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

The authors describe two patients with posterior thoracic pain associated with cysts of the septum posticum. One patient's pain was relieved by surgical removal of the cysts; the second patient's symptoms temporarily resolved after myelography. Posterior thoracic pain can be ascribed to myelographically proven arachnoid cysts when the pain is persistent, positionally exacerbated and associated with radicular sensory changes. Excision of the cysts may provide pain relief for some patients.
Pain 1975 Sep
PMID:Septum posticum cysts: an uncommon cause of chronic back pain. 14 43

Traumatic dislocations of the sternoclavicular joint may be anterosternal or retrosternal. Anterior dislocation is due to forces which retract and depress the clavicle. Posterior dislocation is due to either direct force on the medial end of the clavicle or to a force acting on the posterolateral aspect of the shoulder. From 1950 to 1974 we treated 16 patients with traumatic complete sternoclavicular dislocations. Twelve patients were followed and their cases are discussed. Treatment may be closed or open. In some cases we did not attempt reduction because it may be very difficult to maintain and dislocation may recur. Open reduction is extremely difficult and not recommended unless a serious intrathoracic problem also exists. Based on our cases, we conclude that stability of the sternoclavicular joint is not necessary to ensure normal function of the involved limb. The residual prominence of the medial portion of the clavicle does not cause pain and does not interfere with chest or shoulder function.
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PMID:Traumatic sternoclavicular dislocation. 62 48

1. Central projections of messages evoked by dental pulp stimulation have been searched for in awake cats and recorded at unitary level. A head-top frame screwed to the skull served to fix the animal in the stereotaxic instrument precisely and in the usual orientation. 2. Three types of responses could be distinguished, each with characteristic thalamic localization: --one was of the specific type: it occurred at short latency, followed rapid rates of stimulation, and was localized in VPM and SG; --a second type had longer latency, did not follow rapid rates of stimulation, was frequently bilateral, and was localized in VPM, CM-Pf and Posterior Group; --the third type was a complex response, exhibiting inhibitory and excitatory phases; extremely labile, it disappeared during wakefulness; it was found in LP and CM-Pf. 3. The responses elicited by dental pulp stimulation and recorded in the periaqueductal grey matter mostly originated from face muscle messages provoked by the jaw opening reflex. 4. The possible contributions to pain perception made by each of the different thalamic responses is discussed, as well as the adequacy of dental pulp stimulation for producing a purely nociceptive signal.
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PMID:Thalamic and mid-brain responses to dental pulp afferent messages in awake cats. 92 32

A constitutional narrowing of the cervical spinal canal was seen in 31 patients with neurological disorders. The ratio of the inner diameter of the spinal canal to the diameter of the vertebral body was smaller than 1 (normal greater than 1). Clinical signs were observed from 45 years upwards where reactivedegenerative changes cause additional narrowing. The majority of patients were male, predominantly heavy manual labourers. There is often a trauma preceding. On myelography multilocular deformations of the spinal subarachnoid space and nerve roots are seen. On the mechanical narrowing of the spinal canal a vascular factor supervenes, caused by exostoses, intervertebral disc protrusions, and fibrosing processes. Clinically a chronic progressive spinal transection syndrome (cervical myelopathy) dominates besides a multilocular root involvement. Posterior column sensibility is predominantly lost. Pain in the extemities and the cervical column is an early symptom. Non-specific CSF changes occur frequently. In case of root involvement the electromyogram is pathological. The prognosis is bad. Operation can only remove reactive processes but not the constitutional anomaly.
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PMID:[Constitutional narrowing of the cervical spinal canal. Radiological and clinical findings]. 111 55

Pain along the sciatic nerve can be due to many causes. Sciatica of radicular origin caused by compression of L5 or S1 root is usually separated from truncular or peripheral sciatica. Radicular sciatica is divided into mechanical sciatica and the so-called inflammatory sciatica. In the majority of cases radicular pain is of mechanical origin and due to discal herniation in L4-L5 or L5-S1. The herniation can be visualized by lumbar computerized tomography or by radiculography. However, discal herniation alone does not fully account for the pain suffered, and inflammatory processes around the disc and the nerve root play an important role. Posterior intervertebral osteoarthritis and lumbar canal stenosis also are frequent causes of sciatic pain. Truncular sciatica is much less frequent and should incite clinicians to investigate for pelvic tumoral infiltration. Peripheral sciatica is usually caused by suffering of the external popliteal nerve around the neck of the fibula, but it may also be caused by compression of a ramus from the internal popliteal nerve, resulting in tarsal tunnel syndrome or in Morton's syndrome.
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PMID:[Causes and mechanisms of sciatic pains]. 131 74

Posterior tibial tendon dysfunction, a common entity, frequently is unrecognized and inappropriately managed. Acutely, pain and swelling are present over the medial ankle and longitudinal arch. Long-standing inflammation can lead to tendon rupture, resulting in a progressive planovalgus or "flat foot" deformity. Plain radiographs illustrate the changes in bony anatomy associated with chronic posterior tibial deficiency, while magnetic resonance imaging scans can identify the three stages of posterior tibial tendon pathology. Most cases are amenable to conservative therapy, including rest and administration of nonsteroidal antiflammatory agents. Often a short period of immobilization in a cast or the use of an orthosis is beneficial. In cases with persistent tenosynovitis, complete tendon rupture, or progressive deformity, surgical intervention is indicated.
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PMID:Posterior tibial tendon dysfunction. 143 42

Antituberculous medication for treatment of tuberculosis has been used for nearly a half century. However, tuberculosis of the spine still shows up from time to time in the developed countries and it is still a common scourge in half of the world today. The author reviews his treatment of tuberculosis of the spine over 30 years' full-time work in developing countries. He gives an analytical breakdown of his first 10 years of operating on 236 cases, both paralytic and nonparalytic. Changes in treatment developed with experience. Posterior spinal fusion gave good results. Radical evacuation of the abscess alone gave poor results. Best results were obtained in the combination of the two. This surgery provided a stable, pain-free spine and shortened period of time that antituberculous medication was required. A true lateral approach for spinal decompression was developed and is described. This procedure can be performed by ordinary orthopedic teams in developing countries. It is safer than the transthoracic approach and gives better exposure.
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PMID:Tuberculosis of the spine: a review of 236 operated cases in an underdeveloped region from 1954 to 1964. 843 25

From 1986 to 1990 50 patients with increasing spinal instability due to pathologic fractures of one or more vertebrae were operated in the Orthopedic Department of Mainz University Hospital. In the course of 57 operations anterior decompression and stabilization were performed 3 times, whereas dorsal spondylodesis was done with Cotrel-Dubousset's instrumentation (CDI) 32 times, with Luque's 7 times and with Harrington's 1 time; a combination of CDI and Luque was chosen in 2 cases, a combination of Harrington and Luque in 1 case. 3 times a single-stage combination and 4 times a two-stage combination of ventral and dorsal stabilization was used. The application of the CDI required no postoperative external support. 35 patients suffered from major neurologic deficits preoperatively--among them 11 from a complete and 6 from an incomplete paraparesis--which made spinal cord decompression necessary in advance of the dorsal stabilization. Of these, 16 improved significantly; however, deterioration of the neurologic status occurred in 4 cases with a paraparesis in 3 of them. Survival time postoperatively was approximately 13 months in 27 patients. 9 of these died within half a year after the operative intervention. Failure of fixation as a result of tumor lesion was found in 2 cases of CDI procedure and in 1 case of the Harrington instrumentation. All required a revisional operation. 3 patients developed a radiologic lysis of methylmethacrylate implants fixed by an anterior procedure. Posterior decompression and stabilization render possible resolution of spine pain as well as restoration of mobility until a few days before exitus letalis without restricting adjuvant radio- or chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Significance of dorsal decompression and instrumentation in the treatment of spinal malignancies]. 153 72

We present three patients with a nontraumatic cervical anterior spinal artery syndrome, two of whom developed painful burning dysaesthesias below the level of spinal cord lesion, refractory to opiate, anticonvulsant and tricyclic antidepressant therapy. Quantitative sensory testing and neurophysiological assessment showed absence of pain and temperature sensation below the level of the lesion, with preservation of light touch, vibratory and position sensibilities and cortical somatosensory evoked potentials in all three patients. Dysaesthesias in both affected patients were exacerbated by somatosensory input attributed to intact posterior column function. Posterior column electrical stimulation worsened the dysaesthesias in one affected patient, and was ineffective in the other. Both patients affected with dysaesthesias showed significant improvement in motor function and developed clinical spasticity, while the third patient developed neither dysaesthesias nor spasticity, but remained flaccid without motor improvement, suggesting a more complete lesion of anterolateral spinal pathways. These cases illustrate that lesions of the anterolateral spinal cord may lead to the development of dysaesthesias, perhaps related in part to selective neospinothalamic deafferentation and preservation of the posterior columns.
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PMID:Sensory abnormalities and dysaesthesias in the anterior spinal artery syndrome. 155 53

Shoulder dislocations associated with a displaced fracture of the humeral head or glenoid require different treatment than shoulder dislocations without fracture. If the humeral head is fractured, two possible complications must be considered:impairment of the subacromial gliding mechanism and insufficient blood supply to the humeral head. In glenoid fractures, instability may be induced. The degree of instability depends on the size of the fragment. In fractures of the humeral head, in particular of the greater tuberosity, we differentiate between the so-called en bloc fracture and the so-called supra-spinatus avulsion fracture. In "en bloc" fractures, one has to be aware that displacement of the fragment can occur not only in the superior direction but in the posterior direction as well. Posterior displacement is displayed radiologically by the "tangential" view. Both the duration of pain and range of motion depend on the amount of displacement of the fragment. Displacement exceeding 3 min in one direction should be reduced surgically in the active patient. For operative treatment of a displaced "en bloc" fracture, we recommend closed reduction and percutaneous screw fixation performed under regional anesthesia. "Supraspinatus avulsion fractures" ought to be treated like rotator cuff tears because there is no possibility of the small fragments healing due to their placement on the joint cartilage. In fracture dislocations, the blood supply of the humeral head is seriously jeopardized if the fracture is situated in the anatomical neck, whereas this is not the case in a fracture of the surgical neck. The number of displaced fragments allows a prediction concerning the survival of the articular segment of the humeral head.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dislocation fractures of the shoulder. Special status and therapeutic concepts]. 159 33


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