Back Pain Referred to Chest
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Thoracic Spine Pain) General Information Leaflet
Physiotherapy – Upper and Middle Back Pain (Thoracic spine pain) General Information Leaflet The upper and middle back is the section of the back between the base of the neck and the bottom of the ribcage – the thoracic spine. This type of back pain is less common than neck or lower back pain. Like many other types of back pain, upper and middle back pain can range from aching and stiffness to a sharp or burning sensation. Pain in this area may be the result of a problem with the muscles or ligaments (bands of tissue around joints), an injury, or a pinched nerve in the spine. One cause of pain in this area is poor posture. Try to keep your back as straight as possible and balance your weight evenly on both feet. When sitting, keep your shoulders rolled back and be sure to adopt suitable positions when driving, sitting, or using computers. Upper back pain usually starts to get better within a few weeks. Sometimes upper back pain will come and go over time. The section on preventing back pain has advice about ways you may be able to reduce the risk of the pain coming back. Keep moving One of the most important things you can do is to keep moving and continue with your normal activities as much as possible. It used to be thought bed rest would help you recover from a bad back, but it's now known people who remain active are likely to recover more quickly. This may be difficult at first, but don't be discouraged – your pain will start to improve eventually. -
Type of Breathing- Slow, Rapid, Deep, Shal
Primary survey check pulse; type of pulse- slow, rapid, weak, strong check breathing; type of breathing- slow, rapid, deep, shallow maintain open airway; clear blood vomitus check to see that airway is unobstructed help the athlete find the most comfortable posistion for breathing be prepared to prefrom artificial ventilation and CPR if needed transport to emergency facility Secondary seurvey history what happend? What is the mechanism of injury? When did it happen? Have you ever had any injury to this region before? Have you ever been ill or had a recent episode of mononucleosis? Was there a direct blow? If so by what? Where were you hit? Back, chest, or abdominal area? How large was the area of contact? Did you go to the bathroom prior to practice? Where does it hurt? Point to the area of pain how severe is the pain? What kind of do you have? Sharp, dull, achy, throbbing, radiating what increase the pain? What relieves the pain? Have the symptoms been constant or intermittent? Does the pain increase during respiration or movement? Is the pain located in the chest wall or does it feel deeper or inside the cavity? Do you have any referred pain to your shoulders? Kehr’s sign? Do you have any refferred pain to your flanks? Did you feel anything at the time of injury? Did you hear any sounds at the time of injury? Do you have any crepitation? Possible rib fx or costochondral separation do you feel any tightness, cramping, or rigidity of the abdominal musculature? Do you feel nauseaqted? Do you have any difficulty breathing? Have you urinated -
Evaluation of Abdominal Pain in the Emergency Department Hartmut Gross, M.D., FACEP
Evaluation of Abdominal Pain in the Emergency Department Hartmut Gross, M.D., FACEP Abdominal pain complaints comprise about 5% of all Emergency Department visits. The etiology of the pain may be any of a large number of processes. Many of these causes will be benign and self-limited, while others are medical urgencies or even surgical emergencies. As with any complaint in the ED, the worst diagnosis is always entertained first. Therefore, there is one thought, which the ED practitioner must maintain in the foreground of his mind: “Is there a life threatening process?” Etiology A breakdown of the most common diagnoses of abdominal pain presentations is listed below. Note that nearly half of the time, “unknown origin” is the diagnosis made. This is a perfectly acceptable conclusion, after a proper work-up has ruled out any life threatening illness. Common Diagnoses of Non-traumatic Abdominal Pain in the ED 1 Abdominal pain of unknown origin 41.3% 2 Gastroenteritis 6.9% 3 Pelvic Inflammatory Disease 6.7% 4 Urinary Tract Infection 5.2% 5 Ureteral Stone 4.3% 6 Appendicitis 4.3% 7 Acute Cholecystitis 2.5% 8 Intestinal Obstruction 2.5% 9 Constipation 2.3% 10 Duodenal Ulcer 2.0% 11 Dysmenorrhea 1.8% 12 Simple Pregnancy 1.8% 13 Pyelonephritis 1.7% 14 Gastritis 1.4% 15 Other 12.8% From Brewer, RJ., et al, Am J Surg 131: 219, 1976. Two important factors modify the differential diagnosis in patients who present with abdominal pain: sex and age. Other common diagnoses of abdominal pain in men and women are as follows. -
Pain Pathways in Orthopaedic Practice J
Postgrad Med J: first published as 10.1136/pgmj.38.437.157 on 1 March 1962. Downloaded from POSTGRAD. MED. J. (I962), 38, I57 PAIN PATHWAYS IN ORTHOPAEDIC PRACTICE J. D. G. TROUP, M.R.C.S., L.R.C.P.* Aberdeen DESPITE Steindler's (1959) admirable lectures on of which time is one of the most significant, have the subject, pain in orthopiedic practice remains a to obtain before pain can be appreciated in tissues difficult problem. To some extent the difficulty is remote from a primary lesion, and when the pain is exaggerated by the adoption of diagnoses based on present, so too are palpably pathological changes. pathological processes which are insusceptible of It is probably true that a peripheral pathway for proof-diagnoses for which it is impossible to pain can be excited centrally or by any stimulus establish an association between symptoms and proximal to it, but the pathway cannot be estab- their alleged origin, let alone a direct causal link. lished in the first place without initial pathological For instance a nipped zygapophyseal synovial changes in the periphery. fringe may well cause acute symptoms, but as there is no means of examining the synovia of The Appreciation of Pain zygapophyseal joints, to make this the diagnosis The appreciation of pain is divided into two is purely speculative. Nevertheless pathological parts; first the sensory component-where it is and guesswork of this sort is regrettably common, and what it feels like, and secondly the affective when some of the latest advances in neuro- component which dictates to what extent the pain by copyright. -
Costochondritis
Department of Rehabilitation Services Physical Therapy Standard of Care: Costochondritis Case Type / Diagnosis: Costochondritis ICD-9: 756.3 (rib-sternum anomaly) 727.2 (unspecified disorder of synovium) Costochondritis (CC) is a benign inflammatory condition of the costochondral or costosternal joints that causes localized pain. 1 The onset is insidious, though patient may note particular activity that exacerbates it. The etiology is not clear, but it is most likely related to repetitive trauma. Symptoms include intermittent pain at costosternal joints and tenderness to palpation. It most frequently occurs unilaterally at ribs 2-5, but can occur at other levels as well. Symptoms can be exacerbated by trunk movement and deep breathing, but will decrease with quiet breathing and rest. 2 CC usually responds to conservative treatment, including non-steroidal anti-inflammatory medication. A review of the relevant anatomy may be helpful in understanding the pathology. The chest wall is made up of the ribs, which connect the vertebrae posteriorly with the sternum anteriorly. Posteriorly, the twelve ribs articulate with the spine through both the costovertebral and costotransverse joints forming the most hypomobile region of the spine. Anteriorly, ribs 1-7 articulate with the costocartilages at the costochondral joints, which are synchondroses without ligamentous support. The costocartilage then attaches directly to the sternum as the costosternal joints, which are synovial joints having a capsule and ligamentous support. Ribs 8-10 attach to the sternum via the cartilage at the rib above, while ribs 11 and 12 are floating ribs, without an anterior articulation. 3 There are many causes of musculo-skeletal chest pain arising from the ribs and their articulations, including rib trauma, slipping rib syndrome, costovertebral arthritis and Tietze’s syndrome. -
1 Holistic Life Chiropractic 2275 Deming Way, Middleton, WI 53562 Please Fill out the Following Infor
Holistic Life Chiropractic 2275 Deming Way, Middleton, WI 53562 www.holisticlifechiro.com Please fill out the following information to the best of your knowledge, as completely as possible. *GENERAL INFORMATION Today’s Date: ____/____/______ Title: Mr. / Mrs. / Ms. / Dr. / Prof. Sex: Male / Female / Unspecified First Name: __________________ Middle Name: ________________ Last Name: __________________ Nickname: ______________________ Date of Birth: _______/________/________ Age__________ Address: _____________________________________________________________________________ City: ______________________________________ State: _____________________ Zip: ____________ Primary Phone: _____________________________Secondary Phone: ___________________________ E-Mail Address: _____________________________ Referred By: _______________________________ Emergency Contact Name: _______________________________ Phone #: _______________________ Children Ages:___________________________________ Marital Status: Single / Married / Other Employment Status: Employed / Full-Time Student / Part-Time Student / Other / Retired /Self-Employed Type of Work Performed/Employer: _______________________________________________________ Though we are a cash-based practice and payment is due at the time of service, we are able to print off SuperBills for your reimbursement if our services are covered by your health care insurance provider. Insurance Company: ______________________________________ Race: (circle one) White Black/African American Hispanic American Indian/Alaskan -
Pseudoanginal Chest Pain Associated with Vagal Nerve Stimulation: a Case Report James B
Nichols et al. BMC Neurology (2020) 20:144 https://doi.org/10.1186/s12883-020-01693-5 CASE REPORT Open Access Pseudoanginal chest pain associated with vagal nerve stimulation: a case report James B. Nichols1, Abigail P. McCallum1, Nicolas K. Khattar1, George Z. Wei1, Rakesh Gopinathannair2, Haring J. W. Nauta1 and Joseph S. Neimat1* Abstract Background: Vagal nerve stimulation (VNS) can be an effective therapy for patients with epilepsy refractory to anti- epileptic drugs or intracranial surgery. While generally well tolerated, it has been associated with laryngospasm, hoarseness, coughing, dyspnea, throat and atypical chest pain, cardiac symptoms such as bradycardia and occasionally asystole. We report on a patient receiving vagal nerve stimulation who experienced severe typical anginal chest pain during VNS firing without any evidence of cardiac ischemia or dysfunction. Thus, the pain appeared to be neuropathic from the stimulation itself rather than nociceptive secondary to an effect on heart function. Case presentation: A 29-year-old man, with a history of intractable frontal lobe epilepsy refractory to seven anti- epileptic medications and subsequent intracranial surgery, underwent VNS implantation without complications. On beginning stimulation, he began to have intermittent chest pain that corresponded temporally to his intermittent VNS firing. The description of his pain was pathognomonic of ischemic cardiac chest pain. On initial evaluation, he displayed Levine’s sign and reported crushing substernal chest pain radiating to the left arm, as well as shortness of breath walking upstairs that improved with rest. He underwent an extensive cardiac workup, including 12-lead ECG, cardiac stress test, echocardiogram, 12-day ambulatory cardiac monitoring, and continuous ECG monitoring each with and without stimulation of his device. -
Patient History Form
Dr. Robert DeVincentis Intracoastal Chiropractic Clinic 14255 Beach Blvd, Suite A * Jacksonville FL 32250 Patient History Form Last Name:___________________ First:____________ Middle:____ Single Married Divorced Date:___/___/______ Date of Birth:___/___/_____ Social Security #:____________________ Address:__________________________ Apt#:_______ Email:_____________________________ City:______________________ State:_______ Zip:_____-_____ Employer:_______________________ Work Phone:______________Ext.:_______ Home Phone:______________ Cell Phone:_______________ Emergency Contact Name:____________________ Phone:____________ Relationship:__________________ Who Referred You To This Office?________________________________ Who is Responsible for Your Bill? Health Insurance Auto Insurance Cash Medicare Medicaid Work Comp. Other Are you here as a result of an accident? No Yes If Yes, Date of Accident:___/___/_____ Have you ever been to a Chiropractic Physician Before? No Yes If Yes, Date of last visit ___/___/_____ If Female, is it possible you are pregnant? No Yes If yes, # of weeks?____ First Child? No Yes What Symptoms brought you here today? ________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ A=Ache PAIN SCALE Place an appropriate letter that B=Burning -
Surgical Treatment of Angina Pectoris He Extensive
SURGICAL TREATMENT OF ANGINA PECTORIS INGA LINDGREN, M.D., AND HERBERT OLIVECRONA, M.D. Neurosurgical Clinic, Serafimerlasarettet, (Director: Professor H. Olivecrona) and IVth Medical Service, St. Erik's Hospital (Director: Professor H. Berglund), Stockholm, Sweden (Received for publication October ~3, 1946) HE EXTENSIVE researches of Blumgart I have shown that the structural basis for coronary pain is an arteriosclerotic process with obstruction T or obliteration of one or more coronary arteries before an adequate collateral circulation has been developed. On the other hand, if the develop- ment of the collateral circulation has kept pace with the progressive arterial narrowing, myocardial damage and pain are absent even if one or more of the coronary arteries are obstructed. If the increased blood supply to the myocardium demanded by muscu- lar exercise cannot be delivered through the ordinary or collateral channels, coronary pain results. A short rest is usually sufficient to restore the circula- tory balance and the pain subsides. Dilatation of the coronary arteries by nitroglycerine hastens the process and may, if the drug is taken before muscular exertion, prevent an anticipated attack. Vasoconstriction, on the other hand, is an important factor in anginal pain. Practically every sufferer from angina pectoris is worse in the winter; his capacity for muscular work is much less in cold weather. Sudden cooling from any cause is frequently sufficient to bring on an attack. Freedberg, 7 in a series of experiments, has been able to show the effect of cooling upon the exercise tolerance in angina pectoris. He found by testing the same patient's capacity for exercise at different temperatures that the tolerance was much less at temperatures of 7-13~ (45-55~ than at ~4~ (75~ His in- vestigations thus lend experimental support to clinical experience that cold weather has a bad effect on sufferers from angina pectoris. -
New Patient Paperwork
Patient Information Name (full name please) _________________________________________________________ Date: _____/______/______ Address ____________________________________________ City ____________________ State ______ Zip _________ Email: _____________________________________________________________________________________________ Age _________Date of Birth _________________ SS# ______________________ Home Phone ____________________ Employer __________________________ Occupation ____________________ Work Phone _______________________ Marital Status: S M D W Sep Name of Spouse/Partner __________________ Ages of Children ___________ Have you had chiropractic care before? Yes No DC’s Name____________________________________________ How long has it been since your last Chiropractic adjustment? ________________________________________________ How did you hear about us? Location Doctor Social Media Website Insurance Company Friend/Family Who can we thank for referring you? ____________________________________________________________________ My complaint is due to: Auto Accident Work Accident Sports Accident Home Accident Other:________ ____________________________ History of Concern I am seeking help for (Please circle all that apply): Sinus Neck Pain Upper Back Pain Middle Back Pain Low Back Pain Migraines Neck Stiffness Shoulder Pain Asthma Hip Pain Headaches Numbness Arm Pain Chest Pain Leg Pain Jaw Pain/TMJ Weak Immunity Elbow Pain Ulcers Knee Pain Allergies Depression Hand/Wrist Pain Nervousness/Tension Ankle/Foot Pain Fibromyalgia Chronic -
Abdominal Pain
10 Abdominal Pain Adrian Miranda Acute abdominal pain is usually a self-limiting, benign condition that irritation, and lateralizes to one of four quadrants. Because of the is commonly caused by gastroenteritis, constipation, or a viral illness. relative localization of the noxious stimulation to the underlying The challenge is to identify children who require immediate evaluation peritoneum and the more anatomically specific and unilateral inner- for potentially life-threatening conditions. Chronic abdominal pain is vation (peripheral-nonautonomic nerves) of the peritoneum, it is also a common complaint in pediatric practices, as it comprises 2-4% usually easier to identify the precise anatomic location that is produc- of pediatric visits. At least 20% of children seek attention for chronic ing parietal pain (Fig. 10.2). abdominal pain by the age of 15 years. Up to 28% of children complain of abdominal pain at least once per week and only 2% seek medical ACUTE ABDOMINAL PAIN attention. The primary care physician, pediatrician, emergency physi- cian, and surgeon must be able to distinguish serious and potentially The clinician evaluating the child with abdominal pain of acute onset life-threatening diseases from more benign problems (Table 10.1). must decide quickly whether the child has a “surgical abdomen” (a Abdominal pain may be a single acute event (Tables 10.2 and 10.3), a serious medical problem necessitating treatment and admission to the recurring acute problem (as in abdominal migraine), or a chronic hospital) or a process that can be managed on an outpatient basis. problem (Table 10.4). The differential diagnosis is lengthy, differs from Even though surgical diagnoses are fewer than 10% of all causes of that in adults, and varies by age group. -
Pain in the Arm: a Symptom Ofheart Disease
410 Postgrad Med J: first published as 10.1136/pgmj.35.405.410 on 1 July 1959. Downloaded from PAIN IN THE ARM: A SYMPTOM OF HEART DISEASE By WALTER SOMERVILLE, M.D., F.R.C.P. Assistant Physician, Department of Cardiology, The Middlesex Hospital Pain in the arm was mentioned in Heberden's heat lamp for his shoulder pain. A chauffeur may first description of angina pectoris, '. sometimes blame his forearm pain on heavy steering. Alert there is joined (with the chest pain) a pain about questioning in these cases may uncover a co- the middle of the left arm . .' (I772). Herrick existing chest sensation and lead to the true cause. (19I2) also referred to arm pain in his first paper Ischaemic pain in the arm is often described by on coronary occlusion, the earliest in the English the patient in similar terms to the typical chest language. When the arm and chest pain of pain. It is said to be cramp-like, squeezing, a band ischaemic heart disease occur at the same time, no around the arm or like ' having my blood pressure diagnostic problem arises. But pain confined to taken.' The arms are often said to ache or feelProtected by copyright. one or both shoulders or arms may be misleading. heavy after a severe attack of angina pectoris. Its real meaning may be missed even in well- The pain is usually felt on the ventral and informed circles. Not long ago, a professor in an medial surfaces of the arm and forearm. It may eminent medical school died suddenly from what extend down to the little finger and the ring was shown at autopsy to be a cardiac infarction.