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Jonathan E Fenton, DO, FAAPM&R,
C-AOCPM&R, C-AOBSPOMM, C-AAOM,
RMSK
Interventional Regenerative Orthopaedic
Medicine
Osteopathic Diagnosis & Treatment
321 Main Street, Suite C
Winooski, Vermont 05404
(802) 859-0000
www.JFentonDO.com
Referred Pain Patterns
• Dermatomal (nerve roots) • Myotomal (fascial planes) • Sclerotomal (deep bone--spinal) • “Enthesopathic” (ligament/tendon) • Myofascial (Trigger Points) • Dural • Thermotomal (sympathetic nerves) • Visceral • Other (Chapman’s, Counter-strain, etc)
TOMAL PATTERNS
from Practical Pain Management Volume 3 #6 Woessner
DEMATOMAL/SEGMENTAL PAIN
DEMATOMAL/SEGMENTAL PAIN
Cervical Dermatomes
From Ombregt A System of Orthopaedic Medicine
Cervical Dermatomes
From Ombregt A System of Orthopaedic Medicine
Thoracolumbar Dermatomes
From Ombregt A System of Orthopaedic Medicine
Lumbar Dermatomes
From Ombregt A System of Orthopaedic Medicine
Sacral Dermatomes
From Ombregt A System of Orthopaedic Medicine
From A VISUAL AID TO THE EXAMINATION of NERVE ROOTS,
S. Hernandez and M.L.Argote,
PERIPHERAL NERVE REGIONS OF THE UPPER EXTREMITY
PERIPHERAL NERVE REGIONS OF THE LOWER EXTREMITY
From Chiropractic & Osteopathy 2009; 17: 9.
From Chiropractic & Osteopathy 2009; 17: 9.
From Chiropractic & Osteopathy 2009; 17: 9.
Derm-Myo-Sclero TOMES
Derm-Myo-Sclero TOMES
Figure 3 Cervical and lumbar facet joint pain referral patterns
Gellhorn, A. C. et al. (2012) Osteoarthritis of the spine: the facet joints Nat. Rev. Rheumatol. doi:10.1038/nrrheum.2012.199
Part a adapted with permission from Lippincott Williams & Wilkins © Dwyer, A. et al. Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine (Phila Pa 1976) 15, 453–457 (1990)
Facet Referral Patterns
REFERRED PAIN LIGAMENTS AND JOINT CAPSULES
Enthesopathic (~Sclerotomal) Referral
C5 enthesopathic referral
From Diagnostic and Injection Techniques In Orthopedic Medicine, Dorman & Ravin
C6 enthesopathic referral
From Diagnostic and Injection Techniques In Orthopedic Medicine, Dorman & Ravin
C7 enthesopathic referral
From Diagnostic and Injection Techniques In Orthopedic Medicine, Dorman & Ravin
Transverse process of C7 enthesopathic referral pattern
From Diagnostic and Injection Techniques In Orthopedic Medicine, Dorman & Ravin
HACKETT LIGAMENT PAIN
HACKETT LIGAMENT PAIN
from Practical Pain Management Volume 3 #1 Woessner
HACKETT LIGAMENT PAIN
Hackett
From Diagnostic and Injection Techniques In Orthopedic Medicine, Dorman & Ravin
From Diagnostic and Injection Techniques In Orthopedic Medicine, Dorman & Ravin
From Diagnostic and Injection Techniques In Orthopedic Medicine, Dorman & Ravin
From Diagnostic and Injection Techniques In Orthopedic Medicine, Dorman & Ravin
Trigger Point Referral Patterns
Guteus Minimus Trigger Points
From Travell & Simons Myofascial Pain and Dysfunction
Quadratus Lumborum Trigger Points
From Travell & Simons Myofascial Pain and Dysfunction
From Travell & Simons Myofascial Pain and Dysfunction
Dural Referral
From Ombregt A System of Orthopaedic Medicine
Dural Referral
From Ombregt A System of Orthopaedic Medicine
SPINAL THERMOTOMAL PAIN REGIONS (AUTONOMIC)
From Practical Pain Management Volume 3 #6 Woessner
Visceral Pain Referral
Viscero-Somatic Points
Viscero-Somatic Points
Counter-Strain (Jones) Points
CONCLUSIONS
• Most pain is non-dermatomal
• Many overlapping referral patterns
• Ligaments and joint capsules most common
• Muscles often secondary, not primary
• Diagnosis based on history, passive joint testing and active muscle testing, then palpation!
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