DOCSLIB.ORG

An Approach to the Painful Upper Limb

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
An Approach to the Painful Upper Limb An approach to the painful upper limb Pain in the upper limb is a common presenting complaint in the primary health care setting and the origins of such pain are wide and varied. E Mogere, MB ChB, MMed (Gen Surgery) Division of Neurosurgery, University of Cape Town and Groote Schuur Hospital, Cape Town T Morgado, MB ChB, MRCS (Eng) Division of Neurosurgery, University of Cape Town and Groote Schuur Hospital, Cape Town D Welsh, FRCS (Eng), FCS (SA) Neurosurgery Division of Neurosurgery, University of Cape Town and Groote Schuur Hospital, Cape Town Correspondence to: E Mogere ([email protected]) The pain generator in the upper limb should to the shoulder, arm or hand, suggesting upper limb may require examination of the broadly be considered as: a local musculo-tendinous/skeletal cause.[1] eyes (to exclude Horner’s syndrome), an • spinal (radiculopathy or myeloradiculopa- Alternatively, the pain may radiate from assessment of neck movement, a vascular thy) the neck down into the limb, or from the assessment, breast and axilla palpation • peripheral nerve hand up towards the upper arm, suggesting and a neurological assessment of the lower • musculo-tendinous neurological origin. limbs. This is in addition to a thorough • skeletal (appendicular). neurological and orthopaedic assessment of The pattern of radiation may follow a the limb itself. The clinical approach dermatomal (radiculopathy) or non- The clinical findings are key to pinpointing dermatomal pattern (peripheral nerve or Neurological examination includes the pain source. non-neurological source). Pain radiation assessment of muscle power and bulk, does not preclude a non-neurological tendon reflexes and sensation. Orthopaedic History source. Somatic neck pain may radiate to the examination centres on joint motion and Cervical and upper limb pain may present in shoulder and musculo-tendinous shoulder the surrounding musculature. isolation or be associated with altered sensation. pain may radiate down the arm towards the The sensory alteration may be distributed in a elbow, but seldom beyond. Differential diagnosis radicular or non-radicular pattern. Cervical radiculopathy The pattern of onset of the pain also provides Radiculopathy is characterised by pain Sensory alterations may present in the clues to the pathology. The sudden onset referred from the neck distally and sensory following ways: of symptoms may imply acute mechanical disturbance and weakness with associated • dermatomal (radiculopathy) disruptions or pathological fracture, as loss of tendon reflexes. • non-dermatomal (peripheral nerve) opposed to chronic progressive pain • cape-like (syringomyelia) pattern. associated with degenerative/inflammatory The pain is usually distributed in a conditions. dermatomal pattern (Fig. 1). Dermatomes Sensory disturbance should alert the may overlap to some degree and may also clinician to seek a neurological cause for the Pain that is initiated or worsened by vary slightly between individuals. For symptoms. Sensory disturbance may include movement may originate from any example, shoulder pain may be associated numbness, paraesthesia (pins and needles) or structure involved in motion, including with C5, C6 or C7 radiculopathies. C5 pain dysaesthesia (unpleasant burning pain and joints, capsules, nerves, ligaments and rarely radiates below the elbow. C6 - C8 hypersensitivity). Paraesthesia always occurs muscles. radiculopathies may cause pain in the whole in the anatomical distribution of the involved limb, including the forearm and hand. neural structure. This helps to differentiate A history of systemic or constitutional Subtle variations in distribution of the pain nerve root from peripheral nerve pathology. symptoms and a detailed past medical provide clues to the nerve root origin. history are useful. History of fever and/or Pain of neural origin (neuropathic pain) weight loss (infections and malignancy), The sensory disturbance may include may be associated with muscle weakness, trauma, previous surgery (degenerative or paraesthesia and numbness. In radi- altered tendon reflexes and fasciculations. surgical complications), prior malignancy culopathy, this is always discretely The association with weakness is not or endocrine disorders (hypothyroidism dermatomal in distribution and is a very pathognomonic of neurological pathology, or acromegaly) may guide further accurate guide to the nerve root of origin as this may also occur in association with investigations.[2] (Fig. 2). The C5 root may have a very small musculo-tendinous disorders. sensory ‘footprint’ over the lateral aspect of Physical examination the deltoid. The C6 root invariably supplies The distribution of the pain is a useful Physical examination is guided by the the thumb. The C7 root supplies the index guide to its origin. Pain may be confined history. A thorough examination of the and middle finger. The C8 root usually 96 CME March 2013 Vol. 31 No. 3 Pain in the upper limb C3 C4 C3 C5 C4 C6 C5 C7 C6 C8 T1 C5 Medial to the C6 T1 shoulder blade A B C6 C8 C8 C7 Posterior Anterior Fig. 2. Upper limb dermatomes. C7 C8 C D Compression syndromes (entrapment neuropathies) Fig. 1. Pain patterns in cervical radiculopathy C5 - C8. An entrapment neuropathy results from compression of a peripheral nerve, most supplies the little finger. The dermatomes highly suggestive of a radiculopathy commonly the median nerve. The effect of often overlap to a degree.[3] (Table 1). nerve compression is mediated by ischaemia and oedema. Motor disturbance is variable. Muscle Special examination wasting and fasciculation are usually techniques Carpal tunnel syndrome affects the median late findings. The presence of muscle Certain manoeuvres that are provocative nerve at the wrist, where it passes beneath weakness alone is not pathognomonic in nature assist in localising the lesion, the flexor retinaculum. of radiculopathy, as joint pathology may often by reproducing the clinical affect the local musculature.[4] However, symptomatology associated with the Patients complain of dysaethesia (burning) an associated loss of tendon reflex is pathology (Table 2). pain and paraesthesia in the radial 3 - 4 Table 1. Physical findings associated with each spinal level Root Pain distribution Weakness Sensory loss Reflex loss C5 Lateral upper arm Deltoid Lateral upper arm Biceps reflex C6 Lateral forearm Biceps, brachioradialis Thumb and index finger Supinator (+biceps) reflex Thumb, index finger Wrist extensors C7 Posterior arm, Triceps, wrist flexors Posterior forearm, Triceps reflex middle finger index and middle finger C8 Medial forearm, small finger Intrinsic hand muscles, Little finger Triceps reflex abductors, finger extension Table 2. Special examination techniques Test Description Clinical significance Spurling’s/ neck compression test Passive lateral flexion & extension of neck. Positive test is reproduction of Radiculopathy radicular symptoms distant from neck Shoulder abduction (relief) sign Active abduction of symptomatic arm, placing patient’s hand on head. Positive Radiculopathy test is relief or reduction of ipsilateral cervical radicular symptoms Neck distraction test Examiner grasps the patient’s head under the occiput and chin, while applying Radiculopathy axial traction force. Positive test is relief or reduction of cervical radicular symptoms Lhermitte’s sign Passive anterior cervical flexion. Positive test is presence of ‘electric-like Myelopathy sensations’ down spine or extremities Hoffmann’s sign Passive snapping flexion of middle finger distal phalanx. Positive test is flexion- Myelopathy adduction of ipsilateral thumb and index finger 97 CME March 2013 Vol. 31 No. 3 Pain in the upper limb Median nerve is compressed at the wrist, C5 resulting in numbness or pain C6 Middle scalene muscle C7 Anterior scalene muscle C8 Brachial plexus T1 Clavicle Subclavian artery Subclavian vein Fig. 3. Carpal tunnel syndrome. Fig. 4. Thoracic outlet syndrome. fingers, particularly after strenuous wrist movements or at night (Fig. 3). The pain may radiate proximally.[5]The symptoms are Palpation of the elbow reveals tenderness over the ulna nerve and a often bilateral, but usually start in the dominant hand. Elevation or positive Tinel sign over the elbow will cause paraesthesia in the fifth shaking of the hand may provide some relief. finger. A more sensitive provocative test is the pressure-flexion test, in which the elbow is flexed and pressure applied over the cubital Occupational risk factors (computer work), pregnancy, previous tunnel for 30 seconds, with paraesthesia being reproduced in the wrist trauma, endocrine disease or oral steroid use may alert the ulna nerve distribution. clinician to the potential diagnosis. The diagnosis is more commonly made in women in a ratio of 4:1. Thoracic outlet syndrome(TOS) is due to compression of elements of the brachial plexus (neurogenic) or subclavian vessels (vascular) in Thenar muscle atrophy may be present along with weakness of their passage from the neck to the axilla (Fig. 4).[8] The neurogenic thumb abduction. type is far more common than the vascular syndrome. The C8 and T1 roots course superiorly over the first rib, then beneath the clavicle Tenderness may be elicited along the length of the median nerve and into the upper limb. Neurogenic TOS may be associated with on palpation over the carpal tunnel. Provocative manoeuvres structural abnormalities such as a cervical rib, but more commonly, such as the Tinel sign (tapping over the carpal tunnel) or the there is no anatomical
Load more

Recommended publications
  • A Study on the Absence of Palmaris Longus in a Multi-Racial Population
    108472 NV-OA7 pg26-28.qxd 11/05/2007 05:02 PM Page 26 (Black plate) Malaysian Orthopaedic Journal 2007 Vol 1 No 1 SA Roohi, etal A Study on the Absence of Palmaris Longus in a Multi- racial Population SA Roohi, MS (Ortho) (UKM), L Choon-Sian, MD (UKM), A Shalimar, MS (Ortho) (UKM), GH Tan, MS (Ortho) (UKM), AS Naicker, M Med Rehab (UM) Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia ABSTRACT Most standard textbooks of hand surgery quote the prevalence of absence of palmaris longus at around 15%3-5. Palmaris longus is a dispensable muscle with a long tendon However, this figure varies considerably in different ethnic which is very useful in reconstructive surgery. It is absent groups. A study by Thompson et al6 on 300 Caucasian 2.8 to 24% of the population depending on the race/ethnicity subjects found that palmaris longus was absent unilaterally in studied. Four hundred and fifty healthy subjects (equally 16%, and bilaterally in 9% of the study sample for an overall distributed among Malaysia’s 3 major ethnic groups) were prevalence of absence of 24%. Similarly, George7 noted on clinically examined for the presence or absence of palmaris 276 cadavers of European descent that its absence was 13% longus. This tendon was found to be absent unilaterally in unilaterally, 8.7% bilaterally for an overall absence of 15.2%. 6.4% of study subjects, and bilaterally in 2.9% of study Another cadaveric study by Vanderhooft8 in Seattle, USA participants. Malays have a high prevalence of palmaris reported its overall absence to be 12%.
    [Show full text]
  • The Foot Angiosomes As Integrated Level of Lower Limb Arterial Perfusion
    Research Article iMedPub Journals 2019 www.imedpub.com Journal of Vascular and Endovascular Therapy Vol. 4 No. 1: 7 The Foot Angiosomes as Integrated Level of Alexandrescu VA1* Pottier M1, Lower Limb Arterial Perfusion: Amendments Balthazar S2 and Azdad K3 for Chronic Limb Threatening Ischemia 1Department of Vascular and Thoracic Presentations Surgery, Princess Paola Hospital, Marche- en-Famenne, Belgium 2Department of Anesthesiology, Princess Paola Hospital, Marche-en-Famenne, Belgium Abstract 3Department of Radiology, Princess Paola Introduction: The angiosome concept was initially pioneered by Taylor and Palmer in the Hospital, Marche-en-Famenne, Belgium plastic reconstructive surgery field. The authors described a reproducible model of arterial and venous distribution in humans that follows specific three-dimensional (3D) networks *Corresponding author: Vlad Adrian of tissue. The angiosome model yet represents a specific level among other staged and Alexandrescu graduated levels of harmonious arterial irrigation in the lower extremity. Specific CLTI pathologies enhance characteristic arterial branches affectation, including the angiosomal source arteries. Evaluating main atherosclerotic lesions at peculiar Levels of arterial division [email protected] may afford useful clinical information. Department of Vascular and Thoracic Method: The present study proposes a description of six levels of degressive arterial division Surgery, Princess Paola Hospital, Marche- and collateral distribution in the inferior limb, including the angiosomal stage. Following en-Famenne, Belgium succeeding perioperative 2D angiographic observations over an eight-year period, these levels (I to VI) were analyzed (including the angiosomal Level III) and summarized in attached tables. The medical files of 323 limb-threatening ischemic foot wounds (Rutherford 4-6) in 295 patients (71% men) were retrospectively reviewed.
    [Show full text]
  • Wrist Fracture – Advice Following Removal of Your Cast
    Wrist Fracture – advice following removal of your cast A plaster cast usually prevents a fracture from moving, but allows your fingers to move. The cast also reduces pain. What to expect It usually takes four to six weeks for new bone to form to heal your fracture. When the cast is removed most people find that their wrist is stiff, weak and uncomfortable to start with. It may also be prone to swelling and the skin dry or flaky, this is quite normal. It is normal to get some pain after your fracture. If you need painkillers you should take them as prescribed as this will allow you to do your exercises and use your wrist for light activities. You can ask a Pharmacist about over the counter painkillers. If your pain is severe, continuous or excessive you should contact your GP. The new bone gradually matures and becomes stronger over the next few months. It is likely to be tender and may hurt if you bang it. The muscles will be weak initially, but they should gradually build up as you start to use your hand and wrist. When can I start to use my hand and wrist? It is important to try and use your hand and wrist as normally as possible. Start with light activities like fastening buttons, washing your face, eating, turning the pages of books over etc. Build up as pain allows. Avoid lifting a kettle for 4 weeks If I have been given a Wrist splint You may have been given a wrist splint to wear.
    [Show full text]
  • Musculoskeletal Ultrasound Technical Guidelines II. Elbow
    European Society of MusculoSkeletal Radiology Musculoskeletal Ultrasound Technical Guidelines II. Elbow Ian Beggs, UK Stefano Bianchi, Switzerland Angel Bueno, Spain Michel Cohen, France Michel Court-Payen, Denmark Andrew Grainger, UK Franz Kainberger, Austria Andrea Klauser, Austria Carlo Martinoli, Italy Eugene McNally, UK Philip J. O’Connor, UK Philippe Peetrons, Belgium Monique Reijnierse, The Netherlands Philipp Remplik, Germany Enzo Silvestri, Italy Elbow Note The systematic scanning technique described below is only theoretical, considering the fact that the examination of the elbow is, for the most, focused to one quadrant only of the joint based on clinical findings. 1 ANTERIOR ELBOW For examination of the anterior elbow, the patient is seated facing the examiner with the elbow in an extension position over the table. The patient is asked to extend the elbow and supinate the fore- arm. A slight bending of the patient’s body toward the examined side makes full supination and as- sessment of the anterior compartment easier. Full elbow extension can be obtained by placing a pillow under the joint. Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint, a Pr perpendicular to the humeral shaft. Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis mu- Br scles. Alongside and medial to these muscles, follow the brachial artery and the median nerve: * the nerve lies medially to the artery. * Legend: a, brachial artery; arrow, median nerve; arrowheads, distal biceps tendon; asterisks, articular cartilage of the Humerus humeral trochlea; Br, brachialis muscle; Pr, pronator muscle 2 distal biceps tendon: technique The distal biceps tendon is examined while keeping the patient’s forearm in maximal supination to bring the tendon insertion on the radial tuberosity into view.
    [Show full text]
  • Complex Regional Pain Syndrome Type I (Shoulder-Hand Syndrome) in an Elderly Patient After Open Cardiac Surgical Intervention; a Case Report
    Eastern Journal of Medicine 16 (2011) 56-58 L. Ediz et al / CRPS type I after open cardiac Surgery Case Report Complex regional pain syndrome type I (shoulder-hand syndrome) in an elderly patient after open cardiac surgical intervention; a case report Levent Ediza*, Mehmet Fethi Ceylanb , Özcan Hıza, İbrahim Tekeoğlu c a Department of Physical Medicine and Rehabilitation, Yüzüncü Yıl University Medical Faculty, Van, Turkey b Department of Orthopaedics and Traumatology,Yüzüncü Yıl University Medical Faculty, Van, Turkey c Department of Rheumatology, Yüzüncü Yıl University Medical Faculty, Van, Turkey Abstract. We described the first case report in the literature who developed Complex Regional Pain Syndrome (CRPS type I) symptoms in his right shoulder and right hand within 15 days after open cardiac surgery and discussed shoulder-hand syndrome (CRPS type I) and frozen shoulder diagnosis along with the reasons of no report of CRPS type I in these patients. We also speculated whether frozen shoulder seen in postthoracotomy and postcardiac surgery patients might be CRPS type I in fact. Key words: Complex regional pain syndrome, cardiac surgery, frozen shoulder 1. Introduction Improper patient positioning, muscle division, perioperative nerve injury, rib spreading, and Complex Regional Pain Syndrome (CRPS) is consequent postoperative pain influence the complication of injuries which is seen at the patient's postoperative shoulder function and distal end of the affected area characterized by quality of life (5). In a study Tuten HR et al pain, allodyni, hyperalgesia, edema, abnormal retrospectively evaluated for the incidence of vasomotor and sudomotor activity, movement adhesive capsulitis of the shoulder of two disorders, joint stiffness, regional osteopenia, and hundred fourteen consecutive male cardiac dystrophic changes in soft tissue (1,2).
    [Show full text]
  • Shoulder Pain – Complexity to Simplicity
    Shoulder Pain – Complexity to Simplicity A Regional Approach to Shoulder Pain The best way to approach a problem of shoulder pain is to look at the pain from a regional point of view. This allows for easy identification of specific pathological problems that occur at each region. In this talk, we look at the patterns of pain that occur with the different regions around the shoulder. From this, we will focus on the pathological problems that can be expected in each region and then look at specific physical examination findings that can be used to confirm a diagnosis or help further clarify the problem. Although this talk is focused on the diagnosis of causes of shoulder pain, we also take a look at some updates and salient features of treatment. In general, pain in the region of the shoulder can be grouped into 4 main types. These relate to specific patterns of pain that allow history taking to help us focus on the likely cause(s) before moving on to examination. A fairly clear-cut diagnosis is almost always achievable without the need to resort to special tests to help make the diagnosis. Of course, this does not include all possible causes of pain. The uncommon problem will still need a thorough and complete approach to determining cause, often with the requirement for special investigations. Remember that this is a good guide. Don't neglect other causes of referred pain that may cause pain in and around the shoulder. Included here is cardiac pain, diaphragmatic pain, apical lung disease and malignant bone pain.
    [Show full text]
  • Wrist Fracture
    Hand Conditions: WRIST FRACTURE A wrist fracture is a break in one or more of the bones in the wrist. The wrist is made up of the two bones in the forearm called the radius and the ulna. It also includes eight carpal bones. The carpal bones lie between the end of the forearm bones and the bases of the fi ngers. The most commonly fractured carpal bone is called the scaphoid or navicular bone. This fact sheet will focus on fractures of the carpal bones of the wrist. Causes A wrist fracture is caused by trauma to the bones in the wrist. Trauma may be caused by: • Falling on an outstretched arm • Direct blow to the wrist • Severe twist of the wrist Risk Factors Factors that increase your chance of developing a wrist fracture include: • Participating in contact sports, such as football or soccer • Participating in activities such as in-line skating, skateboarding, or bike riding • Participating in any activity which could cause you to fall on your outstretched hand • Violence or high-velocity trauma, such as an automobile accident Symptoms If you have any of these symptoms, do not assume they are due to a wrist fracture. Symptoms of a wrist fracture include. • Pain • Swelling and tenderness around the wrist • Bruising around the wrist • Limited range of wrist or thumb motion • Visible deformity in the wrist For more information visit us online at www.ptandme.com Hand Conditions: WRIST FRACTURE Diagnosis Your doctor will ask about your symptoms, physical activity, and how the injury occurred. The injured area will be examined.
    [Show full text]
  • Interventional Chronic Pain Treatment in Mature Theaters of Operation
    28. INTERVENTIONAL CHRONIC PAIN pain, nonradicular arm pain, groin pain, noncardiac spinal and myofascial pain); and anticonvulsants TREATMENT IN MATURE THEATERS chest pain, and neck pain. The most common diag- and tricyclic antidepressants (usually prescribed for OF OPERATION noses conferred on these patients were lumbosacral radicular and other forms of neuropathic pain). The radiculopathy, recurrence of postsurgical pain, large majority of patients received at least one inter- IMPACT OF NONBATTLE-RELATED INJURIES lumbar facetogenic pain, myofascial pain, neuro- ventional procedure. The most frequently employed AND TREATMENT pathic pain, and lumbar degenerative disc disease. nerve blocks were lumbar transforaminal epidural The most common noninterventional treatments steroid injections (ESIs), trigger point injections, Acute nonbattle injuries (NBIs) and chronic pain have been nonsteroidal antiinflammatory drugs cervical ESIs, lumbar facet blocks, various groin conditions that recur during war have been termed (NSAIDs; > 90%); physical therapy referral (for back blocks, and plantar fascia injections. Table 28-1 lists the “hidden epidemic” by the former surgeon pain, neck pain, and leg pain); muscle relaxants (for procedures for common nerve blocks conducted in general of the US Army, James Peake. Since statistics have been kept, the impact of NBIs on unit readiness TABLE 28-1 has increased. In World War I, NBI was the fourth leading cause of soldier attrition. In World War II PROCEDURES FOR COMMON NERVE BLOCKS CONDUCTED IN THEATER and the Korean conflict, NBIs were the third leading cause of morbidity. By the Vietnam War, NBIs had Injection Injectate Need for Comments become the leading cause of hospital admissions, Volume* (mL) Fluoroscopy? where they have remained ever since.
    [Show full text]
  • Muscles Connecting the Upper Limb to the Vertebral Column
    Muscles Connecting the Upper Limb to the Vertebral Column 1-Trapezius: O: external occiptal protuberance, superior nuchal line, ligamentum nuchae (along dorsal spine of cervical vertebra ), spines of all thoracic vertebrae and their supraspinous ligament " the extention of ligamentum nuchae ". Ins: (opposite to the Ori. Of Deltoid ) Upper fibers : Post. border lateral third of clavicle. Mid.(lateral fibers): inner surface of acromial process. Lower fibers: upper border of dorsal spine of scapula. N.S: Spinal accessory nerve (motor) and C3 and 4 (sensory) XI(11) cranial nerve (spinal part). *Note that accessory nerve = XI(11) cranial nerve which has 2 parts : cranial / spinal Action : Upper fibers :elevate the scapula. middle fibers: pull scapula medially toward the ribs (retracts). lower fibers: pull medial border of scapula downward . *anterior fibers rotates the scapula. Question 1 : to put your hand over your head what are the responsible muscles?? - Supraspinatus for initiation (0-15) or (0-18) - middle fibers of Deltoid (15 or 18 -90) - Trapezius & serratus anterior :after 90, rotation of scapula. Question 2 : to touch the acromial process of the other side which muscle is responsible , and which nerve will stop the movement of the muscle if we cut it?? -muscle: pectorals major , medial & lateral pectoral nerve. *always choose the easiest movement… 2-Latissimus dorsi : O: Iliac crest, lumbar fascia, spines of lower six thoracic vertebrae (T7-T12), lower three or four ribs, and inferior angle of scapula ,then all fibers make conversion to ins. Ins: Floor of bicipital groove of humerus. N.S: Thoracodorsal nerve (branch of post. Cord of post.
    [Show full text]
  • UK Clinical Guideline for Best Practice in the Use of Vaginal Pessaries for Pelvic Organ Prolapse
    UK Clinical Guideline for best practice in the use of vaginal pessaries for pelvic organ prolapse March 2021 Developed by members of the UK Clinical Guideline Group for the use of pessaries in vaginal prolapse representing: the United Kingdom Continence Society (UKCS); the Pelvic Obstetric and Gynaecological Physiotherapy (POGP); the British Society of Urogynaecology (BSUG); the Association for Continence Advice (ACA); the Scottish Pelvic Floor Network (SPFN); The Pelvic Floor Society (TPFS); the Royal College of Obstetricians and Gynaecologists (RCOG); the Royal College of Nursing (RCN); and pessary users. Funded by grants awarded by UKCS and the Chartered Society of Physiotherapy (CSP). This guideline was completed in December 2020, and following stakeholder review, has been given official endorsement and approval by: • British Association of Urological Nurses (BAUN) • International Urogynecological Association (IUGA) • Pelvic Obstetric and Gynaecological Physiotherapy (POGP) • Scottish Pelvic Floor Network (SPFN) • The Association of Continence Advice (ACA) • The British Society of Urogynaecology (BSUG) • The Pelvic Floor Society (TPFS) • The Royal College of Nursing (RCN) • The Royal College of Obstetricians and Gynaecologists (RCOG) • The United Kingdom Continence Society (UKCS) Review This guideline will be due for full review in 2024. All comments received on the POGP and UKCS websites or submitted here: [email protected] will be included in the review process. 2 Table of Contents Table of Contents ................................................................................................................................
    [Show full text]
  • Management of Radicular Pain
    Management of Radicular Pain Mel Cusi MBBS, FACSP, FFSEM (UK) Sport & Exercise Medicine Physician Dr Mel Cusi Sport & Exercise Medicine Physician Management of Radicular Pain A. Background B. Epidemiology C. Diagnosis D. Treatment Dr Mel Cusi Sport & Exercise Medicine Physician A. Background • Names and concepts – Radicular pain – Radiculopathy • Structures that can produce radicular Sx – Sinu‐vertebral nerve – Nerve root • Mechanisms of pain – Direct toxic effect of disc material – Chemical substances Dr Mel Cusi Sport & Exercise Medicine Physician B. Epidemiology • Occurs in 3‐5% of the population – More frequent in males in their 40’s – More frequent in females in their 50’s • In sporting population – More frequent in sports that combine spinal flexion/extension with rotation – Fast bowlers, gymnasts, dancers, RU backrowers, golfers, weightlifters, baseball pitchers Dr Mel Cusi Sport & Exercise Medicine Physician C. Diagnosis • Radicular pain is only a descriptive symptom • Diagnosis is made on the usual basis of – History – Clinical examination – Appropriate investigations (when required) Dr Mel Cusi Sport & Exercise Medicine Physician History • Acute LBP radiating to buttock / lower limb • Worse with flexion, sneezing, coughing. Sitting worse than standing • Some pointers – Referred pain from L1‐3 does not reach the knee – Unusual Symptoms (weight loss, fever, chills) point to something else – Beware of cauda equina: surgical emergency Dr Mel Cusi Sport & Exercise Medicine Physician Neurological Examination • Sensation – Subjective
    [Show full text]
  • Analyzing At-Home Prosthesis Use in Unilateral Upper-Limb Amputees To
    2017 International Conference on Rehabilitation Robotics (ICORR) QEII Centre, London, UK, July 17-20, 2017. Analyzing At -Home Prosthesis Use in Unilateral Upper -Limb Amputees to Inform Treatment & Device Design Adam J. Spiers, Member, IEEE, Linda Resnik, and Aaron M. Dollar, Senior Member, IEEE Abstract — New upper limb prosthetic devices are continuously being developed by a variety of industrial, academic, and hobbyist groups. Yet, little research has evaluated the long term use of currently available prostheses in daily life activities, beyond laboratory or survey studies. We seek to objectively measure how experienced unilateral upper limb prosthesis-users employ their prosthetic devices and unaffected limb for manipulation during everyday activities. In particular, our goal is to create a method for evaluating all types of amputee manipulation, including non-prehensile actions beyond conventional grasp functions, as well as to examine the relative use of both limbs in unilateral and bilateral cases. This study employs a head-mounted video camera to record participant’s hands and arms as they Figure 1: A video screenshot from the head-mounted camera (for complete unstructured domestic tasks within their own homes. participant P2). A new ‘Unilateral Prosthesis-User Manipulation Taxonomy’ is presented based observations from 10 hours of recorded videos. has been a wide variety of prosthetic TDs (e.g. [4]–[6]). The taxonomy addresses manipulation actions of the intact However, follow-ups of how such devices’ are practically hand, prostheses, bilateral activities, and environmental and specifically used has been limited outside of the feature-use (affordances). Our preliminary results involved laboratory. Further motivation for the need of such tagging 23 minute segments of the full videos from 3 amputee understanding comes from well-known high prevalence rates participants using the taxonomy.
    [Show full text]