{"id":5612,"date":"2025-06-10T09:52:28","date_gmt":"2025-06-10T07:52:28","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=5612"},"modified":"2026-01-01T23:16:16","modified_gmt":"2026-01-01T22:16:16","slug":"processus-de-raisonnement-clinique-de-montreal","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=5612","title":{"rendered":"Processus de raisonnement clinique de Montr\u00e9al"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Mod\u00e8le principal<\/h2>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69d2c5ac9f71a&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69d2c5ac9f71a\" class=\"wp-block-image size-large wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"617\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-22-1024x617.avif\" alt=\"\" class=\"wp-image-5616\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-22-1024x617.avif 1024w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-22-300x181.avif 300w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-22-768x463.avif 768w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-22.avif 1200w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Agrandir\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Mod\u00e8le simplifi\u00e9<\/h2>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"644\" height=\"484\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-20.avif\" alt=\"\" class=\"wp-image-5613\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-20.avif 644w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-20-300x225.avif 300w\" sizes=\"auto, (max-width: 644px) 100vw, 644px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Les cat\u00e9gorisations<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Ph\u00e9notype de la douleur<\/h3>\n\n\n\n<p>IASP&nbsp;: association internationale pour l\u2019\u00e9tude de la douleur<\/p>\n\n\n\n<p>Grands ph\u00e9notypes douloureux selon des patterns et selon des m\u00e9canismes de douleur&nbsp;;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>nociceptif<\/strong>\u00a0: clair, proportionn\u00e9, m\u00e9canique, localis\u00e9 dans la zone de la l\u00e9sion, on-off (peut \u00eatre d\u00e9clench\u00e9 ou soulag\u00e9), pr\u00e9dictif, r\u00e9pond de mani\u00e8re pr\u00e9visible. Mais attention \u00e0 la douleur nociceptive r\u00e9f\u00e9r\u00e9e. Nociceptif inflammatoire\u00a0: douleur diff\u00e9rente.<\/li>\n\n\n\n<li><strong>Neuropathique \/ p\u00e9riph\u00e9rique<\/strong>\u00a0: douleur qui br\u00fblent, \u00e9lectrique, fourmillement, dysesth\u00e9sie, sensation perturb\u00e9e, engourdissement, perte de force. Le patient provoque la douleur en mise en tension dynamique. Palpation du nerf douloureux.<\/li>\n\n\n\n<li><strong>central ou nociplastique<\/strong>\u00a0: disproportionn\u00e9, non m\u00e9canique, non pr\u00e9dictif, pas de pattern, pas de on-off, fortes association avec des drapeaux jaunes (facteur socio-culturel), antalgique et antiinflammatoires ne fonctionnent pas.<\/li>\n<\/ul>\n\n\n\n<p>Le PDDM pour cat\u00e9goriser<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/PDDM-1024x1024.avif\" alt=\"\" class=\"wp-image-5628\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/PDDM-1024x1024.avif 1024w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/PDDM-300x300.avif 300w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/PDDM-150x150.avif 150w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/PDDM-768x768.avif 768w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/PDDM-1536x1536.avif 1536w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/PDDM-144x144.avif 144w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/PDDM-80x80.avif 80w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/PDDM.avif 1575w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Situation de handicap<\/h3>\n\n\n\n<p>CIF<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"692\" height=\"331\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-23.avif\" alt=\"\" class=\"wp-image-5629\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-23.avif 692w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-23-300x143.avif 300w\" sizes=\"auto, (max-width: 692px) 100vw, 692px\" \/><\/figure>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9ficit<\/li>\n\n\n\n<li>Restriction d\u2019activit\u00e9<\/li>\n\n\n\n<li>Restriction de participation sociale<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Echelle sp\u00e9cifique du patient (Patient-Specific Functional Scale) pour quantifier le handicap&nbsp;: on liste les activit\u00e9s et on note&nbsp; de 0 \u00e0 10 \u00e0 combien il est limit\u00e9<\/p>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;69d2c5aca021e&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"69d2c5aca021e\" class=\"wp-block-image size-full is-resized wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"757\" height=\"816\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-24.avif\" alt=\"\" class=\"wp-image-5630\" style=\"width:448px;height:auto\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-24.avif 757w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/06\/image-24-278x300.avif 278w\" sizes=\"auto, (max-width: 757px) 100vw, 757px\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\taria-label=\"Agrandir\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.imageButtonRight\"\n\t\t\tdata-wp-style--top=\"state.imageButtonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Sources de sympt\u00f4mes<\/h3>\n\n\n\n<p>On ne cherche pas de mani\u00e8re d\u00e9taill\u00e9e, on cherche de mani\u00e8re g\u00e9n\u00e9rale.<\/p>\n\n\n\n<p>Ex&nbsp;: douleur dans l\u2019\u00e9paule et le MS<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Local, somatique\u00a0: \u00e9paule p\u00e9ri-articulaire ou intra-articulaire\u00a0(labrum, coiffe, GH, AH,\u2026)<\/li>\n\n\n\n<li>R\u00e9f\u00e9r\u00e9e\u00a0: cervicale (C5)<\/li>\n\n\n\n<li>Neurale\u00a0: nerf axillaire, nerf m\u00e9dian, etc<\/li>\n\n\n\n<li>Autre (circulatoire, neurov\u00e9g\u00e9tatif)\u00a0: diaphragme, foie, rate<\/li>\n<\/ul>\n\n\n\n<p>Ex de tableau<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>source<\/td><td>Sympt\u00f4me 1<\/td><td>Sympt\u00f4me 2<\/td><td>Sympt\u00f4me 3<\/td><\/tr><tr><td>Local somatique (p\u00e9ri\/intra)<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><tr><td>R\u00e9f\u00e9r\u00e9e somatique (ce qui innerve a zone de douleur)<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><tr><td>Neurale<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><tr><td>Visc\u00e9ral \/ autre<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Cat\u00e9gories cliniques \/ chargeabilit\u00e9<\/h3>\n\n\n\n<p><strong>S\u00e9v\u00e9rit\u00e9&nbsp;: <\/strong>petite stimulation provoquant une grande douleur<\/p>\n\n\n\n<p><strong>Irritabilit\u00e9<\/strong>&nbsp;: idem qui dure dans le temps<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>csq clinique\u00a0: tr\u00e8s peu chargeable (basse contrainte).<\/li>\n\n\n\n<li>Pr\u00e9caution\u00a0car objectif de la s\u00e9ance est l\u2019antalgie.<\/li>\n\n\n\n<li>Objectif du bilan est de ne pas aggraver l\u2019\u00e9tat du patient (2 tests actifs, 2 tests passif)<\/li>\n\n\n\n<li>Type de patient souvent associ\u00e9 \u00e0 un m\u00e9canisme nociplastique<\/li>\n<\/ul>\n\n\n\n<p><strong>Groupe standard<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ceux qui ont des douleurs en milieu ou en fin d\u2019amplitude<\/li>\n\n\n\n<li>Examen standard\u00a0: choix des techniques en fonction de la position et du mouvement douloureux (d\u00e9monstration fonctionnelle)<\/li>\n<\/ul>\n\n\n\n<p><strong>Momentary pain<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Douleur provoqu\u00e9es lors d\u2019une grande activit\u00e9 intense ou de longue dur\u00e9e ou par la combinaison de plusieurs m\u00e9canismes<\/li>\n\n\n\n<li>Cons\u00e9quence clinique\u00a0: haute contrainte (les plus chargeables)<\/li>\n\n\n\n<li>N\u00e9cessite des tests sp\u00e9ciaux, plus forts, combin\u00e9s.<\/li>\n\n\n\n<li>N\u00e9cessite techniques plus puissante pour reproduire les sympt\u00f4mes<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Les facteurs pr\u00e9disposants<\/h3>\n\n\n\n<p>Tout ce qui vient se surajouter dans le comportement du patient ou dans le traitement et qui vient maintenir et pr\u00e9disposer le patient \u00e0 maintenir les sympt\u00f4mes<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>physique (\u00e2ge, technique, etc)<\/li>\n\n\n\n<li>environnement (poste de travail, comment il vit, etc)<\/li>\n\n\n\n<li>psycho-sociaux (drapeaux jaunes, croyances erron\u00e9es, mauvaise compr\u00e9hension, comportement qui aggrave les sympt\u00f4mes, interet \u00e0 garder les symptomes)<\/li>\n\n\n\n<li>est-ce modifiable\u00a0?<\/li>\n<\/ul>\n\n\n\n<p>Cons\u00e9quences cliniques&nbsp;: changer notre management du traitement, faire de l\u2019\u00e9ducation th\u00e9rapeutique, changer ses croyances, ses comportements.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Pronostic et pr\u00e9diction<\/h3>\n\n\n\n<p>On va chercher \u00e0 pr\u00e9dire le comportement du patient (comment il va s\u2019am\u00e9liorer ou s\u2019aggraver), donc \u00e7a va nous forcer \u00e0 \u00eatre plus pr\u00e9cis dans nos hypoth\u00e8ses, test-retest.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Management<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Qu\u2019a fait mon patient avant moi\u00a0?<\/li>\n\n\n\n<li>Quelles sont ses attentes<\/li>\n\n\n\n<li>Quelle alliance th\u00e9rapeutique\u00a0?<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Pr\u00e9cautions et contre-indications (drapeaux rouges)<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Alt\u00e9rations de l\u2019\u00e9tat g\u00e9n\u00e9ral<\/li>\n\n\n\n<li>cancers, infections, pb neurologiques, vasculaires<\/li>\n\n\n\n<li>fractures<\/li>\n\n\n\n<li>litt\u00e9rature permettant de d\u00e9celer les risques<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Mod\u00e8le principal Mod\u00e8le simplifi\u00e9 Les cat\u00e9gorisations Ph\u00e9notype de la douleur IASP&nbsp;: association internationale pour l\u2019\u00e9tude de la douleur Grands ph\u00e9notypes douloureux selon des patterns et selon des m\u00e9canismes de douleur&nbsp;; Le PDDM pour cat\u00e9goriser Situation&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=5612\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0Processus de raisonnement clinique de Montr\u00e9al\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[391],"tags":[],"class_list":["post-5612","post","type-post","status-publish","format-standard","hentry","category-clinique-raisonnement-clinique"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5612","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5612"}],"version-history":[{"count":8,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5612\/revisions"}],"predecessor-version":[{"id":5631,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/5612\/revisions\/5631"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5612"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5612"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5612"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}