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

Shoulder pain is one of the most common musculoskeletal complaints in the elderly. The rewards of accurate diagnosis and early treatment often elude the orthopaedist without a systematic approach to this region. A thorough understanding of shoulder anatomy, pain referral patterns, and the pathophysiology of the aging process must be combined with an awareness of the latest treatment modalities and surgical techniques.
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PMID:Approaches to senior care #6. Shoulder pain in the geriatric patient. Part I. Evaluation and pathophysiology. 291 8

Seventeen patients with shoulder pain and radiographic involvement of the sternoclavicular or sternocostal joints, or both, are described. Eleven of these patients also had palmoplantar pustulosis. Histological examination of the joints showed chronic and subacute inflammation, increased osteoblastic activity, and cartilage degeneration. Propionibacterium acnes was cultured in tissue samples from seven of the 15 biopsied patients, a finding at variance with those of previous reports. The possibility that sternoclavicular arthro-osteitis is of infectious origin should be the subject of further investigation. Non-steroidal anti-inflammatory drugs (NSAIDs) may provide pain relief, possibly owing to their inhibitory action on osteoblasts. In cases of severely restricted movement or severe pain resection of the medial clavicle may be considered.
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PMID:Palmoplantar pustulosis and sternocostoclavicular arthro-osteitis. 234 18

Diagnostic cervical medial branch blocks and zygapophysial joint blocks were used to test the hypothesis that the cervical zygapophyseal joints can be the source of pain in patients with idiopathic neck pain. Complete temporary relief of all symptoms was obtained in 17 out of 24 consecutive patients. Two major groups of patients were those with neck pain and headache stemming from the C2-3 joints, and those with neck pain and shoulder pain stemming from the C5-6 joints. Internal-control observations in nine of the 17 patients established the diagnostic validity of the blocks used. The high yield of positive responders in this study probably reflects the propensity of patients with zygapophysial joint syndromes to gravitate to a pain clinic when this condition is not recognised in conventional clinical practice.
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PMID:The cervical zygapophysial joints as a source of neck pain. 317 50

This is a retrospective review of 108 patients who underwent decompressive anterior acromioplasty for chronic impingement in the absence of a full thickness rotator cuff tear. Before operation, all the patients had had shoulder pain for at least one year despite conservative treatment. At operation, the rotator cuff tendons were explored and were intact. Anterior acromioplasty, followed by rehabilitation was successful in 87% of patients. The operation was less successful in women, in those who had diminished movement before operation, who were involved in worker's compensation claims, and whose pain followed direct trauma. Appropriate selection of patients is considered the key to success.
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PMID:Acromioplasty for impingement with an intact rotator cuff. 319 82

Within seven years 506 patients with blunt abdominal trauma were included into a prospective trial. The aim of the study was checking of the validity of clinical parameters, routinely performed laboratory examinations and of the initial circulatory situation in relation to an abdominal organ lesion. Three groups were separated out of the total collective: Group 1: Patients without abdominal lesion (N = 274). Group 2: Patients with abdominal lesion, verified by operation, sonography or CAT scan (N = 232). Group 3: Patients with rupture of the spleen (N = 107) (subgroup of 2). Among the clinical parameters: spontaneous abdominal pain, contusions marks, abdominal tenderness, shoulder pain, and abdominal palpation, the latter does have a high validity (92%). However, in group 1, more than half of the cases also had palpation pain. Shoulder pain has a high sensitivity. Of the laboratory parameters: hemoglobin, hematocrit and leucocytes, only the leucocyte count provided a certain importance: 83% of group 2 had values above 10,000. The circulatory parameters blood pressure and pulse as initial spot picture are of minor validity. Continuous registration of these values at clinical observation has much higher relevance indicating trends towards improvement or deterioration.
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PMID:[The value of clinical aspects, laboratory and circulatory parameters in blunt abdominal trauma]. 321

Forty-eight stroke patients with shoulder pain were assessed for degree of pain at rest and on movement of the affected arm, and presence and grade of subluxation. Degree of pain was assessed using a 6-point verbal rating scale. Presence and grade of subluxation were assessed from radiographs, using a 5-point categorization. Four radiographs were excluded. Subluxation was found in 24 (54.5%) of the remaining 44 radiographs. No statistically significant difference was found in degree of pain between patients with and without subluxation. In addition, no correlation was found between grade of subluxation and degree of pain. It is suggested that the role of subluxation in the production of pain may not be as important as often believed.
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PMID:Degree of pain and grade of subluxation in the painful hemiplegic shoulder. 323 46

A repetitive gripping test for the evaluation of neck and shoulder pain and disability was standardized and validated in a population study. Repeatability of the endurance of gripping was acceptable (correlation coefficient 0.74). Out of 49 women without neck and shoulder pain during the preceding seven days, 18% showed low endurance (endurance time less than 7 min); out of 19 women with disabling pain during the preceding seven days, 58% showed low endurance; and of 10 women with disabling pain at the time of examination, 80% showed low endurance. Low endurance was related to disability especially in some critical functions of the arms as e.g. working with the hands overhead. Endurance was not affected by age. In men, low endurance did not correlate with neck and shoulder pain. The test provides a tool for the evaluation of patients, but the applicability of the test to men needs further research.
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PMID:Neck and shoulder pain and disability. Evaluation by repetitive gripping test. 323 47

The incidence of different types of shoulder pain after open heart surgery was studied prospectively. Of 101 patients studied, 45 developed rheumatic symptoms during the first six weeks after the operation. Thirty eight patients reported pain in the region of the shoulder girdle with no loss of shoulder function (postpericardiotomy rheumatism). Three of these patients also had features compatible with the postpericardiotomy syndrome (fever, malaise, or pleuritic chest pain), and seven developed the syndrome without pain in the shoulder girdle. Of these 10 patients, one had generalised myalgia. Postpericardiotomy rheumatism alone was not associated with increased inflammation (measured by the erythrocyte sedimentation rate and concentration of C reactive protein); immunological tests including measurement of antibodies to cardiac muscle yielded inconclusive results. Replies to a postal questionnaire showed that symptoms of postpericardiotomy rheumatism were present for over three months in 18 patients and for six months or longer in 14. In view of the large number of patients now having open heart surgery postpericardiotomy rheumatism should be considered when patients report pain around the shoulders so that it is not misdiagnosed as angina.
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PMID:Rheumatic symptoms after cardiac surgery: a prospective study. 326 13

The cardinal symptom in all shoulder disorders is shoulder pain. We have to differentiate between genuine shoulder pain originating from the glenohumeral joint and its periarticular structures and referred pain originating at a site distant from the shoulder joint, e.g., the cervical spine or the internal organs. The differential diagnosis of genuine shoulder pain is discussed. The options open to the radiologist for reaching a correct diagnosis in different sorts of shoulder pain are shown.
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PMID:[Diseases of the shoulder joint from the orthopedic viewpoint]. 328 26

Compared to other painful conditions on the shoulder suprascapular nerve entrapment is an obscure and uncommon syndrome causing severe shoulder pain and disability, and is easily cured if only it is recognized. The condition was described by Thompson and Kopell in 1959, Schilf reported a case of isolated suprascapular entrapment in 1952. The nerve passes through the suprascapular notch, the roof of the notch is formed by the transverse scapular ligament. The shape of the suprascapular notch may be guilty for entrapment symptoms. Suprascapular nerve compression may result of acute trauma, of transmitted forces, fracture of collum scapulae, of kinking or traction of the nerve over the edge of the foramen, of sling effect, of compression by ganglia, or its cause may be idiopathic. The hallmark of suprascapular nerve entrapment is a deep and poorly delineated pain, localized to the posterior and lateral aspect of the shoulder. Atrophy and weakness of the supraspinatus and infraspinatus may be noted. Adduction of the extended arm across the body tenses the nerve, increasing the pain. Blocking the nerve by local anesthetic a dramatic, but not long lasting pain relief may be achieved. Electromyographically a decrease in the amplitude or marked polyphasicity of evoked potentials is significant as well as an increased latency time, indicating an impaired conductibility. A surgical release is indicated in case of constant pain and pathological changes of EMG-patterns. From a postero-superior approach decompression of the nerve is performed by simple removal of the transverse scapular ligament.
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PMID:[Compression syndromes of the shoulder and their differential diagnosis]. 332 37


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