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

In 465 patients treated surgically for low back and lower extremity disability, almost 10 per cent had femoral rather than sciatic distribution of pain. The average age of patients who had a primarily femoral distribution of pain is higher by a decade than those who had a predominantly sciatic distribution of pain; the higher level of the lesion and greater incidence of apophyseal joint arthritis may be associated with the aging process. The femoral distribution of pain may lead to difficulties in differential diagnosis between a spinal origin and a hip or knee origin of the problem. Radiculopathy causing femoral pain may be the result of both disk degeneration with protrusion and apophyseal arthritis with synovitis. Neuritis of the L4 nerve root is more commonly the result of a lesion at the L4-5 nerve root foramen than centrally at the L3-4 disk level. The syndrome of low back pain with femoral neuritis is not uncommon 5 or more years after an otherwise successful L4-S1, two level spine fusion. This syndrome can result from an L3-4 disk protrusion with nerve root neuritis but may be a reflex disturbance from the posterior arch structures as evidenced by fusion mass, apophyseal joint or spinous process overgrowth and associated soft tissue inflammation.
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PMID:Low back pain with femoral neuritis. 12 41

Clinical electrophysiological studies were analysed in 60 consecutive patients with back pain with or without other evidence for a radiculopathy. These studies included needle EMG of relevant limb and paraspinal muscles as well as F responses and H reflexes recorded from the soleus muscle. Segmental denervation was found in 29 of the 60 patients. In 57 patients, abnormal slowing of the F response was present in 27, either unilaterally (25) or bilaterally (two). In 18 of 47 patients with H reflex studies, the H reflex was either unilaterally absent (12), asymmetrically prolonged (five), or bilaterally prolonged (one). Statistically significant (P less than 0.05) associations were found between (1) abnormalities of H reflexes and F responses, (2) F response slowing and radicular injury shown by EMG, (3) segmentally consistent radiographic defects and abnormalities of both H reflexes and F responses, and (4) depressed Achilles reflexes as well as sensory loss and abnormal H reflexes. No significant association, however, was present between abnormalities of EMG, F responses, or H reflexes and pain radiation by history or positive straight leg-raising tests. These data suggest that pain in radicular syndromes is related to the functioning of smaller afferent fibres.
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PMID:Clinical and electrophysiological appraisal of the significance of radicular injury in back pain. 20 69

Many diseases affecting the peripheral nervous system or the spinal canal may be associated with pathology in the nerve roots, but the most common sources of radiculopathy are conditions that cause direct compression of nerve roots, including prolapsed intervertebral disks, disk degeneration, and osteoarthrosis of the apophyseal joints. The risk for prolapsed lumbar disk is highest in the group 20 to 39 years of age, and it is probably increased by the driving of motor vehicles, full-term pregnancies, and sedentary occupations. Cervical disk prolapses tend to occur in a slightly older age group, but very little is known of specific etiologic agents. Both lumbar and cervical prolapses usually occur in a posterior-lateral direction, and thus they are generally associated with nerve root impingement. Both osteoarthrosis of the apophyseal joints and disk degeneration sometimes progress to nerve root involvement. Although the shape and position of the involved structures undoubtedly influence the likelihood of radiculopathy, it is unclear what other factors cause some individuals to progress to the stage of nerve root involvement and not others. Prevalence rates for osteoarthrosis of the lumbar and cervical spines increase markedly with age, and both are sometimes associated with generalized osteoarthrosis. Mechanical stresses from heavy occupations such as mining and from certain structural abnormalities of the spine such as spondylolisthesis predispose to osteoarthrosis of the lumbar spine. However, little is known about factors associated with osteoarthrosis of the cervical spine. The nature of the stress related to development of osteoarthrosis in the lumbar spine is not known. Disk degeneration is also strongly related to age, with preliminary degenerative changes occurring as early as 20 to 29 years of age and osteophyte formation tending to occur from the fifth decade on. Mechanical stress from heavy occupations is associated with lumbar disk degeneration, but, again, little is known about etiologic factors in cervical disk degeneration. It is apparent that much remains to be learned about the etiology and natural history of these conditions, and it is clear that the gaps in knowledge are even greater for the cervical region than for the lumbar spine. In view of the relatively high frequency of occurrence of these conditions and the amount of pain and disability they cause, epidemiologic studies of etiology and natural history are urgently needed.
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PMID:Epidemiology of radiculopathies. 36 27

Eighteen women, all of whom had extensive but noninformative breast evaluations, including 10 mammograms and 4 biopies, were successfully treated by cervical traction for chronic breast pain. Each patient had distinct clinical or electromyographic evidence of cervical root compromise. Fifteen had roentgenographic evidence of cervical spondylosis, primarily at levels C6 and C7. Cervical angina, as a symptom constellation produced by cervical radiculopathy and mimicking coronary ischemic disease, is a well-defined entity. Less well recognized is persistent breast pain as a primary presenting symptom of cervical root compromise. In both instances, the early identification of the cervical radicular origin of the pain, with its quite different prognosis and associated therapeutic implications, can promptly help to allay the patient's physical and psychologic discomfort. The pathologic mechanism of pain production and the anatomic pattern of referral are described.
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PMID:Breast pain: a symptom of cervical radiculopathy. 45 30

Clinical and electrophysiological studies were performed on 250 patients with carpal tunnel syndrome. Acroparaesthesia was often referred to all digits (64%) and proximal pain was not uncommon (46%). The male patients as a group differed from the female in that nocturnal acroparaesthesia was less frequent and a causal of predisposing factor was identifiable in the majority (76%). The most common associated condition in the females was trigger finger (11%). An associated ulnar nerve lesion was rare. Delay in diagnosis was attributable to cultural factors or lack of awareness of the occurrence of diffuse acroparaesthesia and proximal pain in the syndrome. Sensory signs were commoner (85%) than motor (53%). The most useful clinical finding was digital sensory 'splitting' (ring finger) which was present in 58% of hands and clearly distinguished the condition from a radiculopathy, myelopathy or a diffuse polyneuropathy. In general, the diagnostic yield of any test depends on the duration of the disease. Of the various electrodiagnostic tests employing surface electrodes, the most sensitive was the comparison of the median (index finger) to ulnar (little finger) sensory amplitude. This was abnormal in 73% of hands and was found to be particularly useful in patients with a probable background of polyneuropathy or suspected cervical rib syndrome. Slowing of sensory conduction was demonstrable in 67% of hands, decreased sensory amplitude in 44% and prolonged motor latency 35 to 32%. A combination of the various electrodiagnostic tests yielded a positive result in 91%. Decompression resulted in complete recovery in 85% and some improvement in all the remaining patients. The outcome was adversely affected by the presence of several neurological deficits but apparently not by the presence of a coexisting disease.
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PMID:The carpal tunnel syndrome: a clinical and electrophysiological study of 250 patients. 61 9

Chronic lumbar radiculopathy following spinal surgery is reported, in which 7 of 25 patients reviewed developed a postoperative syndrome immediately after their original surgery. Later, sometimes years later, all 7 patients developed severe chronic spinal arachnoiditis. This syndrome was characterized by transient violent spasms in the legs, muscle cramps, increased radicular pain, and often fever and chills. The recognition of this syndrome and a proposed method of treatment is discussed.
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PMID:Chronic spinal arachnoiditis. A postoperative syndrome that may signal its onset. 64 96

In diabetes mellitus, pain and weakness in a lower extremity can result from lumbosacral radiculopathy. However, abdominal pain caused by a similar type of thoracic nerve root disease is not generally recognized. Four diabetic patients with abdominal pain were studied. In none of the patients was the actual cause--radiculopathy--suspected until after extensive negative diagnostic investigation, which frequently included invasive procedures. Their clinical features were suggestive of malignant disease. Electromyographic examination revealed the correct diagnosis, and all four of the patients had a spontaneous and complete recovery.
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PMID:Abdominal pain caused by diabetic radiculopathy. 83 36

The exact cause of tennis elbow, a common condition, is still obscure. While the condition may well be entirely due to a local disorder at the elbow, the results of a study of 50 patients whose condition was resistant to 4 weeks of treatment directed to the elbow suggest that the underlying condition may have been (at least in these patients) a reflex localization of pain from radiculopathy at the cervical spine. Clinical, radiologic and electromyographic findings supported this suggestion. The pain was demonstrated to be muscular tenderness, which was maximal and specific at motor points. Treatment directed to the cervical spine appeared to give relief in the majority of patients. The more resistant the condition, the more severe were the radiologic and electromyographic findings in the cervical spine.
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PMID:Tennis elbow and the cervical spine. 126 91

Persistent lower extremity pain after unsuccessful lumbar surgery continues to be a disabling condition. The results of deafferentation procedures for radiculopathy have been disappointing. Hence, the prospect of isolating a potentially reversible component of extremity pain is quite attractive. Given the frequency with which vasomotor complaints occur in this setting, the occurrence of autonomic dysfunction seems quite plausible. Autonomic dysfunction was investigated in 17 patients who had undergone previous lumbar surgery and had chronic limb pain. Patients underwent a preblockade thermogram, sympathetic blockade, and postblockade thermograms. All patients reported substantial relief after blockade, and all underwent retroperitoneal sympathectomy. All patients were followed for at least 2 years. The clinical results were disappointing, with only one patient reporting substantial relief. Although the results of thermography initially seemed to correlate with clinical outcome, further follow-up failed to yield any correlation. Additionally, no specific combination of response to blockade or thermogram was predictive of the clinical success after sympathectomy. Now, lumbar sympathectomy is not recommended in the setting of chronic radiculopathy and persistent extremity pain.
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PMID:The treatment of chronic extremity pain in failed lumbar surgery. The role of lumbar sympathectomy. 750 48

Sacral perineural cyst is a relatively rare condition. To our knowledge, reports of MR findings associated with sacral perineural cyst have been limited to only six cases. We present for the first time high field MR findings in a case of sacral perineural cyst. The cyst appeared as a cystic lesion in the sacral spinal canal and had intermediate signal intensity on T1W images and high signal intensity on T2*W images compared with CSF. Slight erosion remodeling of the sacrum was also seen anteriorly. Our case was symptomatic and present with radiculopathy (sciatic pain). Surgical treatment was done to result in dramatic improvement of the sciatic pain.
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PMID:MRI of symptomatic sacral perineural cyst. 133 20


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