This one’s for the manual therapists out there. A brief little review of 2 landmark papers pertaining to fact joint pain and referral patterns.

Part 1A:

CERVICAL ZYGAPOPHYSEAL JOINT PAIN PATTERNS I: A study in normal volunteers (Dwyer et. al., Spine, 1990)

A study determining whether or not pain from a given joint assumed a characteristic distribution…where the pain pattern in a given patient might be used as an accurate indicator for clinically diagnosing the symptomatic joint

4 asymptomatic subjects were used

A contrast medium was injected into the joints, acting in a prevocational matter (experimental stimulus). Subjects were then examined for tenderness in both the cervical and shoulder regions

The distributions of evoked pain were recorded and a visual analog scale was completed

The medial branches of the dorsal primary rami were also blocked

The pain felt was deep and achy in quality

Pain patterns:

• C2-3: into the head
• C3-4: (coinciding with the levator scapula) was more rostral than C4-5 (which concentrated by the angle formed by the shoulder and neck)
• C5-6: covered the top of the scapula and shoulder above the level of the scapular spine laterally
• C6-7: extended caudally to the inferior angle of the scapula

Following the analgesic blocks, the subjects unexpectedly demonstrated a slight hypesthesia over the area coinciding with the previous recorded area of invoked pain and tenderness

Concluded that the cervical z-joints can be sources of pain, including referred pain and that a physiological mechanism must exist whereby pain stemming from a z-joint can be referred into the related limb or limb girdle

Further, cervical z-joint pain is distributed in a pattern characteristic of its segmental origin

Click here for Part 1B

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