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

Musculoskeletal systems of 19 patients with major and intermediate beta thalassemia were evaluated clinically and radiologically. Rheumatic findings were determined in 17 patients. Symptoms were localized mainly at shoulders, knees, and ankles. The most frequent signs were pain, inflammation, crepitance, radiologically determined periarticular cystic formations, and osteoporosis. Joint involvement was in the nature of non-erosive, destructive osteoarthropathy. It was also found that the symptoms in males were more severe and numerous than in females. No difference was observed between major and intermediate thalassemic cases. There was no correlation between the therapy and the findings. Upper limb involvement was almost equal to the lower limb involvement in contrast to a previous study.
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PMID:[Rheumatologic findings in patients with major and intermediate beta-thalassemia]. 273 54

Upper limb pain occurred in close temporal association with attacks of migraine, cluster headache and cluster-migraine in 22 cases. Seven had also lower limb pain. Limb pain was usually ipsilateral to the headache but could alternate sides and behaved like other accepted migraine accompaniments. It was always ipsilateral to the associated paraesthesiae/numbness (9 cases) and weakness (6 cases). The distribution and restricted localisations of limb pain were similar to those of the sensory symptoms and could not be accounted for by primary dysfunction of the peripheral or autonomic nervous systems. A central origin for limb pain is postulated. A temporary dysfunction in the somatosensory cortex, and/or its thalamic connections, during migraine or cluster headache attacks, might mediate such pain in a number of patients.
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PMID:Limb pain in migraine and cluster headache. 321 4

A syndrome of peripheral polyneuropathy associated with islet cell tumors and hypoglycemia has been reported in 28 patients. Despite varying features in these patients, the clinical characteristics of this syndrome are remarkably similar. These consist of the development of a sensorimotor neuropathy during a protracted course of recurrent severe hypoglycemia, related to underlying insulinoma. Cerebral symptoms dominate the clinical picture and a predominantly or entirely motor, distal and symmetric, peripheral neuropathy ensures. Upper limb involvement is more frequent, accompanied by severe weakness and distal wasting, usually without fasciculations. Painful distal paresthesias without objective sensory loss are characteristic. Direct relationship to a single hypoglycemic insult is often absent. This report describes the clinical features and laboratory investigation of a new case with this condition, reviews the literature and discusses the syndrome with special regard to the etiology.
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PMID:Hypoglycemic peripheral neuropathy in association with insulinoma: implication of glucopenia rather than hyperinsulinism. Case report and literature review. 627 47

Although 90% of the surgical procedures performed on patients with OI are on the lower limbs, intramedullary fixation of the humerus may at times be indicated also in the upper limb for the correction of deformity and improvement of function. Upper limb deformities are generally present only in patients with severe disease (osteogenesis imperfecta congenita or osteogenesis imperfecta tarda I). The recommendations expressed in this paper are based on experience with 36 intramedullary rod fixation procedures on the upper limb in 12 patients with osteogenesis imperfecta, including 24 on the humerus, five on the radius and seven on the ulna. A Rush pin provided satisfactory fixation for the humerus, when inserted from its proximal end. Intramedullary rods were extremely difficult to insert in the forearm bones, and the author considers the operation to be rarely indicated. Two interesting and unusual problems in the upper extremities have been encountered in patients with osteogenesis imperfecta: deformity of the clavicle severe enough to cause pain and limited motion, and unicameral bone cysts in the upper humerus.
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PMID:Upper limb surgery in osteogenesis imperfecta. 728 51

Pain is not usually considered a symptom of chronic relapsing demyelinating polyneuropathy. We report two patients with chronic demyelinating polyneuropathies in whom clinical and electrophysiological worsening was associated with the development of deep and distressing upper limb aching discomfort. One patient had a MGUS-associated hypertrophic demyelinating and prednisone-dependent polyneuropathy, followed over a course of two and a half years. His discomfort regularly predicted electrophysiological relapse of neuropathy, before more obvious clinical signs had emerged. Resolution of the discomfort also predicted subsequent clinical and electrophysiological improvement. Upper limb pain may be an important feature of early relapse in some patients with demyelinating polyneuropathies. Standardized serial electrophysiological testing in patients with chronic demyelinating polyneuropathy can be an important management tool in conjunction with clinical signs and symptoms.
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PMID:Upper limb pain in chronic demyelinating polyneuropathy: electrophysiological correlates. 783 14

In order to clarify the factors that mainly influence arm morbidity following treatment of breast cancer with the full axillary dissection protocol, we evaluated, in a model of multiple regression analysis, parameters such as the type of breast surgery, adjuvant radiotherapy, time of irradiation, age, number of dissected nodes and axillary nodal status. A total of 104 women were studied. Late arm edema was observed in 17% of the patients and was more frequent when (1) irradiation was given immediately after the operation than if it was given 6 months later (p = 0.009) and (2) the number of removed nodes exceeded 40 (p = 0.037). Upper limb pain was reported by 16% of the patients and was reported more frequently from patients over 60 years of age (p = 0.036), as well as from patients who underwent modified radical mastectomy (p = 0.044) and those in whom 30-40 nodes were dissected (p = 0.025). Shoulder joint mobility was impaired in 17% of the patients, and it was not affected by any of the examined factors. It seems that conservative breast surgery or adjuvant breast radiotherapy 6 months after the operation might reduce independently the likelihood of arm morbidity by 25%.
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PMID:Arm morbidity following treatment of breast cancer with total axillary dissection: a multivariated approach. 823 85

Upper limb pain frequently occurs in manual wheelchair users. Analyzing the pushrim forces and hub moments occurring during wheelchair propulsion is a first step in gaining insight into the cause of this pain. The objectives of this study were as follows: to describe the forces and moments occurring during wheelchair propulsion; to obtain variables that characterize pushrim forces and are statistically stable; and to determine how these variables change with speed. Convenience samples (n = 6) of paralympic athletes who use manual wheelchairs for mobility and have unimpaired arm function were tested. Each subject propelled a standard wheelchair on a dynamometer at 1.3 and 2.2 m/s. Biomechanical data were obtained using a force- and moment-sensing pushrim and a motion analysis system. A number of variables that describe the force and moment curves were evaluated for stability using Cronbach's alpha. Those measures found to be stable (alpha > 0.8) at each speed were then examined for differences associated with speed. The tangential, radial, and medial-lateral forces were found to comprise approximately 55, 35, and 10% of the resultant force, respectively. In addition to duration of stroke and propulsion, the following variables were found to be stable and to differ with speed (1.3 m/s +/- SD; 2.2 m/s +/- SD): peak force tangential to the pushrim (45.9 +/- 17.9 N; 62.1 +/- 30 N), peak moment radial to the hub (9.8 +/- 4.5 N x m 13.3 +/- 6 N x m), maximum rate of rise of the tangential force (911.7 +/- 631.7 N/sec; 1262.3 +/- 570.7 N/sec), and maximum rate of rise of the moment about the hub (161.9 +/- 78.3 N x m/s; 255.2 +/- 115.4 N x m/s). This study found stable parameters that characterize pushrim forces during wheelchair propulsion and varied with speed. Almost 50% of the forces exerted at the pushrim are not directed toward forward motion and, therefore, either apply friction to the pushrim or are wasted. Ultimately, this type of investigation may provide insight into the cause and prevention of upper limb injuries in manual wheelchair users.
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PMID:Three-dimensional pushrim forces during two speeds of wheelchair propulsion. 935 97

Clinical, biological and electrophysiological features from a cohort of 39 multifocal motor neuropathies with conduction blocks (NMM with CB) have been studied. There were 29 males and 10 females with an average of 47.3. At the first evaluation, the mean duration of the symptoms was of 8 years with extremes between 1 and 28. Pain and paresthesias were present in respectively 10 and 18 p. 100 of the patients. Fasciculations and cramps were observed in more than 2/3 of the cases. Three patients had tremor at rest. Upper limb muscular weakness was the predominant initial symptom (84.6 p. 100). The weakness always affected distal and unilateral muscles. Radial and cubital nerve distribution are mainly affected and in half of the cases an unilateral motor deficit in the lower limb was associated. Muscle atrophy was frequent (74 p. 100) and rapidly developed in the first 2 years. Reflexes were decreased or absent in 64 p. 100. In 78 p. 100 of cases, biological study showed normal serum immunoelectrophoresis and CSF. IgM anti-GM1 antibodies were found in 24/36 patients. Very high titres were found in 5 cases. All patients had CB in upper limbs. The preferential localizations of the CB were equally at the median and ulnar nerves. Only 7 patients had CB localized to the lower limbs. In many cases, marked reduction of the motor amplitude prevented the detection of CB, marked reduction of the motor amplitude prevented the detection of CB. Moderate fibrillation potentials were found in 28 p. 100 of patients. Giant muscular unit potentials were frequent (21/39). F-waves in nerve with CB were always abnormal with marked increased latencies. Late responses sometimes seemed to be repeater F-waves. Axon reflexes were detected in 5 cases. The late responses abnormalities could precede the block. Clinical, biological and electrophysiological described arguments could may distinguish NMM with CB from motor neuron disease and relate them to the group of chronic demyelinating neuropathies.
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PMID:[Multifocal motor neuropathies with conduction blocks. 39 cases]. 968 22

Diabetic radiculoplexopathy is commonly viewed as a condition affecting the lower extremities. However, other regions may also be affected and the presence of upper extremity involvement has rarely been emphasized. Our goal was to illustrate the clinical features of arm involvement in this condition. Of 60 patients with diabetic lumbosacral radiculoplexopathy, we identified 9 who also had upper extremity involvement. The study included 8 men and 1 woman, ranging in age from 36 to 71 years. Upper limb involvement developed simultaneously with the onset of lower limb disorder in 1 patient, preceded it by 2 months in another patient, and occurred between 3 weeks and 15 months later in the remaining 7. In 5 cases, arm involvement developed after symptoms in the legs began to improve. The upper extremity weakness affected the hands and forearms most severely. It was unilateral in 5 patients and bilateral but asymmetric in 4. Pain was often present, but it was not a prominent feature. In most patients, neurologic deficits in the arms improved spontaneously after 2-9 months. We conclude that diabetic radiculoplexopathy may involve the cervical region before, after, or simultaneously with the lumbosacral syndrome. The upper limb process is similar to that in the legs, with subacutely progressive weakness and pain followed by spontaneous recovery.
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PMID:Cervicobrachial involvement in diabetic radiculoplexopathy. 1136 Feb 63

The objective of this study is to undertake a population based study on the incidence, prevalence, natural history, and response to treatment of complex regional pain syndrome (CRPS). All Mayo Clinic and Olmsted Medical Group medical records with codes for reflex sympathetic dystrophy (RSD), CRPS, and compatible diagnoses in the period 1989-1999 were reviewed as part of the Rochester Epidemiology Project. We used IASP criteria for CRPS. The study population was in the Olmsted County, Minnesota (1990 population, 106,470). The main outcome measures were CRPS I incidence, prevalence, and outcome. Seventy-four cases of CRPS I were identified, resulting in an incidence rate of 5.46 per 100,000 person years at risk, and a period prevalence of 20.57 per 100,000. Female:male ratio was 4:1, with a median age of 46 years at onset. Upper limb was affected twice as commonly as lower limb. All cases reported an antecedent event and fracture was the most common trigger (46%). Excellent concordance was found between symptoms and signs and vasomotor symptoms were the most commonly present. Three phase bone scan and autonomic testing diagnosed the condition in >80% of cases. Seventy-four percent of patients underwent resolution, often spontaneously. CRPS I is of low prevalence, more commonly affects women than men, the upper more than the lower extremity, and three out of four cases undergo resolution. These results suggest that invasive treatment of CRPS may not be warranted in the majority of cases.
Pain 2003 May
PMID:Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. 1458 Nov 29


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