Painful Points

PAINFUL POINTS, places along the course of nerves that are especially painful upon pressure; they exist when various pathological processes are present in the nerve; they are constant during neuralgic attacks, but often retain their tenderness even between attacks, whereas tenderness along the tract of the entire nerve is less frequent. First described by Valleix in 1852, they are therefore called Valleix points. Painful points usually have a definite localization, corresponding either to the sites where the nerve emerges from bony canals or to sites where the nerve can be compressed against denser tissues (bones, ligaments). Thus, in trigeminal neuralgia, painful points are observed in the following locations: in neuralgia of the upper branch—in the region of the supraorbital foramen, in neuralgia of the 2nd branch—in the region of the infraorbital foramen, and in neuralgia of the 3rd branch—in the region of the mental foramen. In diseases of the sciatic nerve, painful points are found at the site of exit of the nerve through the greater sciatic foramen, midway between the ischial tuberosity and the greater trochanter, and in the middle of the popliteal fossa; less constant painful points are at the fibular head, at the medial malleolus, at the medial margin of the foot, and generally wherever the nerve is more accessible to superficial pressure. In diseases of the brachial plexus, painful points are found in the supra- and infraclavicular fossae, on the radial and ulnar nerves, and in the bicipital sulcus. In occipital neuralgia, the painful point is located approximately in the middle of the line connecting the mastoid process and the spinous process of the seventh cervical vertebra. In intercostal neuralgia, painful points follow the course of the intercostal nerves. Local tenderness to pressure in hysteria has a different (psychogenic) origin, for which painful points in the lower abdomen (in the region of the ovaries), the interscapular point, painful points in the region of the mammary glands, and others are especially characteristic. Pressure on the designated places causes a series of phenomena in hysterical patients that characterize the aura period of a convulsive seizure (so-called hysterogenic zones). On the other hand, these same points are also arresting zones (pressure on them terminates an already initiated seizure). In the clinic of internal diseases, painful points undoubtedly also have diagnostic significance. We need only mention the well-known painful points of McBurney, Lanz, Kümmell, and others in appendicitis (see); the painful points of Boas, Oppenховский [Oppenheim/Oppenховский], and Mendel in gastric ulcer (see); the painful point of Ortner in kidney stones; and a number of painful points described by de Mussy in diseases of the diaphragm region (respectively, innervation of the phrenic nerve)—in particular, in diaphragmatic pleurisy.