The concept of painful minor intervertebral dysfunction ... - sofmmoo

This theory is open tocriticism Clinical assessment of hypomobility is not areliable and reproductible test Hypomobility is frequent in osteoarthriticcadaveric vertebral joints– There is no evidence that it may be a source of pain– Hypomobility could be regarded as a protective mechanismagainst overuse of a degenerated joint

SEGMENTAL EXAMINATION Pressure on thespinous process Transversepressure againstthe spinousprocess Longitudinal frictionon the facets joints Pressure on theinterspinous ligament

SEGMENTAL EXAMINATION Pressure on thespinous process Transverse pressureagainst the spinousprocess Longitudinal frictionon the facets joints Pressure on theinterspinous ligament

SEGMENTAL EXAMINATION Pressure on thespinous process Transverse pressureagainst the spinousprocess Longitudinal frictionon the facets joints Pressure on theinterspinousligament

SEGMENTAL EXAMINATIONSource of errors Superficial tenderness ofthe spinous process Interspinous acute bursitis

SEGMENTAL EXAMINATIONSource of errors Pressure of a sensitive orcellulalgic skin over thespinous process

SEGMENTAL EXAMINATIONSource of errors Pressure of a cellulalgic skinor tender taut muscularbands against the z-joints

Pain Originating from a VertebralMotion Segment Can Be Due ToMany Causes (benign or not)Some are more or less easily recognizable– Disc herniation– Acute synovitis of the Z-jointsOthers would be only recognizable with sophisticatedinvestigations– Facet blocks– Discography + MRIThese tests– Are positive in less than 50% of the cases (Schwarzer et al, 1995)– Are not applicable in routine daily practice

Pain from a Motion Segment Can Be DueTo Many Causes Segmental examination focuses the intereston the painful segment Special attention must be paid on thissegment Depending on the clinical and the radiologicalcontext, further investigations may benecessary

Painful Minor IntervertebralDysfunction (MID, R. Maigne)The diagnosis of Painful MID is evoked1 - When the segmental examination is positive2 - When the pain is considered as common3 - Whether the X-Rays films are normal or shownon significant degenerative changes

PAINFUL MINOR INTERVERTEBRALDYSFUNCTION (R. Maigne)MID : Is the result of trauma, efforts, bad postures,repeated micro-traumas... Is not linked to any neurological deficit or X-Rayabnormality The diagnosis of MID is purely clinical It is based on segmental examination

Painful Minor IntervertebralDysfunction (R. Maigne)In the framework of common painsyndromes, the most frequent causesof segmental dysfunction are:– "Painful Minor Intervertebral Dysfunction"(MID)– Disc lesions– Synovitis of zygapophyseal joints

Painful Minor IntervertebralDysfunction Painful minor intervertebral dysfunction may beconsidered as a self-sustaining sustaining sprain of thevertebral segment The Painful MID can be active or latentactive or latent. Thesigns of MID are permanent in chronic caseseven between attacks

Painful Minor IntervertebralDysfunctionPainful minor intervetebral dysfunction appears tobe the common denominator of a great numberof vertebral pain– directly– or by intermediary of reflex manifestationsthat may be determined in the correspondingmetamere : Segmental Vertebral Cellulo -Teno-PeriosteoPeriosteo-MyalgicSyndrome(R. Maigne)