Dysfunction and derangement : how to distinguish
Dysfunction and derangement syndrome : two separate entities ?
Dysfunction syndrome ?
What is a dysfunction syndrome (as described by McKenzie) : any situation in which normal loading on abnormal tissue causes pain. Clinically some movements provoke end range pain without limitation of movement (except from the adherent nerve root, in which the straight leg raise and flexion in standing are slightly limited).
Patients suffering from a dysfunction syndrome mostly have a chronic problem. Part of the treatment consist of remodeling the tissue again, by using an intensive stretching program.
Dysfunction and derangement syndrome simultaneously ?
Sometimes patients suffer simultaneously from an internal derangement and and an underlying dysfunction syndrome.
Mostly the image of the internal derangement is prominent and will be discovered upon the first visit of the patient. We treat the derangement and once this derangement is reduced, then, on retesting the image of the dysfunction becomes more obvious.
How to differentiate a dysfunction syndrome from a small internal derangement ?
Patients with end range pain on certain test movements might suffer from a dysfunction syndrome as well as from a small internal derangement : how to differentiate ?
Well, the secret lies in repeated movement testing : ask for e.g. 20-30 flexions or extensions and analyze : what is happening during repeated testing ?
20 times end range pain, not worse, not better and after the repetitions also not worse, nor better points in the direction of a dysfunction syndrome.
If, however, during repeated testing the patient describes an amelioration or worsening in a certain direction and if the patient, after completion of the repeated movements, feels better or worse, then we think of an internal derangement.