DIFFERENTIAL DIAGNOSIS

Question 1

DIFFERENTIAL DIAGNOSIS FOR CSP PAIN

Answer 1

Malignant lymphadenopathy
Pancoast’s tumour
Vertebral artery syndrome
Subarachnoid haemorrhage
Coronary artery disease
Polymyalgia rheumatica

Question 2

DIFFERNTIAL DIAGNOSIS FOR TSP PAIN

Answer 2

Bronchogenic carcinoma
Other lung disease
Coronary artery disease
Aortic aneurysm
Massive cardiac enlargement
Hiatus hernia
Gall bladder disease - cholecystitis
Herpes zoster

Question 3

DIFFERENTIAL DIAGNOSIS FOR LSP PAIN

Answer 3

Peptic ulcer
Renal disease
Pancreatic cancer
Obstruction of the aorta or iliac arteries
Carcinoma of colon or rectum
Other pelvic carcinomas
Endometriosis
Pregnancy
Dissemonated scoliosis
Spinal cord tumour
Hip disease

Question 4

DDX - MUSCLE STRAIN

Answer 4

AROM - Decreased AROM (painful)
PROM - Within normal limits
MUSCLE TEST - Pain
COMMENTS
- Pain with palpation of damaged muscles
- Stretching or contraction of muscle causes a pain (possible weakness)

Question 5

DDX - TENDINOPATHY

Answer 5

AROM - Within normal limits (pain at end range)
PROM - Within normal limits (pain at end range)
MUSCLE TEST - Pain
COMMENTS
- Pain with palpation of damaged tendon
- Pain at end ROM both active and passive as tendon is stressed or stretched

Question 6

DDX - LIGAMENT SPRAIN

Answer 6

AROM - Decreased AROM (painful)
PROM - Decreased PROM (painful)
MUSCLE TEST - Within normal limits (painless)
COMMENTS
- Pain with palpation of ligament
- Stretching of the ligament, especially with over pressure, causes pain

Question 7

DDX - ARTHROPATHY (ITIS OR OTIS)

Answer 7

AROM - Decreased AROM (painful)
PROM - Decreased PROM (painful)
MUSCLE TEST - Within normal limits (painless)
COMMENTS
- Early may have no loss of ROM or pain
- Scour tests may show crepitus
- AROM may show repeatable ‘snapping’ and ‘popping’

Question 8

DDX - CAPSULITIS

Answer 8

AROM - Decreased AROM (painful)
PROM - Decreased PROM (painful)
MUSCLE TEST - Within normal limits (painless)
COMMENTS
- Pain with direct capsule palpation or multi directional pain with motion - pain in a single direction indicates muscle or tendon damage

Question 9

DDX - FASCIAL STRAIN

Answer 9

AROM - Decreased AROM (painful)
PROM - Decreased PROM (painful)
MUSCLE TEST - Within normal limits (painless)
COMMENTS
- Can have aplpatory subcutaneous adhesions, limited ROM or non-dermatomal pain and posture changes

Question 10

DDX - INSTABILITY

Answer 10

AROM - Increased AROM or within normal range
PROM - Increased PROM
MUSCLE TEST - Within normal range
COMMENTS
- End play may show an empty end feel
- AROM and PROM may cause repeatable ‘click’, ‘clunk’ or snapping sensation

Question 11

DDX - JOINY DYSFUNCTION (SUBLUXATION)

Answer 11

AROM - Within normal range or limited in specific ROM
PROM - Limited in specific ROM
MUSCLE TEST - Within normal range or weak
COMMENTS
- Pain or point tenderness
- Asymmetry/misalignment
- ROM abnormality - joint feels ‘stuck’
- Tissue/muscle tone changes

Question 12

DDX - INTRA-ARTICULAR LOOSE BODY

Answer 12

AROM - Decreased AROM (painful)
PROM - Decreased PROM (painful)
MUSCLE TEST - Within normal range (painless)
COMMENTS
- ROM assessment will result in sudden onset of pain, usually in one direction (typically extension), other movements are within normal range

Question 13

DDX - NERVE INJURY

Answer 13

AROM - Decreased AROM or within normal range
PROM - Within normal range
MUSCLE TEST - Weak
COMMENTS
- Possible numbness, tingling or muscle weakness and shooting electrical pain

Question 14

DDX - VISCERAL INJURY

Answer 14

Pain is secondary to internal organ capsule distention or vascular compromise
Deep, achy, cramping pain that may be sharp at times, often poorly localised and may be immobilising in more severe cases
Pain is often NOT changed by body position