Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pain was considered to be integrated subcortically during most of the 20th century, and it was not until 1956 that focal injury to the parietal opercular-insular cortex was shown to produce selective loss of pain senses. The parietal operculum and adjacent posterior insula are the main recipients of spinothalamic afferents in primates. The innermost operculum appears functionally associated with the posterior insula and can be segregated histologically, somatotopically and neurochemically from the more lateral S2 areas. The Posterior Insula and Medial Operculum (PIMO) encompass functional networks essential to initiate cortical nociceptive processing. Destruction of this region selectively abates pain sensations; direct stimulation generates acute pain, and epileptic foci trigger painful seizures. Lesions of the PIMO have also high potential to develop central pain with dissociated loss of pain and temperature. The PIMO region behaves as a somatosensory area on its own, which handles phylogenetically old somesthetic capabilities based on thinly myelinated or unmyelinated inputs. It integrates spinothalamic-driven information - not only nociceptive but also innocuous heat and cold, crude touch, itch, and possibly viscero-somatic interoception. Conversely, proprioception, graphesthesia or stereognosis are not processed in this area but in S1 cortices. Given its anatomo-functional properties, thalamic connections, and tight relations with limbic and multisensory cortices, the region comprising the inner parietal operculum and posterior insula appears to contain a third somatosensory cortex contributing to the spinothalamic attributes of the final perceptual experience.
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PMID:Pain syndromes and the parietal lobe. 2951 59

BACKGROUND An obstetric brachial plexus lesion arises during childbirth as a consequence of excessive lateral traction of the neonate's head during shoulder dystocia. A small number of patients do not experience spontaneous recovery and secondary glenohumeral deformities can arise due to rotator cuff imbalance. CASE DESCRIPTION A 34-year-old man of Syrian descent with a history of a conservatively treated right-sided obstetric brachial plexus lesion went to the accident and emergency department (A and E) with acute pain in the right shoulder. Additional X-ray diagnostics suggested a posterior shoulder luxation, but attempts to relocate the glenohumeral joint in A and E failed. An additional CT scan of the shoulders revealed a severe right-sided dysplasia of the glenohumeral joint, with severe retroversion and posterior luxation of a rotated humeral head. After 3 weeks of relative rest through use of a sling and pain relief with an NSAID the pain had diminished and the patient had resumed his daily activities. CONCLUSION Posterior shoulder luxation can occur as a complication of obstetric brachial plexus lesion. Closed reduction is not of any use in these cases. The expertise of a specialized multidisciplinary team is indispensable for providing a patient with obstetric brachial plexus lesion with the best advice on treatment.
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PMID:[Suspected traumatic posterior shoulder luxation]. 3164 19