Tenderness (medicine)

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In medicine, tenderness is pain or discomfort when an affected area is touched. [1] It should not be confused with the pain that a patient perceives without touching. Pain is patient's perception, while tenderness is a sign that a clinician elicits.

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Ulcer (dermatology) Type of cutaneous condition

An ulcer is a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue. Ulcers can result in complete loss of the epidermis and often portions of the dermis and even subcutaneous fat. Ulcers are most common on the skin of the lower extremities and in the gastrointestinal tract. An ulcer that appears on the skin is often visible as an inflamed tissue with an area of reddened skin. A skin ulcer is often visible in the event of exposure to heat or cold, irritation, or a problem with blood circulation.

Tietze syndrome

Tietze syndrome is a benign inflammation of one or more of the costal cartilages. It was first described in 1921 by the German surgeon Alexander Tietze (1864–1927).

Tension headache

Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.

Tension myositis syndrome (TMS), also known as tension myoneural syndrome or mindbody syndrome is a name given by John E. Sarno to a condition of psychogenic musculoskeletal and nerve symptoms, most notably back pain. Sarno described TMS in four books, and stated that the condition may be involved in other pain disorders as well. The treatment protocol for TMS includes education, writing about emotional issues, resumption of a normal lifestyle and, for some patients, support meetings and/or psychotherapy. In 2007, David Schechter published a peer-reviewed study of TMS treatment in the journal "Alternative Therapies in Health and Medicine," showing a 54% success rate for chronic back pain. In terms of statistical significance and success rate, the study outperformed similar studies of other psychological interventions for chronic back pain.

Courvoisier's law states that in the presence of a palpably enlarged gallbladder and accompanied with mild jaundice, the cause is unlikely to be gallstones. Usually, the term is used to describe the physical examination finding of the right-upper quadrant of the abdomen. This sign implicates possible malignancy of the gallbladder or pancreas and the swelling is unlikely due to gallstones.

Blumberg's sign is a clinical sign in which there is pain upon removal of pressure rather than application of pressure to the abdomen. It is indicative of peritonitis. It was named after German surgeon Jacob Moritz Blumberg.

Waddell's signs are a group of physical signs, first described in a 1980 article in Spine, and named for the article's principal author, Professor Gordon Waddell (1943–2017), a Scottish Orthopedic Surgeon. Waddell's signs may indicate non-organic or psychological component to chronic low back pain. Historically they have also been used to detect malingering in patients with back pain. While testing takes less than one minute, it has been described as time-consuming and alternatives have been proposed.

Gastrointestinal perforation

Gastrointestinal perforation, also known as ruptured bowel, is a hole in the wall of part of the gastrointestinal tract. The gastrointestinal tract includes the esophagus, stomach, small intestine, and large intestine. Symptoms include severe abdominal pain and tenderness. When the hole is in the stomach or early part of the small intestine the onset of pain is typically sudden while with a hole in the large intestine onset may be more gradual. The pain is usually constant in nature. Sepsis, with an increased heart rate, increased breathing rate, fever, and confusion may occur.

Abdominal examination Physical examination of abdomen

An abdominal examination is a portion of the physical examination which a physician or nurse uses to clinically observe the abdomen of a patient for signs of disease. The physical examination typically occurs after a thorough medical history is taken, that is, after the physician asks the patient the course of their symptoms. The abdominal examination is conventionally split into four different stages: first, inspection of the patient and the visible characteristics of their abdomen. Auscultation (listening) of the abdomen with a stethoscope. Palpation of the patient's abdomen. Finally, percussion (tapping) of the patient's abdomen and abdominal organs. Depending on the need to test for specific diseases such as ascites, special tests may be performed as a part of the physical examination. An abdominal examination may be performed because the physician suspects a disease of the organs inside the abdominal cavity, or simply as a part of a complete physical examination for other conditions. In a complete physical examination, the abdominal exam classically follows the respiratory examination and cardiovascular examination.

Costovertebral angle tenderness

Costovertebral angle (CVA) tenderness is pain that results from touching the region inside of the costovertebral angle. The CVA is formed by the 12th rib and the spine. Assessing for CVA tenderness is part of the abdominal exam, and CVA tenderness indicates kidney pathology. 

Trochleitis is inflammation of the superior oblique tendon trochlea apparatus characterized by localized swelling, tenderness, and severe pain. This condition is an uncommon but treatable cause of periorbital pain. The trochlea is a ring-like apparatus of cartilage through which passes the tendon of the superior oblique muscle. It is located in the superior nasal orbit and functions as a pulley for the superior oblique muscle. Inflammation of the trochlear region leads to a painful syndrome with swelling and exquisite point tenderness in the upper medial rim of the orbit. A vicious cycle may ensue such that inflammation causes swelling and fraying of the tendon which then increases the friction of passing through the trochlea which in turn adds to the inflammation. Trochleitis has also been associated with triggering or worsening of migraine attacks in patients with pre-existing migraines.

An acute abdomen refers to a sudden, severe abdominal pain. It is in many cases a medical emergency, requiring urgent and specific diagnosis. Several causes need immediate surgical treatment.

Counterstrain is a technique used in osteopathic medicine, osteopathy, physical therapy, and chiropractic to treat somatic dysfunction. It is a system of diagnosis and treatment that uses tender points, which are considered to be produced by inaccurate neuromuscular reflexes. The technique inhibits the reflexes by putting the tissues in a position of ease directly opposite to that of the reflex. The Australian and French osteopathic practitioners use the terms: Jones technique,, and spontaneous release by position. Counterstrain was developed by Lawrence Jones in 1955 and was originally called “Spontaneous Release by Positioning,” before being termed “strain-counterstrain.”

Greater trochanteric pain syndrome (GTPS), is inflammation of the trochanteric bursa, a part of the hip.

In medicine, Carnett's sign is a finding on clinical examination in which (acute) abdominal pain remains unchanged or increases when the muscles of the abdominal wall are tensed. For this part of the abdominal examination, the patient can be asked to lift the head and shoulders from the examination table to tense the abdominal muscles. An alternative is to ask the patient to raise both legs with straight knees.

The Markle sign or jar tenderness is a clinical sign in which pain in the right lower quadrant of the abdomen is elicited by dropping from standing on the toes to the heels with a jarring landing. It is found in patients with localised peritonitis due to acute appendicitis. It is similar to rebound tenderness, but may be easier to elicit when the patient has firm abdominal wall muscles. Abdominal pain on walking or running is an equivalent sign.

A phoenix abscess is an acute exacerbation of a chronic periapical lesion. It is a dental abscess that can occur immediately following root canal treatment. Another cause is due to untreated necrotic pulp. It is also the result of inadequate debridement during the endodontic procedure. Risk of occurrence of a phoenix abscess is minimised by correct identification and instrumentation of the entire root canal, ensuring no missed anatomy.

Lépine's sign is one of the medical signs of gallbladder disease. It is positive when effleurage with crooked third finger at the point of the gallbladder projection to anterior abdominal wall elicits pain. It is not to be confused with the following:

Quadrants and regions of abdomen

The human abdomen is divided into quadrants and regions by anatomists and physicians for the purposes of study, diagnosis, and treatment. The division into four quadrants allows the localisation of pain and tenderness, scars, lumps, and other items of interest, narrowing in on which organs and tissues may be involved. The quadrants are referred to as the left lower quadrant, left upper quadrant, right upper quadrant and right lower quadrant. These terms are not used in comparative anatomy, since most other animals do not stand erect.

Heel tap sign, also called heel-jar or jar tenderness, is a clinical sign to identify appendicitis. It is found in patients with localized peritonitis. With the patient supine the right heel is elevated by 10-20 degrees is hit firmly with palm of the examiner's hand.

References

  1. "Point tenderness - abdomen" . Retrieved 14 February 2015.