Daub Clifford W
Chiropr Osteopat. 2007 Jul 19;15:10. doi: 10.1186/1746-1340-15-10.
Similar upper extremity symptoms can present with varied physiologic etiologies. However, due to the multifaceted nature of musculoskeletal conditions, a definitive diagnosis using physical examination and advanced testing is not always possible. This report discusses the diagnosis and case management of a patient with two episodes of similar upper extremity symptoms of different etiologies.
On two separate occasions a forty-four year old female patient presented to a chiropractic office with a chief complaint of insidious right-sided upper extremity symptoms. During each episode she reported similar pain and parasthesias from her neck and shoulder to her lateral forearm and hand. During the first episode the patient was diagnosed with a cervical radiculopathy. Conservative treatment, including manual cervical traction, spinal manipulation and neuromobilization, was initiated and resolved the symptoms. Approximately eighteen months later the patient again experienced a severe acute flare-up of the upper extremity symptoms. Although the subjective complaint was similar, it was determined that the pain generator of this episode was an active trigger point of the infraspinatus muscle. A diagnosis of myofascial referred pain was made and a protocol of manual trigger point therapy and functional postural rehabilitative exercises improved the condition.
In this case a thorough physical evaluation was able to differentiate between radicular and referred pain. By accurately identifying the pain generating structures, the appropriate rehabilitative protocol was prescribed and led to a successful outcome for each condition. Conservative manual therapy and rehabilitative exercises may be an effective treatment for certain cases of cervical radiculopathy and myofascial referred pain.
相似的上肢症状可能由多种生理病因引起。然而，由于肌肉骨骼疾病具有多方面的特性，仅通过体格检查和先进检测手段进行明确诊断并非总是可行。本报告讨论了一名患有两起不同病因导致的相似上肢症状患者的诊断及病例管理情况。
一名44岁女性患者在两个不同时间前往一家整脊诊所就诊，主要抱怨为隐匿性右侧上肢症状。在每次发作期间，她均报告从颈部和肩部到外侧前臂及手部存在相似的疼痛和感觉异常。在第一次发作时，患者被诊断为神经根型颈椎病。开始进行包括手动颈椎牵引、脊柱推拿和神经松动术在内的保守治疗，症状得以缓解。大约18个月后，患者再次经历上肢症状的严重急性发作。尽管主观症状相似，但确定此次发作的疼痛根源是冈下肌的一个活跃触发点。诊断为肌筋膜牵涉痛，并采用手动触发点治疗和功能性姿势康复锻炼方案使病情得到改善。
在此病例中，全面的体格评估能够区分神经根性疼痛和牵涉痛。通过准确识别产生疼痛的结构，制定了适当的康复方案，每种病情均取得了成功的治疗效果。保守的手动治疗和康复锻炼可能是某些神经根型颈椎病和肌筋膜牵涉痛病例的有效治疗方法。
