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Pulmonary S/S
- SOB
- Cough
- Fatigue
- Elderly shoulder pain/ little off: PNA
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Gastrointestinal presented as Neck Pain
- Esophagitis
- Esophageal cancer
- GERD, most common issue
- ----But if have difficult swallowing then may have progressed to esophageal CA
- ----Ask about changes in last week
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GI S/S
- Increased HR/temp
- ----Elevated temp if infection
- For all pts
- ----Should have some improvement in 3-4 sessions
- ----Re-evaluate or refer out
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Infection presented as Neck Pain
- Vertebral osteomyelitis
- Meningitis
- Lyme disease
- Retropharyngeal abscess (post-steroid injection)
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Non-NMS Neck Pain
- 1. Cervical lymphadenitis (inflammation of lymph nodes)
- ----Due to active infection/CA
- ----Pain in neck region that has nothing to do with how they move
- ----ROM doesn’t change how they feel
- 2. Rheumatoid
- ----Other jt pain (smaller jts > larger jts)
- ----Have upper cervical laxity
- ----Manip contraindicated
- 3. Osteoporosis
- 4. Fibromyalgia
- 5. Thyroid disease
- ----Heat/cold intolerance, weight gain/loss
- ----Graves disease
- 6. Psychogenic
- ----Chronic pain
- ----We can help them but other factors have to be addressed
- 7. Fracture
- ----Just it is muscle skiel but we cant tx
- ----Osteoporosis
- ----Female, >70 /o, short stature
- ----Traumatic onset
- 8. Viral myalgias (muscle pain due to virus)
- ----Fever
- ----Other constitutional S/S
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Viscerogenic Thoracic Pain
- Cancer
- CV
- Pulm
- GI
- Infection
- Renal
-
Cancer (Viscerogenic Thoracic Pain)
- 1. Mediastinal tumors
- ----Great risk to metastasize to the spine
- 2. Metastatic extension
- 3. Pancreatic cancer
- 4. Breast cancer
- 5. Multiple myeloma
- ----Bone marrow cancer
- ----High risk to effect the spine
-
mediastinum
- all the structures from the thoracic outlets to the diaphragm and btwn the lungs (lungs not part of mediastinum)
- heart
- great vessels
- thymus gland
- pericardium
- CA can occur here and go into the spine
-
Cardiovascular (Viscerogenic Thoracic Pain)
- 1. Angina
- ----Pain dissipates with cessation of activity (3-5 min after)
- 2. MI
- ----Elephant on chest (not stabbing pain on chest → anxiety)
- 3. Aortic aneurysm
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Pulmonary (Viscerogenic Thoracic Pain)
- 1. Chronic bronchitis
- ----Inflammation of bronchi, productive cough
- 2. Pleurisy
- ----Has to do with infection
- ----Inflammation of pleura
- ----Unchanged with CPA
- ----Increase pain in supine →Better sitting or leaning forward
- ----Increased demand/ deep breathing
- 3. Pneumothorax
- ----Looks like pleurisy after puncture
- ----Punch of chest cavity
- ----Can be from broken rib
- 4. Empyema
- ----Pus filled area in lungs, has to do with constitutional S/S, has to due to infection
- 5. Pneumonia
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Renal (Viscerogenic Thoracic Pain)
- 1. Acute pyelonephritis
- ----Deadly
- ----Murphy’s percussion on kidney
- ----Write IE/progress note to physician of negative findings
- 2. Kidney disease
- S/S based on
- ----Electrolyte and water balance
- ----One kidney can do it on its own so one kidney has to get really bad before you know there is something wrong
-
Gastrointestinal (Viscerogenic Thoracic Pain)
- 1. Severe esophagitis
- ----Bc it is smooth striated muscle
- ----Pain/ difficulty swallowing
- 2. Esophageal spasm
- 3. Gastric (1 hr after intake)/duodenal ulcers
- ----Hurts more when they eat
- ----Bc acid is released
- ----If it hurts earlier on when eat then gastric
- 4. Peptic ulcer
- 5. Acute cholecystitis
- ----Inflammation of gallbladder
- ----Usually bc of disease
- ----Can bc block
- ----When eating high fat foods
- 6. Pancreatic disease
- ----Very unlikely
- ----Pain in abdomen
- 7. Biliary colic
- ----Pain associated with block
- ----“colic”
- --------cyclic nature of pain
- --------(regular occurrence after meal)
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Infection (Viscerogenic Thoracic Pain)
- 1. Vertebral osteomyelitis
- ----Signs of infection of constitutional symptoms
- 2. Herpes zoster
- 3. HIV
- 4. Epidural abscess
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Infections occur in these populations
- 1. Immunocompromised
- 2. Recent surgery
- 3. Suffering from alcoholism
- 4. IV drug users
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