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

The shoulder, a very common site of pain syndromes in medical practice, lends itself well to precise clinical analysis and identification of the pain-sensitive structure or structures. Once identified, rational and effective management can be applied, associated with predictably good prognosis. Early identification of the emerging specific syndrome is important in decreasing the duration of the clinical disorder and in achieving optimum return of shoulder function. Laboratory and X-ray studies are not commonly required in diagnosis and management. There are a confusing variety of names attached to the many shoulder pain syndromes; however, there are two most common categories. One is associated with severe pain but little or no limitation of shoulder movement (at least passive movement), in which the pain-sensitive structure is tendon or tendon sheath; the other is associated with both pain and limitation of active and passive motion, in which the pain-sensitive structures are capsule, bursa, and synovium as well as muscle and multiple tendons.
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PMID:The painful shoulder. 7 60

It is the attempt of this study to determine the efficacy of response to acupuncture at 24 hours, one week, and three week intervals at the end of a series of treatments in 328 patients. Treated for a variety of disorders, approximately 60% had satisfactory responses of up to 3 weeks duration. The 328 patients were classified into 13 categories of problem disorders: headaches, cervical pain, lumbar pain without radiation, lumbar pain with radiation, isolated sciatica, parathoracic pain, knee pain, elbow pain, shoulder pain, gereralized musculoskeletal pains (rheumatism), neurological disorders, and a general miscellaneous category. The problem disorders were then arranged into etiological categories. In general for each problem disorder, except for neurological, the average response ranged in the 60-65% range at the third week interval.
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PMID:The clinical response of 328 private patients to acupuncture therapy. 12 3

We review the literature on the application of electromyographic (EMG) biofeedback to tension-related headaches, back and shoulder pain, and temporomandibular joint (TMJ) pain and present clinical treatment data on 18 patients with tension headaches, eight patients with back and shoulder pain, and six patients with TMJ pain. Electromyographic tension levels declined in all groups of patients; pain declined significantly in 12 of 18 patients with tension headaches and one of eight back pain patients, and decreased slightly in three headache patients, three back and shoulder pain patients, and two patients with TMJ pain. Conclusions suggest that EMG biofeedback is generally more effective in treating tension headaches, but much less effective in the treatment of back, shoulder, or jaw pain, although the numbers of patients are small in the latter two groups.
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PMID:Electromyographic biofeedback for pain related to muscle tension. A study of tension headache, back, and jaw pain. 14 23

Pain syndromes in elderly patients are seldom psychogenic or due merely to "old age." Careful differential diagnosis is important, as judicious use of nerve blocks as adjunctive therapy often can relieve pain and restore activity. In the acute phase of shoulder pain, intrabursal injection of local anesthetic and steroid inhibits the inflammatory process. In the later stages, suprascapular nerve block relieves pain and interrupts afferent pain pathways. The occipital pain and headache of cervical arthritis also often respond to injection of 2 to 3 ml of long-acting anesthetic into the greater and lesser occipital nerves at the sites where they pierce the trapezius. Minor causalgia, shoulder-arm syndrome, or chronic traumatic edema may follow either forearm fracture or inflammation around the shoulder joint. Five stellate ganglion blocks with 1% lidocaine on alternate days, followed by 3 to 4 months of active and passive exercise, is the most effective treatment. This regimen usually produces a fully functional extremity. In degenerative disk disease, osteoarthritis, and metastatic disease, the cause of back pain is essentially the same--edema and inflammation of nerve roots at the intervertebral foramina. Injection of local anesthetic and steroid into the epidural space usually reduces swelling and inflammation. Patients are evaluated in 2 weeks and reblocked if improvement has plateaued. Pain relief most often is prompt and persists for an indefinite period.
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PMID:Relieving pain with nerve blocks. 14 96

For pain relief after thoracotomy, intercostal nerve block with etidocaine 1% and bupivacaine 0.5%, both containing adrenaline 5 mug/ml, was used. Duration of skin analgesia for sharp pain was around 11 hours for both solutions. Post-operative pain was noted 6 and 5 hours after injection for etidocaine and bupivacaine respectively. No pathological changes in acid-base balance or ventilation were observed. Peak expiratory flow decreased to 35-40% of the pre-operative values and remained at this level for about 12 hours. Arterial and venous blood levels of the local anaesthetics were low and no signs of toxicity were noted. All patients experienced a certain pain relief from the blocks. Because of shoulder pain in some patients intercostal nerve block alone does not seem to be a perfect post-operative method for pain relief after thoracotomies.
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PMID:Etidocaine in intercostal nerve block for pain relief after thoracotomy; a comparison with bupivacaine. 24 Nov 97

A questionnaire was circulated to the 708 members of the Spinal Cord Injuries Association in 1976. The response rate was 79.5%. Over one half (51.4%) of the respondents suffered from shoulder pain, an incidence in excess of any age group in a control population derived from a general practitioner's register. The pain, which was related particularly to wheelchair usage and other attendant factors such as transfers, was in some instances clearly in the shoulder, whereas in others it was more likely to be cervical root pain. The implication of these findings are discussed.
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PMID:Wheelchair user's shoulder? Shoulder pain in patients with spinal cord lesions. 41 95

This current concept of treatment of the Thoracic Outlet Syndrome based on a personal experience with 304 patients, resulted in complete (85%) or partial (7%) relief of symptoms in 92% of operated patients. The diagnosis centers upon a thorough history and the exclusion of other causes of arm and shoulder pain utilizing a strict flow pattern of differential diagnosis. Angiography and electromyography are of limited value and are only performed in selected cases. Operation should be reserved for the thoroughly evaluated patient who continues to have pain despite adequate conservative therapy. Transaxillary removal of the first rib, fibromuscular bands and cervical rib, when present, is the operation of choice.
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PMID:Thoracic outlet syndrome: current concepts of treatment. 50 76

186 patients with periarthritis of the shoulder have been studied. The sex ratio was female:male, 1-52:1. The peak age of onset was 54-59 years in both sexes. Over 40% of the patients were referred to the clinic after 6 months had elapsed from the time of onset of the disease. The right shoulder was more frequently involved than the left, particularly in the men. One shoulder only was affected in 75% of patients. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. There were a number of associated diseases, ischaemic heart disease, thyroid disease among women, diabetes among women, hemiplegia, pulmonary tuberculosis, chronic bronchitis, and epilepsy. Acute trauma was rarely a precipitating factor. Manual workers were more frequently seen than sedentary workers in the sample, and there were more in the sample than in the general population of Leeds. The general psychological background was no different from a control group. The Maudsley Personality Inventory gave no different results among patients with periarthritis of the shoulder than among a control group and among the general population. It is suggested that there is no evidence in this study for a 'periarthritic personality'. It is suggested that the cause of periarthritis of the shoulder is likely to be related to chronic trauma occurring in an age range when changes in connective tissue are occurring. Certain associated diseases may predispose the patient to this disorder.
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PMID:Periarthritis of the shoulder. I. Aetiological considerations with particular reference to personality factors. 98 1

A group of 113 women and 73 men with periarthritis of the shoulder have been studied in detail. Electromyography showed 4 patients with neuralgic amyotrophy who had been referred for the shoulder study but were excluded on this basis. Nerve conduction studies showed little difference between the periarthritic group and a control group, apart from some reduction in amplitude and potential, and in women a suggestion of an increased latency. Duration of the action potential was equal. 6 patients had an undoubtedly long latency compatible with median nerve compression. Degenerative changes were found in the glenohumeral joints in 6-9%. Degenerative changes were found at the acromioclavicular joints in 31% of the men and 44% of the women. Calcification was found around 11 of the shoulder joints. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. Arthrography was performed in 7 patients and there was a reduction in volume of material that could be injected in only one patient. There was obliteration of the axillary fold in that patient, and a torn capsule in a patient who had previously been manipulated. Lateral cervical spine x-rays were compared with films from an epidemiological survey. The disc space/vertebral body height ratio was taken, overcoming the magnification effects shown by technical alterations in the method of taking films. Good intra- and interobserver correlation was found for this ratio, but not for the width of the canal. There was no difference in the disc/body ratio between the periarthritic and control group in the upper cervical region. In the C5/6 and C6/7 intervertebral discs there was evidence of more disc degeneration in the periarthritic group. The differences from the control group were not great because of the high incidence of disc space narrowing and osteophytosis after the age of 45 years in the general population.
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PMID:Periarthritis of the shoulder. II. Radiological features. 98 2

Twenty-four patients with spinal cord injuries were studied to correlate their responses to intra-abdominal disease with the level and completeness of the cord lesion. Patients with complete cervical lesions and lesions of the upper part of the thoracic region (C-4 to T-6) usually responded by early noniocalized abdominal pain associated with signs of autonomic dysreflexia. As the disease progressed to involve the parietal peritoneum, these patients were more capable of localizing pain to the corresponding dermatome, whereas patients with incomplete lesions were able to localize their pain earlier. Patients with lumbar lesions and lesions of the lower part of the thoracic region (T-7 to L-3) were able to localize their pain earlier than those with lesions located higher in the thoracic region. All patients had delayed diagnoses except those with hemorrhage of the upper part of the gastrointestinal tract. Irrespective of level of cord lesion, increased pulse rate was themost prominent objective acute intra-abdominal pathologic finding. Shoulder pain in the quadriplegic is a most helpful sign.
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PMID:General surgery problems in patients with spinal cord injuries. 108 Apr 12


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