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.
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
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
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