Several years ago one of my patients presented with a referral from her local GP for treatment of an acute onset of midback and chest pain. She couldn’t remember exactly what caused it, but thought maybe it was from twisting while lifting some boxes. Her pain was sharp, constant, but worse when lying down and taking deep breaths, and eased when leaning forward. What’s your leading diagnosis from these few clues?
The thoracic spine can cause posterior and anterior thorax pain, however keeping in mind other differential diagnoses, any time a patient has chest and thoracic pain, the heart springs to mind as a potential source of symptoms. In this case though, her GP had performed an ECG, which appeared to be fine, and dismissed a cardiac cause.
Her pain pattern - area of pain, and aggravating and easing factors, helped reach a likely diagnosis, and you may have identified she had a potential pericarditis.
I called the GP, and we referred her to the hospital emergency department (ED) for urgent assessment. The ED confirmed my suspicions and diagnosed pericarditis. She received appropriate medical care, and I was relieved I’d picked it up in time for her to receive effective treatment.
Cardiac pain is one of the most well-known visceral sources of chest, arm, neck, jaw and stomach symptoms, but there are a lot of other visceral pain sources.
We’ve all experienced abdominal pain from our stomach, intestines or another organ. Our organs can also cause low back, pelvis, leg, thorax, shoulder, chest, or arm pain, and may appear to have a musculoskeletal cause.
Patients with endometriosis may have low back, pelvic, peroneal, groin, thigh or lower extremity pain. The liver, gall bladder and kidneys can also be sources of symptoms that lead patients to present for treatment.
If we miss organ-related pain in our patients, and provide musculoskeletal treatment or exercises, delaying the medical assessment and intervention they need, it can have serious, or deadly effects. How can you identify if your patients’ pain is from a musculoskeletal or non-musculoskeletal source, and whether your patient needs urgent medical care?
Now available - Pain patterns 2 - How to differentiate headaches, visceral, inflammatory, vascular & cancerous sources of pain with Nick Kendrick
With this presentation “Pain patterns 2 - How to differentiate headaches, visceral, inflammatory, vascular & cancerous sources of pain with Nick Kendrick” (APA Titled Musculoskeletal & Sports Physio), you’ll quickly and confidently identify:
1. Visceral symptoms
- How to identify patients that have pain from their:
- Heart
- Gall bladder
- Liver
- Kidneys
- Uterus
- How to differentiate visceral pain from musculoskeletal sources.
2. Inflammatory pain
In addition to visceral pain sources, patients may also experience inflammatory pain associated with musculoskeletal conditions, infection or autoimmune diseases. In this presentation, you’ll also discover:
- What is inflammatory pain, and what causes it?
- What symptoms will patients with inflammatory pain report?
- Is osteoarthritis (OA) inflammatory, or degenerative, or both?
- If most articular cartilage is aneural, why do OA patients have pain?
- What is bursitis, and what causes it?
- How can you differentiate inflammatory pain associated with musculoskeletal conditions, from autoimmune disorders such as:
- Rheumatoid arthritis
- Gout
- Systemic Lupus Erythematosus (SLE)
- How to identify pain from infective conditions such as osteomyelitis, discitis, septic arthritis, and periprosthetic joint infections.
3. Vascular pain
Discover vascular sources of pain, including:
- Common symptoms in patients with vascular issues.
- How to identify head pain & neurological conditions from stroke, including ischaemic stroke and intracranial haemorrhage.
- Symptoms with abdominal aortic aneurysm (AAA).
- Deep venous thrombosis (DVT).
- Symptoms associated with vascular claudication.
4. Cancer
- How to identify cancer masquerading as musculoskeletal pain.
- Early signs and symptoms of cancer.
- Common signs that will help you identify back pain from cancer.
- Clinical features that are most sensitive and specific for cancer?
5. Headaches
How to identify and differentiate different types of headache, including:
- Tension type headaches
- Migraine
- Cervicogenic headache
- Cluster headaches
Watch this new presentation with Nick Kendrick now to improve your knowledge and accuracy identifying pain from viscera, inflammatory conditions, vascular causes and cancer. Confidently treat your patients knowing their pain is musculoskeletal in origin, and know when to refer your patients for urgent medical review.
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