Diseases of the chest and the principles of physical diagnosis . The bilateral equahty of chest expansion canoften be satisfactorily determined by laying the hands lightly upon thepatients chest during the act of respiration. Some examiners prefer thismethod to simple inspection. 43 44 THE EXAMINATION OF THE LITNGS ZONES OF CUTANEOUS HYPERESTHESIA (HEADS AREAS), AND REFLEX PAIN The nerves supplying the skin and skeletal muscles have become soeducated that any injury to them is accurately located. Such is notthe case with nerves of the internal organs. A painful irritation of theviscera finds e
Diseases of the chest and the principles of physical diagnosis . The bilateral equahty of chest expansion canoften be satisfactorily determined by laying the hands lightly upon thepatients chest during the act of respiration. Some examiners prefer thismethod to simple inspection. 43 44 THE EXAMINATION OF THE LITNGS ZONES OF CUTANEOUS HYPERESTHESIA (HEADS AREAS), AND REFLEX PAIN The nerves supplying the skin and skeletal muscles have become soeducated that any injury to them is accurately located. Such is notthe case with nerves of the internal organs. A painful irritation of theviscera finds expression, not necessarily over the site of the organ, butin a painful area of the skin often remote from it. Head has shown thatthe painful stimulus in the organ travels in a centripetal direction to theposterior part of the cord and there sets up excitation of the nerves whichin the same and in the adjoining segments supply the peripheral surfaceswith sensation. The pain is referred to the skin because therein the painsense reaches its highest Fig. 41.âReferred pleural pain. The horizontal lines indicate the location of inter-costal nerve pain; the dots represent phrenic nerve pain, on the anterior surface of thebody. Referred pain from the viscera has these characteristics to differen-tiate it from pain of peripheral origin: (1) It is often remote from thesite of irritation. (2) It follows the hnes on the skin of the spinal seg-mentation rather than the course of the peripheral nerves. (3) It isusually associated with cutaneous hyperesthesia and tenderness to pres-sure. (4) Often the pain fails to involve the whole segmental area of theskin, but finds expression in one or more points of maximal tendernessand spontaneous pain. Examples.âThe pain of biliary colic is felt at the angle of the scapula,that of renal colic in the testicles, while heart pain is referred to the armor the neck. Hyperesthesia of the skin is determined by light pressure with a dullobject
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