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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

232 patients attending a breast clinic with breast pain as the primary presenting symptom were studied prospectively to define clinical syndromes and to attempt to elucidate aetiological factors. Those women in whom mastalgia was a minor aspect of their complaint, or who were primarily seeking reassurance that they did not have cancer, were excluded. Most mastalgia patients could be placed into well-defined subgroups on the basis of clinical, radiological, and pathological features. After excluding causes of pain arising outside the breast, six specific groups with widely differing aetiological bases were defined, leaving only 7% unclassified lithout known aetiology. The six defined groups were cyclical pronounced mastalgia, (believed to be hormonally based), duct ectasia. Tietze syndrome, trauma, sclerosing adenosis, and cancer. Psychological factors were found to be less important than has been previously suggested. Classification of patients with mastalgia into homogeneous subgroups is a prerequisite of any therapeutic study.
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PMID:Clinical syndromes of mastalgia. 6 May 28

Tietze's syndrome (peristernal chondritis or perichondritis) is a self-limited, painful inflammatory condition of the costochondral, sternoclavicular, manubriosternal or xiphisternal junctions. It is benign, and affects all ages, sexes and races equally. The principal manifestations are pain and, frequently, a mass most commonly at the costochondral junctions. In 1974, C.J. described the first cases to be reported at the xiphisternal junction. We describe here 24 cases at that site. These patients' presenting symptoms suggested cardiac, pulmonary, intraabdominal and other severe disease processes. Diagnosis was made on clinical grounds based on a high index of suspicion. Treatment comprised infiltration of local anesthetic to the afflicted joints with prompt, complete and prolonged relief in 21 (87.5%) of the cases, and complete temporary relief in three (12.5%). We suggest that a possible mechanism for the referral of pain is the relationship of the xiphisternal joint to a variety of structures including autonomic nerves that accompany the internal mammary arteries.
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PMID:Perichondritis (Tietze's syndrome) at the xiphisternal joint: a mimic of severe disease. 92 10

In a prospective study of children with the primary complaint of chest pain, 43 patients were identified. This gave an occurrence (per patient visits) of 0.288%. The average age was 12.9 years for boys and 11.80 years for girls. Diagnostic categories identified were idiopathic chest pain (45%), costochondritis (22.5%), chest pain secondary to bronchitis (12.5%), miscellaneous (10%), chest pain secondary to muscle strain (5%), and chest pain secondary to trauma (5%). These six categories are discussed in terms of age, sex, resolution of symptoms, duration of the complaint, return for follow-up examination, quality of pain, psychiatric profile, and results of laboratories studies. It is concluded that chest pain in children is not as ominous a symptom as it is in adults, and that it infrequently signals underlying cardiac disease or other serious disease that is not apparent from a thorough history and physical examination.
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PMID:Chest pain in children: a prospective study. 94 Jul 5

Between 1982 and 1990, 81 children with localized or diffuse musculoskeletal pain, for which no cause could be found were seen in a pediatric rheumatology clinic. Forty-one children had localized idiopathic pain and 40 had diffuse idiopathic pain. Twenty-four of the patients with localized idiopathic pain fulfilled criteria for definite reflex neurovascular dystrophy. Thirty-five patients with diffuse idiopathic pain fulfilled criteria for fibromyalgia. Four patients with localized idiopathic pain (10%) developed diffuse idiopathic pain during followup; four patients with diffuse idiopathic pain (10%) had a history of localized idiopathic pain and one patient had previously been diagnosed as having Tietze's syndrome. Recurrences or persistence of pain was very common. Many children had potentially important stressors including single parent families, histories of sexual abuse, and learning difficulties. Idiopathic musculoskeletal pain is a common cause of referral to a pediatric rheumatology clinic and is often associated with significant morbidity.
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PMID:Idiopathic musculoskeletal pain syndromes in children. 149 2

Mastalgia (breast pain) is the commonest breast problem women present with in general practice. Mastalgia can be apparent, when due to referred pain or costochondritis, for instance; or real, when it can be localised or diffused. Diffused pain can be cyclical or non cyclical. An important association of cyclical mastalgia is benign mammary dysplasia (fibroadenosis). It is important to exclude malignancy and to reassure patients.
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PMID:Mastalgia. 186 98

Condensing osteitis of the clavicle, better defined as aseptic enlarging osteosclerosis of the clavicle, is a rare and benign idiopathic lesion. It is probably of degenerative or mechanical origin, and is most commonly seen in middle-aged women as a tender swelling over the medial one-third of the clavicle. Although the clinical features may be confusing and nonspecific, the typical radiographic and histopathological findings will mostly lead to a correct diagnosis of this disorder. The differential diagnosis is quite extensive. Most difficult to differentiate are: avascular necrosis of the medial clavicular epiphysis, sternoclavicular orsteoarthritis, low-grade chronic osteomyelitis, sternocostoclavicular hyperostosis and Tietze's syndrome. The authors recommend a thorough physical examination and technical tests, not only in subjects with pain of the clavicle but also in those with shoulder pain only, especially in women who are in their fourth decade. Treatment with analgesic and anti-inflammatory medications may be variably effective. In refractory cases excisions of the medial one-third of the clavicle may be indicated to offer better relief of symptoms as well as to exclude malignancy.
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PMID:Condensing osteitis of the clavicle. Report of two cases and review of the literature. 209 68

The results of treatment of 14 patients (11 males and 3 females) with Tietze's syndrome are discussed. The patient's ages ranged from 22 to 56 years. Most of them were engaged in heavy physical work. The correct diagnosis was established before admission only in 9 patients. The complaints and clinical symptomatology were of the same type almost in all of the patients: pain and swelling in the region of the II-IV costal cartilages at the sternum or along the whole cartilaginous part of the ribs, in some cases pain was referred to the upper part of the shoulder girdle. Clinical and X-ray methods of examination failed to make recognition of the disease easier. The diagnosis was established on basis of scrupulous investigation of the complaints, the history of the disease, and the local clinical manifestations. Most patients were subjected to nonoperative treatment, 2 patients were treated by operation--resection of the hypertrophied cartilage. Local application of hydrocortisone and kenalog produced good results. Pain disappeared completely in 7, was relieved significantly in 5, and was not relieved at all in 2 patients.
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PMID:[Tietze's syndrome]. 227 54

A 28-year-old woman with IgD myeloma was described. The patient presented with pain in the anterior wall of the chest, and tenderness over the ribs, thoracic spine, and right shoulder. A radionuclide bone scan showed increased uptake along the costochondral junctions, ribs, and shoulders, with the diffuse uptake in the costochondral junction being typical for costochondritis. Skeletal survey revealed small lucencies in the ribs, humeri, and shoulders, characteristic of MM. The patient's young age made the diagnosis of MM unlikely. The scintigraphic finding, typical of costochondritis, must be an extremely unusual pattern in MM since we were unable to find a similar case in the literature. It is speculated that MM may have been induced by chemical exposure.
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PMID:Case report 621. Multiple myeloma (IgD) in a 28-year-old woman. 237 8

A prospective study of 72 patients with non-cyclical breast pain was carried out. Non-cyclical breast pain was subdivided into true non-cyclical mastalgia (35 patients) and musculoskeletal pain (37 patients), the latter including Tietze's syndrome and other causes of chest wall pain. Mean age at presentation was significantly greater in the musculoskeletal group (39.3 versus 33.9 years) with a shorter mean duration of pain (14.7 versus 35.4 months) compared with the non-cyclical mastalgia group. True non-cyclical mastalgia was commonly bilateral and located within the upper outer quadrant of the breast, whereas musculoskeletal pain was almost always along the lateral chest wall or costochondral junctions and unilateral in 92 per cent of cases. Breast nodularity was present in 54 per cent of patients with non-cyclical mastalgia, but in only four cases (11 per cent) in the musculoskeletal group. Nine of 14 patients (64 per cent) with non-cyclical mastalgia obtained a good clinical response to drug therapy (over half responding to danazol alone); 19 underwent spontaneous remission, but there was a prolonged mean time to pain resolution of 27 months. In the musculoskeletal group 33 of 34 patients (97 per cent) had a good response to steroid and local anaesthetic injection; three resolved spontaneously without treatment, with a mean time to pain resolution of 17 months. This study indicates that differentiation of musculoskeletal pain from non-cyclical mastalgia may lead to more effective treatment with some prediction of the overall prognosis.
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PMID:Non-cyclical mastalgia: an improved classification and treatment. 280 83

Slipping rib syndrome is a rare and underdiagnosed condition. Since approximately one third of the cases reported to date have involved patients considered to be psychoneurotic and/or who have undergone psychiatric evaluation, a conservative treatment approach is recommended. Many patients respond to simple reassurance, and in others, a single intercostal nerve block provides lasting relief. In the case reported here, radicular pain, a history of injury to the affected side, noncontributory findings on ancillary investigations, a positive response to the hooking maneuver, and relief of pain after intercostal nerve block led to the diagnosis.
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PMID:Slipping rib syndrome. 281 18


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