Neonatal Hypotonia
Two types of muscle tone can be assessed clinically: postural and phasic. Postural (antigravity) tone is a sustained, low-intensity muscle contraction in response to gravity. It is mediated by both…
NEUROLOGY
Neurologic Evaluation of the Somatoform Patient: Somatoform Conversion Reactions
DIAGNOSIS Pain behavior in the context of chronic pain has a wide differential diagnosis, requiring clinicians to incorporate historical and examination findings into an unbiased patient-centered global assessment. However, sensory…
Neurologic Evaluation of the Somatoform Patient: Cutaneous Distribution of Peripheral Nerves
Somatoform diagnoses encompass disorders of somatization, conversion, pain, body dysmorphic disorder, and hypochondriasis, according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria (American Psychiatric Association). Each is characterized…
Peripheral Nerves of Feet, Painful Peripheral Neuropathies
Peripheral nerve degeneration is the underlying pathophysiologic mechanism. Axons require their neuronal cell bodies to remain healthy to maintain appropriate nerve activity and function; however, when neuronal damage occurs, the…
Diagnosis of Hip, Buttock, and Back Pain
In general, true hip pain manifests as groin pain that sometimes radiates to the knee. Thigh pain, buttock pain, and pain radiating below the knee are more often attributable to…
Examination of the Low Back Pain Patient
CLINICAL EVALUATION Focused history and physical examinations are fundamental elements in the assessment of low back pain. They are especially helpful in the preliminary classification of acute LBP into one…
Osteoporosis
Rotation. Place one hand on the pelvis and the other on the opposite shoulder. Rotate the pelvis and shoulder posteriorly and repeat on the other side; note any asymmetry in…
Low Back Pain and Effects of Lumbar Hyperlordosis and Flexion on Spinal Nerves
Lumbar hyperlordosis is 50% more accentuated with standing rather than sitting. This may cause nonspecific LBP localizing to somatic tissues (e.g., paraspinal muscles, facet joints) mediated by inflammatory mechanisms. In…
Lumbar Zygapophyseal Joint Back Pain
PATHOPHYSIOLOGY LZ joint pain primarily results from repetitive load-bearing strain accumulated over a lifetime; rarely, LZ joint arthropathy is traced to one inciting event. During midlife, cartilaginous changes accelerate, and…
Myofascial Factors in Low Back Pain
PATHOPHYSIOLOGY The development of MPS is often associated with postural derangements, such as muscle overload, dystonia, and fatigue. Postural abnormality (e.g., scoliosis) may reflect asymmetric extensor or flexor tone in…
