Referred pain from skeletal structures
Referred pain from skeletal structures
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DOI：
10.1097/00005053-194405000-00023
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发表时间：
1944-01-01
影响因子：
1.9
通讯作者：
Saunders, JBDM
中科院分区：
文献类型：
--
作者：
Inman, VT;Saunders, JBDM
医生在临床诊断中经常面临的一个问题是与涉及骨骼、韧带、肌腱、筋膜和身体其他中胚层结构的创伤性或炎症性病变相关的不明疼痛的意义和意义。在询问患者时，这种性质的疼痛通常被描述为钝痛、疼痛或无聊的性质，他通常发现很难以任何程度的准确度定位。患者经常声称这种疼痛位于皮肤深处，并且经常不同程度地向近端或远端辐射。尽管患者经常表现出死亡或麻木的病史，但医生在检查皮肤感觉时，除了偶尔出现轻微的痛觉过敏外，无法辨别任何客观性质。末梢感觉无减退，无麻醉、无感觉减退、无肌无力、无明确的反射改变。令医生感到困惑的一个事实是，患者疼痛的分布在方向和位置上经常是恒定的，但却无法与任何已知的周围神经或神经根的供应区域相对应。有时，人们可以通过仔细触诊辐射区域来确定深度压痛点，该点在压力下会重现疼痛及其分布。其他症状和体征的存在可能会导致对某些特定病变或综合征的阳性诊断，并且无需进一步考虑即可简单地接受相关辐射的重要性。在许多情况下，在无法诊断出特定病变的情况下，尽管未能引出任何客观体征或涉及任何特定周围神经，但仍表达了患者患有神经炎的模糊意见，或者该病症可能被诊断为纤维组织炎之一并提供了一些姑息治疗。对疼痛的性质、程度和伴随症状进行更彻底的检查，揭示了以下特征： 与皮肤产生的疼痛不同，正如已经提到的，疼痛不能精确定位，除非患者认识到疼痛位于更深的结构中。它往往会传播或辐射相当长的距离，有时甚至覆盖四肢的整个长度。其品质难以描述，
A problem which often confronts the physician in clinical diagnosis is the significance and meaning of the obscure pain found in association with traumatic or inflammatory lesions involving the bones, ligaments, tendons, fasciae and other mesodermal structures of the body. On questioning the patient, pain of this nature is often described as of a dull, aching or boring nature which he usually finds difficult to localize with any degree of accuracy. The patient frequently contends that this pain lies deep beneath the skin and that it frequently radiates proximally or distally to a varying extent. In spite of the fact that the patient often gives a history of deadness or numbness, in the part, nonetheless the physician, on examination of skin sensation, is unable to discern anything of an objective nature except perhaps occasionally a slight hyperalgesia. There is no diminution of peripheral sensation and no anes-thesia, no hypesthesia, no muscle weakness and no definite reflex changes. A puzzling feature to the physician is the fact that the distribution of the pa-tient's pain is frequently constant in direction and position but yet fails to correspond to the area of supply of any known peripheral nerve or nerve root. Occasionally one may be able to determine by careful palpation over the area of radiation a point of deep tenderness, which on pressure reproduces the pain and its distribution.The presence of other symptoms and signs may lead to a positive diagnosis of some specific lesion or syndrome and the significance of the associated radiation is simply accepted without further consideration. In many instances, where no specific lesion can be diagnosed, a vague opinion is expressed that the patient is suffering from neuritis in spite of the failure to elicit any objective signs or to implicate any specific peripheral nerve, or the condition may be diagnosed as one of fibrositis and some palliative treatment offered. A more thorough examination of the nature, extent and concomitants of the pain discloses the following characteristic features: The pain, unlike that arising from the skin, cannot, as already mentioned, be localized with any precision, except that the patient recognizes that it lies in deeper structures. It tends to spread or radiate over considerable distances and sometimes for the entire length of an extremity. Its quality is difficult to describe and it is