Introduction

The potential for referral of pain from systemic diseases to specific muscles and joints is well documented in the medical literature. These referral patterns most often affect the back and shoulder but may also appear in the chest, thorax, hip, pelvis, groin, sacrum, or sacroiliac joint.

Up to this point the text has focused on each organ system and the pain or other signs and symptoms referred from organs to musculoskeletal sites. In this third section the focus is turned around so that the reader can quickly refer to the site of presenting pain or other symptoms and determine possible systemic involvement.

The therapist may then question the client, as suggested, and determine the possible need for referral to a physician or other appropriate resource. The reader is referred to the individual chapters within this text for an in-depth discussion of the specific visceral, medical, or systemic causes of musculoskeletal signs or symptoms.

Decision-Making Process

In Chapter 1, a model for decision making in the screening process was presented, including:

• Client history (client demographics, past medical history, personal and family history, psychosocial history)

• Risk-factor assessment

• Clinical presentation, including assessment of pain patterns and pain types

• Associated signs and symptoms of systemic diseases

• Review of Systems

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