Upper limb Lower limb Spine Other symptoms

forearm wrist and hand Arm

ant lateral med post ant post med lateral

cervical Thoracic Lumber
ant post ant post lat abd post lateral
shoulder elbow
ant post med lateral ant post med lateral
Ankle and leg foot
ant post med lateral dorsum sole med Lat
knee and thigh hip
ant post bukling med lateral ant Buttocks Lat groin
Rom Sclerotome Organ innervation Ref Vs Radicular Dermatome Capsular Pattern
Abdominal Anal pain Appendix Bunion li cramp Dry cough Dizzin Diplopia
cramp /belching type Pai ke ess / Eye
n
Dysmenorrhea Drooling in s Ear pain Face headac Head Head t Head
leep he post op Front
Heart attack type Handwrit-in Intercou-- heel pai Reflux Restless SI pai Stress
g issues rse pain n Esopha leg n Incont.
gitis

Sciatica Swallow Tinnitus TMJ Teeth grinding Vis-Reflex N-Med PHI

Abdominal cramp / colic /
belching

N-Med PHI
Anal and bowel pain

N-Med PHI
Common causes of ankle pain

N-Med PHI
Ankle and leg- ant

N-Med PHI
N-Med PHI
N-Med PHI
 N-Med PHI

Leg and ankle - post

N-Med PHI
N-Med PHI
Ankle and leg - medial

N-Med PHI
N-Med PHI
Ankle and leg -lateral

N-Med PHI
N-Med PHI
Appendix type Pain

N-Med PHI
Arm pain

N-Med PHI
Arm ant

N-Med PHI
N-Med PHI
 N-Med PHI

Arm post
Arm lat

N-Med PHI
N-Med PHI

Arm med
Bunion like

N-Med PHI
 Cervical clinical pearls
• Pain unrelieved by rest or with change in position or pain that do not fit into
mechanical or neuromusculoskeletal pattern should serve as red flag for manual
therapy .
• Dysphagia may be an indication of prevertebral soft tissue swelling-a result of cervical
acceleration/deceleration injury.
• The cervical downward axial compression applied to the head of the seated
patient is helpful for isolating level of nerve root involvement. Radiating pain into the
shoulder or arm suggests nerve root compression in the intervertebral foramen.
Unilateral foraminal compression using extension, lateral flexion, and rotation will be
more likely to result in radiating pain in mild cases
• The cervical (gentle but firm lifting )distraction helps to differentiate nerve root
compression or entrapment from musculotendinous involvement of the cervical spine.
If pain increases with distraction, muscular or ligamentous injury may be present.

N-Med PHI
N-Med PHI
Visceral causes

N-Med PHI
 Cervical
posterior

N-Med PHI
facets
Visceral dysfunction Liver C4 -C5

other causes Whiplash

Acute torticollis
instabilty short neck flexors
longus colli

N-Med PHI
Cervical
anterior

N-Med PHI
N-Med PHI
 cramps

Gastronemius
sartorius

N-Med PHI
• Calf cramps are associated with, and may be induced by, many medical conditions
including dehydration , electrote disturbance and metabolic alkalosis i.e. from persistent
vomiting), low serum magnesium, hypokalemia (from diarrhea), hypocalcemia,
hypoparathyroidism, heat stress with myoglobinuria, Parkinson's disease with dystonia,
and, possibly, diabetes. patients with lumbar disc disease and radiculopathy complained
of night cramps in the compartment supplied by the compressed nerve root: L5
compression produced cramps of anterior compartment muscles; S1 compression
produced cramps of posterior compartment muscles. TrPs reinforces the previous
conclusion despite surgical decompression of the nerve root. Certain drugs
(phenothiazines, vincristine, lithium, cimetidine, and bumetanide) can cause cramps.
Cramps in the calf have been associated with blockage of movement of the proximal
tibiofibular joint ad sleep apnea.

N-Med PHI
Diplopia / dry eyes Blurry/Jumpy Print
Vision

N-Med PHI
Dizziness with head turning
Motion Sickness
DD -Upper cervical
misalignment
Upper cervical instability
and cervical artery
dysfunction
Whiplash
Brain tumor , stroke , injury
BPPV , menierres disease
and other vestibular
disorders
N-Med PHI
Dysmenorrhea/ Mensural
Pain or pelvic issues

N-Med PHI
Drooling in sleep

N-Med PHI
Dry cough

N-Med PHI
Ear Pain/ Tinnitus

N-Med PHI
 N-Med PHI

Elbow
 Elbow Anterior

N-Med PHI
N-Med PHI
Elbow lateral

N-Med PHI
N-Med PHI
Elbow medial

N-Med PHI
N-Med PHI
elbow post

N-Med PHI
N-Med PHI
Face / check

N-Med PHI
NmedPHI -compiled by Prof Maneesh Arora
Wrist And Hand
N-Med PHI
forearm /hand pain -
Post

N-Med PHI
N-Med PHI
N-Med PHI
forearm /hand pain - Ant

N-Med PHI
N-Med PHI
N-Med PHI
N-Med PHI
N-Med PHI
Forearm and hand
radial pain
N-Med PHI
N-Med PHI
 Forearm & hand ulnar pain

N-Med PHI
N-Med PHI
N-Med PHI
groin pain
N-Med PHI

• hip pain
 Ilio-lumber stretch due
to lumbosacral
instability

N-Med PHI
 Osteitis Pubis

N-Med PHI
Common
foot pain
causes

N-Med PHI
Foot Dorsum

N-Med PHI
N-Med PHI
N-Med PHI
foot lateral

N-Med PHI
N-Med PHI
foot medial

N-Med PHI
N-Med PHI
 N-Med PHI

Foot -Sole
N-Med PHI
N-Med PHI
Handwriting issues

N-Med PHI
N-Med PHI
 HIP PEARLS
• Hip generated pain from any pathology is most commonly felt in the groin or
deep buttocks, at times with pain radiating to anterior thigh. Hip Pain may
also be referred to lower back, buttock, groin, SI joint , anterior thigh, or even
knee or ankle pain.
• Pain felt by the patient on lateral side of hip is usually not by an intra-articular
pathology , but likely to be caused by trigger point, or bursitis, SI, or LBA.
• Pain in hip region referred from the upper lumbar region usually radiates into
anterior aspect of thigh, whereas pain from the lower lumbar region and
sacrum can be felt in the gluteal region, radiating down posterior or lateral
thigh. Or may be referred from scrotum, abdomen, kidneys, peritoneum, or
retroperitoneal region.
• A noncapsular pattern of restricted hip movement that is limited hip extension,
lateral rotation and adduction may be because of serious underlying disease.
• To differentiate between hip cause and lumber spine cause – google Cyriax
signs of the buttock

N-Med PHI
N-Med PHI
 N-Med PHI

Hip posterior
N-Med PHI
N-Med PHI
 N-Med PHI

Hip anterior
N-Med PHI
N-Med PHI
 Hip lateral

N-Med PHI
Headache

N-Med PHI
 `
N-Med PHI
N-Med PHI
 Headaches with
red Flags
Headaches with fever and chills-
usually with infections
Headaches with nuchal rigidity .
Headaches with
exultation/delirium/ increasing
fatigue loss of concentration /
ataxia

N-Med PHI
N-Med PHI
N-Med PHI
Head Post

N-Med PHI
Headache top

N-Med PHI
Headache Frontal N-Med PHI

H
heel Pain

N-Med PHI
N-Med PHI
Ankle and

N-Med PHI
 Heart attack type
Irregular Heartbeat

N-Med PHI
N-Med PHI
knee and thigh anterior
N-Med PHI
 With the first and
second degrees kidney
ptosis , there may be
restrictions of Ll-L3
resulting in anterior
thigh and knee pain

N-Med PHI
Referred pain
Kidney and hip
N-Med PHI
Knee and thigh
pain medial

N-Med PHI
N-Med PHI
N-Med PHI
knee and thigh lateral

N-Med PHI
N-Med PHI
N-Med PHI
 Knee and thigh
posterior

N-Med PHI
 N-Med PHI
Referred from hip
N-Med PHI
knee buckling

N-Med PHI
Abdominal
N-Med PHI
N-Med PHI
N-Med PHI
Lumber Post
N-Med PHI
N-Med PHI
N-Med PHI
Lumber Lateral

N-Med PHI
Shoulder pain causes

N-Med PHI
 N-Med PHI

Shoulder
• Refence from viscera • Dermatome
 Referred pain
liver, gallbladder, and right diaphragm to the right shoulder and stomach, left
diaphragm, and heart to the left shoulder. If you are able to reproduce pain during
joint motion, the condition is most likely structural or neuromuscular in origin. Pain
that cannot be readily reproduced suggests a visceral origin., referred shoulder pain
(unilateral or bilateral) often courses via the phrenic nerve ( C4). For example,
pain perceived on top of the shoulder, in the supraspinous or subclavicular fossa or
over the acromion or clavicle, may be the only outward signal of a liver abscess that is
threatening to perforate the diaphragm. Likewise, a perforated gastric ulcer might
allow escaping stomach contents to cause irritation or pressure on the lower surface of
the diaphragm. The same type of phrenic reflex can be set up by diaphragmatic
pleurisy, subphrenic abscess, gallstones, acute pancreatitis, ruptured spleen etc .
In many instances of localized referred pain, the location of the perceived pain
correspondingly reflects the portion of the diaphragm being affected. For instance, it is
generally thought that pain on top of both shoulders indicates a broad or median
irritation of the diaphragm; pain on top of the left shoulder only, a left diaphragmatic
irritation; and pain on top of the right shoulder only, a right diaphragmatic irritation.
In upper-abdominal irritations, for example, a pyloric or duodenal ulcer or gallstones
often refers pain to the right shoulder (often right supraspinous fossa); a ruptured
spleen, which may be spontaneous, will refer pain to the left shoulder; and an anterior
gastric perforation or mid-line diaphragmatic hernia will refer pain to both shoulders .

N-Med PHI
 N-Med PHI

Shoulder Ant
N-Med PHI
N-Med PHI
N-Med PHI
Shoulder Post

N-Med PHI
N-Med PHI
N-Med PHI
N-Med PHI
Shoulder Med

N-Med PHI
Shoulder lat
N-Med PHI
N-Med PHI
N-Med PHI
 N-Med PHI

Painful Intercourse
Reflux Esophagitis

N-Med PHI
Restless Leg

N-Med PHI
Sciatica

N-Med PHI
 D/D in
sciatica

N-Med PHI
N-Med PHI
SI area pain

N-Med PHI
N-Med PHI
Sore throat

N-Med PHI
Swallowing difficulty

N-Med PHI
Stress incontinence

N-Med PHI
Thoracic pain
N-Med PHI
Thoracic posterior
N-Med PHI
N-Med PHI
N-Med PHI
N-Med PHI
Thoracic anterior

N-Med PHI
N-Med PHI
N-Med PHI
later thoracic

N-Med PHI
Teeth Grinding

N-Med PHI
TMJ

N-Med PHI
N-Med PHI
N-Med PHI
N-Med PHI
Stem Clinics
N-Med PHI
N-Med PHI
 The mechanical pain be fissured into major segments

Somatic or Referred Pain Radicular Pain

Facet joint pain Disc herniation

Sacroiliac joint pain Annular tear, discogenic pain

Myofascial syndrome Spinal stenosis

Internal disc disruption

N-Med PHI
 The Symptoms thus are variable

Somatic or Referred Pain Radicular Pain

Dull, ache that is Poorly
localized , deep mimicking an
expanding pressure , Pain in
back worse than leg with No
paresthesia
Sharp, shooting, superficial,
lancinating and well defined or
localised pain , mimics an
electric shock . Paresthesia is
present.

Worse with extension and Worse with flexion but becomes

becomes better with flexion. better with extension.

N-Med PHI
 Signs

Somatic Pain Radicular Pain

Sensory Unlikely Very likely
Alteration
Motor Changes Only generalised Objective weakness
weakness
Motor effects Atrophy rare Atrophy likely to be
present
Reflexes None Occasionally
effected effected
root tension none Present
signs N-Med PHI
N-Med PHI
 Sclerotome

N-Med PHI
N-Med PHI
N-Med PHI
N-Med PHI
• Viscero- somatic pains N-Med PHI
 • Reflexology

N-Med PHI
N-Med PHI
N-Med PHI
ROM of joints
N-Med PHI