By Thomas Tomosy
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Additional info for Camera Maintenance & Repair, Book 2: Fundamental Techniques: A Comprehensive, Fully Illustrated Guide (Bk. 2)
5 Despite their substantial strengths, the VRSs also exhibit a number of weaknesses, based on which other pain researchers have hesitated to recommend these scales. First, the scoring method for a VRS assumes equal intervals between adjectives. ” This assumption is rarely tested, and is likely often violated. This property of the VRS poses difficulties in both the interpretation and analysis of VRS-derived data. Second, in order to use VRS properly a patient must both be familiar with all of the words used on the scale and must be able to find one that accurately describes his or her pain.
Early observations in a less obvious setting provide a basis against which to measure pain behaviors and gait abnormalities and can indicate signs of emotional and mental disturbance that will be more formally tested later. 8 By establishing the nature of the patient’s complaint during the history, the physical examination can be efficiently directed toward the affected region and can also explore possible causes of the chief complaint. A structured plan of examination ensures a comprehensive evaluation.
However, general guidelines are that pain on flexion can indicate a disc lesion, and pain on extension can indicate a facet arthropathy or muscular pain generator. Similar to the cervical region the confidence in lumbosacral lesions localized by confirmatory muscle, sensory and reflex test results is extremely high. Table 4-9 provides an integrated sensory, motor, reflex test outline for L2–S1. In addition to specific nerve root tests, two complimentary tests are heel walk, which tests L4–L5 function, and toe walk, which tests S1–S2 integrity.