{"id":11956,"date":"2022-10-07T10:25:18","date_gmt":"2022-10-07T08:25:18","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=wiki&amp;p=11956"},"modified":"2022-10-07T10:25:18","modified_gmt":"2022-10-07T08:25:18","slug":"cervical-referred-pain","status":"publish","type":"wiki","link":"https:\/\/www.physiotutors.com\/wiki\/cervical-referred-pain\/","title":{"rendered":"Cervical Referred Pain"},"featured_media":10056,"template":"","class_list":["post-11956","wiki","type-wiki","status-publish","has-post-thumbnail","hentry"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":10056,"background_image_alt_text":"Cervical Referred Pain"},"heading":"Cervical Referred Pain | Visceral Referred Pain","subheading":"Cervical Spine","content_editor":"","button_type":"url","button_label":"Check our shop","button_style":"button-five","button_internal_link":null,"button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/orthopedic-physiotherapy-of-the-spine\/","button_file":null,"label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Learn","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Online Course","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":16662,"button_anchor":"","button_url":"","button_file":null},"button_description":"Find this wiki on the Physiotutors platform"},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>Learn<\/h4>"},"column_right":{"content_editor":"<h6>Cervical Referred Pain | Visceral Referred Pain<\/h2>\n<span style=\"font-weight: 400;\">One of the major challenges for a clinician seeing patients with neck and shoulder pain is determining the source of the symptoms. Similar to low back pain and thoracic pain we often cannot accurately determine a source of nociception, but we will have to rule out serious pathology. One such source, that is often overlooked, but that has to be ruled out during your screening process is true and referred visceral pain.<\/span>\n\n<span style=\"font-weight: 400;\">True visceral pain arises as a poorly defined sensation usually perceived in the midline of the body, at the lower sternum or upper abdomen. This diffuse nature and difficulty in locating visceral pain are due to a low density of visceral sensory innervation and extensive divergence of visceral input within the central nervous system. Visceral pain is therefore perceived more diffusely than noxious cutaneous stimulation with respect to location and timing. Subsequent symptoms may entail referred pain to somatic structures that share the same segmental innervation and that are more densely innervated. This way, visceral referred pain can mask as pain from musculoskeletal structures. If you want to dig deeper into the neurophysiological mechanism behind this phenomenon, check out <a href=\"https:\/\/www.physiotutors.com\/wiki\/referred-pain-explained\/\">this post<\/a>.<\/span>\n\n<span style=\"font-weight: 400;\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22246042\/\" target=\"_blank\" rel=\"noopener\">Sikandar et al. (2012)<\/a> pointed out that somatic pain can be distinguished from visceral pain as the latter it is often associated with marked motor and autonomic reflexes, including pallor, profuse sweating, nausea, GI disturbances, and changes in body temperature, blood pressure, and heart rate. At the same time, it often produces strong affective responses, and therefore can be reinforced by anxiety and depression.<\/span>\n<div class=\"embed-container\">\n\n[embed]https:\/\/www.youtube.com\/watch?v=5yNTb8c1sBw[\/embed]\n\n<\/div>\n<span style=\"font-weight: 400;\">So which organs have their segmental innervations in the cervical spine and can potentially refer pain to the neck and shoulder? These are the following:<\/span>\n\n<span style=\"font-weight: 400;\">The cardiopulmonary tract:<\/span>\n\n<img class=\"aligncenter wp-image-11957 size-full\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/10\/cardiopulmonary-tract.jpg\" alt=\"Cardiopulmonary tract\" width=\"770\" height=\"190\" \/>\n\n<span style=\"font-weight: 400;\">In case a patient complains about radiating symptoms along the ulnar side of the arm mimicking C8 radiculopathy or ulnar nerve entrapment is a Pancoast tumor:<\/span>\n\n<span style=\"font-weight: 400;\">Questions you could ask for the pulmonary system are:<\/span>\n<ul>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">History of smoking<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Shortness of breath<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Wheezing\u00a0<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prolonged coughing<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Sputum-amount\/color<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">History of asthma, emphysema, pneumonia, tuberculosis<\/span><\/li>\n<\/ul>\n<span style=\"font-weight: 400;\">For the cardiovascular system you could ask for:<\/span>\n<ul>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Heart trouble<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pain or pressure on the chest<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Palpitations, so an abnormality of the heartbeat<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">History of smoking<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">High blood pressure<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Shortness of breath- including nocturnal<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Swelling of extremities<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family history of cardiovascular disorder<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Elevated cholesterol level<\/span><\/li>\n<\/ul>\n<span style=\"font-weight: 400;\">The organs of the digestive system can refer pain to the neck and shoulder region if an enlargement or inflammation of the organ irritates the diaphragm which is innervated by spinal segments C3 to C5. <\/span>\n\n<img class=\"aligncenter size-full wp-image-11958\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/10\/digestive-tract.jpg\" alt=\"Digestive tract\" width=\"770\" height=\"235\" \/>\n\n<span style=\"font-weight: 400;\">In your interview you should ask for:<\/span>\n<ul>\n \t<li><span style=\"font-weight: 400;\">Difficulty with swallowing<\/span><\/li>\n \t<li><span style=\"font-weight: 400;\">Nausea\/heartburn<\/span><\/li>\n \t<li><span style=\"font-weight: 400;\">Vomiting<\/span><\/li>\n \t<li><span style=\"font-weight: 400;\">Specific food intolerances<\/span><\/li>\n \t<li><span style=\"font-weight: 400;\">Constipation<\/span><\/li>\n \t<li><span style=\"font-weight: 400;\">Diarrhea<\/span><\/li>\n \t<li><span style=\"font-weight: 400;\">Changes in the color of stools<\/span><\/li>\n \t<li><span style=\"font-weight: 400;\">Rectal bleeding<\/span><\/li>\n \t<li><span style=\"font-weight: 400;\">Jaundice<\/span><\/li>\n \t<li><span style=\"font-weight: 400;\">History of liver or gallbladder problems<\/span><\/li>\n<\/ul>\n<span style=\"font-weight: 400;\">You can imagine that some of these questions are very straightforward and private and probably not what a new patient expects during the intake. For this reason, it\u2019s important to explain why you are asking these questions. In our experience, it makes sense to start with more general questions (for example: Do you have abdominal pain?) and dig deeper with the more specific questions if the initial questions were positive.\u00a0<\/span>\n\n<span style=\"font-weight: 400;\">A more general tract that is often overlooked as it is not specific to a certain area is the locomotor tract. If the patient describes the insidious onset of symptoms in multiple joints, the therapist should be wary of the presence of inflammatory disorders (i.e., rheumatoid arthritis, systemic lupus, etc.) as opposed to multiple areas exhibiting pure mechanical musculoskeletal dysfunction. Questions you could ask for the locomotor tract are: if there is pain, swelling, or movement restriction in other joints in the body next to the joint the patient is primarily complaining about.<\/span>\n\n<span style=\"font-weight: 400;\">At last, there are a couple of general evaluation principles that will help you to distinguish visceral pain or visceral referred pain from musculoskeletal pain. These are:<\/span>\n<ol>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pain from musculoskeletal structures can be related to a change in body or limb position or to specific movements. So if the symptoms do not vary, regardless of body position and movement and are present at rest \u2013especially if the pain is most severe waking them up at night - a pathological disorder should be suspected<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">We have already mentioned that visceral pain is described to be poorly localized, diffuse, dull, and vague in character. It can be constant, but may rhythmically build up to a peak and then recede. Sensations of cramping pain have been attributed to spasms of the muscle wall of the hollow viscus and have been described as gastroenteritis, constipation, menstruation, gallbladder disease, and ureteral obstruction.<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The behavior of symptoms from visceral organs will vary depending on the function of the organ. They might thus be related to eating habits or ingestion of certain foods, may occur with bowel or bladder fullness or constipation, or be associated with the actual acts of urination or defecation<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Contrary to musculoskeletal pain in which patients often report an incident, accident, or trauma marking the onset of complaints, a serious pathology might be suspected in case of insidious onset with unexplained symptom development.<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Questions about general health may also reveal critical information. Signs&amp; symptoms like fever, chills, nausea, unexplained weight loss, malaise, vomiting, changes in bowel habits, or rectal and vaginal bleeding for more than 1 or 2 weeks might be an indicator of serious pathology. <\/span><span style=\"font-weight: 400;\">Make sure that you are aware of conditions that the patient is currently treated for or has been treated for in the past as many can have a history of recurrence and ask for family history as well.<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Last, patient information including age, gender, occupation, and ethnicity may place people at higher risk for the development of specific diseases.\u00a0<\/span><\/li>\n<\/ol>\n<span style=\"font-weight: 400;\">Be aware, that no single question allows you to reach a conclusion. What we are looking for is a pattern that might indicate serious pathology. <\/span><span style=\"font-weight: 400;\">It has to be said that you are not trying to make a specific diagnosis for certain organ pathology here. This is out of the scope of a physio and the expertise of an MD. The message that we want to bring across here is that it should become routine to include screening for visceral pathology during your screening process as well, so you can refer out if serious pathology is suspected.<\/span>\n\n&nbsp;\n\n[cta]\n\n&nbsp;\n\nSimilar to the cervical spine, visceral referred pain can also refer to the cervical spine and the lower back. Check out our posts on those two areas as well:\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/referred-pain-thoracic-spine\/\">Referred Pain Thoracic Spine<\/a>\n\n<a href=\"https:\/\/www.physiotutors.com\/wiki\/lumbar-referred-pain\/\">Referred Pain Lumbar Spine<\/a>\n<h6><\/h3>\n&nbsp;\n<h6><strong>References:<\/strong><\/h3>\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22246042\/\" target=\"_blank\" rel=\"noopener\">Sikandar S, Dickenson AH. Visceral pain\u2013the ins and outs, the ups and downs. Current opinion in supportive and palliative care. 2012 Mar;6(1):17.<\/a>\n\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18796872\/\" target=\"_blank\" rel=\"noopener\">Boissonnault, W. G., &amp; Bass, C. (1990). Pathological origins of trunk and neck pain: part I\u2014pelvic and abdominal visceral disorders.\u00a0<i>Journal of Orthopaedic &amp; Sports Physical Therapy<\/i>,\u00a0<i>12<\/i>(5), 192-207.<\/a>\n\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18796873\/\" target=\"_blank\" rel=\"noopener\">Boissonnault WG, Bass C. Pathological origins of trunk and neck pain: part II\u2014disorders of the cardiovascular and pulmonary systems. Journal of Orthopaedic &amp; Sports Physical Therapy. 1990 Nov;12(5):208-15.<\/a>\n\n&nbsp;"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>References<\/h4>"},"column_right":{"content_editor":"<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22246042\/\" target=\"_blank\" rel=\"noopener\">Sikandar S, Dickenson AH. Visceral pain\u2013the ins and outs, the ups and downs. Current opinion in supportive and palliative care. 2012 Mar;6(1):17.<\/a>\n\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18796872\/\" target=\"_blank\" rel=\"noopener\">Boissonnault, W. G., &amp; Bass, C. (1990). Pathological origins of trunk and neck pain: part I\u2014pelvic and abdominal visceral disorders.\u00a0<i>Journal of Orthopaedic &amp; Sports Physical Therapy<\/i>,\u00a0<i>12<\/i>(5), 192-207.<\/a>\n\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18796873\/\" target=\"_blank\" rel=\"noopener\">Boissonnault WG, Bass C. Pathological origins of trunk and neck pain: part II\u2014disorders of the cardiovascular and pulmonary systems. Journal of Orthopaedic &amp; Sports Physical Therapy. 1990 Nov;12(5):208-15.<\/a>\n&nbsp;"}},{"acf_fc_layout":"cta-image-v2","layout":"","background":"transparent","heading":"","content_editor":"<p class=\"subheading\">Like what you\u2019re learning?<\/p>\n<p class=\"heading-two\">BUY THE FULL PHYSIOTUTORS <strong>ASSESSMENT BOOK<\/strong><\/p>\n\n<ul>\n \t<li>600+ Pages e-Book<\/li>\n \t<li>Interactive Content (Direct Video Demonstration, PubMed articles)<\/li>\n \t<li>Statistical Values for all Special Tests from the latest research<\/li>\n \t<li>Available in \ud83c\uddec\ud83c\udde7 \ud83c\udde9\ud83c\uddea \ud83c\uddeb\ud83c\uddf7 \ud83c\uddea\ud83c\uddf8 \ud83c\uddee\ud83c\uddf9 \ud83c\uddf5\ud83c\uddf9 \ud83c\uddf9\ud83c\uddf7<\/li>\n \t<li>And much more!<\/li>\n<\/ul>","button_type":"internal_link","button_label":"Check out our shop","button_style":"button-two","button_internal_link":4464,"button_anchor":"","button_url":"","button_file":null,"side_button":{"side_button_content_editor":""},"bottom_button":{"bottom_button_content_editor":""},"image":22705,"image_alt_text":""},{"acf_fc_layout":"review-slider","heading":"WHAT CUSTOMERS HAVE TO SAY ABOUT THE ASSESSMENT E-BOOK","image_shortcode":"","image":"","image_alt_text":"","shortcode":"[wprevpro_usetemplate tid=\"2\"]","button_type":"internal_link","button_label":"","button_style":"button-one","button_internal_link":"","button_anchor":"","button_url":"","button_file":null},{"acf_fc_layout":"cta-full-width-v2","logo":{"logo_image":22443,"logo_image_alt_text":""},"heading":"<strong>Download<\/strong> the free Physiotutors app now!","content_editor":"","download_image":{"download_image_image":22444,"download_image_image_alt_text":""},"mobile_download_image":{"mobile_download_image_image":22445,"mobile_download_image_image_alt_text":""},"download_image_link":"https:\/\/onelink.to\/6dtzk5","mockup_image":{"mockup_image_image":22447,"mockup_image_image_alt_text":""},"mobile_mockup_image":{"mobile_mockup_image_image":22446,"mobile_mockup_image_image_alt_text":""}}]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Cervical Referred Pain | Visceral Referred Pain<\/title>\n<meta name=\"description\" content=\"Pain from the viscera can refer to the cervical spine region and mask as musculoskeletal pain. 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