.g. Heart - Shoulder

THE PAIN OF JOINT DYSFUNCTION IS:

1) Sharp and intermittent when joint is in function.

2) Sudden onset.

3) Same movement causes same pain.

4) Relieved by rest caused by activity.

5) Usually limited to one joint.

6) Usually no swelling.

7) Not a pain that occurs at night or present when awakens only to ease as moves around.

8) Pain eventually changes from acute phase to phase where rest doesn't help and joint stiffens.

III REFERRED PAIN - In and Around a Joint

It is necessary to forget about nerve distribution. Pains are referred; it seems, at a cortical level. Stimulus comes from tissue A and pain is Felt at point B. Point B is not connected in the normal neurological pattern by necessity. Pure spillover effect can also give referred pain which is then in tile same neuromere.

It is suggested that you learn the trigger point charts of Travell and/or refer to them. It should be noted trigger points are not just sore spots in a muscle. On pressure they must refer pain and/or a numb sensation to a distant area.

If a systematic examination does not produce a diagnosis the doctor should always Suspect referred pain.

If pain is deep, diffuse and not able to he localized, look for a site of referral. Referred pain comes from deep structures such as another joint capsule tendon, muscle, ligament, bursae, etc.

IV PATHOLOGY - X-ray Diagnosis or Other Confirmation

1) Arthritis - O.A., RH, Gout, Ankylosing Spondylitis

2) Tumors - e.g. Synovoma - e.g. Toe Pressure increases Leg Contractions

3) Vitamin Deficiency

4) Hormonal Deficiency

5) Chronic Mineral and Trace Element Deficiency

6) The Bends - Nitrogen Gas

7) Fractures - Last but not least, often missed

V STRESS

Overlasting of joint function by postural or occupational stress. e.g. Short leg syndrome.

VI SUBLUXATION COMPLEX

The reduction of the integrity of certain tissues in a joint system causing inflammation and pain. The pain can be caused by the inflammation itself and/or by the nerve irritation at the spinal level. Reference: Tennis Elbow and the Cervical Spine by C. Chan Gunn and W.E. Milbrandt. U.B.C.

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