Clinical examination as a tool for identifying the origin of regional musculoskeletal pain

A knowledge of the physiopathology of the processing of noxious stimuli in regional musculoskeletal disorders is useful for an understanding of the clinical history. In regional musculoskeletal pain (RMP) the physiopathology of the pain may be separated into two main features. First, the nociceptive pain which results from the activation of nociceptors diffusely distributed among the anatomical structures in and around the joint, apart from the cartilage; the nociceptive pain has a protective role. Second, the abnormal impulses from a nervous tissue lesion give rise to a neuropathic pain which offers no biological advantage and is a maladaptive pain. This chapter describes the main physiological characteristics of these two kinds of pain. From these, in the majority of cases, the clinical history and the physical examination must specify the diagnosis of the RMP and localize the source of pain. Furthermore, the clinical characteristics permit diagnosis of different complex situations where these two types of pain are associated.