Interpreting joint pain: Quantitative sensory testing in musculoskeletal management

Carol A. Courtney, Alicia Emerson Kavchak, Carina D. Lowry, Michael A. O'Hearn

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

SYNOPSIS: Pain is a common complaint among clients seeking physical therapy services, yet interpretation of associated sensory changes can be difficult for the clinician. Musculoskeletal injury typically results in nociceptive pain due to noxious stimuli of the damaged muscle or joint tissues. However, with progression from acute to chronic stages, altered nociceptive processing can give rise to an array of sensory findings. Specifically, patients with chronic joint injury may present with signs and symptoms typically associated with neuropathic injury, due to changes in nociceptive processing. Clinical presentation may include expansion of hyperalgesia into adjacent and remote areas, allodynia, dysesthesias, and perceptual deficits. Quantitative sensory testing (QST) may provide an objective method of examining sensation and, thereby, of recognizing potential changes in the nociceptive pathways. The purpose of this paper is to provide an overview of altered nociceptive processing and somatosensory changes that may occur following a musculoskeletal injury without associated neural injury. Recommendations are made on clinical uses of quantitative sensory testing in orthopaedic physical therapy practice, and supporting clinical and laboratory evidence are presented. Examples related to joint injury are discussed, specifically, osteoarthritis of the knee and low back pain. Quantitative sensory testing may be a useful clinical tool to aid clinical decision making and for determination of prognosis.

Original languageEnglish (US)
Pages (from-to)818-825
Number of pages8
JournalJournal of Orthopaedic and Sports Physical Therapy
Volume40
Issue number12
DOIs
StatePublished - Dec 2010

Keywords

  • Arthritis
  • Central sensitization
  • Hypoesthesia
  • Joint pain
  • Knee
  • Low back pain
  • Nociception

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation

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