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

The anterior interosseous nerve branches off from the median nerve distal of the pronator radii teres. It lies on the interosseous membrane, always innervates the flexor pollicis longus, usually the portion of the deep flexor belonging to the second, sometimes also the portion belonging to the third finger, then runs to the pronator quandratus. In 4 cases of our own and in 49 cases from the literature we could show that an isolated lesion of the motor division of the median nerve has been seen after fractures and in connection with dull traumas, unusual activities, pressure and medical procedures. A mechanical origin can be assumed also in the so-called "spontaneous" cases of paresis without any indication of exogenous influence. It is described twice as often on the right as on the left side and in 15 of 17 cases of operative revision fascial bands, adhesions, and similar compressions were found. Frequently, the only sign of the syndrome is paresis of the flexor pollicis longus. The diagnosis becomes clearer, when the flexor digitorum profundus is also affected, since the extension of the first two or three end phalanges during flexion of all fingers constitutes a characteristic clinical feature. Occasionally, pain is present on the outside of the forearm, and this can lead to differential diagnostic reflections. In spite of the convincing operative findings we find that the experience to date is not sufficient to give a general recommendation for operative treatment. The prognosis is favorable, apparently even without operative revision; in some cases, however, as in one of our patients, the paresis does not improve until the second year after onset.
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PMID:[N. interosseous anterior syndrome. Study in 4 cases of our own and in 49 cases from the literature (author's transl)]. 6 31

In the differential diagnosis of intermittent claudication some rare myopathies have to be considered. The most frequent is phosphorylase deficiency (McArdle's disease). Exercise-induced muscular pain, weakness, contractures and occasionally myoglobinuria are the most prominent clinical signs. Serum creatine phosphokinase, aldolase and lactic dehydrogenase may be elevated after exertion. In the ischemic forearm test there is no rise of serum lactic acid. The enzyme deficiency can be demonstrated by histochemical and biochemical examination of a muscle specimen. Further, but more infrequent, enzymatic disturbances of glycolysis are phosphofructokinase deficiency and phosphohexoisomerase inhibitor, which also yield an abnormal ischemic forearm test and must be demonstrated histochemically and biochemically. Apart from muscular signs, myopathy with lactic acidosis is associated with palpitation, dyspnea and exhaustion, and a disproportionate rise in serum lactic acid level after exertion. Histochemically and electronmicroscopically demonstrable fat accumulation in the muscle can be a sign of a disturbance in lipid metabolism. This type of exercise-induced myopathy has been reported only in a few cases with carnitine-pylmityltransferase deficiency, which has to be demonstrated biochemically. Muscular contractures also exercise-induced but painless and reversible within seconds may be due to deficient uptake of sarcoplasmic calcium in the tubular system. Dyskalemic paralysis causes painless paresis within minutes of hours after exertion, which disappears within hours to a few days. Myopathy with tubular aggregates can be differentiated from other exercise-induced myopathies by morphology. Myotonia combined with painful contractures characterizes myopathia myotonica.
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PMID:[Exercise-induced muscular weakness, myalgia and contractures. I. A clinical review]. 13 80

Cordotomy should be reserved for patients with intractable pain resistant to conservative treatment that is not of a dysaesthetic type. The high cervical percutaneous technique permits exploitation of the principles of stereotactic surgery, especially physiological localization of the lesion site. The induction by 100 Hz stimulation of a warm or cool tingling in some portion of the contralateral half of the body without muscle tetanization ensures location within the spinothalamic tract while attention to the somatotopographic organization of the responses permits a certain degree of tailoring of the extent of analgesia to the patient's needs. During 264 consecutive procedures the spinothalamic tract was successfully located in 99% with a 0.3% incidence of significant persistent paresis.
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PMID:Percutaneous cervical cordotomy. 14 48

Extra- and intraneural ganglionic cysts rarely involved peripheral nerves. They are found in the neighbourhood of large joints. The ulnar nerve is affected most often by extraneural cysts at the wrist. Intraneural cysts prefer the peroneal nerve at the tibiofibular joint. Ganglionic cysts as a cause of peripheral nerve damage are often overlooked, mainly because they are not considered as a cause of pain, paresis or sensory changes. Surgical treatment is recommended.
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PMID:[Ganglions a rare cause of isolated peripheral nerve lesions]. 18 20

The paper is concerned with the results of a clinical electrophysiological, biochemical, histochemical, X-ray and morphological study of 289 patients with different vegetovascular and trophical disturbances, mainly of a regional character, in the facial area. Some clinical aspects and questions of the pathogenesis of these disturbances are discussed which are not sufficiently reflected in the literature. It is suggested that the form of the pterygopalatine ganglion is related to the incidence of the pathological process and the traits of vegetative and pain phenomena, accompanying the Sluder syndrome. Vegetovascular changes were revealed in the skin of the face and enzymatic changes in mucous membrane of the nose on the homolateral to the paresis side of the face in lesions of the facial nerve. Specific vegetative trophical changes were also found in a progressive hemiatrophy of the face, Barrakera-Simons disease, in the syndrome of facial hemistrophy due to lesions of the different vegetative and somatic structures of the nervous system.
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PMID:[Facial autonomic and trophic disorders]. 22 Aug 26

Painful ophthalmoplegia is characterized by unilateral involvement of the IIIrd, IVth and VIth cranial nerves, as well as supra- and retro-orbital pain, i.e. participation of the Vth cranial nerve. The pain is relieved within 48-72 h with steroid therapy. The paresis of the eye muscles in various combinations usually subsides gradually from within a few weeks to several months. The etiology is unknown. The few pathological examinations reported in the literature showed an unspecific inflammatory granulation tissue around the intracavernous portion of the carotid artery and on the dura mater in the vicinity of the cavernous sinus. Carotid arteriography may show stationary waves of this artery and narrowing of its intracavernous portion. With orbital phlebography the occlusion of the supraorbital vein and obstruction of the cavernous sinus are sometimes demonstrable. The syndrome is well defined and its etiology still unknown.
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PMID:Painful ophthalmoplegia: the Tolosa-Hunt syndrome. 23 81

A new technique for the functional treatment of chronic intractable pain with a cerebral stimulation system under the patient's control is described. A four-pole electrode, diameter 0.65 mm (made by Medtronic), was implanted under stereotaxic control into nine patients. Stimulation was via a substernally implanted receiver connected to the intracerebral electrode. A pocket-sized stimulator with circular aerial, intermittently placed on the patient's skin, was activated by the patient whenever pain occurred. Pain suppression was achieved in all instances, best results being obtained with stimulation of the medial mesencephalic lemniscus, including the sensory-motor thalamic nuclei. The pain-suppressing effect lasted for up to seven hours, so that three stimulations for 30-40 minutes daily were sufficient, as demonstrated by an observation period of up to 21 months. The only complication was transitory oculomotor paresis. The described reversible non-destructive stereotaxic and functional technique of stimulation is preferable to the coagulation method in the treatment of chronic intractable pain.
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PMID:[Treatment of chronic pain with intracerebral stimulators]. 30 62

A new apparatus is described which delivers a functional electric stimulation, controlled by the peak EMG output signal as recorded from the forearm muscles. Twelve paretic hands were stimulated with this apparatus. The EMG output, the stimulus strength, the stimulus frequency, and the corresponding improvement of the wrist extension force were measured. Different arrangements of electrodes and various relay adjustments were tested. The investigations showed that even severely paretic muscles were capable of delivering an efficient EMG output, and the resulting improvement of wrist extension force was statistically significant. The necessary stimulus intensity showed no relationship to the degree of paresis, but a certain relationship to the recovery tendency of the hand was evident. Acceptance of the apparatus among the patients was satisfactory; only a few complained of pain during stimulation.
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PMID:EMG-controlled functional electrical stimulation of the paretic hand. 31 29

Spinal arterivenous malformations occur in the pediatric age range more commonly than previously acknowledged. An analysis of 64 cases with onset under 18 years of age demonstrates pain to be the most common first symptom. A long delay to diagnosis permits development of significant paresis or plegia in the majority. Correctly performed myelography (with supine views) provided the diagnosis in 60%. A radical microsurgical excision appears to offer the best long-term results.
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PMID:Arteriovenous malformations of the spinal cord in children. 45 8

Remitting paresis of the left leg accompanied by left trigeminal neuralgia led to the diagnosis of multiple sclerosis in a 46-year-old woman. Over the following 6 years, an incomplete syndrome of the spinal cord developed along with bilateral trigeminal pain. Neuroradiological and neurosurgical exploration a neurinoma located ventrolaterally at C1/C2 on the left side. It is emphasized that since trigeminal fibres descend as far as the upper part of the C2 segment, trigeminal neuralgia should not be considered as an exclusively supraspinal symptom.
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PMID:High cervical neurinoma (C1/C2) diagnosed falsely as multiple sclerosis because of trigeminal neuralgia. 49 15


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