Pain points

Diagnostic pain points are symptomatic points, the definition of which can help to clarify or identify the disease, its localization and nature. They must be distinguished from diffuse pain in muscles, subcutaneous tissue, etc.

Depending on the tissues being examined, pain points are determined in those areas of the body where a nerve or vessel in a pathological state may be pressed against the bone; they are also determined when deep tissues (fascia, places where muscles are attached to bones) and internal organs are irritated.

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Pain points in the head and neck area

• pain points of exit of I, II, III branches of the trigeminal nerve - with neuralgia of this nerve, sinusitis, meningism and meningitis, arachnoiditis (absent in comas);
• Greenstein's vascular pain points: at the inner corner of the eye socket - with phlebitis and thrombophlebitis of the facial veins; behind the ears in the area of the occipital bone tubercles - with vasomotor pathologies of the brain vessels, meningitis;
• pain points in the temple area above the zygomatic process - with arteritis and sympathalgia of the face, leptomeningitis;
• pain points in the area of the mastoid process, in front and below the tragus of the ear - with neuritis and neuralgia of the facial nerve, otitis, mastoiditis;
• pain points at the base of the skull above the first cervical vertebra at the exit point of the occipital nerves - with neuralgia of these nerves, cervical osteochondrosis, meningitis, tumors of the pontine-cerebellar zone;
• pain points of the spinous processes of the cervical vertebrae, intervertebral discs, paravertebral - with osteochondrosis, herniated intervertebral discs;
• pain points of the vertebral artery on the line connecting the apices of the mastoid process and the spinous process of the second cervical vertebra - in case of pathology of the vertebral artery and cardialgia of various origins.

Pain points in the shoulder girdle and arm

• at the outer edge of the sternocleidomastoid muscle - with cervical osteochondrosis;
• under the collarbone, in the middle third - with cervical osteochondrosis, scalene muscle and first rib syndrome, scapulohumeral periarthritis;
• in the area of the coracoid process of the scapula - with scapulohumeral periarthritis and cervical osteochondrosis;
• on the anterior surface of the shoulder joint - with angina pectoris, myocardial infarction, cardialgia;
• on the inner surface of the shoulder along the neurovascular trunk - in Raynaud's disease, pathology of the brachial artery and its trunks, irritation of the distal branches of the ulnar nerve (inflammation and injury of the hand and forearm), irritation of the stellate cervicothoracic ganglion located in the fork between the external and internal branches of the carotid artery (compression, injury, inflammation);
• supraclavicular and subclavian pain points of Erb, 2 cm from the edge of the sternum - for plexitis;
• along the peripheral nerves of the hand - for neuritis and irritation of branches during perineural inflammation and tissue trauma.

Pain points in the chest and abdomen

• spinous processes of the thoracic vertebrae and paravertebral - at the level of the intervertebral discs - in osteochondrosis, chondropathies, intervertebral hernias, juxtamedullary tumors;
• in the intercostal spaces along the paravertebral, axillary and parasternal lines - with intercostal neuralgia, chest trauma, pathology of the pleural cavity;
• Sternberg, 2-3 cm above the navel and slightly to the right - with irritation of the solar plexus - with solaritis, more often due to mesadenitis, or reflex solargia; approximately 5-7 cm from the navel along the line connecting the navel with the right armpit - with local pancreatitis in the area of the head of the pancreas;
• paravertebral pain points of Boas at the level of the 10th-12th thoracic vertebrae and Openhovsky in the area of the spinous processes of the 8th-10th thoracic vertebrae - with ulcers, cancer and other pathologies of the stomach;
• anterior Boas point at the intersection of the rectus abdominis muscle and the right costal arch - in cholecystitis and duodenal ulcer;
• McBurney's point 2 cm below the navel and 1-2 cm to the right - in mesadenitis and reflex solar effusion, more often in appendicitis; at the intersection of the line between the navel and the wing of the ilium with the rectus abdominis muscle - in appendicitis;
• Ortner along the lower edge of the costal arch on the right - for diseases of the liver and gallbladder;
• Mussi above the clavicle, between the legs of the sternocleidomastoid muscle - cholecystitis, subphrenic abscess and pathology accompanied by irritation of the phrenic nerve;
• Herbst at the transverse process of the third lumbar vertebra on the left - in case of gastric ulcer;
• Kümmel's node, located 1 cm to the right and down from the navel, for appendicitis;
• Lantsava, at a distance of 5 cm from the right anterior superior iliac spine on the line connecting both spines - in appendicitis;
• McBurney in the middle of the umbilical spinous line - in appendicitis;
• Munro at the intersection of the outer edge of the right rectus abdominis muscle with the spinous-umbilical line - in appendicitis;
• Chauffard's zone (choledochopancreatic) - 5-7 cm above the navel to the right and left of the midline.

Pain points in the pelvic girdle and legs

• at the exit point of the femoral nerve in the middle of the inguinal fold - in case of neuritis and neuralgia of this nerve;
• Balle's pain points - lateral to the spinous processes, in the lumbar spine, at the crest of the posterior superior iliac spine, at the middle of the crest of this bone, at the ischial tuberosity, in the middle of the back surface of the lower third of the thigh, in the popliteal fossa, behind the head of the fibula, at the outer ankle, on the dorsum of the foot - with lumbosacral radiculitis and radiculoneuritis;
• Tara pain points - when pressing on the spinous processes of the IV-V lumbar vertebrae, in the area of the iliac-sacral joint, in the area of the transverse processes of the IV-V lumbar vertebrae - with lumbosacral radiculitis, radiculalgia, radiculoneuritis;
• Dejerine at the spinous process of the sacral vertebra - for lumbosacral radiculitis and radiculalgia;
• Bekhterev in the middle of the sole - with radiculitis, the appearance or increase of pain in the lower back;
• Schüdel - with radiculitis, pain upon percussion or pressure on the spinous processes of the vertebrae;
• Mayo-Robson test on the anterior-inner surface of the lower third of the left leg - in acute pancreatitis, increased pain in the epigastrium is noted.